the patient/client may be feeling quite anxious
•Regimented wake-up calls and bedtimes, rigidly scheduled meal times, predetermined duration of meal times, a set amount of time for personal hygiene, and other routines that may become frustrating to patients/clients, particularly those requiring long-term care
•Noise, sleep disruption
•Lack of information from medical staff concerning diagnosis, care, test results, or prognosis
•Fear of going home
Criteria: Staffing/Staff Attitude
Comments:
Research has shown that healthcare worker’s behavior and actions towards individual clients may increase the chances of violence occurring. It has been theorized that patients that are potentially violent cause staff members, in their anxiety, to assume more authoritarian roles. This is more likely to trigger patient violence because it can increase the patient's feelings of helplessness.
Staff may develop preconceived attitudes or opinions about a client based on small pieces of information example: another staff’s opinion, disagreeable diagnosis, and disagreeable acts in the client’s past. This can lead to repressive or punitive treatment of the client.
Counter-transference has been identified as a possible indicator in the potential for client violence. The staff may project their own angry impulses onto the client and therefore, exaggerate that client’s capacity for violence. This can lead to rejection, which can provoke more violence. The concept of the “self-fulfilling prophesy” readily comes to mind. If you expect the client to behave in a violent manner, and you alter your behavior to be in control, in all likelihood, the client will respond in kind.
Assess for:
•Excessive workloads: may contribute to care givers’ fatigue and diminished ability to identify and subsequently handle potentially violent situations
•Working alone
•Frequent heavy use of medications, restrictions, seclusion and restraints — intrusive and most restrictive approaches
•Strict structure negating a positive milieu
•Expectations of violence as “part of the job” or common occurrence
•Lack of recognition of the possibility of risk, preventing care provider from identifying and intervening at the earliest stage
•Dislike of client
•Projected animosity
•Authoritarian attitude
•Overcontrolling behavior
•Lack of socializing with client (little persontoperson contact)
•Burnout
Triggers for Aggression:
The literature suggests that just as many patients with pre-assaultive behaviours (verbal aggression, high activity level and invasion of personal space) never go on to assault staff as those that do. So what is it that drives the 50% of violent prone clients to assault staff?
It is generally felt that there is a “trigger” that sets off the physical aggression. It is important that you have an awareness of potential “triggers” in your working environment.
One of the strongest triggers is activated when the client perceives that they are being treated with disrespect or unfairly. When healthcare workers are tired or overworked they may become insensitive to their client’s needs. Staff interaction with their clients can thus become argumentative, authoritarian, and in some cases threatening. To maintain our personal safety we must be able to conduct a self-assessment and identify when we are displaying verbally aggressive behaviour and are becoming part of the problem, rather than part of the solution.
Triggers can include:
•Intoxication
•Loss of a central love relationship
•Acute emotional crisis
•Loss of personal power
•Loss of face
•Fear
•Pain
•Physiological states e.g. hunger, thirst, lack of sleep, boredom and unstructured activity
•Staff rejections
•Rejection
•Disrespect
•Crowding
•Irritating patients and staff
•Tasks a patient may not want to perform
These personal attitudes have been effective when working with disturbed individuals:
•Alertness
•Sensitiveness
•Self-Awareness
•Confidence
•Respectfulness
•Belief in Equality
•Genuineness
Violence in the Workplace Self-Assessment
Here are some selfassessment questions to help you to become more aware of your own feelings regarding violence and the violent client.
1)Do I have a constant sense of fear around this client?
2)Do I feel comfortable turning my back on this client?
3)Do I avoid this client?
4)Do I take sides with either the client or the family?
5)Do I feel capable of handling violent, assaultive behavior if it occurs?
6)Do I feel judgmental about the client’s behavior?
7)Do I want to punish the client because of their behavior?
8)Have I become so uptight and anxious about the client that I am distorting his/her behavior in my mind?
9)Am I so angry with the client and with my fellow staff that we can no longer deal therapeutically with the client?
10)How am I coping with the feelings that I have about the client?
Proactive Tip: If you have answered “Yes” to any of these questions it might be a good idea to talk to one of your fellow workers about your feelings. Odds are
