Front-line staff at Tan Tock Seng Hospital being taught techniques to protect themselves against abuse. Among other things, they are taught how to manoeuvre away from being grabbed by the hand or collar, and from being bitten or choked, as well as how to restrain an uncooperative patient safely. ST PHOTO: MARK CHEONG
The Straits Times (2 May 2023)
To break away from an aggressor who has you by the shirt collar, you would have to hold on to his wrist with both hands, and press your thumbs firmly against his palms while twisting the wrist inwards and pushing away.
“Find that acupressure point in the palm for this to be more effective,” said Ms Leong Jan Mui, a senior nurse educator at Tan Tock Seng Hospital (TTSH), to her class of students.
These quick techniques to protect oneself against violent persons are not being taught in a martial arts class, but are sessions for front-line workers like nurses and patient service associates, as part of the hospital’s efforts to protect them against abuse.
A tripartite workgroup surveying more than 3,000 healthcare workers and 1,500 members of the public found that more than two in three healthcare workers had witnessed or experienced abuse or harassment in the past year. Among them, half experienced abuse at least once a week.
Efforts are under way by the Ministry of Health (MOH) to implement a standardised zero-tolerance policy against abuse in the public healthcare sector, with the healthcare clusters to develop details of the policy in the second half of 2023.
MOH has said the policy will include a common definition of abuse and harassment across healthcare institutions, an effective reporting and escalation protocol, and clear consequences that are enforced.
Hospitals like TTSH have in place their own measures to protect staff that include calling the police if necessary.
trend of verbal and physical assaults on healthcare staff, the hospital developed the Workplace Safety on Aggression and Fearful Encounter programme or WorkSAFE.
A group of about 100 champions were trained in 2019 on techniques that are being passed on to 3,000 front-line staff on the ground.
The programme is made up of eight modules, including how to recognise workplace violence and de-escalate the situation.
Classes also include hands-on and practical tips on how to manoeuvre away from being grabbed by the hand or collar, and from being bitten or choked, as well as how to restrain an uncooperative patient safely.
The curriculum was developed by TTSH based on the most common scenarios faced by staff.
“We use the concept of microlearning because nurses don’t have the time for a one-hour course. So during roll call in between their shifts, we take 20 minutes to teach them these skills,” said Ms Leong, who helped develop the curriculum for WorkSAFE.
She said it took about four to eight months to roll out the modules to all the front-line staff.
Nurse manager Ranjeeta Kaur, 35, who has worked at TTSH for 15 years, recounted an incident eight years ago where a colleague was so badly bitten by a patient that she still has a scar on her arm.
“If we had this kind of training earlier, my colleague wouldn’t have the extent of injuries that she had,” said Ms Kaur.
“Because she would know that she shouldn’t just pull away from the bite. You’re supposed to push the person’s head towards you before removing your arm. The training is effective, and better late than never.”
EFFECTIVE TRAINING If we had this kind of training earlier, my colleague wouldn’t have the extent of injuries that she had. Because she would know that she shouldn’t just pull away from the bite. You’re supposed to push the person’s head towards you before removing your arm. The training is effective, and better late than never.
”MS RANJEETA KAUR, 35, a nurse manager at Tan Tock Seng Hospital, recounting an incident eight years ago where a colleague was so badly bitten by a patient that she still has a scar on her arm.
At Sengkang General Hospital (SKH), four videos depicting different situations of aggression and abuse, based on real incidents faced by front-line staff such as nurses, pharmacists and call centre agents, are aired during regular front-line staff orientation and inhouse training.
Each scenario provides specific training on the protocol to be followed.
For example, in a situation where a patient turns verbally abusive because he is not able to get a refill of a medication he is no longer prescribed, pharmacists are advised to acknowledge the patient’s frustrations, make three attempts to tell him his behaviour is unacceptable, and then activate hospital security if he continues to be aggressive.
A spokesman for SKH said staff found the videos helpful in guiding them on the workflow in managing abusive situations.
Ms Ng Sow Chun, chief nurse at Ng Teng Fong General HospitaL, said abuse can result from a mismatch of expectations from members of the public, who may expect more frequent updates from doctors than they are getting, to be served when they show up after office hours, or cared for by a specific staff member instead of the person they have.
“A strong message needs to be sent to deter further abuse. This is to protect our staff from abuse when things do not work out despite our best efforts to mitigate the situation,” said Ms Ng.
TTSH and Yishun Health Campus, which comprises Admiralty Medical Centre, Khoo Teck Puat Hospital (KTPH) and Yishun Community Hospital, said repeat offenders who abuse healthcare workers may be issued warning letters.
Ms Geeta Pattath, assistant director of nursing at TTSH and cochair of the hospital’s staff protection committee, said the hospital has issued warnings to four patients since 2018.
“It is used as a last resort, because we have no choice,” she said, noting that the four were really abusive and had harassed staff to the extent that they could not carry out their duties.
A patient who demanded to smoke in the ward and used expletives on staff was among those warned.
Both TTSH and Yishun Health said they have seen an increase in the reporting of abuse over the years.
Ms Eileen Cheah, assistant director of nursing administration at KTPH and a member of Yishun Health’s safety committee, said it is an encouraging sign as healthcare workers have often chosen to suffer in silence in the past.
“Staff safety is one of our key priorities, and it is encouraging to see increased willingness to come forward to report incidents,” she said.
Adjunct Associate Professor Habeebul Rahman, chair of TTSH’s staff well-being committee, said that in the past, only the most severe cases like those involving serious violations or injuries would be reported, but more and more, even verbal abuse is being reported.
“We are quite heartened by it because staff are not waiting until it escalates to significant harm before it’s reported,” he said.