kathy chrisfield, australian nursing & midwifery federation: occupational violence and...
DESCRIPTION
Kathy Chrisfield, OH&S Unit Co-ordinator, Australian Nursing & Midwifery Federation (Victorian Branch) delivered this presentation at the 2013 Safe and Secure Hospital Conference. The comprehensive program addressed the following issues: Early intervention via early reporting of disruptive, aggressive, and bullying behaviour to minimise work place violence An innovative training model to help clinicians, security and policy makers respond to the problems of challenging behaviours Therapeutic sedation in the Emergency Department: Best practice in managing the highly agitated patient A systems approach to the prevention of Occupational Violence and Aggression (OVA) Contract management security: The change from in-house security to contract security Role of the Risk Based Approach throughout the design process Preventing and managing clinical aggression in the paediatric and youth health setting The roles, functions and training provided by the Mental Health Intervention Team (MHIT), New South Wales Police Force Interactions between Police, Health staff, Ambulance and Hospital Security and future directions A Legal Perspective: Prevention and management of violence in hospitals Code Grey responses - Are they legal? For more information about the annual event, please visit the conference website: http://www.healthcareconferences.com.au/safehospitalsTRANSCRIPT
K AT H Y C H R I S F I E L D
O H S U N I T C O O R D I N AT O R , A N M F ( V I C B R A N C H )
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SESSION OUTLINE 1. Objectives
2. Background… Setting the Scene
3. Causes and Consequences of Violence in Nursing &
Midwifery
4. What are we doing right, and where are we going wrong
5. Specific OHS Obligations
6. A Systems Approach to Prevention of OVA
7. OVA Prevention Strategy Framework
8. Closing the Loop
9. Conclusion & Questions
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OBJECTIVES
To contextualise the ‘recent’ phenomenon of violence in healthcare in Victoria
To identify the common causes of violence in nursing and midwifery, and the consequences for Nurses and Midwives exposed to these situations
To highlight the need for change in approach to prevention of occupational violence and aggression
To provide guidance on where to start…
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SETTING THE SCENE…
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MORE SETTING THE SCENE…
88% of Australian nurses and midwives consider occupational violence a risk (Driscoll, T, 2008)
36% - high risk
Reporting of violence incidents - approx. 50% (Farrell, Shafei and Gaynor, 2010)
Main types of occupational violence - Verbal abuse (90%) Physical (44%) Threat of harm (27%)
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Main perpetrators
Patients (75%)
Visitors (19%)
Over half of perpetrators are aged
50+, and 61% are male
55% rate organisation’s management
of situations as only “fair” or “poor”
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CAUSES OF VIOLENCE IN NURSING & MIDWIFERY
No single factor – multifactorial
Some contributing factors include: Mental health of clients (53%) Patient’s personality (63%) Drug and alcohol-affected patients / clients Inexperience of nurse / midwife
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CAUSES OF VIOLENCE…(CONT)
Organisational contributing factors include: Management commitment to elimination of violence
Situational and/or Environmental factors
e.g. Physical layout, design
Policies and Procedures
Training
Security
Support
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CONSEQUENCES OF VIOLENCE IN NURSING & MIDWIFERY
Workers Compensation Claims Injuries
Physical Psychological Friends and Family
Absenteeism High staff turnover Lost to profession Economic loss
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WHAT ARE WE DOING RIGHT?
Some individual health services are taking action
Some are consulting with staff
Some are considering many factors
Some are implementing individual components of a system (but not the entire system…)
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WHERE IS IT GOING WRONG?
Lack of true consultation
Lack of collaboration
Short sighted
Superficial
Single factorial approach
No systemic view
Too much concentration on ‘mopping up after’ (and even then poorly…)
Lack of consistency in approach across health services
MONEY
Section 21 (1)– Duties of Employers to Employees - overall
Section 21(2) (a) – Duties of Employers - to provide safe systems of work
Section 21 (2) (e) – Duties of Employers – to provide information, instruction, training and supervision of employees
Section 25 – Duties of Employees – take reasonable care of self and others and co-operate with actions taken by employer
SPECIFIC OBLIGATIONS UNDER OHS LAW
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RISK MANAGEMENT FRAMEWORK
Control Assess
Review Identify
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A SYSTEMS APPROACH TO PREVENTION OF OVA
Integrates OVA into OHS, Risk Management, Clinical Management, Clinical Assessments and any other dealings with persons
Does not only look at how OVA is dealt with AFTER the fact
Recognises that OVA can be prevented in many instances, and minimised in others
LEARNS from instances where the system has failed… and doesn’t accept that ‘it is going to happen’… rather the question is asked as to
HOW CAN WE PREVENT THIS HAPPENING AGAIN?
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OVA PREVENTION STRATEGY FRAMEWORK
Physical environment /
workplace design
(CPTED)
Post-incident support
Pre-admission/ admission risk assessment
Security – access,
personnel, CCTV, alarms
Incident reporting,
investigation, review and feedback
Training and education
Organisational policies and procedures,
including Code Grey and Black
Cross disciplinary understanding, communication and consistent
approach
Empowered staff
Management plans /
Care plans
Executive commitment to OVA
prevention
OHS Management
System
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STRATEGIES TO PREVENT AND REDUCE VIOLENCE AGAINST NURSES AND MIDWIVES Risk management approach – address causes
Full implementation of all 29 Recommendations of Violence in Nursing Taskforce
Full implementation of the Parliamentary Inquiry recommendations (including 19 & 20 regarding waiting times but addressing root cause would be more effective)
Implement and ensure compliance with WorkSafe guidance “Prevention and management of Aggression in Health Services“
Listen
True consultation
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CLOSING THE LOOP – ALWAYS LEARNING
IMMEDIATELY Make area safe
Ensure nurses / midwives involved / affected have received appropriate medical treatment / support / psychological assistance
Complete / assist in completion of RiskMan / Incident Report
IN FOLLOWING DAY or 2 ALWAYS make contact with affected staff – personally and contemporaneously
Provide information about claiming workers compensation
Provide information and support about reporting to the police
IN WEEK FOLLOWING Incident investigation – involving affected staff (potentially both from OHS and clinical
perspectives)
‘No Blame’ culture for incident reporting
Outcomes of investigation must be shared with staff in the area, as well as corrective actions taken, and to be taken
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CONCLUSION
Causes of violence many and varied
Consequences for nurses and midwives not so varied
Not an insurmountable problem
This can be done
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Please Note: All Rights Reserved © - No part of this document or any of its contents may be reproduced, copied, modified or adapted, without prior written consent of the author, unless otherwise indicated.
CONTACT DETAILS
Kathy Chrisfield OHS Unit Coordinator ANMF (Vic Branch) [email protected] Ph: 9275 9365 or 0409 594 495