Violence in health care: the contribution of the Australian Patient Safety Foundation to incident monitoring and analysis

The document attached has been archived with permission from the editor of the Medical Journal of Australia. An external link to the publisher’s copy is included.Because of growing concern about violence in health care in Australia, we reviewed the relevant data on incidents involving violence collected using the Australian Incident Monitoring System (AIMS). Among 42 338 incidents reported from 1 July 2000 to 30 June 2002, 3621 (9% of all incidents) involved patients and physical violence or violent verbal exchange; staff injury was reported in 5% of cases. The proportion was higher in emergency departments (16%, with frequent involvement of mental health problems or alcohol or drug intoxication) and mental health units (28%). Contributing factors include changes in our society and in mental health service provision. With the closure of public psychiatric hospitals in the past decade, more patients with mental illness are seeking care in public hospital emergency departments. AIMS analysis highlights the importance of understanding the contributing and precipitating factors in violent incidents, and supports a variety of preventive initiatives, including de-escalation training for staff; violence management plans; improved building design to protect staff and patients; and fast-tracking of patients with mental health problems as well as improved waiting times in public hospital emergency services. We recommend that a national system be developed to share and compare incident monitoring data, to monitor trends, and to facilitate learning and thinking at all levels - ward, department, hospital, state and national.Klee A Benveniste, Peter D Hibbert and William B Runcima

Nursing home caregivers' explanations for and coping strategies with residents' aggression: a qualitative study

Aims and objectives. This study explored caregivers' perspectives regarding the conditions and situations of resident aggression and practical strategies caregivers use to deal with aggression. Background. Working in a nursing home is associated with a high risk to experience aggression from residents or patients. Despite existing recommendations for dealing with aggression there is a lack of information about caregivers' ways of dealing with it in practice. Design. A qualitative study with focus group method was conducted. Method. Five focus group interviews, with a total of 30 participants, from nursing homes in Switzerland were undertaken employing a semi-structured interview guideline. For analysing the data, qualitative content analysis was employed. Results. Analysis of the data produced three themes with additional sub-themes. One main theme concerns the explanations of the caregivers in regard to the occurrence of aggressive behaviour. This theme is subdivided into two areas, the contributory resident related factors and the caregiver related factors. The measures for handling aggressive behaviour are illustrated in the second theme 'dealing with residents'. The third theme refers to the strategies of the caregivers when confronted with aggressive behaviour - 'self-protection' and 'coping with the situation'. Conclusion. Caregivers use a broad spectrum of interventions for reducing aggression, some of which are recommended by guidelines but often ignore the link between aggressive behaviour and physiological issues like pain or elimination. The caregivers only very rarely linked their practical knowledge about aggressive behaviour with theoretical knowledge. Relevance to clinical practice. The results give insight into the caregivers' perspectives on factors leading to aggression and their coping strategies. Caregivers are informed about relevant reasons for aggressive behaviour and its management, but do not apply a systematic approach. Furthermore, the anxiety of caregivers involved in aggression incidents is an under examined area