Action 5.33

Predicting, preventing and managing aggression and violence

Action 5.33 states

The health service organisation has processes to identify and mitigate situations that may precipitate aggression

Intent

The risk of aggression and violence is minimised by reducing environmental or procedural triggers for aggression.

Reflective questions

What processes are in place to ensure that the workforce can identify situations that may precipitate aggression?

What processes are used to mitigate these situations?

What features of the environment are used to minimise sources of potential conflict?

Key tasks

  • Identify factors in the environment that could trigger aggression or complicate management of aggression when it occurs.

  • Identify elements of the organisation’s procedures that could contribute to stress, which may lead to aggression.

  • Implement strategies to lessen stresses caused by environmental or procedural factors.

Strategies for improvement

Hospitals

Aggression and violence are predictable in healthcare settings, and health service organisations need to implement strategies to reduce the risk of aggression occurring, and reduce the risk of harm when it does occur. This action relates to steps that an organisation can take to modify environmental or procedural factors that can contribute to the risk of aggression.

It links to Action 1.29, which addresses designing healthcare environments to maximise safety. It also links to Action 5.34, which addresses strategies to reduce the risk of aggression in individual patients.

Healthcare environments can be stressful places. People are dealing with uncomfortable experiences, including pain and uncertainty, in environments that are both unfamiliar and high stimulus. People also experience frustration with processes that may be routine for members of the healthcare workforce, but are new and not always comprehensible from the perspective of the patient or carer. For some people, these contextual factors can lead to feelings of aggression.

Although the design of healthcare environments can contribute to reducing aggression, it is not always possible to change the ‘bricks and mortar’ in the short term.

Use the given environment in ways that reduce the risk of aggression, such as:

  • Allowing people to move around, preferably with access to outside areas
  • Reducing stimulus such as bright lights or loud noises
  • Providing privacy using curtains or side lounges.

Sensory modulation spaces and resources help people to manage their own distressing feelings and regain control without restrictive interventions or aggressive outcomes.

The Safewards intervention is a specialist concept, designed for use in mental health inpatient units. The model acknowledges the settings and processes through which mental health inpatient services are inherently stressful. It guides members of the workforce to recognise potential sources of conflict or ‘flashpoints’, and implement a range of strategies to contain risks.

Day Procedure Services

Many of the factors that can precipitate aggression within health services are not relevant in day procedure services, because people are typically admitted for only a few hours, and may be sedated for much of this time. Admission is also typically voluntary, and interactions with others are minimal.

Some people experience a period of confusion after anaesthesia. In rare instances, they may behave aggressively while in this agitated state. Members of the workforce should be trained in recognising the signs of postoperative delirium, and implement environmental and supportive measures to prevent the onset of delirium and shorten its duration (see Action 5.29).

Refer to the hospital tab for detailed implementation strategies and examples of evidence for this action.

MPS & Small Hospitals

Aggression and violence are predictable in healthcare settings, and health service organisations need to implement strategies to reduce the risk of aggression occurring, and reduce the risk of harm when it does occur. This action relates to steps that an organisation can take to modify environmental or procedural factors that can contribute to the risk of aggression. It links to Action 1.29 which addresses designing healthcare environments to maximise safety. It also links to Action 5.34, which addresses strategies to reduce the risk of aggression in individual patients.

Healthcare environments can be stressful places. People are dealing with uncomfortable experiences, including pain and uncertainty, in environments that are both unfamiliar and high stimulus. People also experience frustration with processes that may be routine for members of the healthcare workforce, but are new and not always comprehensible from the perspective of the patient or carer. For some people, these contextual factors can lead to feelings of aggression.

Although the design of healthcare environments can contribute to reducing aggression, it is not always possible to change the ‘bricks and mortar’ in the short term. Use the given environment in ways that reduce the risk of aggression, such as:

  • Allowing people to move around, preferably with access to outside areas
  • Reducing stimulus such as bright lights or loud noises
  • Providing privacy using curtains or side lounges
  • Implementing sensory modulation strategies.

Hospitals

Aggression and violence are predictable in healthcare settings, and health service organisations need to implement strategies to reduce the risk of aggression occurring, and reduce the risk of harm when it does occur. This action relates to steps that an organisation can take to modify environmental or procedural factors that can contribute to the risk of aggression.

It links to Action 1.29, which addresses designing healthcare environments to maximise safety. It also links to Action 5.34, which addresses strategies to reduce the risk of aggression in individual patients.

Healthcare environments can be stressful places. People are dealing with uncomfortable experiences, including pain and uncertainty, in environments that are both unfamiliar and high stimulus. People also experience frustration with processes that may be routine for members of the healthcare workforce, but are new and not always comprehensible from the perspective of the patient or carer. For some people, these contextual factors can lead to feelings of aggression.

Although the design of healthcare environments can contribute to reducing aggression, it is not always possible to change the ‘bricks and mortar’ in the short term.

Use the given environment in ways that reduce the risk of aggression, such as:

  • Allowing people to move around, preferably with access to outside areas
  • Reducing stimulus such as bright lights or loud noises
  • Providing privacy using curtains or side lounges.

Sensory modulation spaces and resources help people to manage their own distressing feelings and regain control without restrictive interventions or aggressive outcomes.

The Safewards intervention is a specialist concept, designed for use in mental health inpatient units. The model acknowledges the settings and processes through which mental health inpatient services are inherently stressful. It guides members of the workforce to recognise potential sources of conflict or ‘flashpoints’, and implement a range of strategies to contain risks.

Day Procedure Services

Many of the factors that can precipitate aggression within health services are not relevant in day procedure services, because people are typically admitted for only a few hours, and may be sedated for much of this time. Admission is also typically voluntary, and interactions with others are minimal.

Some people experience a period of confusion after anaesthesia. In rare instances, they may behave aggressively while in this agitated state. Members of the workforce should be trained in recognising the signs of postoperative delirium, and implement environmental and supportive measures to prevent the onset of delirium and shorten its duration (see Action 5.29).

Refer to the hospital tab for detailed implementation strategies and examples of evidence for this action.

MPS & Small Hospitals

Aggression and violence are predictable in healthcare settings, and health service organisations need to implement strategies to reduce the risk of aggression occurring, and reduce the risk of harm when it does occur. This action relates to steps that an organisation can take to modify environmental or procedural factors that can contribute to the risk of aggression. It links to Action 1.29 which addresses designing healthcare environments to maximise safety. It also links to Action 5.34, which addresses strategies to reduce the risk of aggression in individual patients.

Healthcare environments can be stressful places. People are dealing with uncomfortable experiences, including pain and uncertainty, in environments that are both unfamiliar and high stimulus. People also experience frustration with processes that may be routine for members of the healthcare workforce, but are new and not always comprehensible from the perspective of the patient or carer. For some people, these contextual factors can lead to feelings of aggression.

Although the design of healthcare environments can contribute to reducing aggression, it is not always possible to change the ‘bricks and mortar’ in the short term. Use the given environment in ways that reduce the risk of aggression, such as:

  • Allowing people to move around, preferably with access to outside areas
  • Reducing stimulus such as bright lights or loud noises
  • Providing privacy using curtains or side lounges
  • Implementing sensory modulation strategies.
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