Violence in the Healthcare Workplace ___________________________________________________________
Self-care may be conceptualized along a continuum, with proactive planning and reactive intervention on either ends of the continuum [79]. Self-care includes an array of activities that touch on the following domains [79]: • Physical (e.g., exercise, nutrition, sleep) • Recreational (e.g., play activities, vacation time, hobbies) • Social support (e.g., interaction with friends, family members) • Spiritual/religious (e.g., prayer, meditation) On the organizational level, administrators can create a culture of promoting self-care in organizations. Practitioners should be discouraged from skipping breaks and lunches in order to catch up on work. Built-in supervision and support can also reduce burnout [33]. An organizational culture with strong leadership that endorses and promotes respect, support, and care for oneself and each other is key to helping clinicians cope after experiences with workplace violence [197]. Practitioners should not merely consider these activities in passing but spend time asking themselves about the self-care activities they are currently undertaking [79]. Practitioners must view self-care as proactive rather than reactive [79]. Practitioners who have experienced workplace violence may also consider going to their employee assistance program (EAP) to obtain assistance, if available. Counseling and mental health services are free and confidential through EAPs. OCCUPATIONAL POLICIES It is important to view occupational policies regarding work- place violence in the context of the range of different types of organizational responses to incidents of workplace violence or bullying. Ferris divided organizational responses into three categories: “See no evil, hear no evil, and speak no evil” [80]. Organizations that fall into the “see no evil” category acknowl- edge the existence of workplace violence or bullying but nor- malize the behavior. When affected staff members approach the employer, they are told to toughen up and to learn how to deal with the behaviors [80]. Organizational responses identi- fied as “hear no evil” acknowledge the problem but frame it as an interpersonal conflict. The victim is often blamed for somehow triggering the negative behaviors due to his or her personality [80]. The third and final response is classified as “speak no evil.” These organizations acknowledge the problem and its deleterious effects. Consequently, they take allegations seriously, follow up with an investigation, and take action against the bullying or violent individual. Ferris noted that the “speak no evil” organizations had learned from previous encounters of workplace violence that had resulted in lawsuits [80]. Organizations may ask where their current policies would be categorized based on this system.
and others to address the act appropriately than untrained employees, who are more likely to panic, deny the incident, and feel helpless. General Training In addition to training about safety, healthcare providers may also be given guidance regarding trauma-informed care and the use of different standardized assessment tools (including stan- dardized behavioral observation tools) to evaluate a patient’s or client’s risk of violence [194]. If everyone in the organiza- tion uses the same standardized assessment(s), this will ensure consistency in definitions and measurements. Counterbalance training and Tactical Approach to Car- ing Training (TACT) may also be useful tools. TACT refers to evidence-based techniques that focus on skills to maintain composure and a calming presence to manage a patient/client’s emotional distress [194]. All staff members should receive training about the channel of communication. Communication strategies that emphasize giving patients/clients the space and time to think and pro- cess information and emotions are paramount. For example, providers should be encouraged to use silence, empathy, and language that are clear and supportive [194]. SELF-CARE FOR EMPLOYEES/STAFF For some practitioners who witness workplace violence, com- passion fatigue, secondary traumatization, and burnout are typical consequences. Compassion fatigue is a relatively new term, coined in 1992, and is meant to convey a nonpathologic concept [77]. It is a natural consequence of the emotions that stem from either witnessing or knowing about a traumatic event or daily continual contact with those who are suffering [77]. Secondary, or vicarious, traumatization is defined as “transformation of the inner experience of the therapist that comes about as a result of empathic engagement with clients’ trauma material” [78]. Vicarious traumatization can cause emotional and cognitive arousal symptoms, such as increased emotional sensitivity, lack of well-being, intrusive thoughts, and difficulty concentrating [79]. Finally, burnout has been defined as physical and emotional symptoms that are linked to the workplace experience, ranging from working with clients to environmental components of the workplace [79]. The practitioner experiencing burnout feels exhausted and, at times, emotionally detached from clients [79]. In one study, Levine, Hewitt, and Misner found that nurses withdrew from their patients after an incident of workplace violence [55]. Self-care is integral to the prevention of negative symptoms such as burnout, secondary traumatization, and compassion fatigue. Twemlow suggests a self-care plan for persons at risk for these effects that includes cognitive and stress management techniques, such as biofeedback or hypnosis [76]. In addition, nutrition and regular physical exercise are vital. Maintaining social and familial relationships is also crucial.
46
EliteLearning.com/Social-Work
Powered by FlippingBook