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When an episode of patient care turns into a frightening moment of violence, the caregiver suddenly becomes someone who needs care. Will he or she get it? Increasingly, the answer is yes, as hospitals adopt the Assaulted Staff Action Program (ASAP). Developed by psychologist Raymond B. Flannery Jr., PhD, in response to assaults at a large state mental hospital, ASAP offers a peer-based system of crisis intervention and support for employees who have suffered a workplace assault. Hospitals that implement ASAP have lower staff turnover due to assault-related issues and actually register a reduction in the facility assault rate. The staff learn not just how to respond to violence, but how to avoid it.1
In the ASAP model, staff members volunteer to be ASAP team leaders, team supervisors, or first-line responders. The responders carry a beeper and are on-call for 24-hour periods. When an incident occurs, the ASAP volunteer provides immediate crisis intervention. "We would make sure the physical needs are attended to first," explains Margaret Corrigan, RNC, nurse manager at Quincy (MA) Mental Health Center and an ASAP team leader. "Within the first eight hours, the person would be contacted to discuss what happened and to see if [he or she has] any symptoms [of psychological trauma].
"People usually say, I don’t need anything,’" she says. "They’re stunned, they’re frightened, [and] they become angry. A lot of people go through physical symptoms. They may become hypervigilant; they’re watching everything really closely. They have trouble sleeping, difficulty with memory and focus, intrusive thoughts and dreams."
Corrigan knows those symptoms and feelings personally. As a psychiatric nurse, she has been knocked down, kicked across a room, and had her jaw broken by a patient. "If you don’t deal with your feelings and get some mastery over them, you’re going to carry them with you. It’s going to affect your interactions with your family or other patients."
The ASAP volunteer follows up with the employee within eight hours of the incident, then at three days and 10 days. The staff member may be referred to a staff victims’ support group, led by the ASAP team leader and an ASAP supervisor, or for more extensive counseling. "It usually takes a month or more to get over [the trauma]," says Corrigan. In some circumstances, the ASAP team may hold staff meetings to allow employees to discuss their feelings about a violent incident.
The design of the ASAP team depends on the facility (such as the number of sites) and the frequency of violence. Corrigan suggests gathering baseline information on incidents for a month, including verbal threats and nonverbal intimidation. "You use that information to measure how many people you need on your team to handle the assaults that are happening," she says.
The ASAP members receive training in violence, psychological trauma, and crisis intervention. "Teams work best when members are drawn from all disciplines, including management, and reflect the cultural diversity of the work force to be served," writes Flannery.
When a hospital implements ASAP, employees are reassured that someone is concerned about their feelings and needs if they’re hurt. "Because we’re caregivers, we think we have to take care of our patients. We always put their needs before our own," says Corrigan. With ASAP, caregivers can get some caring, too.
[Editor’s note: A complete description of ASAP can be found in The Assaulted Staff Action Program: Coping with the Psychological Aftermath of Violence by Raymond B. Flannery, Jr. ($25 plus $5.50 shipping and handling) Chevron Publishing, 5018 Dorsey Hall Drive, Suite 104, Ellicott City, MD 21042.]
1. Flannery RB. The Assaulted Staff Action Program. Ellicott City, MD: Chevron Publishing; 1998.