Special report into hospital ward assaults

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Most people are lucky enough to go off to work in the morning without the threat of attack or physical assault.

But there are certain jobs in which coping with aggressive behaviour has become a regular part of a day’s duties.

One recent Chron story revealed that of the 149 assaults which took place at Northampton General Hospital in 2011-2012, a third of these happened in Creaton Ward, a 28-patient medical ward which deals with a high number of elderly patients, some of whom have dementia.

But why has there been such a problem?

Helen Hale, Creaton ward manager, said: “I think there is a lot more dementia in the community.

“Patients will become ill and need to come to us because they have an infection or another condition, but they may also have dementia care needs.”

As the number of patients with these needs has increased, so the hospital’s response to their care has had to improve.

Not only is a butterfly logo used alongside the beds of patients suffering from dementia but, since the period in which the latest assaults figures were counted, a health care assistant has also been brought in specifically to provide one-to-one support with those who need extra attention.

There are also plans to transform the wards with colours and pictures as part of a £2,500 project funded by the NGH staff lottery.

The use of these design features should help make it easier for patients to remember vital points, such as where their beds are and where the toilets are; another tool to keep them calm and stop agitation from developing.

Matron Helen Shrives said: “Each bed space looks the same at the moment, but we will soon be able to say things like ‘you are by the picture of the kitten and the red colour.’”

Not all dementia patients are aggressive and it is also true that confusion and upset can also be present in patients who do not have mental health issues. Ms Hale said: “We have to treat them as individuals.

“If someone comes to us with particular needs, whether learning disabilities or physical, or if they have some confusion, we need to find out enough about the patient and involve the family and carers.”

Mrs Shrives said: “As part of the Trust-wide dementia project we have the Butterfly Patient Profile, which has basic information about the patients, so we know what they did for a living, what pleases them and what they are scared of.”

Ms Hale said: “We send our staff on dementia training.

“We also have a box on the ward (with items such as old black and white pictures) and there are communication aids in it.”

She added: “If someone is aggressive to me, it isn’t the person being aggressive, it is that they have an illness.

“I have been nursing for a number of years and I have had a number of fairly minor assaults and not once has it been malicious.”

Anyone who would like to raise funds or donate to Creaton Ward can ring Alison. 
McCulloch in the NGH charitable fund office on 01604 545857 or email greenheart@ngh.nhs.uk.

KNOWING THE PERSON BEHIND THE CONFUSION

When attacks do happen, staff at Creaton Ward have to know how to respond effectively. According to ward manager, Helen Hale, staff are trained in how to cope with aggressive behaviour if it takes place.

One technique learned is how to “break away”, a method which staff can use to easily move free when they are being gripped hard by a patient. Matron Helen Shrives said: “It is a way to get yourself out of situations safely so you don’t put yourself in a vulnerable position.”

But talking can also be a vital tool. Ms Hale said: “If someone is getting increasingly agitated you talk to them to find out why.”

Mrs Shrive said: “Sometimes someone might need to go to the toilet and can’t say what they need, we need to know the person and the signs so they don’t get agitated or upset. It is looking at the patient and seeing if they are becoming restless at certain times, it could be something as simple as someone has been a milkman all his life and now wants to get up at 3am.”

If a situation escalates then security or, ultimately, the police can be called to a scene, but the aim for all staff is not to allow things to get to that state. Julie Yusuf, senior health care assistant, said: “It’s important for us to get to know what patients like and dislike. Distractions are good too. We have a distraction box in the ward with pictures in it of people like Prince Charles and Queen Victoria.”

Toni Paul, senior ward sister, said: “It is still an enjoyable job, especially when you can get to know the real person behind the confusion.”