An exploration of the discrepancy between actual and reported incidents of violence and aggression within the speciality
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Background. Approx. 65,000 incidents of violence in the NHS were reported in1998-99 (DOH,1999)Increased to 84,273 in 2001 (DOH, 2001)60,385 physical assaults experienced by staff members in 2004-5 (CFSMS, 2006). Background: However
An exploration of the discrepancy between actual and reporte...

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1. An exploration of the discrepancy between actual and reported incidents of violence and aggression within the speciality of learning disability nursing By Joanne Skellern Thank you for attending, I hope you are enjoying the conference so far. My name is Joanne Skellern and as part of my MSc in Professional Practice I undertook a piece of research which I entitled An ?Thank you for attending, I hope you are enjoying the conference so far. My name is Joanne Skellern and as part of my MSc in Professional Practice I undertook a piece of research which I entitled An ?

2. Background Approx. 65,000 incidents of violence in the NHS were reported in1998-99 (DOH,1999) Increased to 84,273 in 2001 (DOH, 2001) 60,385 physical assaults experienced by staff members in 2004-5 (CFSMS, 2006) Violence and aggression is a risk that many nurses, especially those working within the fields of mental health and learning disabilities, regularly faceViolence and aggression is a risk that many nurses, especially those working within the fields of mental health and learning disabilities, regularly face

3. Background: However? Mental health/learning disability Trusts ? violent incidents averaged 2.5 times higher (DOH, 2001) 43,301 incidents of physical assault in MH/LD Trusts i.e. one in five staff members (CFSMS, 2006). As a learning disability nurse these figures obviously caused me some concern thus I undertook a literature review and found further evidence of the extent of violent and aggressive incidents practitioners within the learning disability and mental health fields of nursing. In a study conducted by Whittington in 1994 it was found that, on average, aa violent assault is reported every 11 days within mental health settings McCafferty and McMahon in 1999 found that 77% of all nurses had experienced at least one violent within the last 12 months and 78% had suffered verbal abuse McMillan who studied the prevalence of violence within 11 inner-London mental health Trusts in 1998, found that a violent assault occurred every 3 days whilst a violent incident occurred almost every day However as the literature review deepened I discovered that the number of incidents reported was almost certainly an under-estimationAs a learning disability nurse these figures obviously caused me some concern thus I undertook a literature review and found further evidence of the extent of violent and aggressive incidents practitioners within the learning disability and mental health fields of nursing. In a study conducted by Whittington in 1994 it was found that, on average, aa violent assault is reported every 11 days within mental health settings McCafferty and McMahon in 1999 found that 77% of all nurses had experienced at least one violent within the last 12 months and 78% had suffered verbal abuse McMillan who studied the prevalence of violence within 11 inner-London mental health Trusts in 1998, found that a violent assault occurred every 3 days whilst a violent incident occurred almost every day However as the literature review deepened I discovered that the number of incidents reported was almost certainly an under-estimation

4. Literature review Literature suggests there is an under-reporting of violence within nursing: DOH (2002) its in Zero Tolerance Campaign RCN (1998) in the publication Dealing with violence against staff: An RCN guide for nurses and managers UKCC (2002) in the publication The recognition, prevention and therapeutic management of violence in mental health care

5. Literature review Lack of consensus regarding definitions of violence and aggression Literature available specifically relating to mental health/ learning disabilities is minimal Systems for reporting incidents of violence and aggression varied according to organisation Figures are reliant on staff members completing reporting forms Most importantly, I feel. The figures are reliant on staff members themselves completing the reporting forms and submitting themMost importantly, I feel. The figures are reliant on staff members themselves completing the reporting forms and submitting them

6. Literature review RCN (1998) suggest that incidents go unreported because of nurses belief that they should be able to cope unaided with any situation. Stark and Kidd (1995) suggest a lack of time Lack of support (McGregor, 2006) Incidents being classed as ?minor? (Turnbull, 1994, Keily et al, 1999) Waste of time (Keily et al, 1999) Fear of repercussion (RCN, 2002, Dowson, et al, 1999) McGregor (2006) highlighted that at least one trust had disregarded physical attacks of staff members where it was felt that the perpetrators clinical condition was o blame ? mental health problems were cited as a reason for omission Fear of repercussion ? Dowson found that incidents requiring the use of physical restraint techniques were less likely to be reported and of the reports submitted, 51% of staff involved in restraint omitted their names from the report These would later form the basis of the questions asked when conducting my researchMcGregor (2006) highlighted that at least one trust had disregarded physical attacks of staff members where it was felt that the perpetrators clinical condition was o blame ? mental health problems were cited as a reason for omission Fear of repercussion ? Dowson found that incidents requiring the use of physical restraint techniques were less likely to be reported and of the reports submitted, 51% of staff involved in restraint omitted their names from the report These would later form the basis of the questions asked when conducting my research

7. Research Questions Does a discrepancy between actual and reported incidents exist in the LD Directorate of the Partnership Trust? If so, are there indications as to the extent to which the discrepancy exists? What are the reasons why such a discrepancy exists? What ideas for future improvements are there?

8. Research Design Semi-structured postal interview schedule with questions concentrating on ? biographical and demographic data, classification of incidents, reasons for non-reporting, suggestions for future development, but also allowing for further comments to be made. All practitioners (qualified and non-qualified) within one Trust I used a constructed questionnaire, made up of forced choice questions and some open ended questions to obtain quantitative data specific to the research questions The questionnaire was sent out, in the form of a census, to all qualified and non-qualified clinical staff within the learning disability directorate of the identified TrustI used a constructed questionnaire, made up of forced choice questions and some open ended questions to obtain quantitative data specific to the research questions The questionnaire was sent out, in the form of a census, to all qualified and non-qualified clinical staff within the learning disability directorate of the identified Trust

9. Ethical considerations Key issues were confidentiality, anonymity, and informed consent University ethical committee ? some concern expressed about the sensitivity of the research subject Local Research Ethical Committee (LREC) ? no major concerns expressed. The key issues for me were: Confidentiality To maintain confidentiality and ensure the participants in the research remained anonymous, no identifying data was collected ? it was hoped that with this assurance, the proposed participants would feel more able to complete the questionnaire openly and honestly Informed consent An accompanying letter was sent with the questionnaires explaining who I was, what I was doing and what I intended to do with the collected data. As the questionnaires were for self completion, informed consent and voluntary status of respondents was gained through the right of non response University ethics committee ? recognised the sensitivity of the subject and requested that I as the researcher provided some support for the recipients of the questionnaire in case any distress was experienced. Following discussions with local occupational health departments it was agreed that their contact details were enclosed with the questionnaire directing the recipients of their services if they were required The local ethics committee recommended a couple of administrative changes were made but had no concerns in regards to the research study and a favourable ethical opinion was grantedThe key issues for me were: Confidentiality To maintain confidentiality and ensure the participants in the research remained anonymous, no identifying data was collected ? it was hoped that with this assurance, the proposed participants would feel more able to complete the questionnaire openly and honestly Informed consent An accompanying letter was sent with the questionnaires explaining who I was, what I was doing and what I intended to do with the collected data. As the questionnaires were for self completion, informed consent and voluntary status of respondents was gained through the right of non response University ethics committee ? recognised the sensitivity of the subject and requested that I as the researcher provided some support for the recipients of the questionnaire in case any distress was experienced. Following discussions with local occupational health departments it was agreed that their contact details were enclosed with the questionnaire directing the recipients of their services if they were required The local ethics committee recommended a couple of administrative changes were made but had no concerns in regards to the research study and a favourable ethical opinion was granted

10. Respondent profile 154 completed questionnaires out of 367 (42% response rate) 24% male 76% female Average age 41 yrs 8 months 21% worked in nursing 16-20 years 20.1% - 5-10 years 39.5% from community teams 10.9% respite care 21.8% residential homes 21.8% assessment & treatment 6.1% forensic service I feel that 42% is a good response rate ? although I was unable to clarify this within the literature as many researchers state it is impossible to estimate a response rate or provide an ?average? as they vary so much depending on what the research topic is about I then used a statistical package for the social sciences to assist me in analysing the collected data. The demographical and biographical findings were . . . (these figures were representative of the Trusts figures provided by the workforce planning department) I feel that 42% is a good response rate ? although I was unable to clarify this within the literature as many researchers state it is impossible to estimate a response rate or provide an ?average? as they vary so much depending on what the research topic is about I then used a statistical package for the social sciences to assist me in analysing the collected data. The demographical and biographical findings were . . . (these figures were representative of the Trusts figures provided by the workforce planning department)

11. Profile 49.4% band 3 1.3% band 4 5.8% band 5 23.4% band 6 9.7% band 7 1.3% band 8 1.3% other 7.1% didn?t respond Again these are representative of the workforce in the mental health Trust Again these are representative of the workforce in the mental health Trust

12. Initial findings 74.7% of respondents had been subjected to violent and aggressive incidents within last 6 months 18.2% reported each incident 15.6% failed to report any incidents 78.3% reported each incident involving physical violence 28.6% reported each incident of verbal aggression Frighteningly this is a 3 in 4 ratio of people who have experienced violence and aggression within the workplace not the 1 in 5 that the literature highlightedFrighteningly this is a 3 in 4 ratio of people who have experienced violence and aggression within the workplace not the 1 in 5 that the literature highlighted

13. Findings Reasons for not reporting/ recording incidents: Other = part of jobOther = part of job

14. Emergent themes Didn?t confirm the literature on gender differences Slight negative correlation between banding and experiencing incidents The most common reason for not reporting, respondents classed it as ?minor incident? secondly respondents opted to choose other stating it was ?part of the job? 81.5% stated they had received no feedback following the submission of an incident form Literature indicates that male colleagues are more likely to be involved in incidents of violence and aggression within the workplace, however this theme was not evident within the research study ? 75.6% of respondents who had experienced violence and aggression were male and 74.1% were female ( on examination of these figures, the male respondents worked in the more volatile services for example 50% of them worked within assessment and treatment and forensic services thus possibly explaining the difference in the findings) The literature also suggested that healthcare assistants (band 3s and 4s) were more likely to experience incidents within the workplace. However the research I conducted did not show this, in fact there was a slight negative correlation indicating that the respondents employed on higher bandings had experienced more incidents than the respondents on the lower bands. On further exploration of this though it appears this could possibly e explained by the fact that the people employed on high bands had worked in nursing professions longer for example the majority of band 3s had worked in nursing for 5 ? 10 years whilst the majority of band 6s had worked for 16 ? 20 years.Literature indicates that male colleagues are more likely to be involved in incidents of violence and aggression within the workplace, however this theme was not evident within the research study ? 75.6% of respondents who had experienced violence and aggression were male and 74.1% were female ( on examination of these figures, the male respondents worked in the more volatile services for example 50% of them worked within assessment and treatment and forensic services thus possibly explaining the difference in the findings) The literature also suggested that healthcare assistants (band 3s and 4s) were more likely to experience incidents within the workplace. However the research I conducted did not show this, in fact there was a slight negative correlation indicating that the respondents employed on higher bandings had experienced more incidents than the respondents on the lower bands. On further exploration of this though it appears this could possibly e explained by the fact that the people employed on high bands had worked in nursing professions longer for example the majority of band 3s had worked in nursing for 5 ? 10 years whilst the majority of band 6s had worked for 16 ? 20 years.

15. Further themes Support ? 92.1% of respondents felt supported by their colleagues, 68.5% supported by their managers, 52.2% by the organisation, 78.2% by legislation, policies and procedures. Training ? 88% had received some training in the management of violence and aggression. On a more positive note:On a more positive note:

16. Training As vere-jones (2006) highlights 30% of permanent staff and 70% of temporary staff are unable to access mandatory training As vere-jones (2006) highlights 30% of permanent staff and 70% of temporary staff are unable to access mandatory training

17. Initial conclusions A discrepancy exists within the learning disability directorate of the identified partnership Trust Further research is required to identify if the findings of this research study can be generalised to other Trusts/ organisations

18. Implications The research highlighted the need to evaluate: Risk assessment strategies Skill mix within the workplace Professional responsibilities Documentation systems Training programmes Support services Post incident review process Partnership working (police, local health services and related agencies) None of these procedures are new to healthcare professionals working within the NHS but we need to improve the effectiveness of the processes in order to minimise violence and aggression within the workplace None of these procedures are new to healthcare professionals working within the NHS but we need to improve the effectiveness of the processes in order to minimise violence and aggression within the workplace

19. Finally. . . The research highlights the need for a consistent approach across the NHS, nationally, in order for Trusts to fulfill the aim of providing a high quality, cost effective, accessible, locally focused service for people with a learning disability

20. For any further information please contact me on: joanneskellern@btinternet.com


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