Navigation and a Couple Tips for On-line Modules Navigation Instructions: Whenever you see words in this color and style or this icon in the module click on it for additional information De-escalation and Management of Aggressive Behaviors Module 1: Understanding Workplace Violence in Healthcare, An Introduction Today more than 5 million U.S. hospital workers from many occupations perform a wide variety of duties. They are exposed to many safety and health hazards, including violence. The purpose of this module is to increase worker and employer awareness of the risk factors for violence in hospitals and to provide strategies for reducing exposure to these factors. I

According to estimates of the Bureau of Labor Statistics nonfatal assaults on hospital workers occur at a rate of 8.3 assaults per 10,000 workers. This rate is much higher than the rate of nonfatal assaults for all private-sector industries, which is 2 per 10,000 workers. Health care workers represent approximately 10 percent of the total workforce; they represent over half of all reported workplace assaults Close Hospital workers are at high risk for experiencing violence in the workplace. I

The National Institute for Occupational Safety and Health (NIOSH) defines workplace violence as violent acts (including physical assaults and threats of assaults) directed toward persons at work or on duty. Examples of violence include following: Threats: Expressions of intent to cause harm, including verbal threats, threatening body language, and written threats. Physical assaults: Attacks ranging from slapping and beating to rape, homicide, and the use of weapons such as firearms, bombs, or knives. Muggings: Aggravated assaults, usually conducted by surprise and with intent to rob. I I I I Workplace violence ranges from offensive or threatening language to homicide Domestic Violence can take place at a person’s place of work. Approximately one out of four females has at some point in her life been the victim of domestic violence. Healthcare organizations typically have a large number of female employees. Although men are also victims of domestic violence, it is not to the same extent. Close

In other workplaces such as convenience stores and taxicabs, violence most often relates to property crime. Violence in hospitals usually results from patients and occasionally from their family members who feel frustrated, vulnerable and out of control. Who is at risk? Although anyone working in a hospital may become a victim of violence, nurses and aides who have the most direct contact with patients are at higher risk. Other hospital personnel at increased risk of violence include emergency response personnel, hospital safety officers, and all health care providers. Violence may occur anywhere in the hospital, but it is most frequent in the following areas: Psychiatric wards Emergency rooms Waiting rooms Geriatric units Where does violence occur? I I The circumstances of hospital violence differ from the circumstances of workplace violence in general.

Violence may also have negative organizational outcomes such as low worker morale, increased job stress, increased worker turnover, reduced trust of management and coworkers, and a hostile working environment. I The effects of violence range in intensity. The effects of violence can range in intensity and include the following: Minor physical injuries Serious physical injuries Temporary and permanent physical disability Psychological trauma Death

Be aware of risk factors for workplace violence The risk factors for violence vary from hospital to hospital depending on location, size, and type of care. Common risk factors for hospital violence include the following: Working directly with volatile people, especially if they are under the influence of drugs or alcohol or have a history of violence or certain psychotic diagnoses Working when understaffed—especially during meal times and visiting hours Lack of staff training and policies for preventing and managing crises with potentially volatile patients Transporting patients Long waits for service Overcrowded, uncomfortable waiting rooms Working alone Poor environmental design Inadequate security Drug and alcohol abuse Access to firearms Unrestricted movement of the public Poorly lit corridors, rooms, parking lots, and other areas put workers at risk.

To prevent violence in hospitals, employers should develop a safety and health program that includes management commitment, employee participation, hazard identification, safety and health training, and hazard prevention, control, and reporting. Employers should evaluate this program periodically. Although risk factors for violence are specific for each hospital and its work situation, general prevention strategies can be applied in the areas of: Develop emergency signaling, alarms, and monitoring systems. Install security devices such as metal detectors to prevent armed persons from entering the hospital. Install other security devices such as cameras and good lighting in hallways. Provide security escorts to the parking lots at night. Design waiting areas to accommodate and assist visitors and patients who may have a delay in service. Design the triage area and other public areas to minimize the risk of assault: — Provide staff restrooms and emergency exits. — Install enclosed nurses’ stations. — Install deep service counters or bullet resistant and shatterproof glass enclosures in reception areas. — Arrange furniture and other objects to minimize their use as weapons. Close Behavior Modifications Click on each below: Design staffing patterns to prevent personnel from working alone and to minimize patient waiting time. Restrict the movement of the public in hospitals by card-controlled access. Develop a system for alerting security personnel when violence is threatened. CLOSE Environmental Designs Administrative Controls Provide all workers with training in recognizing and managing assaults, resolving conflicts, and maintaining hazard awareness Close Workplace violence prevention strategies at an organizational level enhances staff safety

Violence may occur in the workplace in spite of preventive measures. Employers should be prepared to deal with the consequences of this violence by providing an environment that promotes open communication and by developing written procedures for reporting and responding to violence. Employers should offer and encourage counseling whenever a worker is threatened or assaulted. Workers should make use of such support. Be prepared for workplace violence

Take these steps if you can’t defuse the situation quickly: All workers need to know basic safety steps to maintain safety. These safety step include: Prevent workplace violence by following a few safety tips Watch for signals that may be associated with impending violence: Maintain behavior that helps diffuse anger: Be alert: Evaluate each situation for potential violence when you enter a room or begin to relate to a patient or visitor. Be vigilant throughout the encounter. Don’t isolate yourself with a potentially violent person. Always keep an open path for exiting—don’t let the potentially violent person stand between you and the door. Click here to close Verbally expressed anger and frustration Body language such as threatening gestures Signs of drug or alcohol use Presence of a weapon Click here to close Present a calm, caring attitude. Express your intent to help Don’t match the threats. Don’t give orders. Acknowledge the person’s feelings (for example, “I know you are frustrated”). Avoid any behavior that may be interpreted as aggressive (for example, moving rapidly, getting too close, touching, or speaking loudly). Click here to close Remove yourself from the situation. If person is a danger to self or others attempt physical restrain only if you have been trained to do so. Call security for help. Report any violent incidents to your management. Click here to close

Summary All hospitals should develop a comprehensive violence prevention program. No universal strategy exists to prevent violence. The risk factors vary from hospital to hospital and from unit to unit. Hospitals should form multidisciplinary committees that include direct-care staff as well as union representatives (if available) to identify risk factors in specific work scenarios and to develop strategies for reducing them. All hospital workers should be alert and cautious when interacting with patients and visitors. They should actively participate in safety training programs and be familiar with their employers’ policies, procedures, and materials on violence prevention. Preventing workplace violence strategies takes organizational and individual effort

This module is provided without charge as a service of Change Dynamics for use by individuals and organization wishing to enhance their effectiveness in the topics presented. We believe that the information in this and other modules in this series is a small part of complete training in the topics covered. Complete training requires further explanation and clarification of the principles, and demonstration of and practice in the skills presented. Change Dynamics provides consultation and instructor led training in the following: Preventing and Responding to Workplace De-escalation and the Management of Aggressive Behavior: Verbal De-escalation and Physical Intervention (Train-the-trainer training available) Reducing the Use of Seclusion and Restraints in Healthcare Settings Conflict Resolution Stress Management This module with additional supporting material, is available in a variety of formats for purchase by organizations wishing to modify it, or make use of it according to organizational requirements. This module also available with audio. For information on consulting and training for your organization, or to purchase this module contact: John Lundholm, M.A., RN: lundholm@juno.com (208)691-4468 About this Module.