Disruptive patient behaviours on haemodialysis units

1
Disruptive patient behaviours on haemodialysis
units

• A multidisciplinary approach
• Julia Jones Sarah Eales
• Department of Mental Health Learning Disability

2
A multidisciplinary team

• Julia Jones (PI) Health Geographer
• Sarah Eales Lecturer/
• Mental Health Nurse
• Gayle Ridge (RA) Health Psychologist
• Neil Ashman Renal Consultant
• Patrick Callaghan Professor/
• Mental Health Nurse
• Jo Higman Renal Liaison Mental Health
  Nurse

3
A problem identified

• An increasing no. of renal nurses attending
  mental health awareness days at City University
• No. of incidents of abusive violent patient
  behaviours in renal service second only to AE
• Anecdotal that these official figures greatly
  underestimate true extent of problem
• April 2005 serious assault on Haemodialysis Unit,
  2 staff hospitalised
• April-Aug 2005 on Haemodialysis Unit, 21
  incidents of perceived abuse or threat recorded

4
Working definition of disruptive patient behaviour

• Verbal abuse (threatening or abusive language,
  excessive swearing or offensive remarks)
• Physical abuse
• Non-adherence to treatment
• Medication
• Diet or fluid restrictions
• Missing or shortening dialysis treatment
• Substance use
• (King Moss, 2004)

5
The Study

• Funded by Barts The London Charity (99K)
• Two year study, started 5 June 2006
• Research setting Haemodialysis Units at St
  Bartholomews The Royal London Hospital
• Project Advisory Group clinicians, patients,
  carers, local managers, national experts

6
Aims of study

• First 2 stages of an action research study 1) to
  identify problem 2) identify interventions
• 1) To identify factors contributing to disruptive
  behaviours
• 2) To identify effective strategies for the
  management of future disruptive behaviours
• Project Advisory Group will make decisions about
  appropriate interventions (Aim 2).

7
Whats working

• Multidisciplinary team we each bring our
  different expertise to the research table
• Support from Trust management senior clinical
  staff
• Feedback mechanisms to management and senior
  staff
• Project Advisory Group supportive challenging
  

8
Current challenges

• Under-reporting of incidents
• Engaging more junior nursing staff support
  staff (e.g. domestic admin)
• Engaging with patients carers not involved in
  the KPA

9
Acknowledgement

• This study is funded by
• The Research Advisory Board of St Bartholomews
  and The Royal London Charitable Foundation, Grant
  no RAB05/PJ/08

10
For further information

• Julia Jones
• Senior Research Fellow
• Department of Mental Health and Learning
  Disability
• City University
• Tel [phone]
• Email j.jones-4_at_city.ac.uk
• Sarah Eales
• Lecturer in Mental Health
• Department of Mental Health and Learning
  Disability
• City University
• Tel [phone]
• Email S.Eales_at_city.ac.uk