Table 1 Nurses suggestions how violence prevention could be more effective
Category | Detailed suggestions | Example |
|---|---|---|
In-service training | ||
To make treatment policies more coherent Should be more high-quality, concrete and offer new knowledge | Information: early warning signs, prediction of violence, new drugs and violence-related subcultures More in-service training for the all staff - especially de-escalation technique training | To be able to practice together—the one who does and what, I suppose everyone knows broadly what to do, but what is their location at the situation, it demands some co-practice (ID 6) |
Competent interaction | ||
Staff-to-patient and staff-to-staff, e.g. between a nurse and a physician Interaction problems with a physician may endanger patient care: e.g. insufficient medication and lack of information provided to a patient | Courage to ask straight whether a patient has violence-related thoughts Consequences of violent behavior should be discussed clearly with the patient The importance of leadership and clear instructions clarification of nurses’ work in violent events A consensus among the staff how to deliver treatment Adequate, stable workforce: when staff knows each other well, interaction is easier | It’s terribly hard for the patients, too — when there is no such line and they don’t have time to get used to anybody — it increases the risk that something might happen because such a stabile situation is aimed for in which everything is very consistent and everybody knows how to proceed, what they can and cannot do, it is always such a thing that holds the thing together (ID 17) |
Presence of nurses | ||
Patients being themselves, if ward climate tense and frustrated and can lead to violence | Familiar nurses provide safety for the patients Time to be present for the patients and a named nurse with primary responsibility to take charge if there are signs of violent behavior Only one of the nursing staff speaks to the patient in case of violent event | That the more we can be there, so called present and displayed on the ward, so that way we can make the situations more calm (ID 17) |
Security improvement | ||
Lack of privacy and overcrowded wards Unsupervised places, e.g. smoking rooms, balconies Dysfunctional computers: if the files are unreachable, critical information may not be reported to next shift A patient or a visitor may smuggle drugs or bring weapons into wards | Reduction of beds, increase of single rooms for patients Avoidance of certain one-to-one situations, e.g. being twosome in kitchen with the patient Ensuring functioning electronic equipment for efficient reporting Compliance of security instructions: e.g. locked places should be locked When in doubt, permission to check patients’ bags even against patients’ will Drug detection dog on wards if needed Surveillance cameras and metal detectors on ward exits | Neglecting such direct safety instructions, for example, locked places are left open, e.g. in the kitchen -knife drawers might be left unlocked, I think it is such a security deficit here, as well as dangerous chemicals, such detergents, might be unsupervised that one has a change to drink them for intoxication purposes (ID 3) |