Common causes of conflict

In 2015/16, there were 70,555 reported physical assaults against care staff in England. Anecdotal evidence shows there has been an increase in attacks on staff including emergency workers.

It is essential that all staff feel safe whilst at work. Violent behaviour can have an adverse personal effect on staff and it can impact negatively on the standards of patient care.

This session describes the impact that violence and aggression can have on an individual and steps that can be taken to avoid conflict.

Firstly, it is important that we consider the definition of conflict. Conflict is described as:

A disagreement, struggle or fight, to be incompatible. A common factor is that there are issues with communication between the parties involved.

All of the following can cause conflict:

Ø Poor communication

Ø Poor information sharing

Ø Staff attitude

Ø Physical health

Ø Unmet needs

Ø Environmental factors

Ø Religious and cultural differences

Ø Lack of resources

ASSAULT

Assault is an extreme form of conflict. There are two types of assault:

Physical Assault (also known as Assault and Battery)

The intentional application of force to a person from another, without lawful justification, resulting in physical injury or personal discomfort.

There are three key phrases in relation to physical assault:

Intentional – a person has to have mental capacity and intent for it to be considered as a possible criminal act. Examples of people who may not have capacity include dementia patients, stroke victims, someone in extreme pain
Lawful justification – sometimes there’s lawful justification in being hands on which prevents it being an assault, for example use of reasonable force, physical interventions within mental health trusts and security staff
Physical injury or personal discomfort – within Learning Disability services or when working with children there’s a lot of pinching, touching and minor slaps, all, by definition physical assaults as there’s physical contact but they wouldn’t be reported as such unless it affects the victim or breaks an acceptable threshold

Non-physical Assault (also known as Verbal Assault)

The use of inappropriate words or behaviour causing distress and/or constituting harassment. Examples include:

Threatening behaviour (for example, threatening to hit someone but there is no actual physical contact)
Abusive behaviour (verbal or by any other means of communication – email, texting, graffiti, via social media, includes swearing or other offensive language)
Anything racial or sexual in nature (a potential hate crime)
Harassment
Stalking

The Assault Cycle [2] is a 5-stage model that helps to identify why an assault has occurred and t

The 5 Stage Assault Cycle

The 5 Stage Model helps identify why an assault has occurred and the most appropriate type of intervention.

typically it takes a person 90 minutes to go from crisis to calm.

Trigger phase

The trigger phase is the aggressor’s first behaviours which indicate a movement away from how they usually behave.

Unless you have a detailed understanding of the person, these early warning signs may be missed.

The change in behaviour may well reflect a sense of being psychologically ill at ease. When identified, it is important to try different interventions to prevent further escalation. Consider the following:

Environment - too hot/too cold/too noisy etc.
Other patients and staff around you
Meetings about their care or mental health
Loss of freedom
Change in routine or the routine itself
Frustration for any reason
Contact with family, for example a good/bad visit
Loss of contact with family and/or friends

There may be no obvious triggers.

Escalation phase

This phase leads directly to assaultive behaviour. The patient deviates more and more from their baseline behaviours.

If there is no intervention, the deviation becomes increasingly obvious and it is more difficult to divert their attention on to other activities.

They become overly focussed on a particular issue and are less likely to respond to any form of rational intervention.

It is therefore necessary to intervene as early as possible in this phase. This can be done by:

Counselling
Removal from the immediate environment
Anger management techniques

Crisis phase

As the patient becomes increasingly physically, emotionally and psychologically aroused, his or her control over aggressive impulses lessens and direct assaultive behaviour becomes likely.

Simultaneously, your physical and psychological responses may be hampering your control and effectiveness.

In this phase, the least effective strategy is to adopt an intervention that presumes the patient can respond rationally.

It is important to focus on the safety of yourself, the patient and anyone else who may be threatened.

Options may be limited - escape from danger.

Plateau and post crisis depression phases

During the recovery phase, the patient may start to relax and decreases any aggressive behaviour. It is important to note that the confrontation may appear to be over but it could be temporary and could easily re-escalate.

During the post-crisis phase the patient tries to return to a stable base level and may experience tiredness, depression and guilt

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