“It’s all about Communication”– An Intervention to Minimise Patient Perpetrated Aggression for Healthcare Support Workers: A Cluster Randomised Controlled Trial

Abstract

Background Workplace violence is becoming increasingly difficult to ignore as it has become a significant problem within the healthcare sector. In New Zealand, much of the day-to-day care of people with challenging behaviours, disabilities and mental illness are provided by Non-Governmental Organisations (NGOs) in community based residential settings, often staffed by untrained healthcare support workers. A previous survey suggested the possibility of a direct relation between the communication style and approach that a caregiver uses in their work to the level of aggression experienced by them from patients. Staff training is often recommended as an essential part of any comprehensive approach for preventing and managing workplace violence, yet there is paucity of scientific evidence on the effectiveness of such interventions.

Methods The thesis consists of two parts: a preliminary survey and a controlled trial. A web-based cross-sectional survey assessed the nature of violence experienced and safety and training measures available to healthcare staff working in mental health and older peoples’ services of district health boards, non-governmental organisations and aged care facilities across New Zealand. A two arm, cluster randomised, single blinded, controlled trial was conducted among unregistered healthcare support workers to evaluate the effect of an intervention (communication skills training) to reduce the experience of aggression for healthcare support workers compared to an active control condition of mindfulness. Both the intervention (communication skills) and control condition (mindfulness) were group-based, fully scripted, and structured training interventions that consisted of four once weekly workshops. Results From the survey, managers reported high rates of verbal aggression (97.01%) and assaults against staff within their services. Sixty-eight percent of respondents stated that an increase in assaults against staff was due to an increase in violent events, and 43.1% related this to increased staff awareness and reporting of violent events to management. Safety measures were more widely available and accessible within hospital settings while the community sector was found to mostly rely on police for assistance when violence occurs. For the RCT, there was a significant drop in the rate of aggression over time with a mean score and standard deviation of 10.37(9.169) at baseline dropping to 6.07(6.923) for the Perception of Patient Aggression Scale-New Zealand across both the intervention and control groups. Equivalent results were noted with increased psychological well-being and communication competence, and decreased distress with both interventions. This was sustained at a six-month follow-up. However, the between-groups effect did not demonstrate a statistically significant difference between the intervention and control groups.

Discussion The perception of violence is high in healthcare. Prevention and management training is provided in public hospitals and aged care settings, but not so much in NGOs. All areas of healthcare provision could benefit from increased evidence-based aggression prevention training programmes. The results of the RCT suggest that communication skills training intervention was effective at reducing perceived aggression, improving mental well-being, increasing communication competence and decreasing level of stress – but no better than the control condition of mindfulness.