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 ,
ANMF (VIC BRANCH)
SESSION OUTLINE
1.

Objectives

2.

Background… Setting the Scene

3.

Causes and Consequences of Violence in Nursing &
Mi...
OBJECTIVES
 To contextualise the ‘recent’ phenomenon of violence
in healthcare in Victoria
 To identify the common cause...
SETTING THE SCENE…

Please Note: All Rights Reserved © - No part of
this document or any of its contents may be
reproduced...
MORE SETTING THE SCENE…
88% of Australian nurses and midwives consider
occupational violence a risk (Driscoll, T, 2008)
...
 Main perpetrators
 Patients (75%)
 Visitors (19%)
 Over half of perpetrators are aged
50+, and 61% are male
 55% rat...
CAUSES OF VIOLENCE IN NURSING &
MIDWIFERY
 No single factor – multifactorial
 Some contributing factors include:
Mental...
CAUSES OF VIOLENCE…(CONT)
 Organisational contributing factors
include:
Management commitment to elimination of violence...
CONSEQUENCES OF VIOLENCE IN
NURSING & MIDWIFERY
 Workers Compensation Claims
 Injuries
Physical
Psychological

 Frien...
WHAT ARE WE DOING RIGHT?
 Some individual health services are taking
action
 Some are consulting with staff
 Some are c...
WHERE IS IT GOING WRONG?








Lack of true consultation
Lack of collaboration
Short sighted
Superficial
Single f...
SPECIFIC OBLIGATIONS UNDER OHS
LAW
Section 21 (1)– Duties of Employers
to Employees - overall

Section 21(2) (a) – Duties ...
RISK MANAGEMENT FRAMEWORK

Review

Control
Please Note: All Rights Reserved © - No part of
this document or any of its con...
A SYSTEMS APPROACH TO
PREVENTION OF OVA


Integrates OVA into OHS, Risk Management, Clinical
Management, Clinical Assessm...
OVA PREVENTION STRATEGY FRAMEWORK
Organisational
policies and
procedures,
including Code
Grey and Black

Training and
educ...
STRATEGIES TO PREVENT AND REDUCE
VIOLENCE AGAINST NURSES AND MIDWIVES








Risk management approach – address cau...


CLOSING THE LOOP – ALWAYS
LEARNING
IMMEDIATELY

 Make area safe
 Ensure nurses / midwives involved / affected have re...
CONCLUSION
 Causes of violence many and varied
 Consequences for nurses and midwives
not so varied

 Not an insurmounta...
Please Note: All Rights Reserved © - No part of
this document or any of its contents may be
reproduced, copied, modified o...
CONTACT DETAILS
Kathy Chrisfield
OHS Unit Coordinator
ANMF (Vic Branch)
kchrisfield@anmfvic.asn.au
Ph: 9275 9365 or 0409 5...
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Kathy Chrisfield, Australian Nursing & Midwifery Federation: Occupational Violence and Aggression Against Nurses and Midwives - Why Is It Ok?'

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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/safehospitals

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Kathy Chrisfield, Australian Nursing & Midwifery Federation: Occupational Violence and Aggression Against Nurses and Midwives - Why Is It Ok?'

  1. 1. 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 , ANMF (VIC BRANCH)
  2. 2. 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 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.
  3. 3. 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… 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.
  4. 4. SETTING THE SCENE… 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.
  5. 5. 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%) 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.
  6. 6.  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” 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.
  7. 7. 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 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.
  8. 8. 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 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.
  9. 9. CONSEQUENCES OF VIOLENCE IN NURSING & MIDWIFERY  Workers Compensation Claims  Injuries Physical Psychological  Friends and Family     Absenteeism High staff turnover Lost to profession Economic loss 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.
  10. 10. 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…) 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.
  11. 11. 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 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.
  12. 12. SPECIFIC OBLIGATIONS UNDER OHS LAW 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
  13. 13. RISK MANAGEMENT FRAMEWORK Review Control 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. Identify Assess
  14. 14. 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? 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.
  15. 15. OVA PREVENTION STRATEGY FRAMEWORK Organisational policies and procedures, including Code Grey and Black Training and education Management plans / Care plans OHS Management System Cross disciplinary understanding, communication and consistent approach 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. Empowered staff Pre-admission/ admission risk assessment Executive commitment to OVA prevention Post-incident support Security – access, personnel, CCTV, alarms Physical environment / workplace design (CPTED) Incident reporting, investigation, review and feedback
  16. 16. 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 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.
  17. 17.  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 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.
  18. 18. CONCLUSION  Causes of violence many and varied  Consequences for nurses and midwives not so varied  Not an insurmountable problem This can be done 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.
  19. 19. 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.
  20. 20. CONTACT DETAILS Kathy Chrisfield OHS Unit Coordinator ANMF (Vic Branch) kchrisfield@anmfvic.asn.au Ph: 9275 9365 or 0409 594 495 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.
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