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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

The Spinney Psychiatric Services

1 Day De-escalation Programme

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introduction
Introduction
  • Facilitators
  • Facilities
  • Fire exits
  • Toilets
  • Refreshments
  • Breaks

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ice breaker
Ice Breaker

To start the course proper we will start with an exercise.

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slide4
Aims
  • Management of aggression in health care settings
  • Permissible forms of control
  • Organisational issues
  • Increase confidence

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objectives
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

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

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legal requirement
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

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what the law requires
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

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violence to staff in health care
Violence to Staff in Health Care
  • Health service advisory committee 1987 survey
  • Major injuries
  • Minor injuries
  • No physical injury due to threats
  • Verbal abuse

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mezey shepherd 1997
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

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health service advisory committee 1997
Health Service Advisory Committee 1997
  • Training
  • Causes of violence
  • Warning signs
  • Interpersonal skills
  • Incident reporting

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violence in mental health care ukcc 2001
Violence in Mental Health Care UKCC 2001
  • Violence directed towards anyone is unacceptable.
  • Recognition, prevention and management of violence
  • A need for appropriate training

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break
Break

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reasonable force definition
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)

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reasonable force principles
Reasonable Force (Principles)
  • Assessment
  • Assessing reasonable force
  • Rule of engagement
  • There must always be a resolution

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use of force
Use of Force
  • Lord Griffiths ………
  • Section 3 criminal law act 1967

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scenario 1
Scenario 1
  • Exercise on the use of force and what is reasonable
  • Justification of actions
  • Correct documentation

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review scenario 1
Review scenario 1
  • Discussions on the scenario on the use of force.

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body s autonomic response
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

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

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responses21
Responses
  • Flushed, pale or blotchy complexion
  • Pacing, foot tapping, page flicking

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group work
Group work
  • Divide into three groups and brainstorm to find definitions of the following
  • Anger
  • Aggression
  • Violence

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lunch break
Lunch Break

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anger
Anger
  • Emotional response
  • Disrupts thinking
  • Disrupts problem solving
  • Intense irritation
  • Motivation

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aggression
Aggression
  • Outward act
  • Acceptable
  • Physical, verbal, mental and passive
  • Difficult to define barrier

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violence26
Violence
  • Extreme end
  • Great force
  • Damaging
  • Physical and mental
  • Two kinds

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manifestations
Manifestations
  • Thoughts
  • Feelings
  • Actions
  • Bodily functions

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triggers
Triggers

Personal factors

  • Genetic/constitutional/physiological
  • Personality
  • Attitude

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triggers30
Triggers

External factors

  • Frustration
  • Powerlessness
  • Threat
  • Fear
  • Provocation/abuse

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assault cycle
Assault Cycle
  • Trigger
  • Escalation
  • Crisis
  • Plateau
  • Post crisis

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

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trigger
Trigger
  • A shift from baseline
  • Enforced socialisation
  • Lack of choice
  • Lack of privacy
  • Lack of autonomy
  • Trigger reduction

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escalation
Escalation
  • Deviates more from baseline
  • Over focused
  • Early intervention
  • Non verbal cues

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

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

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post crisis
Post Crisis
  • Fall below the base line
  • Physically and mentally exhausted
  • Remorseful
  • Need support
  • Time to explore
  • Comprehensive documentation

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role plays
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.

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break40
Break

.

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

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questions and answers
Questions and Answers
  • A little question and answer sheet for you to participate in

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feedback and evaluation
Feedback and Evaluation
  • Verbal
  • Written

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references
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.

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references46
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.

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references47
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.

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references48
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.

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home time
Home time

.

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zero tolerance
Zero Tolerance

The NHS zero tolerance statement has two principal targets. They are:

  • Public
  • Staff

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zero tolerance public
Zero Tolerance – Public

To get over to the public that violence against staff working for the NHS is unacceptable. The government and the NHS are determined to stamp it out.

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zero tolerance staff
Zero Tolerance - Staff

To get over to all staff that violence and intimidation is unacceptable and is being tackled.

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zero tolerance survey 1998
Zero Tolerance – Survey 1998
  • 3/1000 incidents every month in acute hospitals
  • 7/1000 incidents every month in ambulance services
  • 14/1000 incidents every month in community settings
  • 24/1000 incidents every month in learning difficulties/mental health units

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zero tolerance targets
Zero Tolerance Targets
  • Record
  • Publish
  • Reduction
  • Police

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european human rights act 1998
European Human Rights Act 1998
  • Article 2 - A right to life
  • Para 3.14
  • Para 3.15
  • Para 3.16
  • Article 3 - freedom form torture or inhumane or degrading treatment
  • Para 3.24
  • Para 3.25
  • Article 5 – personal freedom

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