Violence in the Healthcare Workplace ___________________________________________________________
Cognitive Therapy The goal of cognitive therapy for individuals who have experi- enced workplace violence is to reduce symptoms of depression, post-traumatic stress, trauma disorder, anxiety disorders, and substance use disorder, all of which are common following workplace violence [192]. In a quasi-experimental design with 405 participants who had experienced workplace bullying, a cognitive-behavioral intervention was found to be effective in reducing systems of depression and anxiety and facilitating return to work compared with a waitlist control group [193]. Considerations for Non-English-Proficient Victims Because the population of the United States is constantly diver- sifying, it is important for clinicians to consider each victim’s cultural and linguistic limitations when it comes to reporting violence. When a victim does not speak the same language as the clinician, a professional interpreter should be consulted to ensure accurate communication. Use of professional interpret- ers has been associated with improvements in communication (errors and comprehension), utilization, clinical outcomes, and satisfaction with care. Individuals with limited English language skills have indicated a preference for professional interpreters rather than family members or friends. SAFETY TRAINING FOR EMPLOYEES/STAFF Several experts emphasize the importance of safety training for healthcare and human service professionals [56; 68]. Training must be ongoing, beginning at new employee orientations and continuing at staff meetings and in-service training. By raising staff’s awareness of their immediate surroundings, training can increase professionals’ sense of competence and control and lessen feelings of helplessness. Some topics that have been recommended as part of safety training are environmental assessment, techniques for de-escalation of violence, and self-awareness. Environmental Assessment Environmental assessment entails service providers evaluating the work environment, such as office spaces, cars, and for those professionals who conduct home visits, their clients’ residences and neighborhoods, for violence risks and potential opportu- nities for self-defense [56]. For example, when healthcare or human service professionals conduct patient interviews in their offices or interview rooms, several questions regarding the environment should be raised. This includes determining the most effective room layout so the professional can exit quickly if there are visual cues that the patient is getting angry or violent. The office should be scanned for items that can easily be used by a potentially violent patient to cause harm; for example, books, ashtrays, and furniture can potentially be used as weapons [69; 194]. In addition, evaluating what in the environment can be used as a barrier (e.g., tables, shelves) is equally vital [194]. It is also important to determine the extent of which the interviewing or evaluation office is vis- ible to others. This requires a delicate balance, because it is
important to promote the privacy and confidentiality of the client, but simultaneously, it is also important for the clinician to be safe [69]. The environment of waiting rooms can be potential breed- ing grounds for patient violence [131]. Organizations should evaluate the mechanisms in place to manage patients’ emotions and safety. For example, what can be done to keep the environ- ment peaceful and calm? What mechanisms are in place to reduce waiting times or to communicate waiting times most effectively [131]? What security measures are in place (e.g., cameras, patrols) [132]? Workers’ vehicles are often taken for granted. However, main- tenance issues are important, particularly for staff who work late at night or who conduct home visits in unfamiliar neigh- borhoods [56]. Staff members should have their keys readily available when they walk to their cars, and they should check the back seats before getting in their vehicles. Items that place a car at risk of being vandalized, such as a supply of psychotro- pic medication, should be put away or not left in the vehicle. When going on home visits, knowledge of neighborhoods is a prerequisite to safety. The following questions may be helpful in determining the risk associated with certain neighborhoods [7; 56; 57]: • Do workers know which neighborhoods or areas are unsafe at night? • Do workers know where to find secure parking and easy exits? • Are workers apprised of recent incidents of violence or drug-related activities in the neighborhood? • Is it possible for a worker to be accompanied by another staff person on home visits or rounds? • Is there a clear plan for workers who conduct home visits to communicate their whereabouts and a protocol to follow if a worker does not report as expected? • Is it possible for workers in the field to carry hand- held alarms or noise devices? Twenty-three social workers participated in a study conducted in rural areas in Australia. The study consisted of a forum to identify safety concerns and for workers to convey their experi- ences with abuse and violence with clients while working [70]. A prominent theme that emerged was the risk involved in con- ducting home visits and transporting clients from one location to another. In some cases, agencies did not have the resources for radios, mobile phones, security papers, and duress alarms. Even when the equipment was available, it was unreliable in remote locations. As a result, issues of personal safety were a paramount concern for many of these rural social workers.
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