Violence in the Healthcare Workplace ___________________________________________________________
• Capacity: It is necessary to ask whether the patient has the capacity to carry out the violence and potential harm. In other words, does the patient have the physical, emotional, and intellectual capacity to carry out his/her threat? To what extent does the patient know the intended victim’s routine? • Threshold crossed: This factor pertains to the patient’s previous history of violence. Has the patient broken any laws? Has the patient previously used violence to accomplish his/her goals? What are the patient’s future plans with the intended victim? • Intent: This dimension refers to whether the patient merely has a thought or if plans have been made to execute the behavior. Again, does the patient have a plan, and can the plan be executed? • Other’s reactions: It is important to obtain collateral information from individuals who know or who are acquainted with the patient. What are their perceptions of and experiences with the patient? What are their opinions about the patient’s capacity to harm? • Noncompliance with interventions: What is the extent of the patient’s willingness to work with the clinician (and other professionals) to reduce the risk of using violence? To help assess this, the clinician may examine the patient’s previous history regarding use of medications and other therapies and his/her beliefs about the efficacy of the interventions. Another violence assessment tool has been created to assist in specifically identifying potentially violent patients in emer- gency departments [103]. Cues that indicate a patient is more likely to resort to violence include [103]: • Prolonged staring at nurse or practitioner • Sharp or caustic tone of voice, including rapid speech, sarcasm, rudeness, and swearing • Anxiety exhibited in behaviors such as flushed appearance, tense posture, clenched fists, and dilated pupils • Mumbling (e.g., talking under breath, slurring, repetitive questions) • Pacing and fidgeting Another acronym used to assess a patient’s behavioral cues as indicators of potential violence is STAMP [191]. STAMP stands for:
Additional tools targeted to assessing patients at risk of violence are available at https://wwwn.cdc.gov/WPVHC/Nurses/ Course/Slide/Unit6_8. None of these behaviors above are definitive indicators of a vio- lent patient, but if taken as part of the holistic assessment, they can be used to alert practitioners of potential at-risk situations. Administrators should assess the work environment for factors that might make the workplace more vulnerable to violence by asking the following questions [166]: • What policies and protocols exist to discipline employees who engage in workplace violence? • What are the reporting protocols for workplace violence incidents? • What type of security is in place to prevent violence (e.g., guards, panic buttons, video surveillance)? • How is traffic flow monitored (e.g., badges, electronic keys/passes)? • What is the level of employee and/or patient stress? • What are the wait times for patients and family members? • Where are frustration levels high (e.g., crowding, uncertain outcomes)? PREVENTION AND INTERVENTION Many experts maintain that the occurrence of any type of violent or abusive incident, including workplace violence, is not necessarily a single incident but can be conceptualized as a chain of events [64]. In terms of healthcare workplace violence, this cycle is most applicable to violence perpetrated by patients/ clients or service recipients (OSHA’s classification Type III). Understanding the phases and stage-specific characteristics of violence or aggressive behaviors can assist clinicians and other helping professionals to determine the appropriate tasks and interventions for each stage of the crisis. It may also help to reduce the tendency to pathologize the perpetrator, ultimately promoting autonomy and dignity. The first phase of the perpetrator’s cycle of violence involves experiencing rising emotions. This phase is characterized by a sense of unspecified panic or anxiety. The perpetrator may not necessarily be able to name his or her feelings or associate these emotions to the event (whether real or imagined) [64]. The goal in this phase is to help the individual identify and discuss the problem. If the perpetrator is unable to identify and address the problem in the first stage, he/she then enters the second stage. The second phase is characterized by an escalation of inner anxiety and a mounting feeling of loss of control. This causes the individual to attempt to regain control through the use of threats, abuse, and/or verbal intimidation [64]. During
• Staring and eye contact • Tone and volume of voice • Anxiety • Mumbling • Pacing
42
EliteLearning.com/Social-Work
Powered by FlippingBook