Preventing workplace violence in healthcare

An estimated 81.6% of nurses will experience physical assault, verbal abuse or disruptive or combative behaviors in their careers. Unfortunately, according to OSHA, only 30% of health care professionals report these incidents to a supervisor or manager.

It is important to educate staff and develop and implement well-defined behavior management programs and safety protocols to mitigate the risk of violence. Healthcare workers may:

• Believe that violence is “part of the job”
• Be uncertain about what constitutes violence
• Often believe their assailants are not responsible for their actions due to conditions affecting their mental state 

Why are safety protocols needed in hospitals

All staff should be aware that violence could occur but can be avoided or mitigated through preparation.

Health care professionals are frequently required to respond to individuals demonstrating challenging behaviors.  These could be more appropriately managed with well-defined processes and resources.
How health care professionals respond to challenging behaviors can impact several aspects of patient care and organizational operations, including:

• Improved patient outcomes
• Reduction of workplace violence
• Improved employee engagement and turnover

Common causes of violence in the health care

Violent behavior can stem from various factors, including mental disabilities, frustration, fear, substance abuse, trauma or unmet needs. It is vital that nurses understand how to identify possible causes and triggers, utilize de-escalation techniques and manage maladaptive behaviors. The most common characteristic among those who initiate violence is altered mental status, often associated with:

• Dementia
• Delirium
• Substance intoxication, abuse or withdrawal
• Decompensated mental illness

How to mitigate risk

Workplace violence is a complex issue that requires an interdisciplinary approach to create a safer working environment for patients and healthcare professionals. Some of the mitigation techniques could include:

• Shifting from reactive approach to proactive approach to behavioral management
• Reporting, tracking and trending of workplace violence events
• Educating and setting clear expectations with staff, patients and visitors
• Conducting hospital-specific workplace violence and safety risk assessments
• Conducting hospital-specific “Interdisciplinary” violence prevention programs/plans
• Leveraging EMR capabilities to effectively capture patient behaviors, which streamlines communication across the team and enables quick collaboration to create a plan of care for behavior management.

Patient verbal de-escalation techniques

Understanding patients’ needs and utilizing de-escalation techniques is key. Strategies could include:

• Distraction: Ask the patient to take a walk with you to burn energy, find a lost item or introduce them to someone who can help with their concern. Offer food, drinks or activities to give patients a job or duty to help you with. Reduce environmental stimulation.
• Get Assistance: Find someone familiar with the patient or situation. Use familiar names when the patient can’t find a loved one or is wanting to leave.
• Choices: Instead of saying “no” or “you can’t,” provide patients with various options.
• Element of surprise: Use disarming or vulnerable responses like, “You’re right;” “Let’s try that again;” “I’m sorry that happened;” or “Let me help.”

 

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