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The Spinney Psychiatric Services

The Spinney Psychiatric Services. 1 Day De-escalation Programme. Introduction. Facilitators Facilities Fire exits Toilets Refreshments Breaks. Ice Breaker. To start the course proper we will start with an exercise. Aims. Management of aggression in health care settings

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The Spinney Psychiatric Services

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  1. The Spinney Psychiatric Services 1 Day De-escalation Programme Desmond Loo

  2. Introduction • Facilitators • Facilities • Fire exits • Toilets • Refreshments • Breaks Desmond Loo

  3. Ice Breaker To start the course proper we will start with an exercise. Desmond Loo

  4. Aims • Management of aggression in health care settings • Permissible forms of control • Organisational issues • Increase confidence Desmond Loo

  5. Objectives • Raise knowledge concerning aggressive/violent behaviours • Examine own feelings and attitudes towards people who exhibit such behaviours • Recognise triggers which cause aggression • Identify ways to reduce aggression • Learn strategies for dealing with aggression and violence • Understand the main laws, policies and guidelines in respect to work setting Desmond Loo

  6. Violence • Extreme end of spectrum • Causes damage, destruction or injury • Abuse, threats or assaults at work • Who is at risk? • Is it MY concern? Desmond Loo

  7. Legal Requirement • Section 2(1) of the Health and Safety at Work Act 1974 • Management of Health and Safety at Work Regulations 1999 • UKCC (1996) • The Spinney Policy Manual Desmond Loo

  8. What the Law Requires • The Management of Health and Safety at Work Regulations 1999 • The Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995 (RIDDOR) • Safety Representative and Safety Committees Regulations 1977 • Health and Safety (consultation with employees) Regulations 1996 Desmond Loo

  9. Violence to Staff in Health Care • Health service advisory committee 1987 survey • Major injuries • Minor injuries • No physical injury due to threats • Verbal abuse Desmond Loo

  10. Mezey & Shepherd (1997) • Primary health care and A & E increased assaults • Increased injuries to nursing staff • Increased injuries to junior doctors, support workers and student nurses Desmond Loo

  11. Health Service Advisory Committee 1997 • Training • Causes of violence • Warning signs • Interpersonal skills • Incident reporting Desmond Loo

  12. Violence in Mental Health Care UKCC 2001 • Violence directed towards anyone is unacceptable. • Recognition, prevention and management of violence • A need for appropriate training Desmond Loo

  13. Break Desmond Loo

  14. Reasonable Force (Definition) “ Reasonableness means, firstly, that the force should be no more than is necessary to accomplish the object for which it is allowed (so retaliation and punishment are not permitted) secondly, the reaction must be in proportion to the harm that it is threatened… obviously, the greater the severity of the threatened anger, the more reasonable it is to take tougher action” Dimond (1995) Desmond Loo

  15. Reasonable Force (Principles) • Assessment • Assessing reasonable force • Rule of engagement • There must always be a resolution Desmond Loo

  16. Use of Force • Lord Griffiths ……… • Section 3 criminal law act 1967 Desmond Loo

  17. Scenario 1 • Exercise on the use of force and what is reasonable • Justification of actions • Correct documentation Desmond Loo

  18. Review scenario 1 • Discussions on the scenario on the use of force. Desmond Loo

  19. Body`s Autonomic Response • Outward non-verbal cues • Indication of person aroused • Bodily responses to threat and stress • These come in a variety of forms Desmond Loo

  20. Responses • Clenched fists, teeth and muscles • Wrinkled brow, frowning • Lack of eye contact • Invading personal space • Hands on hips, provocative movements • Square on, confrontational Desmond Loo

  21. Responses • Flushed, pale or blotchy complexion • Pacing, foot tapping, page flicking Desmond Loo

  22. Group work • Divide into three groups and brainstorm to find definitions of the following • Anger • Aggression • Violence Desmond Loo

  23. Lunch Break Desmond Loo

  24. Anger • Emotional response • Disrupts thinking • Disrupts problem solving • Intense irritation • Motivation Desmond Loo

  25. Aggression • Outward act • Acceptable • Physical, verbal, mental and passive • Difficult to define barrier Desmond Loo

  26. Violence • Extreme end • Great force • Damaging • Physical and mental • Two kinds Desmond Loo

  27. Manifestations • Thoughts • Feelings • Actions • Bodily functions Desmond Loo

  28. Aggression in Healthcare Desmond Loo

  29. Triggers Personal factors • Genetic/constitutional/physiological • Personality • Attitude Desmond Loo

  30. Triggers External factors • Frustration • Powerlessness • Threat • Fear • Provocation/abuse Desmond Loo

  31. Assault Cycle • Trigger • Escalation • Crisis • Plateau • Post crisis Desmond Loo

  32. Assault Cycle Chart Desmond Loo

  33. Baseline Behaviour • Normal behaviour • Settled • Feeling in control • Different from person to person • Maslow`s(1970) hierarchy of needs Desmond Loo

  34. Trigger • A shift from baseline • Enforced socialisation • Lack of choice • Lack of privacy • Lack of autonomy • Trigger reduction Desmond Loo

  35. Escalation • Deviates more from baseline • Over focused • Early intervention • Non verbal cues Desmond Loo

  36. Crisis • Physically, emotionally and psychologically more aroused • Direct assault likely • Focus on own safety • Intervention of physical restraint (pre-emptive) Desmond Loo

  37. Plateau • High arousal slowly returns to baseline • Adrenaline and glucose levels remain • Possible further risk of assault • Interventions similar to escalation phase Desmond Loo

  38. Post Crisis • Fall below the base line • Physically and mentally exhausted • Remorseful • Need support • Time to explore • Comprehensive documentation Desmond Loo

  39. Role Plays • There will be a series of role plays to be presented with your participation to illustrate the interventions at various stages of the cycle. Desmond Loo

  40. Break . Desmond Loo

  41. Assault Cycle Chart Desmond Loo

  42. Self positioning • Clear exits • Angled sitting position • Ready for departure • Hand gestures • Distance • Not standing over person • Tone of voice • Peripheral vision Desmond Loo

  43. Questions and Answers • A little question and answer sheet for you to participate in Desmond Loo

  44. Feedback and Evaluation • Verbal • Written Desmond Loo

  45. References • Department of health and welsh office (1993). Code of practice: mental health act 1983. London HMSO • Department of Health Guidelines HC(72)11 : Dealing with violence in the hospital setting • Dimond, B. (1990). Legal aspects of nursing. London: prentice-hall. Desmond Loo

  46. References • Health and safety at work act (1974). London HMSO. • Kaplan, S. G., & Wheeler, E. G. (1983). Survival skills for working with potentially violent clients. Social casework: the journal of contemporary social work. Desmond Loo

  47. References • Farrell,G.A. & Gray,C.(1992). Aggression, A Nurses guide to Therapeutic Management, London, Scutari Press • Health and Safety at Work Act 1974 Section 2(1) • Hogan, G (1995) Care and Responsibility the Legal Framework, Ashworth Hospital handout. Desmond Loo

  48. References • Maslow, A (1970) The farther reaches of human nature, New York: The Viking press. • The Spinney Policy Manual 2002 • UKCC (2001) The recognition, prevention and therapeutic management of violence in mental health care. Desmond Loo

  49. Home time . Desmond Loo

  50. Zero Tolerance The NHS zero tolerance statement has two principal targets. They are: • Public • Staff Desmond Loo

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