Reducing Verbal and Physical Aggression towards Mental Health Nurses in NSW Mental Health HDU

This article discusses the challenges faced by mental health nurses in NSW Mental Health HDU due to verbal and physical aggression from patients. The project aims to reduce this aggression through preadmission education. The article explores the purpose, justification, and stakeholders of the project, as well as the context of its implementation.

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BY ()
The name of the class
Professor
The name of the school
The state and city where it is located
Date

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The verbal and physical aggression towards mental health nurses soon after patients
arriving on ward
Your employing agency’s name
The aggression of the nurses and patient’s frustrations is one of the major and up coming issue
within the psychiatric field. Working at NSW mental health high dependency unit of Wagga
wagga has not been easy for many nurses.
The area/role you work in.
As a registered nurse Newsouthwale mental health HDU, my primary role is to take care of
mentally ill patients or those have induced psychosis issues in the HDU (High dependency Unit).
A high percentage of the patients have been admitted through mental heath act under
involuntarily program.
Your ‘Puzzle”/Project - Identify what you want to change/improve.
The clients are brought in the high dependency unit from the EDs (emergency department)
immediately after being examined by the doctor the mental health emergency consultation
service (MHECS) or through the directives from the local hospitals. Mostly the clients brought in
the HDU are never directed concerning the restrictions within the HDU associated with mental
illness, they as well carry personal belongings like clothes, phones and other dangerous objects
like metals. In the fact that these patients are never taught concerning these restrictions from the
small hospitals or when being examined, this has resulted to physical and verbal aggression

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experienced within high dependency Unit. Hence my own concern is help in reducing the verbal
and physical aggression these mentally ill patients experience.
The primary focus of your role.
The clients at NSW mental health high dependency unit of Wagga wagga feel unfairly treated
since they were never taught on the restrictions during the examination processes. Therefore, this
is the reason why I decided to carry out the project on implementing the preadmission education
to help in reducing the aggression and frustration faced by the patients to bring good results.
The purpose behind your proposal.
Patients' education is one of the key aspects of an efficient self-management and the monitoring
needed for many patients from the emergency department and the small hospitals. Hence this
project will equip the patients with a clear information concerning the cigarette smoking
regulations at HDU and the provisions of using the NRT if necessary. This may be achieved
through,
 Presenting the statement of rights to the patients during Emergency department
examinations.
 Communicating clearly concerning the regulations on the mental health high dependency
unit admitting and assessing an individual.
 Informing the stakeholders to ensure all these procedures are followed
According to (Siegel, Miller and Jemal, 2018) within the ambulatory health care and inpatient
settings, the education provided to the patients has shown significant improvement to the

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patients' results. Although it has not been recognized by many medical practitioners, EDs
(emergency departments) provides a very vital for the educational intervention. However, the
mental health at HDU seems to have undermined the delivering of the healthcare education
(Househ, Borycki, and Kushniruk, 2014).
Effects on the multidisciplinary team
By offering the patients with education at the emergency department and peripheral small
hospital, I hope that there shall be a positive impact on the patients. These overwhelm the doctors
at the emergency department MHECS workers ED and the mental health HDU nurses. This
project will call for input from all the members that are involved with the patient's treatment for
the success of its implementations. The project is expected to reduce the number of the
incidences linked to verbal and physical aggression towards the mental health nurses. Thus,
when all the patients are fully empowered through education, it will ease their recovering process
(Vadiee, 2012).
Justification/rationale for the change.
The cause of the frustration experienced by the patients can be linked to mental sickness, the
social or physical environment of the patient and the relationship of the patients with other
people. The frustration of the patients while at mental health high dependency is a field that
require more attention. Considering the cause of the frustration, nurses in the mental health HDU
apply a variety of the person-centered health care and measures like medication and restrictions
to contain the frustration of the patients. According to (Johnson and Kimsey, 2012) such events

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have no practical way of solving or controlling them hence challenging the capability of the
nurses to work effectively. Therefore, the administrators of mental health high dependency unit
should focus in empowering the patients in order to promote the productivity and the
effectiveness in aggressive and frustrations events
With respect to Kanter’s empowering concept, empowerment can be described as the access of
social make up by the employees within their workplace setting that enhances them to complete
their work effectively. The findings from a psychiatric wards research indicated that
empowerment within an organization was linked to nurses’ work aggression in controlling the
situations. The study pointed the necessity of empowering the patients and nurses in order to
counter the obstacles that might result to insufficient performance of mental health high
dependency nurses. The research results have also proven that incapability of the nurses in
implementing the right measures in managing the frustration of the patients is due to inadequate
education. Hence educating the nurses and the patients in this case will enhance the confidence,
attitude and the knowledge in reducing frustration and aggression (Krill, Staffileno, and Raven,
2012).
This study was designed with the aim of exploring psychiatric nurses’ experiences of the
challenges of empowerment in the management of patients’ aggression. Identifying the
challenges can help authorities to be aware of deficits, and nurses can have better efficacy in
delivering optimal and safe measures. This will have an important subsidiary benefit of reducing
the need of staff for containment measures.
Emergency departments are today becoming main access spots for the healthcare within a wide
range of jurisdictions in which a high percentage of the visits are linked to mental health

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(Johnson and Kimsey, 2012). To some extent, the presentation to the emergency department due
to nonurgent problems is associated with the inability in accessing the primary health care.
Hence due to these shifts in utilizing the healthcare, patients' education and counseling within the
emergency departments are highly needed. However, implementing the whole education idea is
not simple since it might be faced with some barriers especially with the mental health HDU
setting. For instance, overcrowding and the period needed in providing the required information
might negatively impact emergency department staffs' capability in offering the teachings (Lin
and Mann, 2012).
Other individuals believe that educating the patient at prior the emergency department visit may
not make an impact or not the right avenue. Although there is another group of individuals that
believe the education provides unique teaching moments in which the patient might get
motivated and get an excellent time to learn from the health professionals. This has been proven
by (Leske, Strodl, and Hou, 2012) in which the author states that in most cases, the education
provided to the patients help in moderating the stress. Thus, enhancing the patient's ability to
learn especially if the information is not very complicated. Therefore, looking at all privileges for
patient's education, and the self-management overwhelming the emergency department is very
vital in the healthcare surrounding today.
The taxonomy by the Bloom used in learning domains is one of the frameworks employed in the
education to recognize the learning domains or outcomes (Claude, Juvenal, and Hawkes, 2012).
With regards to Bloom concept, training can be categorized into the three major fields. These
domains are the effective, psychomotor and the cognitive. Every area incorporates the levels of
raising the mastery (Ray, 2012). The cognitive domain deals with the way of acquiring

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knowledge. The easy cognitive aims can be gauged by evaluating the understanding,
comprehension or recalling while the problematic goals can be measured by the ability to apply
the acquired knowledge. The valid domain overwhelms the internalization of the attitudes, values
and the beliefs. The field can as well as incorporate the willingness in hearing the teachings and
taking part in the learning process. The most complex goal in the effective requires the person
participating in the new belief or the value. Lastly, the psychomotor learning domain demands
the mastery of the skills (Sweet and Wilson, 2011). All the three learning domains range from
imitating the demonstrations or mastering the technique automatically. The author has used the
Bloom's method in identifying the optimal learning procedures for every level of the three
learning domains (Jucks, Paus and Bromme, 2012).
However, the Bloom framework was established to utilize it within the evaluation and the
designing of the education within the classrooms. The structure set up was not to be used within
the healthcare set up although some of the procedures proposed can be very vital to the
implementation of education prior EDs. The only difficulty is providing optimal learning with
the available period and the resources (Epstein, 2013).
It's undeniable that today, many health institutions like mental health at HDU have not yet
discovered the effectiveness in offering education within the emergency departments. A review
conducted in the year 2000 on patient's culture within the emergency department, indicated that
teachings are fundamental to issues linked to Psychiatric and trauma conditions (Lam and Leat,
2013). It was discovered that very few medical practitioners focused on the education conducted
exclusively within the emergency departments. The researchers showed that the training

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performed with the intervention and continued after the discharge improved the outcome of the
patients (Van Wilgen and Keizer, 2012).
There might be differences between the emergency department and other acute healthcare setups,
but there are other main distinguishing factors that can influence the effectiveness of education
like the available resources, time and patients' anxiety (Janssen and Lagro-Janssen, 2012). The
education and counseling program could be an ideal idea, but the other challenge could be
encouraging the patients on the importance of attending the education and counseling sessions. A
research conducted to examine asthma education plan showed that out of 164 potential
participants, only 31 percent were present for the program. It is, therefore, important to
comprehend what can be delivered in a reasonable way within the Emergency Department and
consider the patient's education and that should be provided prior the emergency department visit
(Lam and Leat, 2013).
The stakeholders
The stakeholders in this project implementation will be the following
The emergency department nurses
The ED nurses will be assisting in therapies and medication in order to help the patients to
master the mental sickness. The right nurses take their time in explaining the diagnosis to the
families and the patient. Concerning determination, the patients' education will major on the
meaning of the diagnosis to the patients. According to (Sawatzky and Enns, 2012) the first stage
of the treatment is accessing the patient's knowledge of his or her condition. Mostly, the patients
will be required to adjust to the new long-term or the short-term transformations. Therefore, the

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central role of nurses, in this case, will be to answer the questions of how the medical condition
developed and how it affects the patient (Suárez, Asenjo, and Sánchez, 2017).
The Psychiatrist
Mental doctors play a crucial role in treating the mentally ill patients in the psychiatric hospitals
hence they can help in minimizing the healthcare cost according to the recent research. The
psychiatrist will be required to diagnose the mental illness. However, the psychiatrist must utilize
the skills in making the final decisions legal problems arise when ethics are not followed
properly. (Crilly, Chaboyer and Creedy, 2004).
The HDU nurses
In the mental health emergency department rooms, the HDU nurses will act as the educators and
the advisors. They will as work together with the mentally ill patients and doctors since the
emergency room some empathy and compassion in the care for the patients. Their leading role
will assist in calming down and listening to the questions asked by the patients. They will as well
help in translating complicated medical jargons from the physicians concerning the patient's
diagnosis and the treatment into layman's language. After and before the discharge the HDU
nurses can be consulted by the family members concerning the further care and the treatment.
These nurses will as well prepare the charts which will direct the patient on what to and not to

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while in the ward. For instance, why they should not smoke or walk out while in their respective
departments.
MHECS worker
The mental health workers like MHECS worker will work together with other members of the
staff in identifying the problems that are facing the patients. MHECS worker will as well the
strategies in meeting the needs of the patients.
The context of the project implementation
Empowering the patients is a movement that was started the long time ago in the year 1970 with
the aim of advocating the right of the patients and the family members. The principal goal of the
empowerment was to educate the patients by establishing their capacity to become partners in
their self-management care and involve them in making decisions concerning their health. This
empowerment can only be achieved through the support and training. Some options can be used
in implementing the patient empowerment for this project. The options depend on the uniqueness
and the perspective other than the methods of training. These options include multimedia, the
information sheet, IT (information technology) and the skills building like self-management
programs.
For the case of mental health at HDU project, the option to be employed is the skill building
which will major on self-management program. Some researchers have shown that many patients
involved in their own clinical decision making and self-management have better results
compared to not in the decision making. The medical practitioners' perceptions on the patient
empowerment are as well positive in the fact that it helps the patient in recovering faster and

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enables patient's satisfaction. This project will, therefore, ensure there is the good relationship
between the medical staff hence will speed up the diagnosis and ease the negotiation treatment
options. The medical practitioners will be required to submit the needs for controlling and
involving the patients in making the health care decisions. For instance, why, the patient should
quit or reduce the rate of smoking while in the ward or outside the ward. In this implementation
project plan, in case of treatment failure, it's the responsibility of patients and not nurses (C.,
S.M., and M., 2015).
How to mobilize co-operation, engagement, and facilitation
The first step will involve preparing and enlisting the patients. This will include the recruitment
and make the family member advisors. It will as well call for support for the family and the
patient's engagement through the initiatives across the organization.
Secondly, mobilize the members of the staff in involving the patients. This will help the patients
in influencing the decisions, policies and the workflow. The members of the crew must adhere to
the patient's input, establish a good link with the patient and the patient's family members and
acknowledge their experiences. Members of staff will be required to be open to revising their
current methods of making decisions. This will incorporate the use of the published toolkits in
giving the guidance to provide the right support while engaging the patients. Enabling an
engagement environment will empower and motivate the patients and the staff in working
together in developing the rights practices in medical health at HDU.

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Thirdly, I will ensure the strategic and leadership support focus. Empowering the staff and the
patients in working in various methods call for a very corporative leadership. The team helps
significantly in transforming the culture of a health organization, articulate and improving the
standards of the patients. The administration establishes accountability and expectation of other
leaders in partnering with the patients allowing them to take part not only in making the
decisions but also in other issues within the healthcare Centre.
Lastly, I will make sure all the stakeholders have the necessary resources to conduct the
education and other engagement events.
The process you will be using to scope the project
Activities consultations timelines reporting Reference
group
Inter-personal
professional
involvement
Admission About the ward The arrival
time
The contact
information
provided
The HDU
nurses
The nurse in
charge.
Education on EDs Identifying the
problems that
are facing the
8:00 a.m.-
10a.m
- Doctors. MHECS worker

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patients
Exercises The importance
of support
systems
10 a.m-11
a.m. Monday-
Friday
Inpatient
mental health
HDU
EDs nurses Doctor in-charge
Evaluation
The expected outcome in this project is to reduce the number of the events of physical and verbal
aggression towards the mental health nurses. The aggression is experienced when the nurses try
to get rid of cigarettes and the lighter overwhelming the restricted belongings when the patients
are arriving in the ward. This will increase the speed of the patient to recovery and reduce
treatment complications as well. The medical practitioners will submit the needs for controlling
and involving the patients in making the health care decisions. The patients will quit and reduce
the rate of smoking while in the ward or outside the ward.

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References
C., L., S.M., O. and M., H. (2015) ‘Improving recognition and management of chronic kidney
disease in primary care’, Journal of General Internal Medicine.
Claude, K. M., Juvenal, K. L. and Hawkes, M. (2012) ‘Applying a knowledge-to-action
framework for primary prevention of spina bifida in tropical Africa’, Maternal and Child
Nutrition. doi: 10.1111/j.1740-8709.2010.00271.x.
Crilly, J., Chaboyer, W. and Creedy, D. (2004) ‘Violence towards emergency department nurses
by patients’, Accident and Emergency Nursing. doi: 10.1016/j.aaen.2003.11.003.
Epstein, R. M. (2013) ‘Whole mind and shared mind in clinical decision-making’, Patient

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Education and Counseling. doi: 10.1016/j.pec.2012.06.035.
Househ, M., Borycki, E. and Kushniruk, A. (2014) ‘Empowering patients through social media:
The benefits and challenges’, Health Informatics Journal. doi: 10.1177/1460458213476969.
Janssen, S. M. and Lagro-Janssen, A. L. M. (2012) ‘Physician’s gender, communication style,
patient preferences and patient satisfaction in gynecology and obstetrics: A systematic review’,
Patient Education and Counseling. doi: 10.1016/j.pec.2012.06.034.
Johnson, H. L. and Kimsey, D. (2012) ‘Patient Safety: Break the Silence’, AORN Journal. doi:
10.1016/j.aorn.2012.03.002.
Jucks, R., Paus, E. and Bromme, R. (2012) ‘Patients’ medical knowledge and health counseling:
What kind of information helps to make communication patient-centered?’, Patient Education
and Counseling. doi: 10.1016/j.pec.2012.01.011.
Krill, C., Staffileno, B. A. and Raven, C. (2012) ‘Empowering staff nurses to use research to
change practice for safe patient handling’, Nursing Outlook. doi: 10.1016/j.outlook.2011.06.005.
Lam, N. and Leat, S. J. (2013) ‘Barriers to accessing low-vision care: the patient’s perspective.’,
Canadian journal of ophthalmology. Journal canadien d’ophtalmologie. doi:
10.1016/j.jcjo.2013.02.014.
Leske, S., Strodl, E. and Hou, X. Y. (2012) ‘Patient-practitioner relationships desired by
overweight/obese adults’, Patient Education and Counseling. doi: 10.1016/j.pec.2012.07.002.
Lin, J. J. and Mann, D. M. (2012) ‘Application of persuasion and health behavior theories for
behavior change counseling: Design of the ADAPT (Avoiding Diabetes Thru Action Plan
Targeting) program’, Patient Education and Counseling. doi: 10.1016/j.pec.2012.06.017.
Ray, L. A. (2012) ‘Clinical Neuroscience of Addiction: Applications to Psychological Science

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and Practice’, Clinical Psychology: Science and Practice. doi: 10.1111/j.1468-
2850.2012.01280.x.
Sawatzky, J. A. V. and Enns, C. L. (2012) ‘Exploring the key predictors of retention in
emergency nurses’, Journal of Nursing Management. doi: 10.1111/j.1365-2834.2012.01355.x.
Siegel, R. L., Miller, K. D. and Jemal, A. (2018) ‘Cancer statistics, 2018’, CA: A Cancer Journal
for Clinicians. doi: 10.3322/caac.21442.
Suárez, M., Asenjo, M. and Sánchez, M. (2017) ‘Job satisfaction among emergency department
staff’, Australasian Emergency Nursing Journal. doi: 10.1016/j.aenj.2016.09.003.
Sweet, G. S. and Wilson, H. J. (2011) ‘A patient’s experience of ward rounds’, Patient
Education and Counseling. doi: 10.1016/j.pec.2010.08.016.
Vadiee, M. (2012) ‘The UK “expert Patient Program” and self-care in chronic disease
management: An analysis’, European Geriatric Medicine. doi: 10.1016/j.eurger.2012.02.003.
Van Wilgen, C. P. and Keizer, D. (2012) ‘The Sensitization Model to Explain How Chronic Pain
Exists Without Tissue Damage’, Pain Management Nursing. doi: 10.1016/j.pmn.2010.03.001.
.

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