Violence in Health and Social Care Settings A training resource package for organisations and individuals Joanne Skellern and Andrew Lovell Department of Mental Health and Learning Disabilities University of Chester

Background Violence in health and social care settings is now recognised as a major international concern. Organisations are required to develop effective strategies for the prevention and management of violence perpetrated by service-users. The effects of violence include: physical injury, increased stress levels, reduced self-confidence and self-esteem, increased sickness and absenteeism, compromised productivity, low staff morale, problems with recruitment and retention, which ultimately affect the quality of service provision offered by the organisation for service-users.

Introduction Training in the recognition and management of potentially violent situations can assist to prevent situations escalating to the point where violence occurs. Service providers have concentrated on the provision of training in the management of violence for professionals. The number of incidents of violence experienced by professionals working in health and social care settings continue to rise. The recognition of potentially violent situations, the warning signs, possible triggers and the point at which intervention is necessary remain causes for concern.

Aims and Objectives Our aim was to produce the materials required to educate professionals working within health and social care settings in the recognition and prevention of violence perpetrated by service-users. Our objectives were to: create a forum where violence can be discussed. encourage reflection on personal responses to threatening situations. facilitate assessment and planning for potentially violent or threatening situations. encourage a review of practices in relation to national and local policies and procedures.

Methods The training resource package, containing a DVD and training manual, was informed by the research into violence and aggression conducted by the authors. The DVD was filmed using actors and simulated situations demonstrating actual or potential service-user violence. 25 scenarios, which vary in length from 7 to 60 seconds, each place the viewer in a position of responding to the situation. A range of circumstances and locations are illustrated but the underlying principles are pertinent to all health and social care professionals, service-users and settings.

The training resource package contains: A DVD of 25 simulated scenarios A training manual on how to use the DVD including a ‘notes for trainers’ section

Using the Package It is proposed that the training resource package is used to facilitate a one-day training session, comprising of: Group viewing of all 25 scenarios. Group split into smaller groups and each requested to respond to one/several specific scenario(s). Using the single scenario selection tool, smaller groups view relevant scenarios and discuss how they might respond to each incident. The facilitator will record these responses to identify any themes or patterns. Whole group discussion assisted by facilitator.

Example 1 This scenario portrays a young woman stood on the fire escape of a building which is three floors high. She is accompanied by a professional and threatening to jump.

Discussion of the scenario It is expected that the smaller group reflections on the scenario will relate to a variety of possible ways the professional could respond to the situation, debate of the effectiveness of each possible response and consideration of alternative responses. The training manual contains a ‘notes for trainers’ section which prompts the facilitation of the discussion of the scenario to further consider the psychological effects on the professional, staff support services available as well as a review of local policies and procedures relating to self-injury.

Example 2 This scenario involves two young men, holding what looks like a bottle of alcohol and a long stick-like object. As you (the viewer) turn a corner into a dark alley, the two men are approaching you.

Discussion of the scenario The smaller group discussions of the scenario could concentrate on the possible responses available to the professional. Reflections on the situational and interpersonal factors are also anticipated. The ‘notes for trainers’ section prompts the facilitation of the discussion of the scenario to further consider lone- working and the applicable policies and procedures and reflection on beliefs systems relating to stereotypes.

Example 3 This scenario demonstrates a woman entering a room where a professional is sat. She slams the door and remains in the room, agitatedly stood between the professional and the only exit from the room.

Discussion of the scenario The reflections of the smaller group on the scenario might relate to the necessary communication techniques and interpersonal factors which are required to reduce the likelihood of the situation escalating to a point where violence could occur. The ‘notes for trainers’ section prompts the facilitation of the discussion of the scenario to further consider the applicable policies and procedures relating to lone-working and also the situational factors influencing the scenario.

Example 4 This scenario illustrates a situation that occurs within a clinical setting. A nurse is administering medication from a medication cabinet but as she is distracted by reading a document, a person approaches and takes a bottle containing medication from the trolley without authorisation.

Discussion of the scenario The smaller group reflections of the scenario may relate to the retrieval of the medication from the individual who took them, the intentions of the individual and the situational and environmental factors relating to the scenario. The ‘notes for trainers’ section prompts the facilitation of the discussion of the scenario to further consider local policies, procedures and practices related to the administration of medication and additionally those policies relating to poisoning.

Conclusions It is expected that the materials contained in this training resource package will assist in the reflection, discussion and exploration of the underlying social, environmental and interpersonal factors contributing to violence and the consideration of situational influences. It is intended that national and local policies and practices are examined and reviewed to minimise the risk of violence occurring. Therefore maintaining the health, safety and well-being of professionals and service-users and improving the quality of service provision provided by health and social care organisations.

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