___________________________________________________________ Violence in the Healthcare Workplace
this phase, clinicians should assist perpetrators in redirecting their feelings toward arenas in which they feel some degree of control. Practitioners often miss or fail to recognize anxiety and stress cues [152]. Work should also be continued in iden- tifying and discussing the problem. At this point, staff and other relevant persons should be alerted to the situation [64]. The third phase of the cycle of violence is called the crisis stage. In this phase, the individual uses aggressive behaviors to regain a sense of control. McAdams and Foster note that this may also symbolize a “primitive plea for external intervention” [64]. Clinicians should take steps to ensure the individual’s safety as well those around him/her. Interventions must be clear and firm in regards to what is needed and expected [64]. The fourth stage is recovery and involves a decline in the indi- vidual’s crisis symptoms. However, the individual may continue to feel angry or frustrated and may be resistant to interventions. Therefore, clinicians should continue working to ensure the individual’s safety and to identify a resolution [64]. The fifth and final stage is characterized by the perpetrator feeling emotionally and physically exhausted. Feelings of guilt may also be evident, with the perpetrator wanting to make reparations to victims. The task of clinicians in this phase is to assist the individual in making reparations and to discuss the triggers for aggression. It may then be possible to identify pro- social mechanisms to deal with frustrations in the future [64].
• Fact phase: In this phase, the client is encouraged to describe the trauma and to describe his/her sensory experiences. • Thought phase: It is recommended that the client share his/her feelings and describe how thoughts and feelings have affected his/her sense of self- esteem, confidence, and sense of self. • Reaction phase: This phase is characterized by a focus on the individual’s reactions to the trauma. The mental health professional should carefully assess the individual’s emotional state during this phase. • Symptom phase: The objective of this stage is to help the individual move from an emotional to a cognitive level in understanding his/her symptoms. • Education phase: The sixth phase consists of education about responses to stress and the normalcy of the individual’s feelings, experiences, and reactions. • Re-entry phase: The debriefing is brought to a closure in the re-entry phase, in which the clinician
determines how helpful the debriefing was to the individual. Finally, if needed, referrals for continued services are made.
Career Counseling Not only is workplace violence harmful to victims’ mental health and physical health, it may also have a negative impact on their careers [67]. Part of the career counseling that should follow an occurrence of workplace violence involves discussing whether the victim should make a job change. If the individual decides to make a change, feeling anxious about the future is common. It may also be necessary to work with the client on concrete tasks like updating resumes, obtaining letters of reference, and general support. Bibliotherapy Lewis, Coursol, and Wahl have recommended bibliotherapy for victims of violence, which involves providing educational information, such as books and pamphlets about workplace violence [67]. Information regarding available sources for this information is provided later in this course. Bibliotherapy is done within the context of the therapeutic experience. Personal Reflective Narrative After a traumatic event, one may cope with the stress by writ- ing a reflective narrative that documents the event and the associated emotions [104]. This should be done as soon as possible after the event. Ideally, it provides an opportunity for the victim to examine the event holistically and review the entry with a supervisor, reflecting on how the crisis affected his/her life on a professional and personal level.
COUNSELING THE VICTIM Debriefing
After a critical incident, it is imperative for agencies to help in the victim’s recovery by providing support, education, and referral services. A critical incident is defined as the acute stress response normally experienced after a traumatic event. During a crisis, the range of physical and psychological responses is often so overwhelming and intense that it taxes the individual’s normal coping experiences; anxiety and numbness often fol- low [9]. Debriefing is a crisis intervention that aims to reduce stress symptoms [65]. This, along with defusing (e.g., giving the traumatized individual an opportunity to vent emotions about an event) may be helpful for many victims [104]. However, debriefing is not considered a replacement for psychotherapy [9]. The debriefing and defusing process should begin within 24 to 72 hours of the incident [66; 104]. The process typically consists of sessions, either group or individual, led by a mental health professional to discuss the traumatic experience, normalize feelings, and process emo- tions [65]. Antai-Otong identified seven phases of debriefing that occur in a group format [9]: • Introductory phase: In this first phase, the goals of the sessions are reviewed, client confidentiality is discussed, and the client is encouraged to talk about the incident.
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