prevention of violence toward health care workers
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Prevention of Violence Toward Health Care Workers. Prof. Dr Yasemin Balcı Department of Forensic Medicine Eskisehir Osmangazi University [email protected]. He al th Care Workers and Violence. The role of health care workers in their struggle against violence - PowerPoint PPT PresentationTRANSCRIPT
Prevention of Violence Toward Health Care Workers
Prof. Dr Yasemin BalcıDepartment of Forensic Medicine Eskisehir Osmangazi [email protected]
Health Care Workers and Violence
• The role of health care workers in their struggle against violence
• Health care workers as the injured parties of violence
• Violence resulting from the environment of the health care sector
The Struggle against Violence
• In order to avert the reflection of violence on society and its consequences on the individual:– Occupational responsibility– Humane responsibility
The effects of violence on individuals
Social results of violence
• Physical effects• Psychological effects
• Increase in suicide rate • Increase in child abuse• Increase in hospital admissions • Decrease in productivity• Transition between generations
The causes of child mortality1- Reasons related to conflict (war, refugee
displacement, accidents, child abuse, honor/custom traditions).
2- Reasons related to poverty and inadequate health care (hunger, infection and others).
3- Pathological mortality (congenital malformation, SIDs and so on).
Groups susceptible to violence• Lone children• Vulnerable women• The elderly living alone • People with physical or psychological
disabilities• Social or ethnic minorities and refugees• People connected to gangs
Health care workers cannot detach themselves from violence
“In a new approach, violence is defined as the health of society. Traditionally, violence has been considered as a matter of criminal law by health care workers. Doctors, nurses and those who work in social service related services should view violence as being in their own area…”
C. Everett Koop, 1991
Health care workers as victims of violence
• Directly• Indirectly
Prevention of violence toward Prevention of violence toward health care workers is importanthealth care workers is important
In health care workers:• Depression and intense stress• Physical and psychological problems• Problems created by the judicial
process
In providing service:• Decrease in worker efficiency• Negative approach to patients• Increase in mistakes made
Precautions against violence1- Pre-violence preventative measures2- First aid at the time of attacks3- Post-violence treatment and rehabilitation
Pre-violence• There is a relationship between the feasibility
of violence and• Etiology
– Sociological– Ideological– Cultural– Psychopathological– Biological
Those exhibiting a greater tendency to violence toward health care workers
• People forced to wait in crowded and uncomfortable conditions
• People forced to wait for unduly long periods • Good Samaritans who help the injured or
sick • People working with volatile substances• Those under the influence of alcohol or drugs• Unemployed people• Those with insufficient medical insurance
Vulnerable health care workers
• Those working alone or with few colleagues• Those who work at night• Those working in high crime areas with
inadequate security• Emergency service workers• Those working in the psychiatric services• People working in units with insufficient expert
support and inadequate health support
Lack of communication and violence
• Work related stress• Intense stress• Excessive tiredness• Role dilemma• Dissatisfaction • Uncertainties• Complex procedures
A lack of communication VIOLENCE
Studies in Turkey regarding violence toward health care workers
• Ayranci U, Yenilmez C, Günay Y,Kaptanoğlu C. Frequency of Ayranci U, Yenilmez C, Günay Y,Kaptanoğlu C. Frequency of exposureexposure to violence in various health institutions and health to violence in various health institutions and health profession groups, Anatolian J Psychiatry 2002; 3(3): 147-54. profession groups, Anatolian J Psychiatry 2002; 3(3): 147-54.
• Hancı H, Boz B, Demirkan Ö, Kılıççıoğlu B, Yağmur F. Medical Hancı H, Boz B, Demirkan Ö, Kılıççıoğlu B, Yağmur F. Medical personpersonnnel subjected to violence in the emergency department-enquiry el subjected to violence in the emergency department-enquiry study. Acil Tıp Dergisi 2003; 3 (2): 16-20. study. Acil Tıp Dergisi 2003; 3 (2): 16-20.
• Ayranci U. Violence toward health care workers in emergency Ayranci U. Violence toward health care workers in emergency departments in westdepartments in westernern Turkey. The Journal of Emergency Medicine, Turkey. The Journal of Emergency Medicine, 2005; 28 (3): 361-65.2005; 28 (3): 361-65.
• Ayranci U, Yenilmez C, Balci Y,Kaptanoğlu C. Identification of Ayranci U, Yenilmez C, Balci Y,Kaptanoğlu C. Identification of Violence in Turkish Health Care Settings. Journal of Interpersonel Violence in Turkish Health Care Settings. Journal of Interpersonel Violence 2006; 21 (2): 276-96.Violence 2006; 21 (2): 276-96.
• Erkol H, Gökdoğan MR, Erkol Z, Boz B. Aggression and violence Erkol H, Gökdoğan MR, Erkol Z, Boz B. Aggression and violence towards health care providerstowards health care providers - A problem in Turkey? Journal of - A problem in Turkey? Journal of Forensic and Legal Medicine 2007; 14 (7): 423-28.Forensic and Legal Medicine 2007; 14 (7): 423-28.
Results• One in two health workers reported exposure
to violence in the last year• Women, the young with less than 10 years
work experience, general practitioners, assistants, nurses, emergency service workers, and lone workers
• People having to deal with violent situations on their own are a majority
• Education aimed at protecting oneself from violent attacks is out of the question
Prevention of violence in the work environment
• Precautions relating to the physical environment:– Preventing the carrying of weapons onto the
premises– Use of camera equipment– Operating a Helpline system
• Planned use of manpower including security• First aid and emergency procedures• Education
Suggested personal precautions in the event of violent threat
• If the violent hospital admission is likely to be carrying a weapon or behaving in a violent fashion: - Enlisting support of security staff- The nature of the examining room - Removal of potentially dangerous items
Suggested personal precautions in the event of violent threat
• If threatened with a weapon during an examination• If the assailant attempts strangulation • If the attacker attempts to bite
During a violent attack• Urgent assistance
– Health aid– Judicial aid
• Notification of crime• Reporting and filing the outcome of the
violence The rate of applications made to judicial
bodies is approximately 10%
Relevant sections in TCK Relevant sections in TCK (Turkish Legal System)(Turkish Legal System)
Section 86/3. If intentional injury is caused whilst the victim is in public service, complaint is not required, and punishment increases at half rate.
Sections 125/3 and 131/1. If the offence of insult to public service workers is committed as a result of them performing their duties, the minimum punishment may not be less than one year, and a condition of complaint is unnecessary for the matter to be investigated.
Section 280. Health care workers not reporting incidents.
Section 281. Destroying, concealing or altering evidence in a criminal case.
• History• Clinical examination• Defining the findings
– Physical findings– Psychological findings
• Evaluation of findings• Judicial report
“What we didn’t record is what we didn’t do”
Filing the findings of violent incidents Judicial report
Evaluation
Defining and recording
History and clinical examination
Post-violence
• Treatment and rehabilitation• Elimination of results of violence
Violence caused as a result of the health environment or system
• Errors in medical application• Health environment becoming unsuitable• Unethical approaches
– Inequality– Discrimination– Labeling– Fighting
Errors in medical applicationPoor observation, allowing the
early discharge of patients% 20.7
Late attendance to patients % 20.7Delayed or wrong referral % 10.4Inadequate advice or treatment % 15.5Wrong or careless treatment % 10.4Poor diagnosis % 8.6Illegal medical application % 5.1
52% of complaints made by patients about health care workers are unrelated to diagnosis or treatment.
Precautions• Suitable adherence to ethical standards• Well lit environment prior to examination• Examination, diagnosis and treatment up
to accepted medical standards• Observation • Privacy
Education-Education- Education
Final Comment
In order to prevent violence and to guard ourselves from violence in all sectors of the health services, a realistic and feasible plan should be formulated.