Violence in the Healthcare Workplace ___________________________________________________________
The overall emphasis on community mental health treatment has also contributed to the problem of workplace violence. With the shift of psychiatric and mental health treatment and provision of services from in-patient psychiatric hospitals to community-based mental health organizations, volatile psychiatric patients are released home for additional treatment and may experience continued symptoms of their disorders [56]. Although the majority of individuals with severe mental disorders are not dangerous, the unpredictable nature of their illness poses a risk to service professionals providing care. Because hospitals, health clinics, and mental health centers keep medications and drugs at their facilities, there is also a risk for robbery. This, coupled with long waits that can exacerbate patients’ already low tolerance for frustration, can increase the risk for violence [7]. Furthermore, clinicians and other service professionals may be perceived as authority figures and, therefore, targets for persons acting on their frustrations [57].
association between nurses’ productivity levels and exposure to patient violence. Although nurses indicate that they are generally able to continue working at their usual pace after the violence, they have more difficulty remaining focused after the incident [102]. With more insidious examples of workplace violence, such as workplace bullying or mobbing, similar physical and psycho- logical responses are also common. Leymann has identified potential effects that mobbing may have on the victim(s) [11]: • Inability to communicate: Through verbal threats, the victim is silenced and may feel unable to communicate with coworkers or supervisors. • Inability to maintain social contacts: Colleagues may avoid the victim in order to avoid getting involved or because they have been told to stay away from the victim. In essence, this isolates the victim. • Detriment to reputation: Due to the gossiping and ridiculing, the victim’s personal and professional reputations are negatively impacted. • Detriment to occupational satisfaction: The victim is given meaningless tasks at work. • Detriment to health: The victim’s health suffers due to harassment. This categorization offers a context to understand the con- sequences of workplace violence, bullying, or mobbing. In a qualitative study of 10 women who experienced bullying behaviors, the symptoms associated with workplace bullying were initially attributed to other factors [18]. The symptoms were attributed to individual health, ultimately pathologizing the symptoms and causing the participants to feel even more inadequate. Studies have shown that the presence of social support for vic- tims can alleviate some psychological and somatic symptoms. In a survey study of 229 workers in a healthcare setting, research- ers found that instrumental support, defined as support avail- able from coworkers, supervisors, and management after the violent event, was a positive factor in alleviating psychological problems (e.g., loss of well-being) and somatic symptoms (e.g., sleep disturbance, gastrointestinal problems) [85]. In another study, coworker support was found to be a protective buffer against workplace bullying and psychological distress, albeit relatively small [163]. Instrumental and emotional support have been suggested to moderate burnout stemming from workplace bullying [164]. It is important to note that feelings of isolation are typical in the aftermath of a traumatic event. The victim may feel that no one understands what he/she is going through regardless of the amount of support available. In one study, for example, some nurses revealed that they did not want to disclose to their family members for fear of worrying them nor did they feel comfortable talking to co-workers [55]. It is therefore vital that instrumental support, having a network at the work setting
CONSEQUENCES OF WORKPLACE VIOLENCE
Not unlike victims’ experiences with other types of violence, such as family violence, domestic violence, or witnessing a trau- matic act of violence, there are a host of emotional, somatic, and psychological reactions associated with experiencing work- place violence. Research also indicates that secondary victims of all types of violence (i.e., those who do not experience the violence directly but who hear about or witness it) experience similar stress responses. Fear reactions are common, and these responses can then lead to more serious psychological disor- ders, such as depression and anxiety, and an array of somatic symptoms, such as sleep and gastrointestinal disturbances [58]. Suicidal ideation is also twice as likely to occur among those who have experienced workplace bullying compared with those who have not experienced workplace violence [161]. In a systematic review of 137 studies, sadness, shock, embarrass- ment, and stress symptoms were common in the short term [128]. Most research has focused on the emotional impact of workplace violence [190]. Victims of workplace violence often experience irritability, stress, fear, anxiety, depression, anger, decreased self-esteem, shame/embarrassment, and lowered resilience. On a longer-term basis, avoidance of the workplace was common, which also resulted in loss of work days as well as loss of confidence and good working relationships with peers and colleagues. In a longitudinal study, those who had been exposed to physical workplace violence were 1.67 times more likely to have an increased number of visits to a physician after seven years compared with those who were not exposed to physical workplace violence [162]. Post-traumatic stress disorder (PTSD) and acute stress symp- toms are also common. Interestingly, Rogers and Kelloway found that fear symptoms surrounding future workplace experiences appear to play a role in triggering a host of mental health and physical symptoms [59]. There also appears to be an
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