In Isère, internships to learn how to manage aggression in the hospital

A man arrives at the emergency room covered in blood, accompanied by a relative who quickly becomes very aggressive towards the nurses. The tone rises and with it the degree of aggressiveness. The accompanying person insults the caregivers and jostles them… This fictitious scene is part of the practical course offered for two days to the medical teams of the Cedars clinic in Echirolles in Isère.

Since 2016, a private company specializing in risk management (JR Prevent) has been providing theoretical but above all practical advice to caregivers. Objective: to give them simple and effective tools to quickly avoid and manage threatening behavior of patients and their loved ones. Established in 2016 in this Isère establishment, this type of internship is now essential.

Violence against hospital staff has indeed become a recurrent and growing phenomenon. In 2019, according to figures from the Observatory report on violence in health care settings, 451 establishments (i.e. 7.8% of establishments) declared 23,780 reports of attacks on persons and property. These assaults are not necessarily followed by the filing of a complaint, but when this is the case, 52% of the complaints concerned acts of personal injury. The ONVS report thus shows that in 2019, an increase of nearly 3,000 acts of attack on persons compared to 2018.

Since 2016, a classification has made it possible to quantify violence according to four levels of seriousness: insults, heckling and occupation of premises (level 1), physical threats (level 2), intentional violence, threat with a weapon (level 3), violence with a weapon (level 4). It is the first two levels that remain the most represented in the statistics.

In an interview published by The world in August 2022, Karim Tazarourte, SAMU 69 department head and president of the French Society of Emergency Medicine (SFMU), noted that“we now have a declaration of violence by the staff every three days. In 90% of cases, in the emergency room, this declaration falls under level 1, exceptionally level 2. families, the other coming from the patients”.

The impact of these attacks on caregivers is of course catastrophic. Anxiety, stress, fear, feeling of insecurity and injustice… Impossible to work calmly after having experienced an attack. All the more so when the working conditions, particularly in the emergency room, prove to be increasingly difficult.

Without waiting for support from the hierarchy, some practitioners have therefore grasped the problem head on. In 1995, in Limoges, after the aggression of a nursing assistant and two companions in the emergency room, Dominique Grouille and François Smolis thus developed a self-defense technique adapted to the hospital environment. The first is specialized in anesthesia-resuscitation at the University Hospital of Limoges and a long-time practitioner of martial arts; the second is a psychiatric nurse and karate teacher. Their method called “Grouille-Smolis” has been registered. Based on simple gestures and a psychological approach (dialogue is always preferred).

It is now used in many French hospitals to train staff to react to attacks, by protecting themselves and also protecting the patient. Reacting without hurting is also one of the imperatives of caregivers, even when they are victims of violent aggression. A difficult equation to maintain when fatigue is already there.

His management internships stress and risks prove to be very effective and if they do not settle all the questions (what are the triggering factors of this violence and can weare they to contain?), they make it possible to give back to the nursing staff the bases to work in safety. In the conclusion of its 2019 report, the ONVS also underlined the importance of this training “which make it possible to ensure an essential cohesion of the team, the pole, the unit, etc. in the face of a phenomenon that sooner or later, the personnel will encounter”. And to conclude: “The adage ‘prevention is better than cure’ should take on its full meaning in healthcare.”