Violence in healthcare settings: identification and control measures

¶ … Controlling Violent Health Care Patients and Employees

This is a paper discussion on the identification and control of violence amongst health care patients and employees. It has 11 sources.

An Introduction to Violence

Violence has become a common feature of our society found in every area of the nation from quiet neighborhoods in the suburbs to the urbanized cities of the U.S. To make the matter worse, the media including radio, TV, private cable networks, have become a part of the culture that promotes the concepts of violence, if there is no violence exhibited in either every day programs then these programs, including those of children are presumed to be a failure. Hence, it would not be wrong to assume that our entire culture has been virtually gripped in a sphere of violence to which there is no end.

This culture of violence continues despite the fact that the sociologists get together to suggest that the controlled violence that is being used to target the audience is creating a virtual reality after which the violence depicted is featured in real life. The irony is that violence is also targeting the healthcare institutes which are institutes that are supposed to save lives not harm them. The following paper will discuss the concept of violence including its identification amongst health care patients and employees in particular. The paper will conclude with some of the suggestive measures for controlling violence in the healthcare institutes.

Beginning our discussion through the identification and control of violence amongst health care patients, the statistics presented by the Occupational Safety & Health Administration are perhaps the best evidence to the notion that healthcare and social service sectors are the singularly, as well as the largest areas of the nation's economy where incidents of assaults and violence are said to occur. Also provided are some of the initial reasons presented by the OSHA, which include amongst others the easy availability of handguns, the increasing growth of mentally ill patients, the falling levels of employment in the health care industry, and more than isolated working conditions whenever exams are conducted (Erickson 2000).

Statistics as of the year 1994 provided by the OSHA note that in the health care industry alone, some 26 physicians, 27 pharmacists, 18 registered nurses, and 17 nurse's aides died as a result of physical violence by the patients or their immediate family members. In addition similar surveys carried out over employees working in psychiatric institutions revealed that the number of assault and injury cases was much higher than the traditional hospital and clinical settings. For example those working in psychiatric settings, it was found that the prevalence rate of violence was 16 assaults per 100 workers, in contrast to the 8.3% as noted for other health care settings (Erickson 2000).

Some Principle Factors for the Patient's Violent Behavior

An overview of the patients attitudes studied in the particular setting of the office of the physician revealed that there are number of factors that cause the patients first getting impatient and later turning utterly violent. A combination of factors were reviewed in the ensuing violence in a physician's office that included a frustrated attitude on the part of the patients, the staff at the physician's offices, or family members of the patients accompanying the patient. For example with the number of patients increasing on the list of the respective patients, it is common to observe that patients tend to get impatient either when waiting too long for their turn, when they fail to get an appointment, and if they do get one, the tendency to break the queue and get into a dispute with the staff at first, followed by a complete resemblance of a market place brawl which could start from verbal assaults and eventually turn into use of physical violence, such as grabbing another individual, or even the pushing or throwing of the weaker individual by the stronger individual (Felton 1997).

Another set of reasons for the patients or their family members showing violence is that with an increasing number of patients and their families begin to think that they are not getting the right treatment from the physician and/or the treatments offered are not effective as to the expectations of both the later groups. A growth of such feeling tends to create a sense of escalating tension on the part of patients, and this becomes all the more serious when the patients do not recuperate. Such occurrences are more noticeable in conditions where the patients are suffering from psychological or mental health related ailments. The findings and surveys carried out by OHSA duly support these trends, as also evidenced in their statistics, already mentioned in the preceding paragraphs. (Felton 1997).

The increasing prevalence of violence in hospital settings as compared to clinics for outpatient or other health care facilities is also said to be attributed to such factors as larger hospital settings aside from providing treatment facilities for their patients to serving as temporary holding cells for 'potentially violent criminals' including drug dealers/users. Such a situation is likely to increase the prevalence of violence in the traditional hospital settings, as these facilities are ample grounds for obtaining, or even looting drugs stored for treatment purposes. (Felton 1997).

Stress as an Important Factor in Raising Levels of Violence in health care settings

In evaluating the reasons and factors for the rising levels of violence in health care patients and settings, it is also observed that aside from the patients and their families being responsible for the rising levels of violence, the role of the employees at the hospitals, clinics and other health care settings too plays an equally threatening role. Hospital employees intermediating between the physicians and the patients receive some of the worst forms of verbal and possible physical assaults, but for reasons of their own stress and inability to control, or take charge of an already heated patient-physician environment (Hegal & Ferguson 2000).

Perhaps one of the best explanations for such situations have been provided in the writings of McClure, who in her book titled "Risky Business: Employee Violence in the Workplace" duly notes that employees tend to ignore some of the most common behaviors including those of acting out in the event of a patient getting angry; failure to act and take complete responsibility for the irresponsible behavior towards patients, or their families; failure to make the right choice for adopting a passive or aggressive behaviors as per the requirement of the situation; failing to adopt a rigid and controlling posture when the situations so demands; working under the influence of drugs or alcohol, or even working while still in the stages of withdrawal symptoms.

In a related set of factors, stresses on the part of the employees at hospital settings and other health care facilities is also attributed to such factors as involving in the personal problems of the patients, or suffering from the more greater problems including shortages of equally trained staff. Then there is the tendency of exploiting the availability of drugs at these settings, that more than act as triggers for getting addicted, in turn resulting in the poor performance, getting agitated or charged up for smallest of reasons, or even getting involved in verbal duels with patients and their families. (Hegal & Ferguson 2000).

Thus, checking upon staff profiles before hiring them, training them in such aspects as handling anger and stress, as well as attentively listening to employee problems can serve to significantly reduce any future problems arising out of the employees' faults.

Comments by McClure in her on this particular condition best provide a truly understanding tone for employers and physicians alike as they hire personnel. Thus, McClure notes that "You should be aware of the potential risks when you hire staff, train them in dealing with anger and stress, and be open to hearing about employee problems," (McClure, "Risky Business: Employee Violence in the Workplace")

From the business perspective too, aspects such as planning and pursuing policies that best serve the organization can also help reduce potential dangers that may arise out of hiring employees with unknown backgrounds. More often then not, it is observed that physicians tend to hire employees or assistants, without checking the background, or history of the respective employee. It is only when the employee gets into some sort of real trouble with the patients that the physicians really come to notice as to the true nature, psychology, and background of the employees. Thus, instead of taking a purely medical approach, and limiting themselves to the patient-physician relationship, the same physicians could well check into the background history of the newly appointed employee. Factors such as prior references and working history of the potential employee can well serve to protect a future problem from getting worse simply because the respective employer failed to carry out a simple background check on his or her employee (qt. Hegal & Ferguson 2000).

Identifying and Controlling Violence in Employees

According to the survey carried out in the United States by the Bureau of Labor Statistics (BLS), and duly confirmed by the National Institute for Occupational Safety and Health (NIOSH), workplace assaults continues to lead as the number two cause of all fatalities, with an average of 20 workers being murdered, and more than 18,000 employees being assaulted every week. These statistics are more than sufficient evidence as to the nature and extent of violence at the workplace, and the following part of the paper will strive to identify some of the factors that become or are a cause for large scale fatalities and casualty amongst the nation's workforce, as well as suggest some controlling measures to curb, and possible limit the expansion of these statistics, and precious lives (Nabb 2000).

A general concept of violence is construed be physical violence, whether at the workplace or at home. Yet, violence could be applied to a number of other acts including but not limited to verbal abuse, threatening behavior, intimidation, and physical assault at the workplace. A broader explanation of each reveals that verbal or written threats could include any expressions with the intention of harming or inflicting harm; threatening behavior may include such acts as showing fists, or the more physical forms such as destruction of other individual's property, or simply throwing the other individual's objects; intimidation, or harassment may include such acts as all behaviors that are meant to embarrass, demean, humiliate, annoy, alarm, or even verbally abuse the other individual including but not limited to bullying, annoying gestures and verbal abuses; and physical attacks can include kicking, pushing, shoving or even hitting the other person.

Some other examples of workplace violence can include such acts as murder, rape, arson, anger related incidents, causing psychological trauma, physical assaults, sabotaging property, vandalism, or as simple acts as swearing and using prank language. (Nabb 2000).

Yet another important aspect in the identification of workplace violence is that it is not the workplace alone that is witness the violence, as work related violence's can also occur at such places as off-site business related functions, conferences, trade shows, or even social events that are some how or the other related to work.

Factors That Give Rise to Workplace Violence

Having briefly discussed the nature of violence at the workplace, and work-related violence, it is imperative to present some of the salient factors that tend to increase as well as initiate violence at the workplace. These may include such factors as employees working during the intermediate periods of organizational change such as strikes and downsizing; working as a taxi-driver; working in health care institutions for example hospitals, social workers and those community workers assigned to visit homes as part of their community work; working in isolated environments such as highway petrol pumps, storage go-downs, and utility rooms; working in locations where alcohol is served such as food and beverage outlets; working with mentally ill or unstable patients such as hospitals, penitentiaries and prisons; working with the public; and working at places where cash, or other valuables, or even drugs are handled, such as cashiers or pharmacists (Simonowitz 1996).

Yet another set of factors that can give to increasing violence at workplace may include late hours, tax return seasons, at the time of performance appraisals; pay days, and important holidays such as Christmas.

Controlling/Preventing Violence at Workplace

One of the most sought after strategies adopted by numerous professionals and management experts alike in controlling and/or preventing violence is provided in the management's commitment, and approach adopted for employees. This commitment is perhaps best exhibited in a written policy statement outlining the primary objectives, aims, and most important of all the responsibilities assigned to each employee, either through an independent contract, or through an agreement with a group of employees (Yody et al. 2000).

Some of the features that should constitute a part of such a written policy may include making a commitment for a regular monitoring and review of the organization's policy; offer employees such incentives as an 'Employee Assistance Program' that can allow the employee to freely discuss and come forward for seeking advice or help for a personal problem; making a commitment for providing support services and assistance in times of violence against the employee; ensure as to how information about any potential risks of violence can be averted; providing assurances with respect to reporting of violence by co-workers or senior employees; providing that no reprisals will be taken when reporting any violence; and most important of all explicitly stating the conditions and consequences when any threatening behavior is adopted or acts of violence committed (Southcott & Howard 2002).

In discussing measures for the prevention of violence at the workplace, with a focus on the employees, it is a general notion that since violence can be predicted, the same can be prevented as well, hence the above set of measures mentioned in the preceding paragraphs. However, there are conditions where violence prevention calls for an altogether different set of strategies including for employees working if far off locations. These prevention strategies can include such activities on the part of the management as keeping a daily roster and keeping a contact person informed about the whereabouts the employee in the field; using/providing a cellular phone enabling the employee to remain in constant touch with headquarters; or if the employee is assigned at a sensitive location, he or she must be provided with adequate protective equipment, devices and if need be arms. (Southcott & Howard 2002).

From the administrative perspective, the employee should be accompanied with other equally able employees, thus reducing the chances for the employee to work alone and inviting violence; and provision of security escorts for late night or early morning workers and keeping the primary working area with suitable lighting arrangements to ward off possible intruders (Yehuda 1999).

From the above, it is thus evident though the principles, strategies and acts at preventing violence at the workplace differ according to the workplace, so do the requisite policies and effective measures for controlling the same. A combination of these measures, some of which have been mentioned in the above paper, thus each measure however effective and practical that may be, entirely depends upon the respective organization and the relationship with the employees. Hence, the best strategy is one that reduces the risks of violence as well as provides maximum set of preventive measures, in turn providing for an ideal working environment.