Managing Aggression: A holistic approach to

challenging behaviours in an acute general healthcare

setting.A pilot study

Rebecca Thompson & Honie Thomson

10th Seclusion and Restraint ForumMelbourne, Victoria 2015

Overview

1. Introduction2. Background3. Literature review4. Aim5. Research Design6. Instrument7. Results8. Conclusion

Rosebud Hospital

Rosebud Community

Health Centre

Hastings Community

Health CentreMornington

Centre

MorningtonCommunity

Health Centre

Mt ElizaCentre

Michael Court

Residential Aged Care

Peninsula Health Mental Health

Services

Youth PARC

Frankston Hospital

Frankston Community

Health Centre

Golf Links Road

Spray Street

Adult PARC

RiSCERisk Identification Safety Communication Environment

There has been a higher incidence of reported assaults in acute health than the ED or MH. There has also been an increase of Code Grey (emergency response to aggressive incidents) on the acute health wards

BACKGROUND

The literature around violence in healthcare is largely focused in Mental Health and Emergency Departments.

Minimal literature around managing violence and aggression in acute wards.

LITERATURE REVIEW

There are limited studies that have investigated the impact of training programs on staffs’ attitudes to the causes of aggression and violence and the management of the aggression and violence (Gerdtz, et al. 2013)

Staff’s attitude about causes of aggression can influence the management of a situation (Duxbury, et al. 2008)

LITERATURE REVIEW

To test the effectiveness of an educational package of a DVD and PowerPoint presentation entitled ‘Managing Aggression:- A holistic approach to challenging behaviours

AIM

Explanatory sequential: Mixed methods;

Including a pre test and post tests for nursing staff, with the option for written open ended dialogue. Additional face to face interviews with the Nursing Unit Managers

Ethics approval; Peninsula Health HREC

RESEARCH DESIGN

Sampling and Recruitment

Inclusion Criteria

Registered nurses and enrolled nurses employed at Peninsula Health

Aged 18 years or older

Working in an acute general health ward

Exclusion CriteriaStudents

Nurses with previous mental health training

RESEARCH DESIGN

The Management of Aggression and Violence Attitude Scale (MAVAS)

The survey items are representative of four sub scales:

The Internal Mode

The External Mode

The Situational Mode

Management of the Situation (Duxbury, 2002)

RESEARCH DESIGN

  StronglyAgree

Agree Disagree StronglyDisagree

 Patients are aggressive because of the environment they are in.

 

 

 

 

Other people make patients aggressive or violent.

 Patients commonly become aggressive because staff do not listen to them.

 Gender mix on the wards is important in the management of aggression.        

 It is difficult to prevent patients from becoming violent or aggressive.        

The Management of Aggression and Violence Scale (MAVAS)

Managing Aggression: A holistic approach to challenging behaviours in an acute general healthcare setting.

Drug and Alcohol

Trauma

Health and Well-being

Environment

Communication

Person

Managing Aggression: A holistic approach to challenging behaviours in an acute general healthcare setting.

71 Nurses attended the education sessions – 44 completed the pre and both post surveys

Of the 30 MAVAS items there was a positive movement in agreement on all items, with a statistically significant shift on 7 of those (P=<.0012)

RESULTS

Sex n (%) Male 10 (14.1) Female 61 (85.9)Age   20 – 29 years 15 (21.1) 30 – 39 years 19 (26.8) 40 – 49 years 15 (21.1) 50 – 59 years 16 (23.9) Over 60 years 3 (4.2)Registered nurses 69 (97.2)Enrolled Nurses 2 (2.8)Years of Experience   Less than 5 years 17 (23.9) 5 – 10 years 16 (22.5) 11 – 20 years 18 (25.4) 21 – 30 years 12 (16.9) More than 30 years 8 (11.3)Attended previous RiSCE education 38 (53.5)Attended another aggression management course 7 (9.9)

RESULTS - PARTICIPANTS

  Pre to post Pre to 6 weeks Post to 6 weeks

  Z d P* Z d p Z d P*Patients are aggressive because of the environment they are in.

4.10 1.15 <.0001 2.14 0.73 .0325 0.26 0.10 .7963

Patients commonly become aggressive because staff do not listen to them

 4.60

 1.33

 <.0001

 1.00

 0.37

 .3173

 -2.07

 -0.81

 .0389

Poor communication between staff and patients leads to patient aggression

 3.88

 1.06

 .0001

 1.70

 0.64

 .0896

 0.26

 0.09

 .7963

Cultural misunderstandings between patients and staff can lead to aggression

 3.64

 0.98

 .0003

 1.67

 0.63

 .0956

 -0.63

 -0.23

 .5271

Other people make patients aggressive or violent

 3.41

 0.91

 .0007

 1.07

 0.39

 .2850

 -1.67

 -0.64

 .0956

Gender mix on the wards is important in the management of aggression

 3.65

 0.98

 .0003

 1.29

 0.49

 .1967

 -0.28

 -0.10

 .7815

Patients who are violent are restrained for their own safety

3.39 0.91 .0010 -0.94 -0.36 .3458 2.83 1.21 .0047

RESULTS - MAVAS

‘It identifies I need to listen to patients and clarify with them more, the importance of communication and the need to be reflective about the approach to use with each patient’(Participant 39)

‘It has made me more

aware of situations and that I could use my

skills to prevent escalations happening’ (Participant 36)

RESULTS

All Managers who participated in the education session felt it was beneficial and would recommend it for other areas

All thought clinical experience and training were useful for managing aggressive situations and thought that undergraduate training lacked in this area

RESULTS

This educational tool has been valuable in increasing nursing staffs confidence in dealing with challenging behaviours

Reduction in restraint in general wards

CONCLUSION

Virginia Plummer: RN, PhD, FACN, FACHSM- Associate Professor Nursing Research, Monash University and Peninsula Health

Dr Cadeyrn Gaskin: Statistical support and analysis

Peninsula Health: Funding of this project and encouragement to try something new and innovative

ACKNOWLEDGMENTS

Duxbury J. (2002) An evaluation of staff and patients’ views of and strategies employed to manage patient aggression and violence on one mental health unit. Journal of Psychiatric and Mental Health Nursing 9, 325-337

Duxbury J., Hahn S., Needham I. and Pulsford D. (2008) The Management of Aggression and Violence Attitude Scale (MAVAS): a cross-national comparative study. Journal of Advanced Nursing 62 (5), 596-606.

Farrell and Cubit’s Farrell, G., and Cubit, K. (2005) Nurses under threat: A comparison of content of 28 aggression management programs. International Journal of Mental Health Nursing (2005) 14, 44-53

Taylor, J., L., and Rew, L. (2010) A systematic review of the literature: workplace violence in the emergency department Journal of Clinical Nursing, 20, 1072-1085.

REFERENCES

Rebecca Thompson – rthompson@phcn.vic.gov.au

Honie Thomson - hthomson@phcn.vic.gov.au

QUESTIONS