workplace violence in the healthcare setting
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Workplace Violence in the Healthcare SettingSCSU Leadership Students
Matt Baumann and Kayla Dube
Overview
• As healthcare professionals, we see the consequences of violence in the patients we treat.
• However, healthcare professionals are increasingly becoming the targets for violence in our work environment.
• Workplace violence is preventable and should NEVER be accepted as part of a healthcare professional’s job.
Objectives
1. Define workplace violence
2. Understand the prevalence of workplace violence in the healthcare setting and its impact on healthcare workers’ career
3. Learn strategies to prevent workplace violence
4. Identify risk factors for potentially violent patients
5. Identify appropriate situations when to report workplace violence to the authorities
Definitions
• The National Institute for Occupational Safety and Health (NIOSH)• “Any physical assault, threatening behavior, or verbal abuse
occurring in the work setting”
• The World Health Organization (WHO) and the International Council of Nurses (ICN)• “Incidents where staff are abused, threatened or assaulted in
circumstances related to their work, including commuting to and from work, involving an explicit or implicit challenge to their safety, well-being or health.
Prevalence
• According to the Bureau of Labor Statistics (BLS) data records, healthcare and social assistance workers were victims of approximately 11,370 assaults by persons in 2010.
• This is a greater than 13 % increase over the number of assaults in 2009.
• From 1997 to 2009, there were 130 workplace homicides in the healthcare and social assistance industry and private sector.
• Many incidents probably go unreported.
Impact on Career
• Increased stress-related outcomes (ex. psychological distress)
• Associated with decreased organizational skills• Increase in errors• Decreased job satisfaction• May intentionally avoid patients to avoid a recurrent
violent act• Financial burden for health economy and society
Prevention Strategies
• What not to wear:• Long hair down• Jewelry• Overly tight clothing (restricts movement)• Overly loose clothing• Stethoscope around neck• Glasses, keys, or name tags dangling from cords/chains (use
break away safety cords or lanyards)
Prevention Strategies
• Be aware of your environment• Know the exits and location of emergency phones• Confusion, background noises, and crowding can ↑ stress
levels• Meal times, shift changes, and patient transportation are
times of ↑ disruptive behaviors
Prevention Strategies
• Pay attention to your own responses• Be aware of your own feelings, responses,
instincts and sensitivities (ex. Flight or Fight response)
• Be aware of the way you express yourself• Acknowledgement of a personal history of abuse• Fatigue (diminishes alertness and ability to
respond)
Prevention Strategies
Verbal• Lower pitch and loudness of
voice• Speak with confidence• Things never to say:• Come here!• Calm down!• Those are the rules/policy• What do you want ME to do about
it?• I am doing this for your own good.
Non-Verbal• Approach person form side
(not front or back)• Never block a doorway• Align yourself with the
speaker• Keep at least one arms
lengths away• If agitated or aggressive at least
two arms lengths away.
What to Watch For
Verbal cues• Raised voice/yelling• Swearing• Threating tone of voice
Non-verbal cues• Physical appearance (neglected
hygiene and clothing)• Arms folded tight against chest• Clenched fists• Heavy breathing• Pacing or agitation• A terrified look (signifying fear or
high anxiety)• A fixed stare• Aggressive or threatening posture• Thrown objects• Sudden changes in behavior• Indications of drunkenness or
substance abuse
Violent Behavior Indicator
• Staring and eye contact• Tone and volume of voice• Anxiety•Mumbling• Pacing
Activity!
Threat vs Limit Setting
Threat or Limit Setting?
“Please sit down. I don’t want to involve security but I may have to if you can’t control yourself.”
“Please sit down. I don’t want to involve security but I may have to if you can’t control yourself.”
Answer: Limit Setting
Threat or Limit Setting?
“If you keep pushing the call button like that I won’t help you.”
“If you keep pushing the call button like that I won’t help you.”
Answer: Threat
Threat or Limit Setting?
“That type of behavior won’t be tolerated.”
“That type of behavior won’t be tolerated.”
Answer: Threat
Threat or Limit Setting?
“Ms. Ferris: I know you need help, but please don’t ring your call like that, and give me a chance to get to your room.”
“Ms. Ferris: I know you need help, but please don’t ring your call like that, and give me a chance to get to your room.”
Answer: Limit Setting
Threat or Limit Setting
“Mr. Barren: Would you please stop yelling and screaming at me… I’m trying to help you.”
“Mr. Barren: Would you please stop yelling and screaming at me… I’m trying to help you.”
Answer: Limit Setting
Threat or Limit Setting
“If you don’t stop I’m going to call security!”
“If you don’t stop I’m going to call security!”
Answer: Threat
Legal Action
• The nurse has the right to press criminal charges when threatened or intentionally harmed by a patient
• Notify the law enforcement as soon as possible• Summit a detailed written report to your supervisor• Utilize iCare, “fight against non-reporting culture”• Utilize the security available at the facility
References
Esmaeilpour, M., Salsali, M., & Ahmadi, F. (2011). Workplace violence against Iranian nurses working in emergency departments.
International Nursing Review, 58(1), 130-137. doi:10.1111/j.1466-7657.2010.00834.x
NIOSH-WPVHC-Workplace Violence Prevention for Nurse.Retrieved from http://wwwn.cdc.gov/wpvhc/Course.aspx/Slide/Intro_1
Safety and Health Topics | Healthcare - Workplace Violence. Retrieved from https://www.osha.gov/SLTC/healthcarefacilities/violence .html
Stressful Incidents of Physical Violence Against Emergency Nurses. Retrieved from
http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/V ol-18-2013/No1-Jan-2013/Stressful-Incidents-of-Physical- Violence-against-Emergency-Nurses.html