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Occupational violence in mental health units

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Author Occupational violence in mental health units



  • Joined: Aug 2005
  • Location:
  • Posts: 41

Sat Aug 06, 2005 5:08 pm

I am interested to hear about the programs and initiatives that inpatient units have to manage aggressive patients.



  • Joined: May 2006
  • Location:
  • Posts: 4

May 23, 2006, 05:45 am

Around this place it oftens feels like cross your fingers and duck. We have asked management many times for some form of practical training in how to manage the aggressive patient ie take down proceedures etc. but so far all we have gotten is a nice little how to talk to aggressive people to de-escalate course and as i am sure you are aware the average nurse in psychiatry does this on a daily basis and did not need this training. The question still remains ..... What do you do when the talking fails?

Canadian RPN


Canadian RPN
  • Joined: Jan 2007
  • Location: Surrey, BC, Canada
  • Posts: 5

May 05, 2007, 12:21 pm


In Canada, all hospitals provide their new staff with a version of the program 'Non-Vilent Crisis Intervention' training. This teaches us how to work with acting out, confused, delirius, psychotic, drunk, and 'drugged' patients and/or their visitors. The mini-course is given at Orientation and renewed every year or two. It is mandatory to take it, especially in the Province of British Columbia.

We also have a Code White program across the country. Do you have this in Australia? When a violent or potentially violent incident occurs, a 'code' is called and well-trained staff arrive at the scene. They come from all over the hospital, generally but more significantly in British Columbia, the RPN... the Registered Psychiatric Nurse who works in the Emergency Department as the Nurse-Clinician/Psychiatric Nurse Liason always responds and deals with the person acting out. The other trained staff that arrive follow the RPNs lead. After that, she/he offers Critical Incident Stress Debriefing for the staff on the unit. Do you have this?

Always curious about how things are done in other countries......

Melodie in Canada

Senior RN


  • Joined: Dec 2008
  • Location:
  • Posts: 24

Dec 26, 2008, 12:07 pm Last edited Dec 26, 2008, 12:07 pm update #1

Hi Melodie... how's the weather your way?

I've worked in psych. ( many prefer the term Mental Health Nursing ) for a good ten years or so.

One large hospital I worked at, called their program CIPO ( usually pronounced Z I P P O ) ' Critical Incident - Positive Outcome '.

Five days full time, includes theory and practical sessions on 'the mats'..... that is, actual take down drills; break away tactics; approach formations, and leadership exercises in the 'unstable environment'.

You will probably laugh, but we used to call our 'response team' the F A R T .....

Fast Aggression Response Team !!!

Our 'black humor' would have us smiling, when someone would say, " Looks like I need a FART here now ".

( oh, in case you don't get it.... FART is an Australian saying for 'breaking wind' out aloud )

Anyway, regarding 'take downs'.....

We were trained in the 'Arrowhead' approach.

This is where there Team Leader ( the negotiator ) is at the head; on either side of him / her, about one pace back, are the guys who will take 'the arms'. A pace back and slightly out, are the guys who will take 'the legs'.

So, five staff minimum. Four to a take an arm and leg each. TL will do ALL the talking, and if necessary, take 'the head' during the process of laying the subject face down ( to maintain an open airway and keep the subject engaged, that is asking to stop struggling / fighting us.... and to prevent subject from biting etc. )

In most NSW Public Hospital Emergency Departments, we now have Mental Health Liaison nurses. These guys are usually graded as CNCs ( Clinical Nurse Consultant ), and can have a 'team' of RNs available to assist as PRN.

In most cases, a 'drugged' or psychotic patient would be 'specialed', meaning, a 1 : 1 situation, and Hospital Security are now in all our EDs to back up nursing staff. ( in most cases, they will take the lead, so that nurses are free to continue caring for the other patients )

Hope you had a nice Christmas,



modified: Friday 26 December 2008 12:12:27 pm - Senior RN

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