NURSES at risk of being assaulted when they visit patients in their own homes are to get 'self-defence' lessons to help them cope with potential attackers.

The 'breakaway' training will be offered to all community nurses, health visitors and hospital staff who may have to deal with potentially aggressive or violent patients on their own.

They will learn four different techniques to break free from attackers without harming them, as well as being taught how to defuse situations by talking them down or by positive body language.

The new training is just part of a package of new measures being proposed by managers at York Health Trust to increase safety of staff.

Other measures include:

* extra 'panic buttons' in consulting rooms and health centres

* better lighting in areas of York District Hospital and at health centres and surgeries deemed to be a risk

* A 24-hour call-back number to which community nurses and home visitors have to make regular calls to 'check in' and prove they are OK. Failure to do so would spark an alert.

The moves come as concerns about the safety of health workers - especially those who have to visit patients in isolated locations late at night - escalate.

Eighteen months ago, York GP Dr Judy Greenwood took the step of hiring a bodyguard to accompany her on night visits after being threatened by a man brandishing a knife.

Community nurses based at the Clementhorpe health centre said all had been in situations where they had felt threatened.

They had been verbally abused, followed late at night and trapped in homes when patients - sometimes innocently - locked the door after they came in.

One nurse who went to give a bath to a disabled woman was pressed up against the kitchen sink by the patient's husband.

She said: "He was telling me about how he had not had any sexual relations with his wife for a long time. I was really scared."

Diane Reddington, community nurse manager at Clementhorpe health centre, said: "You are very vulnerable as nurses visiting patients. You can be giving some very intimate care to men in their own homes.

"If you're behind a curtain in a hospital ward, there is always someone there. It is very different in someone's house. It is their home.

You're on their territory and they're more assertive. You have to be very careful not to give off the wrong signs."

All York Health Trust's 700 'lone workers' - which include community nurses, health visitors, midwives and any other staff, including receptionists, who may have to deal with potentially aggressive patients on a one-to- one basis - already carry personal attack alarms.

They emit a shrill, high-pitched squealing when set off.

To minimise the risk of attacks, all nurses visiting patients after 6pm or patients who are believed to be a potential risk do so in pairs - though midwives still make home calls alone.

The latest security measures come after a risk-assessment study involving all 'lone workers' at the health trust.

They will be paid for out of the Trust's £100m-a-year budget - though just how much the measures will cost is not yet clear.

Deputy chief executive George Wood said they would be brought in as quickly as possible, depending on cost.

He said: "The safety of staff is clearly very important to the Trust. We will continue to consider on an ongoing basis any further improvements that can be made."

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