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									                          Workplace Safety in Forensic Psychiatric Care

Training Staff to Manage and Prevent Aggression in a Forensic Psychiatric Hospital
S. Kusters and N. Oud
Forensic Psychiatric Hospital De Kijvelanden, the Netherlands

To enhance safety in Forensic Psychiatric Hospital De Kijvelanden, staff members receive extensive training to prevent and
manage aggressive situations. During training, preventive communication skills, physical self-defence skills (e.g., break-away
techniques), and safe ways of restraining and secluding violent patients are practiced repeatedly. In this presentation, the
backgrounds, contents, and first results of this training are presented.


Dealing with Aggressive Psychotic Patients; a Case Presentation
M. Mol
Forensic Psychiatric Hospital De Kijvelanden, the Netherlands

Patients admitted to the very intensive care wards of Forensic Psychiatric Hospital De Kijvelanden generally suffer from severe
psychosis, addiction, and display various disruptive and dangerous behaviours. The case of Mr. K., a patient with chronic
paranoid schizophrenia, is presented to illustrate the difficulties in managing extremely violent patients within a forensic
psychiatric hospital. To manage Mr. K‟s extreme violence, staff members were trained to use a consistent behavioural approach
towards the patient. As a result of his individual, highly structured, and labour-intensive treatment plan, Mr. K‟s behaviour
became more manageable, and gradually his psychiatric condition improved.

Measurement and Analysis of Aggressive Incidents in a ForensicPsychiatric Hospital
H. Nijman
Forensic Psychiatric Hospital De Kijvelanden, the Netherlands

Proper assessment of aggressive behaviour is essential for understanding its causes. The Staff Observation Aggression Scale -
Revised (SOAS-R of Nijman et al., 1999) was developed to measure both the frequency and the severity of aggressive behaviour
by psychiatric inpatients. From September 2001 onwards, all aggressive acts of patients admitted to two wards for very intensive
care at Forensic Psychiatric Hospital De Kijvelanden were recorded with a computerized version of the SOAS-R. In this
presentation, the antecedents, nature and severity of aggression of forensic psychiatric patients will be addressed.

Towards a Policy on Aggression
M.A. Polak
Forensic Psychiatric Hospital De Kijvelanden, the Netherlands

Inpatient aggression threatens the safety and well being of both staff members and patients. Nursing staff in particular is at risk of
being assaulted. Apart from its physical and psychological consequences, inpatient aggression also has considerable financial
implications. To protect personnel and patients, forensic psychiatric hospitals need a clear policy to prevent aggression and
minimize its consequences. In the session “Workplace safety in the forensic psychiatric care”, preventive measures that target
different levels of the hospital organization are described. As an introduction to this topic, the general principles of managing
aggression in forensic psychiatric hospital De Kijvelanden are presented.

Caring for Victimized Staff
Ch Van Nieuwenhuizen
Forensic Psychiatric Hospital De Kijvelanden, the Netherlands

People working with forensic psychiatric patients are vulnerable to assault by aggressive patients. Though workers in our clinic
are trained extensively in preventing and dealing with aggression, incidents cannot be prevented at all times. Therefore, a
specialized team was formed to take care of workers involved in shocking incidents. In this presentation, the protocol for caring
for victimized staff members will be presented. This protocol consists of a minimum of one session to a maximum of three and
aims at the „normalization‟ of people‟s reactions and at helping them get back to their daily routine. The results of working with
this method in the last one-and-a-half years will be presented.

								
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