spitting, biting and severe verbal abuse.
Editorial Comment: Throughout my career I’ve been involved in situations where I have been punched, kicked and almost had my thumb bitten off. I have had ashtrays; books; glasses; chairs; coffee; and pop thrown at me. I’ve been spit at, and on and called every profanity that I was aware of and some that I wasn’t.
•Assaults may be either unprovoked as staff perform their duties or sustained as direct result of staff interventions.
Editorial Comment: I've known fellow workers that have been hit with canes and walkers. While I was working with mentally challenged adults with major psychosis, one of my fellow female coworkers experienced a patient attempting to use her head as a battering ram, trying to knock the bricks out of a concrete wall. While working on a psychogeriatric ward I reached under one elderly fellow’s sheets to see if he was dry and got a “knuckle sandwich” in the face for my efforts.
Let’s look at injuries resulting from these assaults.
The severity of injuries varies greatly. Three degrees of injury have been identified: (physical contact must have taken place)
•First degree: no physical injury detectable.
You might have been pushed or shoved, maybe shaken up, but with no visible injury resulting.
•Second degree: includes minor injuries such as bruises, abrasions and small lacerations.
•Third degree: large lacerations, fractures and loss of consciousness, as well as injuries resulting in permanent physical disability or death.
Proactive Tip: One study indicated that after being assaulted some staff members reported experiencing fright, anger, and apprehension. Sleep disturbances, intrusive memories, and hyper vigilance were also reported. The example that I gave earlier of the young woman who was used as a battering ram would certainly be an example of this. She had headaches and nightmares for a year or so after the incident.
These symptoms have been identified as being associated with Post Traumatic Stress Symptoms (PTSD). PTSD is discussed later in this book.
Definitions of Violent and Aggressive Behaviour
Before we look at the definitions it might be helpful to draw from the area of interpersonal communication known as “assertiveness.”
Behaviorally speaking, an individual who is assertive can establish close, interpersonal relationships; can protect themselves from being taken advantage of by others; can make decisions and free choices in life; can recognize and acquire more of his/her interpersonal needs; and can verbally and non-verbally express a wide range of feelings and thoughts, (both positive and negative).
This is to be accomplished without experiencing undue amounts of anxiety or guilt and without violating the rights and dignity of others in the process.
Abuse, assault and violence are terms used interchangeably in the literature to describe behaviors ranging from verbal abuse and emotional harm, to criminal activities such as common assault (which includes wounding, maiming, disfiguring, or endangering life).
We can consider three terms in helping to define the area of aggression and violence.
These are:
•Assertion
•Aggression
•Violence
1.Assertion is a generic term for all behaviour, as described above, without hostile intent, which is designed to gratify a need.
(Assertion (Latin asserera; claim, affirm) To state positively, To affirm, To maintain insistently)
2.Aggression is a specific form of assertion that has hostile intent.
(Aggression (Latin aggressio; a going towards, attack)
3.Violence pertains to the use of physical force and is the exertion of physical force so as to injure or abuse.
(Violence (Latin violentia; vehemence, ferocity)
The use of definitions vary between organizations, therefore the following definitions will be used to define the behavior that this manual is targeting.
(a)Workplace Violence is:
•a hostile or aggressive behavior resulting in physical or emotional injury to [Hospital] staff members or damage to [Hospital] property. The incident or act may be committed by a patient, resident, volunteer, visitor, physician or staff member and may involve but is not limited to name calling, swearing, threats, use of a weapon, sexual harassment, assault and/or battery, any of which may occur in the normal course of the regular duties and job responsibilities.
(b)Assault is:
•any action by another which creates a situation in which a person has reasonable cause to feel afraid for his or her safety, whether or not an injury (physical or psychological) occurs.
Comment: The two components of assault are the threat and the ability of the person to carry out the threat. Examples of assault are hits, grabs, shoves, kicks, pinches, sexual assaults, threats with an object such as a chair, cane or sharps container, or with a dangerous weapon such as a knife, gun or blunt instrument, any physical injury, and verbal hostility and abuse.
(a)Aggression is:
•the verbal or physical acting out of anger or hostile feelings. Aggressive behavior may be directed towards self, other people or objects and may include everything from: agitation, restlessness, threatened aggression, offensive gestures to destruction of environment, self-abuse and physical injury to others.
Threats:
•Threats generally involve any communication of intent to injure that gives a worker reasonable cause to believe there is a risk of injury. A threat against a worker’s family arising from the worker’s employment is considered a threat against the worker.
Examples of threats include:
•Threats (direct or indirect) delivered in person or through letters, phone calls, or electronic mail
•Intimidating or frightening gestures such as shaking fists at another person, pounding a desk or counter, punching a wall, angrily jumping up and down and screaming
•Throwing and striking objects
•Stalking
•Wielding a weapon, or carrying a concealed weapon for the purpose of threatening or injuring a person
Editorial Comment: Years ago, while working in psychiatric hospital, I received a phone call from a distraught family member of a patient who was incarcerated under a Warrant of the Lieutenant Governor, having committed murder. I was told “I know where you live
