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PROFESSIONAL

As the pandemic sees abuse towards practice nurses continue to rise , Dr Ellie Mein offers advice on dealing with patient hostility

Aggression from patients towards clinical staff of all disciplines in both primary and secondary care is a longstanding issue . While most consultations or home visits start and end well , with the patient feeling their expectations have been met , there has been growing evidence during the Covid pandemic of an increase in abuse and aggression towards nurses and other staff .

Recent incidents in primary care In an MDU survey of 418 members in August 2021 , 79 % of GP respondents said levels of abuse from patients and their representatives had increased since the start of the pandemic , with 44 % having experienced bullying , abuse or harassment from patients or relatives . ¹ Of course , the increase is not solely directed at doctors ; nurses , paramedics , healthcare assistants and administration staff also bear the brunt of this unacceptable behaviour .

Nearly half of primary care-based respondents to the survey ( 49 %) said waiting times for treatment and referral were the main cause , with a third ( 32 %) citing appointment availability as a trigger .

Nurses are at the forefront of dealing with patient frustration , and it can be difficult to avoid confrontations given the delays currently being experienced in our stretched health service . However , being aware of common trigger factors and techniques for diffusing difficult situations can help when dealing with challenging behaviour .

Causes of aggression Patients can become aggressive or violent for many reasons . They may have an underlying medical problem or an acute physical or mental illness that causes them to behave in a way that may not be in keeping with their usual character , especially when faced with a stressor such as the current delays in treatment . People who are ill , scared or in discomfort , or who feel their request isn ’ t being listened to or actioned appropriately , can react in an unpredictable manner .

Other contributing factors might include communication problems , frustration , previous poor experience and unrealistic expectations . Some patients may have a history of difficult behaviour , even when there is no underlying problem to explain this , and in such cases , it may be possible to anticipate and prepare for problems .

Anticipating challenging behaviour Being aware of the possibility of a situation escalating ,

even in patients with no history of challenging behaviour , is the first step . Observe what patients say and how they say it . Acknowledging that a patient is unhappy or frustrated and indicating that you wish to understand why and help , if possible , may de-escalate the situation .

Showing a willingness to listen , asking open-ended questions and avoiding encroaching on personal space can also help to calm the situation . Give careful thought to the layout of consulting rooms , or the use of panic alarms . NICE has published guidance on how to manage violence and aggression in a healthcare setting including recommendations for staff training . ²

If a patient becomes aggressive or violent despite these steps , then it may be appropriate to consider what response is required . Have a clear policy in place showing how hostile behaviour from patients will be dealt with . This should be readily visible , for example a notice in the waiting room , or on the practice website .

Set clear boundaries from the outset It is important to be clear that unreasonable or unnecessary requests will not be met . For example , notify patients , via the website and a waiting room notice , how to make requests and set out the type of requests that cannot be processed .

We ’ ve also seen cases where entirely reasonable requests for patients to wear a mask , sanitise their hands on entering practices , or advice to get a Covid test have been met with anger . Ensuring patients know in advance about current infection and control policies may reduce the risk of an aggressive reaction .

ALAMY