This paper is written with the main purpose to present a position on a very scary issue of patient violence against nurses. The main aim is to convince the readers and the entire audience that the position stated is valid. The discussion the paper will provide disapproves the traditional thought among the public that the nursing profession is a safe heaven and regarded as a place for protection and care. The discussion will form the foundation of my position on the existence of continual rise of patient violence in many healthcare facilities.
According to Royal College of Nursing (Great Britain), & National Collaborating Centre for Nursing and Supportive Care (Great Britain) (2006),the venues with the highest probability of violence in hospitals include the emergency departments, facilities of psychiatry, home offices, private offices of the outpatient, forensic settings, community centers for mental health, clinics for outpatients and general hospitals.
Violence of the patients to the nurses takes many forms. According to Conroy & Murrie, (2007), they include physical, harassment, threats, stalking, frivolous lawsuits, scurrilous and false accusations, complaints to licensure medical boards, vandalism, excessive or abusive letters and phone calls, obscene or threatening mails, loitering, trespassing, home visits and drive-by, display of knowing of the personal life of the nurse. Many cases are being reported on violent crimes such as rape, assaults and homicides especially in the emergency departments and the psychiatry facilities with nurses as the main targets (Tardiff, 1999).
Patient violence against nurses has been a thorny issue in the health sector. Eichelman & Hartwig (1995) gives an overview of the issue when they document the survey done in 2011 by the American nurses association. From the survey, the numbers of registered nurses who have reported cases of assault by the patients were 34%. This represented a rise in assault from 25 % in the year 2001. More shocking results indicate that from the statistics of the government, eight nurses were reported killed in the work place from the year 2003 to the year 2009. In addition to that, 2050 more incidences were reported by the nurses and involved violent assault and harassment (Eichelman & Hartwig, 1995).
Similarly, the report of Bureau of Labor Statistics of 2006 indicates that 60% of the assaults in work place took place in the healthcare and most of them were as a result of the patient’s violence (Crichton, 1995). Moreover, the occupations of the healthcare support had a 20.4% injury rate due to assaults and the practitioners of the healthcare had a 6.1% rate. This is just the results from the reported cases and this figure could be large due to underreporting form the nurses due to the general perception that the assaults forms the part of work in the nursing profession (Babich, 1981). My argument from these statistics is that the nurses and the healthcare practitioners in the health profession faces a monster of a problem which is underrated but affects their performance in their bid to deliver services to the patients.
The issue of the patient violence is further validated by Richter& Whittington (2006) when they point out that the nurses in the emergency departments of the hospitals experience the highest rate of physical assault. Furthermore, Richter & Whittington (2006) observes that 28% of nurses working in the emergence departments reported that they have been victims of physical assault for the past one year.
Violence in Emergency Departments
In the hospital set up, patient violence to the nurses is a great issue that needs to be discussed soberly. Eichelman & Hartwig (1995) points out that the studies conducted by many bodies indicates that the nurses and other healthcare professional assigned in the emergency departments experience the highest level of violent patients. This is because evaluation and treatment of the violent patients that are of high risk are initially done at the emergency department. Furthermore, the patients brought by the police often in handcuffs are directed to the emergency department.
Crichton (1995) observes that the emergency department is always open to the public and therefore the population of the patients and the third parties accompanying the patients are in most cases not screened for violence potential. Furthermore, therapeutic alliance to mitigate the violent impulses of the patients is not always present. Therefore, the patient may view the nurse at the emergency department as an enemy and not as a medic trying to help.
Babich, (1981) points out a research which was done in Henry Ford Hospital in Detroit for six months. The research entailed screening of the patients at the emergency department by magnetometer. The shocking results revealed that 33 handguns, 97 sprays of mace type and 1324 knives were discovered (Babich, 1981). This clearly validates the argument of the potential violence that healthcare professionals are constantly exposed to.
Resentment from nurses
It is saddening that the nurses who offer to care for the sick at the hospitals are violated by the same patients they take care of. The violence affects the hospital governance, healthcare professionals and the patients. According to Richter& Whittington (2006), the nurses who are mostly violated do experience physical injury, chronic pain, disability, muscle tension. Moreover, the nurses also suffer from psychological problems such as nightmares, lack of sleep and flashbacks associated with the patient’s violence (Tardiff, 1999). According to Conroy& Murrie 2007), the health workers assaulted by the patients experience long term and short term emotional reactions such as sadness,anger,frustration,irritability,anxiety,apathy,helplessness and self blame. From the discussion, the assaulted nurses are most likely to suffer from role stress, occupational strain, anger, decreased feeling of being unsafe, dissatisfaction with the job, and future of being assaulted in future.
Contrary to the public view that a patient would not desire to harm a nurse or any other health worker, my position still hold that there is rampant violence toward the health care workers from the patients. To validate the argument, the paper continues to elaborate on the facts to support the argument.
The cases of patient violence cannot be dismissed so easily. All facts and evidence portrays the existence of the patient violence towards the health workers. Patients who have taken alcohol or which portrays syndromes of toxic drugs and violent behaviors is common in the hospitals set up. Moreover, the accompanying persons to the patients sometimes can be more violent than the patient (Eichelman & Hartwig, 1995).
Violent psychiatry patients
Additionally, according to Royal College of Nursing (Great Britain), & National Collaborating Centre for Nursing and Supportive Care (Great Britain) (2006), some of the validating factors to the patient violence that are common are cases of the psychiatric patients. They endure the long queues or wait for long in the ever busy emergency departments with noisy hallways before they are attended to. It is senseless because some of the psychiatric patients wait for up to 24 hours before evaluation is done on them. This can prompts already angry patients to be enraged and become violent.
Nurses encounter many disgruntled, deranged and angry patients (Crichton, 1995). Furthermore, the reasons for the violence against nurses are diverse because violence is a function of the interactions between a specific situation and individuals and are dynamic. Patients with the feeling that they have been psychologically or physically injured have highest risk of violating nurses especially if they happen to report and their reported complaints were dismissed (Babich, 1981).
Fear and helplessness
According to Richter & Whittington (2006), sometimes a patient may feel helpless or fearful in the process of undertaking treatment. These feelings come about especially when some painful intrusive procedures are being applied in the process of giving treatment care to the patients by the nurses. Consequently, fear and helplessness on the patient may result to violence as a means of venting out the fear and the accumulated stress in the hand of the nurses. This strongly supports the argument’s position of patient violence on nurses. For instance, this is prevalent in minor surgeries and during injections especially to the adolescents. Their fear eventually leads to violence.
Continual existence of the internet and its daily evolutions strongly supports debate on the patient violence on the nurses. Violence does not necessary have to be physical, it can be done online. Tardiff (1999) observes that a patient who wants to harm the nurse can do online cyber snooping and will be facilitated by online forums, search engines, chat rooms and discussion boards. Moreover, internet sources where people expose their personal information such as the social sites like face book, MySpace, linkedIn and twitter exposes the nurses to variety of physical and psychological harm. Conroy & Murrie (2007) points out the assaults that can be done on the internet and they include:
- Derogatory statements and false accusations
- Personal information gathering
- Sending of emails, viruses and repeated messages
- False victimization
- Ordering of services and goods in the name of the nurse such as the sex toys and pornographic materials.
Nurse- patient strains
The surprising factor on the issue of patient violence towards nurses is whether the rising cases of patient violence towards nurses is an emblematic representation of a health system that is dysfunctional. Many patients are coming to terms that healthcare has become an essential commodity. In the first place, Eichelman & Hartwig (1995) observes that the relationship of the nurse- patient deteriorates as the nurses are under pressure to attend to more patients in the shortest time. On the other hand, the patients are frustrated rightly and some even lash out.
Management of patients’ violence towards healthcare professionals
- Engage the patient verbally
The threat of patient violence to the healthcare professionals can be countered by many strategies. The basic strategy is engaging the patient verbally. According to Royal College of Nursing (Great Britain), & National Collaborating Centre for Nursing and Supportive Care (Great Britain) (2006), it is important to respond actively to threat behaviors which are escalating. Furthermore, encouragement should be done to the patient to verbally respond and give explanation to the threats reasons. Failure of verbal intervention, the nurse should seek other methods discussed below. However, in an event of an attack, pepper sprays and other agents of immobilization should be at hand for protection.
- Conduction of proper inquiry to the severity of the illness
To reduce incidences of patient violence toward healthcare professionals, before a healthcare worker accepts patients for referral treatment or for private consultation, a proper inquiry should be made to determine the severity and nature of the illness, drug abuse, violence history and adherence to treatment (Eichelman & Hartwig ,1995). From the inquiry, a nurse will be able to make a sound judgment whether the patient can be treated as evaluated and later treated as one of the outpatient. According to Crichton (1995), the violence risks to the nurse increases when the patient who is severely ill such as the psychotic patients are evaluated or are treated alone especially during evenings or weekends.
Similarly to manage the patient’s violence toward the nurses, Babich, (1981) advises that it is prudent to recognize the escalating violence of the patient such as threats, agitation and the violation of the nurses’ personal space. The ethic of “does no harm first” and the therapeutic zeal can lull a nurse into a sense of security which might be false. In addition, a nurse requires the presence of a third party which is reliable in doing the initial evaluation to unknown patient with mental illness which are severe. There is need of the nurse to be cognizant but not over cautious about the ever presence of potential patient violence towards the healthcare professionals (Richter & Whittington, 2006).
- Safety management plan
Similarly, in the bid to prevent the patient violence towards healthcare workers, a safety management plan carefully thought is necessary. Although experiencing patient attack by most nurses during their medical career do not happen, consulting the safety expert on the issue of safety should be considered. As the nurse practice more and continue the number of years in nursing, the higher possibility of encountering patients who are disgruntled or deranged. More risk factors to nurses include the type of patients the nurse treats, year of practice and the style of managing the patient by the nurse (Tardiff, 1999).
According to Conroy & Murrie (2007), it is fallacious to generally think that all patients treated are grateful. In contrast, some patients are always angry and even blame the nurse for their illness. In the proposed safety plan, the nurse must consider his or her physical condition and age during the process if determination of his or her ability to escape from the assault or fend him or herself.
In addition, Eichelman & Hartwig (1995) is of the opinion that safety plan is important on nurses who offer their services to patients at night. It is important that the offices have two free doors. One open door should lead to the area of the receptionist and another locked door leading to the office of the nurse. Furthermore, the second door should be fitted with a peephole to see the persons in the reception area. A buzzer system or an alarm that can alert the police or the security personnel should be fitted within the offices of the nurses. Similarly, a warning light or a silent alarm can also be fixed in place to be used in warning the receptionist or the security.
According to Royal College of Nursing (Great Britain) & National Collaborating Centre for Nursing and Supportive Care (Great Britain) (2006), a safety management plan that is comprehensive should preempt the violence of the patient. For instance, the persons entering the building must prove their identity as well as their intended destination before granted access to the offices. Furthermore, the security man should call the office of the healthcare professional to verify if the individual is known to the nurse or any other staff member and has a scheduled or a pre planned appointment. However, in addition to installation and adoption of the sound safety management plan, every healthcare professional should do extra for their own personal safety.
- Understanding the psychodynamics of violence
As noted by Crichton (1995), violence is most often a reaction to helplessness, passivity, humiliation and fear. In prevention of the risk factors, the nurse should do violence prodome to provide the nurse with an opportunity for intervention before violence outbreak. The components of prodome which can alert the nurse include the escalation of verbal abuse, anxiety and agitation. According Babich, (1981), the risk factors that are associated with violence include:
- History of violence
- Substance and alcohol abuse
- Stated desire to kill or harm another
- Personality disorders particularly borderline and antisocial
- Paranoid ideation
- Fear of humiliation and harm
- Organic brain disorder
Understanding the psychodynamics of violence by nurse will form the intervention strategies. According to Richter & Whittington (2006), the presence of a nurse can both act positively or negatively. The patients’ view of the nurse can be of a savior or a devil. Therefore the therapeutic alliance presence or absence to a patient can be powerful and a protective factor. Angry, disgruntled and treatment rejecting patients are prone to lawsuits filling against the health professionals (Tardiff, 1999).
Eichelman, B., & Hartwig, A. C. (1995). Patient violence and the clinician. Washington, DC: American Psychiatric Press.
Crichton, J. (1995). Psychiatric patient violence: Risk & response. London: Duckworth.
Babich, K. S. (1981). Assessing patient violence in the health care setting. Boulder, Col: Western Interstate Commission for Higher Education.
Richter, D., & Whittington, R. (2006). Violence in mental health settings: Causes, consequences, management. New York: Springer.
Tardiff, K. (1999). Medical management of the violent patient: Clinical assessment and therapy. New York: M. Dekker.
Conroy, M. A., & Murrie, D. C. (2007). Forensic assessment of violence risk: A guide for risk assessment and risk management. Hoboken, N.J: John Wiley & Sons.
Royal College of Nursing (Great Britain), & National Collaborating Centre for Nursing and Supportive Care (Great Britain). (2006). Violence: The short-term management of disturbed/violent behaviour in in-patient psychiatric settings and emergency departments. London: Royal College of Nursing.