Awareness programs help prevent violence
July 1, 1997 4 minutes read
Awareness programs help prevent violence
Employees, too, can become violent due to stress
Workplace violence as an occupational hazard in hospitals is a serious problem (see cover story), but hospitals also could be the site of employee-perpetrated violence. Prevention programs can approach the problem from both perspectives. Either way, training in nonviolent conflict resolution can help prevent and manage incidents.
"That’s another whole side of the problem," says Carole H. Patterson, MN, RN, deputy director of the department of standards at the Joint Commis sion on Accreditation of Healthcare Organizations (JCAHO) in Oakbrook Terrace, IL. "While OSHA [the U.S. Occupational Safety and Health Administration] focuses on protecting the staff of health care organizations, we also have to focus on the violence perpetrated on patients by staff."
Many such incidents are caused by nursing staff, aides, and orderlies, Patterson says.
"It includes nurses giving patients an overdose to end their suffering, or an orderly sexually assaulting an elderly patient. These horrible things appear on the front pages of our newspapers. They are happening in health care organizations, and patients have a right to expect to be secure in those organizations," she states.
Extreme stress also can lead to violence among workers. Spurred by a variety of job and personal stressors, workers can lose control, become irrational, and engage in behaviors ranging from sabotaging hospital policies to threatening supervisors to physically assaulting patients or co-workers. (See related story in Hospital Employee Health, July 1996, pp. 82-84.)
Two task forces are addressing both aspects of hospital violence at Baptist Medical Center in Columbia, SC, says Bev Thames, RN, COHN-S, occupational health nurse at the 2,500-employee facility.
The stress task force was formed in January 1996 to help employees identify and manage their own stress, as well as stress that affects them in the hospital and at home.
"The thought is that if employees do not manage their stress, they may become perpetrators of workplace violence. If we don’t address the stress levels of employees, there’s a potential for assaults on patients. Someone is going to be the victim, and it could possibly be a patient," Thames says.
The hospital’s "Stress-Busters" program for employees focuses on boosting morale with mood-brightening events such as luau day, random acts of kindness day, and handshake/hug day, she says, often combined with distributing information on serious topics such as managing depression.
The hospital’s violence task force focuses more on preventing workers from becoming victims of violence perpetrated by patients or visitors. Metal detectors are being installed in the emergency room, where a security guard is posted at all times. Awareness training is being developed for all employees, modeled after programs already in place for workers on the hospital’s large psychiatric unit. Special training will be given to home health care employees, who often are alone in a patient’s home or community when confronted with violence.
Programs emphasize dignity, respect
The National Crisis Prevention Institute Inc. (CPI) in Brookfield, WI, offers both a "Street Smart" program and a nonviolent crisis intervention program for employees of hospitals and other industries prone to violence.
"Both programs emphasize treating people with dignity and respect," says Linda Steiger, MS, CPI director. "If you don’t treat people with dignity and respect, it can come back to you as a manager or supervisor. There are ways to give employees bad news or positive discipline measures without taking away their dignity. There are ways to interact with people without degrading them or being condescending. Many hospitals are concerned about this due to downsizings and mergers."
Training includes familiarizing employees with the crisis cycle and how to prevent a potentially violent situation from escalating. (See ten tips for crisis prevention, p. 76.) Both CPI programs focus on managing human behavior, Steiger says. The key is to be proactive and to try to minimize the potential for violence as much as possible.
She recommends being aware of areas in the hospital where violence is most likely to occur, such as emergency rooms, where people who are hurt and anxious often have to wait for attention.
"Think about whether someone could be placed in the emergency room to work with people to keep them calm," Steiger suggests. That person should be trained in recognizing the signs that violence could erupt and intervening before that happens.
For example, when people begin fidgeting, pacing, or showing other signs of agitation, let them know you are aware of how long they have been waiting, and tell them how much longer the wait might be.
"Be supportive," she advises. "Once that behavior starts, very few people are going to calm themselves down. When they are becoming anxious, people generally will respond to conversation. Say, We appreciate that you’ve been here for quite some time. It will be about 20 more minutes, and then I’ll be sure to get you in right away,’ rather than saying, Why don’t you just sit down; you’re bugging everyone else.’ Don’t make a judgment on their behavior; just acknowledge that you see they are becoming anxious."
The next step of escalation is defensive behavior, such as verbal acting out, which includes swearing and intimidation. Such behavior shows that people are beginning to lose rational thought processes, but the escalation still can be managed by setting limits and consequences for the behavior.
However, despite one’s best efforts, "things are going to happen. Random acts of violence happen anywhere, in rural or urban areas," she adds. "The best you can do is take steps to minimize the potential."
[Editor’s note: For more information on programs and materials offered by CPI, call (800) 558-8976, or write to: CPI, 3315-K North 124th St., Brookfield, WI 53005.]
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