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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
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