HEALTH FORUM

As someone who was a trained psychiatric nurse I have seen and
experienced some abuse and violence at the hands of patients and
visitors in the NHS and I have seen at least one fellow nurse driven
out of nursing after a serious assault. As someone who also used to be
a trade union steward and health and safety representative I have
also, at times, had to deal with a managerial attitude that violence
was part of the job and that managers were not going to bother to make
any real effort to actual protect staff from violence. So, although I
no longer work in the NHS, I am pleased that the Department of Health
and the NHS have decided to produce a national campaign designed to
reduce the risk of violence to staff.

However there are negative consequences to this campaign which need to
be considered and the senior management of South Staffordshire Health
Care Trust are, in my considered opinion, not bearing in mind these
negative consequences and are also using the Campaign as an instrument
to impose their own personal attitudes onto vulnerable people and to
frustrate and stifle legitimate complaints about the services they
provide. In so doing the Senior Management of this Trust are bring
this important campaign into disrepute and increasing the danger of
violence to their staff.

The main problem with the NHS Zero Tolerance Campaign is that it tends
to focus the minds of staff onto patients as potentially violent
people. Of course the people responsible for this campaign are aware
of this potential problem and much of the campaign is about trying to
make staff aware of their prejudices and how their own attitudes and
actions can actually provoke violence. I would argue that the attitude
most likely to provoke violence is one where a member of staff
believes someone is going to be violent. A frightened patient facing a
frightened member of staff is more likely to become frightened and
very frightened people will, sometimes, lash out in fear. An angry
person met by an angry member of staff will get more angry still and
again my get to such a state as to resort to violence. The Campaign
makes much of the need to deescalate violence and the first step to
this is for staff to not expect every patient to be violent. The
effect that negative staff attitudes has on producing negative patient
behaviour was clearly shown by Ervine Goffman way back in the 1960s
(see fore instance Asylums, first published in 1968) although the
message has had some considerable difficulty getting across. My own
personal experience as a nurse was that, since I gave attention to
patients and held them in positive regard, I had to deal very little
with

Philip Davis wrote ...



So its OK for you to act in an uncaring and inconsiderate way, utterly
failing to respect the feelings of others, and yet wrong for a health care
professional to ask you to be more considerate.

As nurse of many years experience, I am saddened by the expectation that
professions are expected to absorb verbal (and presumably) physical
violence.

Im sure youd have been most upset if his response had been Fuck off you
rude git. In fact Ill bet youd have trashed him all over the Internet (Oh
... you have anyway!)

Double standards never helped in the care of people with mental health
problems; never, and they never will. Accepting aggression as normal does
no-one any favours.

Some folk - obviously not you or I, find certain words - not just the
implied or present aggression - to be extremely offensive. You might care to
learn from your experience. Or not.

As it happens, the Zero Tolerance policy has much more to do with drunks and
people forced to wait for hours in A&E.

Is it OK for them to hit staff as the mood takes - or are you reserving that
right for people living with mental illness?

I believe you seriously underestimate the professionalism of staff who face
aggression daily; it is rarely - if ever *their fault*, although I accept it
is not always the *fault* of the perpetrator.

None the less, anything other than zero tolerance is a betrayal of staff
(who have *rights* too - including the right to work in safety). Fostering
an atmosphere where violence is tolerated - and so expected - will
ultimately harm the very people you claim to be supporting.

Andrew Heenan RMN RGN

Andrew L. J. Heenan wrote in message news:<4011971d
2@mk-nntp-1.news.uk.worldonline.com>...

Mr Heenan believes that me using my normal strong language, in a quiet
tone, to describe my feelings, and in response to a question put to
me is an act of aggression. My response to this is that Mr Heenan is
attempting to force his own narrow middleclass mores on people. I
personally believe that attempting to force people to change their
normal behaviour to suit a limited set of bourgoise mores is an actual
aggressive act. Its of the same quality and character of the mind set
in the Soviet Union in the 1970s where not believing in the benefit
of communism was considered a deviation from acceptable norms and
resulted in people being detained in psychiatric hospitals.
If Mr Heenan does not want to work in an environment where people use
strong language on occassion I suggest he apply for a job as a
lighthouse keeper or shepherd.

Fostering an envirnoment where the NHS Zero Tolerance Zone Campaign is
abused by people like Mr Heenan will bring discredit to this important
campaign and will result in becoming worthless. Tolerance and
understanding is the key to the deesculation of violence and Mr Heenan
would do well to look at the details of the campaign. The campaign
repeatedly mentions the benfits of allowing people to express their
feelings. If he can find anywhere in the campaign where he is told it
is a good idea to restrict the language people use to express their
feelings I will be very suprised.

My sympathies are with the collegues of Mr Heenan who will undoubtable
have to deal with the fall out that his negative attitudes to service
users will produce.

Philip Davis wrote in message
news:6e32f763.0401240702.4eba987b@posting.google.com...

no one has suggested , what has been suggested is that profanity, is
unacceptable in helathcare settings, and while it may demomnstrate the
frustration of the user it is neither beneficial or porductive, Agression
and violence usually only results from the inapprorpaite response to
requests that the person using profanity refrain from doing so.

Often this descends to the person using profanity, making direct insults ,
threatening or using violence, all of which are in approrpaite and threats
or use of violence are criminal matters


No it is based in respect and in providing an approrpaite therpeutic
environment for other services users and a less threatening environment for
front line staff, a consistant and firm attiude must be taken across all
facets of the NHS service otherwise it leaves us open to deliberate
manipulation by those who wish the NHS to belive that their unacceptable
behaviour is a facet of real or imagined mental illness, often with the
aim of attempting to seek medication or admission.


this of course is utter rubbish, it is currently the hardest its ever been
to get even obviously mentally disordered people into in patient
psychiatric services i nthe UK


this is not a solution to dealing with violent or aggressive behaviour and
smacks of the old, discredited attitude that violence nad agression are
part of the job for front line health workers

sadly you are out of step , it is obvious that you do not consider that
your unacceptable behaviour is unacceptable, what aobut your tolerance
respect and understanding for the professionals you interact with ?


peopel are encouraged to express their concenrs , however this does not and
should not involved profanity, threats or violent behaviour, if people are
unwilling to work in a collaborative and sensible manner then they bring
it upon themselves to have sanctions taken, should Staff feel that the
behaviour is inappropriate or shoudl hey feel that an offence may be
commited then approrpaite action needs to be taken.


Oddly the levels of violence and aggressive behaviour are seen to fall in
those front line environments where zero tolerance policies are in
operation, especially once it becomes common knowledge that those who are
threatening or violent will be dealt with within the criminal justice
setting, for far too long we have made too many accommodations for
patients on the basis solely of them being patients, as health service
staff we are not judge and jury and should not make those decisions.

in the emergency care setting once it becomes common knowledge that those
who are not patients and behave in inappropriate manners will be removed
or even arrested from breach of the peace, it tends to make for a much more
settled environment, or do you consider it appropriate for staff to be
harangued and abused by the relatives of patients ?


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I think that during this thread, and the one on Violence against nurses,
some interesting points have been raised about the rights and
responsibilities of both nurses and patients.

Comments within this group and on uk.people.support.mental-health and
uk.local.midlands about the treatment Philip Davis states he has received
are outside my knowledge and experience and I wouldnt want to comment on
them, however I would like to comment on the use of strong language by
patients.

In my many years in A&E I heard just about every expletive imaginable and
was never upset by them - recognising that they were often signs of
distress, anger, etc. But on many occasions I tried, and was often able, to
persuade the patient to modify their language - not for my sake, but for the
sake of other patients and relatives (often including children) who may be
within hearing distance.

As a charge nurse my responsibilities went beyond the care of the one
individual patient to all the others in the department and I needed to
balance the right of the specific patient to express their feelings, with
the rights of others to be treated in an appropriate environment ( and also
responsibilities to staff for their working environment).

I do not believe that my asking patients to moderate their language was a
deeply patronising and very uncaring response or imposing my own narrow
middle class mores but was valid concern for the well being of a wide
range of people for whom I had some responsibility at the time.

I hope that we can discuss this, as with all aspects of care, without
resorting to abusive langauage and or a slanging match about specific
patients or staff.

Rod

Rod wrote in message
news:...

You raise a valid point about protecting other patients and visitors
from distress. And I am, of course, unable to comment about care but I
generally agree with what you say. I too have been a charge nurse and
believe I suceeded in producing a thereaputic milieu.

My example, as I mentioned, was in the context of a ward round where
the only person who was not paid to be there was me and the only
person not free to leave was me. (I could have left the ward round but
not the ward. The next week I refused to see this rude consultant
making it clear both verbally and in writing that I did not want to
see him and yet he forced himself onto me against these expressed
wishes. The Trust has lost the note I wrote.)

I would add, therefore, that whilst your comments are valid, to quote
from my example and to attempt to relate it to an entirely different
situation is both a argumentative fallacy and a disingenious remark.

The argument I have been making elsewhere about the importance of
quality non-subjective research applies here. If effective schemes are
to be drawn up to protect staff, patients and visitors from violence
then these schemes have to be based on accurate data and applied in
place and way to which that data applies. A scheme designed for A&E
may well be completely inappropriate for mental health, or for a
neurosurgury units (somewhere I have been assualted often by confused
patients).

As an aside whilst I was detained I was with fellow patient who spent
many hours of the day shouting that his wife was a fucking bitch.
The staff attempts to deal with behaviour consisted of intermittant
comments to him to not swear usually in the form of I wont talk to
you if you continue to swear. I didnt see or hear staff ask him to
consider the other patients. I dont know what care plan, if any, was
in place to help this man find a less distressing way to express his
anxiety but it certainly wasnt effective. Of course the staff were
only there for 37.5 hours a week and could go out when they wanted
whilst I was there 168 hours a week and not able to escape. I do find
shouting, regardless of the content, distressing and during this
period this contributed to a very marked increase in my angina.

Philip Davis

eh??

but I

Did you keep a copy? I thought you said something early on about being a
union rep or something?


Speak english please, using clever words doesnt make you arguement any the
more credible.


And what, why should it be different in different areas.??


Did you report that to anyone?
--
Donegal Paul
Li Mugello 186 (woohoooooo!)
CB350SG (Rebuilt and running!)
www.thepilgrimssc.co.uk

Philip Davis

eh??

but I

Did you keep a copy? I thought you said something early on about being a
union rep or something?


Speak english please, using clever words doesnt make you arguement any the
more credible.


And what, why should it be different in different areas.??


Did you report that to anyone?
--
Donegal Paul
Li Mugello 186 (woohoooooo!)
CB350SG (Rebuilt and running!)
www.thepilgrimssc.co.uk