Table Of ContentViolence and Aggression in
the Workplace
A practical guide for all
healthcare staff
Paul Linsley
Senior Lecturer in Nursing
The Faculty of Health, Life and Social Sciences
The University of Lincoln
Foreword by
Professor Dame June Clark
Radcliffe Publishing
Oxford Seattle
•
CRC Press
Taylor & Francis Group
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© 2006 by Paul Linsley
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Contents
Foreword iv
Preface v
About the author vi
Acknowledgements vii
1 Violence and aggression 1
2 Theories of aggression 15
3 Managing violence and aggression: risk reduction and prevention 25
4 Managing an aggressive incident 45
5 Staff support 79
6 Special considerations: care in the community 95
7 Special considerations: gender, violence, health and healthcare 103
Julie Dixon, edited by Paul Linsley
8 Special considerations: legal issues 119
Index 131
iii
Foreword
The first time it happened to me I was stunned. It was just so unexpected. I was a
newly qualified health visitor, working in a 'nice', middle class area, visiting a
'nice' family with a new baby in the middle of a Monday morning. I didn't expect
the 'eyeball to eyeball' tirade from the smartly dressed father about how health
visitors were nosey government spies and anyone who worked in the public
sector was a lousy parasite on the nation's economy. I wasn't physically hurt, but
I was certainly shaken, and it affected my practice as a health visitor for quite a
long time.
So I was delighted to read this book, and I commend it to you. In those days
violence and aggression were expected only by those working in acute psychiatric
settings, or big city accident and emergency departments, or as community
nurses in 'tough' areas. Nowadays we know it can happen to any health worker,
any place, any time, and all of us need, like the boy scouts, to 'be prepared'.
This is not a book to be carried around in the back pocket and whipped out in
an emergency. It ought to be read by everyone during their initial preparation,
used during CPD and in-service education, and kept handy for reference. I would
have also found it helpful to read afterwards, to help me better understand what
had happened and why, and to come to terms with it.
Professor Dame June Clark DBE PhD RN RHV FRCN
Professor Emeritus
University of Wales Swansea
May 2006
iv
Preface
The following book is aimed at all healthcare staff that may have cause to come
into contact with the patient or their family, including reception staff and those
that deal with complaints. It is designed to reflect good practice which is in use
throughout the NHS and other organisations to help protect healthcare staff from
the risk that is violence and aggression. While the book aims to be as com
prehensive as possible, such work cannot cater for every situation that may or
may not occur within a working environment. As such the book should be used
as a reference source and general guide only. Specific interventions and
procedures will be provided by individual employers, and these should be
adhered to in the event of an incident occurring.
The author has been keen to avoid the word victim, as this implies a degree of
helplessness, and would instead ask the reader to replace this with the word
target, as this better describes the role in which the individuals find themselves
as part of the assault process. Within each chapter there are a number of differ
ent types of information and activities that are highlighted within the text. This
includes keywords and concepts to help structure thinking and understanding
around the topic.
Paul Linsley
May 2006
v
About the author
Paul began his career as a general nurse working within acute medicine.
Following conversion to mental health nursing he gained valuable experience in
a variety of clinical settings, and is a nurse specialist within acute mental health
care. He has held a number of managerial and educational posts, teaching on a
number of courses for the University of Nottingham, and now works for the
University of Lincoln as a Senior Lecturer in Nursing. In addition to this Paul sits
on a number of national forums for the Royal College of Nursing as well as being
a nurse advisor to the Department of Health. He has had a number of articles
published and is actively involved in the research of violence and aggression
within the healthcare setting.
Chapter 7 of this book was written by Julie Dixon who is health lecturer with the
University of Nottingham, teaching mental health and gender theory. She works
within a life-course perspective, and her current research and interests focus
around women as recipients and providers of healthcare, particularly with
regards to those suffering from a mental disorder. She teaches on a number of
modules that explore the relationships between gender, the family and health, as
well as being involved in a number of outside agencies seeking to promote
equality within healthcare service provision.
vi
Acknowledgements
Thanks to Vicki, Andrew and Adel for their continued love and support.
Thanks also to Rodney, Andy and Carol for their friendship and encouragement.
I would also like to acknowledge the help of Julie and Jan in putting this
book together.
vii
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Chapter 1
Violence and aggression
Introduction
The level of violence and aggression against healthcare staff has become an
1
important issue in recent years. Indicators would suggest that anyone who
works for the health and social care sector and who has contact with the general
2
public is at risk from such behaviour. This is not a new problem and reflects
wider concerns about violent crime in society generally. More and more
healthcare staff face the prospect of violence and aggression in the workplace, not
only from the people that they care for, but from strangers and within families. 3
People who behave in ways that bring them into conflict with others make
4
special demands on a service and its staff who are already under pressure.
Violence and aggression raise special concern because they significantly increase
the risk of injury and harm. This can have an impact on staff confidence and
morale as well as patient care. Threats, aggravation and tension caused by
potential aggressors can lead to stress-related problems, emotional burnout and
result in some staff leaving the service altogether. 5
Appropriate interventions from healthcare staff are crucial to the immediate
6
physical and psychological safety of themselves and those that they care for.
As with other risks, reducing violence and aggression requires a systematic
approach involving a number of strategies. Measures to reduce violence and
aggression need to be based on sound risk assessment and risk management,
underpinned by effective strategies worked out in collaboration with other
7
agencies such as the local police department and prosecution service.
Defining violence and aggression
One of the difficulties in addressing violence and aggression is that they are not
easy to define.3 Violence and aggression are subjective terms that mean different
things to different people and groups. This means that the same kind of violent
incident may have quite different impacts according to the individual involved.
Because of this, healthcare organisations and staff groups have defined violence
and aggression in different ways for different purposes. However, in order to
recognise, address, and prevent violence and aggression, healthcare staff must
have a clear understanding as to what these terms mean. This requires a
description that encompasses the different forms that violence and aggression can
take, while allowing for personal interpretation and understanding. In doing this,
it allows staff to take ownership of the problem and goes some way to
acknowledging their concerns.
1
