protection literature i.e. the Three A’s (Awareness, Assessment, Action.)
We will be using the following icons as road maps to keep us focused on our journey together.
We begin with an overview of violent and aggressive behaviour within the healthcare field. We then explore methods and criteria for assessing the potential of violence. It progresses into Crisis! What Crisis? an exploration of the nature of crisis and systematically develops strategies to effectively diffuse a crisis.
We discuss a newly recognized form of workplace violence, that of bullying and horizontal/vertical violence. This develops into an exploration of two possible consequences of workplace violence: Post Traumatic Stress Disorder (PTSD) and “burnout”.
Finally, therapeutic communication skills are explored and we look at proactive techniques and resources that you can utilize in developing a violence prevention program for your particular worksite.
Throughout this manual I have used what I refer to as the “onion” method of instruction. That is, we look at a particular point, explore it, then peel back another layer and study it once again, perhaps from a different angle. It is important to note that many of us likely believe that violent behavior comes without warning and from the least expected source. This isn’t always true. The warning signs are there if we are tuned to them.
We need to be vigilant and proactive in our goal to prevent workplace violence. This is a practical manual in dealing with workplace violence. You will find extensive use of bulleted lists and checklists. Some of these lists are called “Quick Lists.” This has been done intentionally so that you can take them and use them as a tool in your work-site. Start talking about violence in your workplace. The silence has gone on for far too long!
Author’s Note* This manual has developed from many years of personal experience by the author. Much of the information has been gleaned from other sources and repackaged into a form that is practical, yet easy to use.
Whilst every effort has been taken to ensure accuracy in the preparation of the material in this manual, the author shall neither have liability nor responsibility to any person or entity with respect to any loss or damage caused or alleged to be caused directly or indirectly by the information contained within.
The purpose of this manual is to educate and suggest strategies to reduce the likelihood that you will be injured at work. It does not constitute a definitive or authoritative statement of the law. The information is offered as strategies you might like to consider and should not be held as expert.
Rae A. Stonehouse RN.
Chapter Two
OVERVIEW: THE PROBLEM OF VIOLENCE IN THE WORKPLACE
There is a disturbing trend in our society towards violence and it is clearly reflected in the growing number of incidents of physical, verbal, and emotional acts of violent, aggressive, assaultive and/or threatening behavior being reported to police.
A report by the Ministry for Women’s Equality [British Columbia, Canada (1999)] noted that one in four women is the victim of domestic violence. Sadly, this trend is reflected in the growing violence against health care providers, most of which are women.
In community care settings, incidents are also on the rise as community care providers care for more high risk clients. Incidents involving aggressive language, slapping, biting, and kicking, while less frequently reported, are also part of the violence toward health care providers.
Statistics would seem to indicate that violence within healthcare is on the rise. I was taught to be wary of statistics. There is an old adage “Figures never lie, but liars can figure.” Now, I’m not saying that statisticians are liars but statistics can be used to illustrate any point. The biggest criticism against current workplace violence statistics is that they do not reflect the true picture.
One reason cited is that violence in the workplace will not always be reported to the employer. The worker may see the event as trivial, or accept some amount or degree of violence as part of the job description. Alternatively, the worker may perceive that there will be no benefit or value in reporting the incident to the employer. Some may feel that they might be blamed for the incident and that their job may be placed at risk if they report it.
Violence at work may also not be reported to the police. Again, the incident may be seen as trivial and as part of the job. Or it may be that the perpetrator of the violence would not likely be charged criminally, given his or her state of mind. This is particularly true of violence from elderly, psychiatric or mentally handicapped clients.
In 1986, while I was working in a psychiatric hospital, a patient purposely attacked and assaulted me. I contacted our local police department and tried to press charges. They just laughed at me and told me that it was part of my job just as it was part of theirs. They said they would press charges if I really wanted to but “why bother the guy was crazy anyway.” I'll leave you to your own thoughts on that one.
Finally, workers are often reluctant to report violence to their Worker’s Compensation Board (WCB). Again, the incident may be viewed as trivial, or as part of the job risk. As mentioned before, how many workers are cautious of reporting because of the idea that they may lose their jobs? It seems to be the new reality that there are people lining up at the door for our job if we can't do it [or some employers would have us believe!] In addition, many workers may see the claims process, i.e. completing the WCB forms, as being too cumbersome. They might bypass this requirement by phoning in sick, utilizing their short term sick leave. You have to wonder how many employers encourage the worker to “book off sick” rather than make a WCB claim. This would keep the employer’s assessment premiums lower. Some workers may erroneously believe that by completing a claims form they are admitting that they were at fault or that blame be placed on them for the incident.
The intent of this manual is to focus on violence in the workplace, specifically in a healthcare setting. Current statistics consistently relate that the nursing profession is composed of 98% women. It is difficult to separate the concept of “work” and “nonwork.” A British Columbia, Canada, initiative “Live Violence Free” from 1998 stated the following facts about Violence Against Women:
Because such a small percentage of violent crime is reported, especially spousal and sexual assaults where women are the primary victims, many of the statistics used in the Live Violence Free information sheets were taken from the Violence Against Women Survey. This 1993 survey by Statistics Canada is the only statistically reliable report on women’s experience of violence.
The survey found that:
•5.38 million Canadian women have experienced violence (of 10.5 m over 18 yrs.)
•One in four Canadian women were victims of assault by a spouse or partner.
•One in three Canadian women were victims of sexual assault.
•Women are the victims in four out of five spousal murders according to 1997 homicide statistics.
•One
