Managing Disruptive Patients _ ________________________________________________________________
FACTORS THAT MAY INCREASE THE RISK OF VIOLENCE IN HEALTHCARE SETTINGS
Patients and Visitors
Staff
Environment
Patients who are acutely agitated, violent, or volatile
Lack of training in recognition, early intervention, and management of escalating, hostile, and assaultive behavior or patients who are potentially volatile Low staffing levels during times of specific increased activity, such as mealtimes, visiting hours, and shift changes Solo work, particularly in remote locations Interventions demanding close physical contact, such as examinations, treatments, or transporting patients Shift work, including commuting to and from work at night
Poor or inadequate security measures
Patients with a history of violence or certain psychotic diagnoses
Poorly lit corridors, rooms, parking lots, and other areas
Patients who are on criminal holds by police and the criminal justice system
Highly accessible worksites with little or no privacy Unrestricted movement of the public in clinics and hospitals Long waits in emergency or clinic areas that are overcrowded and uncomfortable Availability of drugs or money at hospitals, clinics, and pharmacies, making them likely targets for robbery Prevalence of handguns and other weapons; home visiting, with its associated isolation
Patients with a history of trauma
Patients who abuse drugs or alcohol, are under the influence of these substances, or are withdrawing from substances
Distraught family members
Demanding workloads
Presence of gang members
The use of temporary and inexperienced staff; working alone
Source: [19; 13; 22]
Table 1
hospital workers. Individual states have enacted legislation to help curb this problem. Through these efforts, many emergency departments have added secure entry systems and, as much as possible under current budget restrictions, additional security personnel. PREVENTION OF WORKPLACE VIOLENCE Healthcare professionals in all healthcare settings should expect training in dealing with patient aggression. Being pre- pared for situations that may escalate allows healthcare profes- sionals and other staff to defuse potentially violent situations before injuries occur. Areas where patients are most likely to become violent require lower staff-to-patient ratios to decrease incidents of violence. Suggested prevention strategies include (i) substitution by transferring a client or patient with a his- tory of violent behavior to a more suitable secure facility or area; (ii) engineering control measures that include installing barrier protection, metal detectors and security alarm systems, and allocating conducive patients or visitors areas and clear exit routes; (iii) administrative and workplace practice controls
that include implementing workplace violence response and zero-tolerance policies, ability to resolve a conflict situation, establishing a mandatory timely reporting system, ensuring employees are not working alone, and a flowchart for assess- ing and response in emergency situations; (iv) post-incident procedures and services that include trauma-crisis counselling, critical-incident stress debriefing, and employee assistance programs; (v) safety and health training in order to ensure that all staff members are aware of potential hazards and how to protect themselves and their co-workers through established policies and procedures (Lim et al., 2022; Jones et al., 2023). Patients are not the only individuals responsible for work- place violence. Family, other visitors, staff, and vendors are all potential aggressors. Healthcare professionals educated in de-escalation techniques may be able to help any of these individuals calm down rather than create a violent episode. Everyone benefits when an emotionally charged situation does not end in violence of any sort.
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