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 , A N M F ( V I C B R A N C H )

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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

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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…

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SETTING THE SCENE…

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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%)

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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”

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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

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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

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CONSEQUENCES OF VIOLENCE IN NURSING & MIDWIFERY

Workers Compensation Claims Injuries

Physical Psychological Friends and Family

Absenteeism High staff turnover Lost to profession Economic loss

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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…)

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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

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

SPECIFIC OBLIGATIONS UNDER OHS LAW

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RISK MANAGEMENT FRAMEWORK

Control Assess

Review Identify

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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?

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OVA PREVENTION STRATEGY FRAMEWORK

Physical environment /

workplace design

(CPTED)

Post-incident support

Pre-admission/ admission risk assessment

Security – access,

personnel, CCTV, alarms

Incident reporting,

investigation, review and feedback

Training and education

Organisational policies and procedures,

including Code Grey and Black

Cross disciplinary understanding, communication and consistent

approach

Empowered staff

Management plans /

Care plans

Executive commitment to OVA

prevention

OHS Management

System

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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

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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

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CONCLUSION

Causes of violence many and varied

Consequences for nurses and midwives not so varied

Not an insurmountable problem

This can be done

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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.

CONTACT DETAILS

Kathy Chrisfield OHS Unit Coordinator ANMF (Vic Branch) kchrisfield@anmfvic.asn.au Ph: 9275 9365 or 0409 594 495