Violence

Protecting Yourself from Workplace Violence
Lesson Plan and Speaking Notes

The OSHA (Occupational Safety and Health Administration) Act of 1970 states that all employers have a general duty to provide their employees with a workplace free from recognized hazards likely to cause serious physical harm.

Assaults are a serious safety and health hazard in the health care industry. In 2000, 25% of all non-fatal injuries from occupational assaults and violent acts occurred in health care settings.

Why is this? We have many patients who are demented or have psychiatric diagnoses. The times of greatest risk occur during personal care, patient transfers, mealtimes, and at night.

Violence toward staff members primarily comes from patients, but it could also come from family members.

Have you ever been physically abused in the workplace?

A Patient May be Physically Abusive Related to:
Dementia
Poor impulse control
Anger
Depression
Ineffective coping skills

This May be Evidenced by:
History of threats or violence toward others
Body language: Pacing / clenching fists / threatening stances
Patient scratches / bites / hits / kicks / spits / pinches / grabs
Staff / Other patients / Family members / Self
At random times
During personal care

When You Think You May Have Been Injured
Even if you think you and/or a patient may have been injured, you should have your
supervisor fill out an incident report immediately.
Some injuries don't reveal themselves until hours later.
If there were witnesses, have them contribute to the report.
Document the time, place, exact circumstances - describe in detail.

What are some ways you can protect yourself from workplace violence?

Protecting Staff Members

Arrange furniture to prevent entrapment of staff

Avoid wearing necklaces or other jewelry and attire that could be grabbed or pulled

Use a buddy system when caring for potentially violent patients

Learn to recognize warning signs that may lead to assaults - we will review these

Learn the therapeutic response action plan for violent situations - we'll review this also

Goals for a Violent Patient

Patient will have less than one episode / fewer than 3 episodes per shift / per day

Patient will verbalize understanding of need to control physically abusive behavior

Patient will demonstrate effective coping skills

Patient will seek out staff member when agitation occurs

Patient will not harm self or others

Interventions for Violent or Potentially Violent Patients
Monitor and assess the patient
Modify environment
Modify socialization
Modify care
Use therapeutic communication

Monitor and Assess

Monitor patient frequently

Monitor for danger to self and others

Analyze the Event
Analyze key times, places, circumstances, triggers, and what de-escalates behavior:
What was the problem?
Why did patient act this way?
What may patient have been feeling or wanting?
What did patient say indicating why she was upset?
What are the triggers here?
What could be done differently next time?
What helped / what hindered?
Assess patient's needs: Evaluate food, thirst, toileting needs, comfort level, body
positioning, pain

Modify Environment

Adjust room temperature to more comfortable level

Reduce noise

Dim lights

Place pleasant and/or familiar objects in room

Modify Socialization

Patient tolerates ______________ number of people at a time

Amount of personal space needed:

Patient reacts to touch:

Likes to be alone

Modify Care

Staff to introduce self, explain procedures to patient

Give patient as many choices as possible about care

Maintain patient's personal space

Therapeutic Communication

Give positive feedback

Assist patient to verbalize source of agitation and to set goals for more pleasant behavior

Set goal with patient to seek out staff member when agitation occurs

What should you do when a potentially violent patient becomes agitated?

When Patient Becomes Agitated:

Intervene before patient's agitation escalates

Guide patient away from source of distress

Offer to talk with patient

If patient becomes aggressive, walk calmly away, approach patient later

Notify charge nurse of incident, and participate in analyzing event

Nonverbal Indicators of Agitation
Crying
Defensive behavior
Pacing
Fidgeting
Rocking
Tense or strained position
Wringing hands or clenching fists
Frowning, Grimacing
Scared, fearful, or alarmed expression
Tightly closed eyes
Wrinkled forehead