Annotated Bibliography 12 articles

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nurses’ well-being / feature

In 2019, a member of the nursing team working in the emergency department at Newham Hospital in London was stabbed multiple times with a pair of scissors. Understandably, the incident prompted Barts Health

NHS Trust to review its security arrangements. As a result, all emergency department (ED) staff at

Hostile environment – learning to manage aggression at work

Employers have a duty to support nursing staff who come under attack, whether physical or verbal, from patients, the public or colleagues

By Petra Kendall-Raynor

Newham Hospital will receive training in the management of actual or potential aggression.

The training, to be completed by the end of August 2020, teaches staff techniques to cope with the escalation of aggressive behaviour in a way that is professional and safe.

‘Managing violence in the workplace is an organisational priority for Barts Health, which we’re taking very seriously with support from the board all the way down through the organisation,’ says trust associate director of culture change Geraldine Cunningham.

‘There is an increasing amount of violence and aggression across the NHS and we need to keep our staff safe and secure so they can continue providing compassionate care.’

Identifying problem behaviour Alongside the training, the trust has developed a film for staff to use to improve their understanding of the issues, and has updated its policy on managing abuse and violence to help the workforce identify behaviour that is unacceptable, and feel confident to manage potential risk and escalate appropriately.

Psychological support following an incident has also been increased so staff feel valued and can ‘return to work well’. There is growing concern about the vulnerability of healthcare staff to workplace violence. A 2019 survey of 8,307 RCN members revealed that 29% had experienced physical abuse in their workplace.

In 2018, the Assaults on Emergency Workers (Offences) Bill came into effect in England and Wales and provided increased sentencing powers for offences of common assault and battery committed against emergency workers.

On 6 January 2020 a joint agreement between Her Majesty’s Prison and Probation Service, NHS England, the National Fire Chiefs Council, the National Police Chiefs Council and the Crown Prosecution Service (CPS) came into force.

It provides a broad framework to ensure more effective investigation and prosecution of cases where emergency workers are the victim of a crime, and sets out the standards victims of these crimes can expect.

Figures published by the CPS show there were 20,000 offences charged under the Assaults on Emergency Workers (Offences) Act in the year to November 2019. The RCN has called for a more detailed breakdown of the figures, including the job roles of those assaulted – this would establish precisely how many nurses have been involved.

A public health approach ED advanced clinical practitioner Adam Fouracre would like to see a ‘public health’ approach to violence, with nurses like him involved in prevention, rather than just becoming (or treating) victims.

Mr Fouracre founded the charity Stand Against Violence (SAV) in 2005 after the murder

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‘We find that some simple measures are effective, such as noise reduction or keeping people occupied’ Geraldine Cunningham, Barts Health NHS Trust associate director of culture change

of his 17-year-old brother Lloyd, who was beaten to death in Taunton, Somerset.

Lloyd had been walking home with friends when a group of five young men who had been drinking launched an unprovoked attack.

The teenager was beaten repeatedly with a wooden sign, kicked and punched in the face. He died of brain injuries later the same night in the emergency department where his brother now works.

Adam Fouracre was in his first year as a nursing student when his brother died. He believes that working in front-line urgent care services has bolstered his understanding of the effect of violence on communities and services.

SAV aims to prevent violence and its long-term consequences through prevention workshops and talks attended by young people.

The award-winning charity also offers conflict resolution and anti- bullying training to organisations in a bid to reduce aggression in the workplace.

Mr Fouracre says: ‘Since 2005, we have delivered countless

workshops to hundreds of thousands of young people across the country.’

He is confident that SAV’s work ‘will have prevented a number of violent incidents over the years’.

Training to understand the issues The conflict resolution training, led by experienced facilitators, develops participants’ understanding of what workplace conflict is, the types of behaviour this includes and the impact of violent and aggressive behaviour.

SAV has worked with the corporate sector and local authorities; Mr Fouracre hopes its next step will be to deliver training in the NHS.

Participants in conflict resolution training learn skills to de-escalate and prevent potential conflict and explore the different ways of dealing with it.

The course encourages discussion about appropriate responses to situations. Emotional resilience, communication and assertiveness skills are covered to help staff deal with conflict in a confident and positive way.

The anti-bullying training

Top tips for conflict resolution

» Behaviour affects behaviour – maintain a professional approach and be aware of your actions » Try to understand why someone is being aggressive or speaking in an abusive way » Don’t take their behaviour personally » Allow time for reflection » Take time to listen to the person's concerns » Respect their personal space » Get help early if you feel the situation is escalating

Source: Barts Health NHS Trust

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‘We need our employers to take the issue seriously and invest in training’ Adam Fouracre, pictured, emergency department advanced clinical practitioner and founder of Stand Against Violence

R enables participants to develop skills designed to help them manage situations where they encounter bullying, and empower them to play a role in preventing it.

Conflict with public or in teams Mr Fouracre says the SAV approach could benefit NHS staff who are working with members of the public in emergency or outpatient departments and assist with conflict resolution in staff teams.

‘The profit generated from the training fee is ringfenced to cover our front-line work, educating young people about the consequences of violence and equipping them with the skills to avoid violent situations,’ he says.

‘Our training provides an invaluable contribution to the workforce, but also means we can reach more young people. Employers can show that through using us, they can have a direct positive charitable impact on their local community.’

He points out that conflict and harassment in the workplace have a significant negative impact on employees, which include mental and physical ill-health, increased absenteeism and reduced productivity. ‘The NHS is no exception with these issues and should recognise the need to offer training to staff across the board.

‘In the NHS we may see ourselves as separate to standard businesses but we still deal with customers in the form of patients, clients and relatives, and we still suffer absenteeism and sickness. We all know how stress, mental and physical ill-health are rife in the NHS.

‘We need our employers to take the issue seriously and invest in training.’

‘A disease of society’ He has no doubt that healthcare professionals have a role to play in violence prevention: ‘Violence is a disease in society, much like the epidemiological picture of a virus.’ A public health approach to violence places it ‘firmly in the remit of healthcare’.

Nor should nurses fear that getting involved in prevention is too much to take on: ‘Sharing anonymised data on assaults is a good starting point and one which can build a clear picture of violence in local areas. This will aid early intervention programmes.’

At Barts health, where the trust commissioned international training organisation the Crisis Prevention Institute (CPI) to help with its staff training, the

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programme has been offered to all staff members across the organisation.

A total of 400 have already completed the training, and 21 have since become trainers.

Preventable triggers The trust has also looked at tracking patient flow in and out of the ED at Newham Hospital, particularly to identify environmental triggers that might lead to an increase in violence and aggression.

Ms Cunningham explains: ‘Conflict resolution is extremely important, and we’re training our staff to keep themselves safe, not take things personally and be able to de-escalate any situation.

‘Preventive measures are also vitally important. Our training programmes cover the importance of having empathy and understanding people’s backgrounds and what they may have experienced before they came to hospital.

‘We also find that some simple measures are effective, such as noise reduction or keeping people occupied during their hospital stay so that they’re not bored.’

Petra Kendall-Raynor is a health journalist

u�A training session by Stand Against Violence

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