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Facing Violence at work

April 2006

Training to help healthcare staff deal with violence at work is making a difference - but only where it has a solid grounding in day-to-day situations, researchers have found. Practical training being given to nurses, doctors and other health professionals is generally yielding 'positive, but limited, short-term benefits' in dealing with the rising tide of aggression and violence they face in the workplace.

The UK University of Nottingham researchers conclude that to achieve this, training has to mesh with the over-arching systems and procedures in place in an organisation.

But they also found that poorly thought-out training being offered in some organisations is actually having the opposite effect, leaving staff feeling more anxious and less capable of coping with the verbal and physical abuse aimed at them.

In these organisations, a worrying gulf has grown up between the training theory and the reality of the situations actually faced by healthcare staff, the study revealed.

The Nottingham research, funded by the UK Health and Safety Executive (HSE), is the first national evaluation of violence management training of its kind. The academics hope it will help to inform future policy in the field of workplace violence and encourage good training practice nationwide.

Work-related violence remains one of the most serious occupational hazards facing staff working in the healthcare sector. Only police and security staff experience more violence at work than nurses and other health professionals, according to recent British Crime Surveys.

National Audit Office figures for 2001-2 revealed there were 95,501 reported incidents of violence committed by members of the public against healthcare staff at work. Tens of thousands more incidents are thought to go unreported.

'Violence management training' offered to staff - for example de-escalation, breakaway moves, control and restraint, or some combination thereof - has often been a key element of strategies to prevent or manage the problem. The Nottingham project was designed to both gather evidence about such training but also to inform and support those who manage, deliver and attend such courses.

Antonio Zarola, of The University of Nottingham's Institute of Work, Health and Organisations (IWHO), carried out the research with Dr Phil Leather, Associate Director of the Institute.

Mr Zarola said: "With the huge investment accorded to training in this area within the healthcare sector the question is no longer 'should we train?' but 'is training worthwhile and effective?'

"Until now, the simple answer to this question was, by and large, 'we don't know'! Research commissioned and published today by the HSE is an important milestone towards answering such an important question.

"On the basis of the substantial data gathered during the project, the healthcare sector is now in much stronger position to assess the impact of violence management training. In addition, important lessons have been learned and can now be disseminated about how to evaluate violence management training in any sector.

"Furthermore, and arguably for the first time, hard evidence has been gathered to inform the broad contours of what makes for an effective curriculum."

Recommendations made by the researchers include:

Two complementary reports have been published. Part 1, the Research Report, details the key research findings in answer to two fundamental questions: what impact does violence management training have? And what is the broad content and curriculum of the most effective violence management training?

Part 2 is the companion Practitioner Report. This report specifically addresses the issues of how to evaluate training and in doing so offers a series of tools to support and guide those with a responsibility or interest in designing, delivering or managing violence management training.

The report can be accessed at:

The University of Nottingham undertakes world-changing research and provides teaching of the highest quality. Ranked in the THES World Top 100 Universities, its academics have won two Nobel Prizes since 2003. An international institution, the University has campuses in the United Kingdom, Malaysia and China.

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