_________________________________________________________________ Managing Disruptive Patients
Research demonstrates that among healthcare personnel, nurses are the most likely victims of workplace violence (National Institute for Occupational Safety and Health [NIOSH], 2024). According to the World Health Organiza- tion, up to 38% of healthcare workers have experienced some form of physical violence within their career. Many more are threatened or exposed to verbal aggressions often perpetrated by patients and visitors. The risk factors for violence vary with each healthcare facility, depending on location, size, and type of care. According to Lim et al. (2022), risk factors for workplace violence in healthcare settings include attitudes and behaviors of patients, family members, friends, or visitors who are often under intense emotional charge and expecta- tions. Work factors that increase the risk of violence include shortage of staff, inexperienced or anxious staff, poor coping mechanisms, and lack of training. System or environmental factors include overcrowded areas, long waiting hours, and inflexible visiting hours. Factors that may influence the risk for violence in healthcare settings are listed in Table 1. Workplace violence is destructive and has a profoundly negative impact on healthcare professionals. Healthcare professionals may experience physical injuries, psychological trauma, anxiety, or even death. Feelings such as anger, depres- sion, fear, self-blame, and powerlessness might take over the healthcare professional’s life. This can affect the institution by causing loss of job satisfaction, low worker morale, increased job stress, and an increased staff turnover rate (Kafle et al., 2022; OSHA, 2024). Members of the healthcare professional staff need guidelines for dealing with workplace aggression, just as they do for a fire or dangerous situations. These guidelines should be based on a team approach with security staff since both groups have their own unique perspectives and skills to offer. Healthcare professionals who work in long-term care facilities should have training in the management of patients who are potentially aggressive; both the frequency of incidents and the delicate nature of some patients’ conditions increase the likelihood of violent incidents. The areas of a hospital where violence is most likely to occur are the emergency department, intensive care units, psychiatric services, and geriatric units (Chakraborty et al., 2022). Ideally, all healthcare professionals should receive education on how to handle violence in their workplace.
INTRODUCTION Hospitalization can sometimes be frightening, disorientating, and may even cause a patient to resort to behaviors that include hostility, noncompliance, and manipulation. Psychiatric healthcare professional personnel are trained in the manage- ment of aggressive behavior and crises. However, healthcare professionals working in a general hospital setting may not have been given specific instructions in handling such situations. In acute care settings, security staff frequently manage the occa- sional behavioral incident associated with patient aggression. Healthcare institutions must take necessary precautions to protect healthcare professional personnel from workplace violence. The Occupational Safety and Health Act of 1970 requires that employers ensure each employee has a place of employment that is free from recognized hazards that are causing, or are likely to cause, death or serious physical harm (Occupational Safety and Health Administration [OSHA], 2024). Healthcare professionals may experience disruption with patients who are noncompliant or nonadherent with treat- ment. The concept of noncompliance , or nonadherence , is a subject of debate in healthcare. At the heart of the issue is the right of the patient to choose a treatment course that is different from the recommendations of the healthcare team. Discovering the cause of nonadherence is a necessary first step. If it can be determined, then patient education or problem solving by the healthcare professional may assist in future adherence. Helping patients truly understand the risks of not following the treatment regimen can go a long way toward achieving better adherence. Another way patients may demonstrate disruptive behavior in a hospital setting is through manipulation. The term manipu- late means to influence the behavior or emotions of others, often at their expense, for one’s own purposes. The stress of hospitalization may cause a patient to resort to manipulation to meet needs that are absent in a hospital setting. Patients who demonstrate manipulative behaviors are typically trying to gain power over the healthcare professional to get what they need/ want. This behavior can evoke a negative response towards the patient from healthcare professionals and other clinicians.
INCIDENCE OF VIOLENCE IN HEALTHCARE SETTINGS
FACTORS THAT MAY INCREASE THE RISK OF VIOLENCE
Hospital workers are at high risk for experiencing violence in the workplace (National Institute for Occupational Safety and Health [NIOSH], 2024). According to a 2022 study by the U.S. Bureau of Labor Statistics, incidence of nonfatal assaults on healthcare workers was 8.5 assaults per 100 full time employees. This rate was much higher than the rate of nonfatal assaults in private sector industries, which was 1.7 per 100 full time employees. Healthcare workers are five times more likely to experience workplace violence than individuals in other professions. It continues to be a critical issue for all
Workplace violence ranges from offensive or threatening language to homicide. Incidents of violence are episodes or outbursts that involve hitting, choking, or assaulting another person; damaging property; throwing cups; smashing glass- ware; and so forth. One of the difficulties with providing a safe environment is that sickness and potential life-threatening factors cause stress in patients, their family members, and personnel in healthcare workplaces. Such stress can aggravate factors that lead to violence, which is reportedly on the increase (Sari et al., 2023).
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