How do you deal with aggressive psychiatric patients

Dealing with aggressive patients has to be learned

They abuse, scream, spit or beat - patients are by no means always peaceful. 4,000 cases are reported each year of health care workers being injured in patient attacks. "For many employees in the care and nursing professions, such incidents are part of everyday working life", reports Annett Zeh from the professional association for health services and welfare (BGW).

The BGW considers the reported number of attacks to be the tip of the iceberg - the number of unreported cases for some facilities is estimated at 50 percent. The figures on this are scanty. According to Professor Dirk Richter from the Bern University of Applied Sciences, various studies from psychiatry in Germany show that two to three percent of patients are physically assaulted against staff. In a large somatic clinic in Switzerland, 17 percent of employees stated that they had been physically assaulted at their workplace within a year. Verbal attacks are far more common, but not all employees classify them as threatening.

The attacks sometimes lead to minor injuries such as scratches or hematomas. Post-traumatic stress disorders are also possible. "The psychological stress is relatively high, especially in the first weeks and months after an incident," said Richter. In the medium to long term, he warned in a BGW forum, recurring incidents could lead to burn-out. The problem: Many incidents are not reported because the employees concerned are afraid of being condemned as unprofessional.

For prevention, Richter recommended de-escalation techniques after an adequate risk assessment. For employees who are exposed to a higher risk, he also considers training in physical defense techniques to be useful. In his opinion, employers should also think about aftercare for affected employees.

According to Marc Engeldinger, head of the occupational health and safety department at the St. Louis Hospital in Ettelbrück (Luxembourg), the reason for the aggressiveness of patients is an increasing irritability due to stress, fear and pressure of expectation. In addition, in his opinion, representations in the media lower the natural inhibition threshold for violence. In the hospital there would be added fear, the feeling of being at the mercy, pain and uncertainty about the course of the disease. Engeldinger: "Dealing with patients requires special procedures that preserve one's dignity without losing sight of the safety of the staff." A few years ago a project to deal with violence was therefore implemented at his hospital (280 beds). This includes:

  • Recording of incidents:These are classified into categories on the wards, analyzed monthly by an interdisciplinary working group and, if necessary, improvements are initiated.
  • De-escalation techniques: Employees are trained to identify the causes of attacks. In this way, threatening aggression should be prevented at an early stage by means of communication and behavioral techniques. Gentle liberation techniques are also trained.
  • Workplace design: A new arrangement of the desk and examination couch created escape routes for the employees. Dangerous objects were locked up, loose cables and lines were withdrawn from the patient's access.
  • Alerting: Psychiatric specialists and, if necessary, additional guards, are alerted via an emergency call.
  • Psychological support: Employees can apply for psychological support anonymously. You will be referred to external advice centers.

Engeldinger's interim conclusion is positive: the number of serious attacks has decreased by almost 50 percent.