Violence in Healthcare Part 1: Risk Factors & Warning Signs
Once you have an understanding of the risk factors and warning signs that may lead to workplace violence in a healthcare setting, it’s imperative to implement a plan to prevent and intervene in these situations to provide a safe environment.
Environmental Intervention
A number of environmental interventions can reduce the risk of violence to healthcare providers. These measures can help healthcare workers safely and effectively manage possible assaults.
| Create calm, quiet environment that is nurturing and healing. | Avoid pointing a finger or making a fist. |
| Use verbal intervention with scripts. | Stay at eye level with patient, but avoid direct eye contact. |
| Use verbal reassurance. | Ask permission for certain activities. |
| Show concern for patient’s welfare. | Give short, assertive, nonthreatening directives. |
| Use defusing techniques. | Acknowledge that patient is angry. |
| Offer patient safety, control and decision-making. | Note that patient’s anger is justified. |
| Give patient something to do. | Point out that the anger is working against patient’s care. |
Sometimes a simple show of compassion and acknowledgement of a patient’s distress can go a long way in diffusing their anger.
Violence Prevention
Healthcare institutions have the responsibility to provide a safe environment for the staff and patients. They can reduce violence in a number of ways, including staff education, environmental modifications and the use of security.
Violence Prevention Programs and Education
Institutions have a responsibility to develop, promote and monitor programs to reduce violence in their facilities.
- Outline a comprehensive plan for maintaining security in the workplace.
- Assign responsibility and authority for the program to individuals or teams with appropriate training and skills.
- Affirm management commitment to a worker-supportive environment.
- Set up company briefings.
Culture
Creating a culture that is intolerant of violence and harassment is a top-down, bottom-up decision. It must exist at the uppermost levels of hospital administration and be widely recognized and understood by each staff member. The organization must have a method by which staff members are encouraged to report inappropriate or dangerous practices without fear of retribution; management must take these concerns seriously and take appropriate action when warranted.
A system that allows behavior to go unchecked, or worse, one that asks for the reports but does nothing with the information, creates a hostile environment. This impacts the quality of work and the resultant quality of care provided to patients. Staff should feel empowered to address concerns with management as a means to bring about real change.
Environment
Some facilities have resorted to metal detection of patients in all or part of their facility. Studies have demonstrated that staff, patients and families have a favorable attitude about the use of metal detectors in the ED. Metal detectors may be placed at all entry points into the hospital or just in the ED. Appropriate policies should address who gets scanned, at what point they get scanned, and what is done with weapons that are found. It is important that metal detection be performed in a non-biased fashion to ensure there is no concern about discrimination; for example, scan all patient populations, not only those that may seem threatening.
Security
All hospitals have some form of security on their premises; this may include cameras, restricted access or controlled access points. The security plan needs to be well thought out and reexamined on a yearly basis. Those who perform this function vary from receptionist to armed police; just as varied is their level of qualification, training and experience.
Security drills are another means to keep the staff focused on potential security problems and appropriate responses when faced with a security threat; examples of drills include hostage situations, man with gun, suspicious packages, gang violence, etc. This provides opportunities to be proactive about what should be done when security threats occur. Debriefing and continued education help reinforce lessons learned.
Medical-Legal Context
Medical-legal issues can arise at any point when patients, families or care providers enter a healthcare institution. The steps in addressing workplace violence include:
- Prevention
- Education
- Intervention
- Recovery
While workplace violence incidents are bound to occur in the healthcare setting, organizations have a responsibility to employees, patients and visitors to provide a safe and secure environment. Education and security measures can go a long way in not only protecting these individuals, but also in avoiding expensive lawsuits.
Interested in learning more for CME?
Review our course: Workplace Violence in the Healthcare Setting
