Mr Kristoffer Laurence Abeleda1
1MONASH HEALTH, BERWICK, Australia
Biography:
Bio to come
Abstract:
Introduction
Occupational violence and aggression (OVA) remains a significant and underreported challenge in dialysis settings, with serious implications for staff wellbeing and the delivery of safe, high-quality patient care. Nephrology services must balance their duty of care to patients with the responsibility to protect staff from abusive or threatening behaviour. Recurrent OVA incidents within our dialysis unit negatively affected staff morale and care delivery, prompting the development of a structured approach to improve prevention, early recognition, and management of OVA.
Case Description
This case involved a 58-year-old man with a prolonged history of aggressive and challenging behaviours, resulting in transfers across four dialysis units. His medical complexity included morbid obesity, previous NSTEMI, lifelong vancomycin therapy for an infected arteriovenous graft, and multiple failed vascular accesses, leaving him reliant on a lumbar cuffed dialysis catheter. Behavioural escalation during dialysis sessions was frequent and included persistent swearing, threatening and intimidating language, throwing personal items, and repeated disputes regarding ultrafiltration targets and treatment plan. These behaviours caused significant staff distress, fear, and disruption to patient care.
Discussion
Ongoing staff anxiety and anticipatory stress highlighted a clear need for change. A skills gap was identified, leading to the implementation of a four-stage training framework: review of OVA prevention and management theory; psychologist-led sessions focusing on reflection, stress management, and psychological safety; interviews with an experienced OVA champion; and scenario-based role-play.
Conclusion
This structured, multidisciplinary training approach improved staff confidence, communication, and early OVA intervention, supporting safer dialysis environments and more consistent, patient-centred care.