Because health care professionals often have to deal with emotionally and mentally disenfranchised individuals, a lot of caring human service personnel is at high risk of being violated and assaulted. Thus, from 1996 to 2000 the U.S. health care services industry has counted 69 homicides committed at the workplace (James & Gilliland, 2013). Although according to the statistics, the violent crime in health care services has been decreased in the recent years, non-fatal assaults in health care and social services take place for nearly a half of all occupational assaults. Therefore, the topic of violence in the workplace should be properly researched and analyzed in order to understand its reasons, as well as find the ways to its resolution.
The Precipitating Factors
According to the American Psychological Association, “between 35 and 50 percent of psychologists in clinical practice had reported being assaulted” (James & Gilliland, 2013, p.542). Besides, a lot of health care workers, who are not assaulted directly, suffer from the large psychological tension associated with the threats of being assaulted. Although the health care workers have received the right to terminate the therapeutic practice if they are threatened by the potential assault, the denial of the practice is not the resolution of the problem (Crow & Hartman, 2005).
Among the precipitating factors of the occupational assaults in health care services, the main factors are substance abuse and mental illnesses. Thus, because of the disinhibiting effect of the intoxication, the substance abuse patients are more inclined to display aggression, impulsivity, and, hence, show higher rates of violence and assaults than non-abusers (Rugala, 2003). Besides, the role of mental illness is considerable in violence, as according to the evidence “a subset of mentally ill people will and do become violent” (James & Gilliland, 2013, p. 542). Although personality issues differentiate depending on the type of the mental disorders, most of them involve the patient’s disability to control his/her emotions. Hereby, the issues such as delusions, violent fantasies, and dementia are often the prerequisites for the increased violent behavior. The gender cannot be considered as a significant precipitating factor, as according to the latest research, women can assault the staff with the same probability as men do ” (James & Gilliland, 2013). Other precipitating factors are gang participation, prison overcrowding, as well as deinstitutionalization.
The health care institutions have a lot of unresolved issues that contribute to the display of violence at the workplace. The core questions include time and financial burdens associated with the safety measures, the managerial problems, such as lack of structural organization of the health care service activities, unclear distribution of staff roles, and downsizing of personnel, as well as underestimation of the needs of both mentally ill patients and health care staff who have to care for them (Rugala, 2003). Moreover, schools and universities do not report on crimes occurred on the campus, which also leads to the rise of the general violence in the industry (James & Gilliland, 2013). All these things influence largely on the mood of the staff, which, in turn, transfers its frustration to the patients, thus complicating the situation even more.
The behavior of the health care service providers can also provoke the violent behavior of their patients (Crow & Hartman, 2005). According to the most philosophical theories, people are treated the way they deserve. Consequently, if the service workers behave in a caring, well-intentional way towards their patients, they will also receive a positive response from the patients (James & Gilliland, 2013). Eventually, the specialists cannot always know what can provoke the violent response of the patients. In many cases, the provocation is the treatment conducted in an authoritative manner, restriction of the patient’s setting and personal borders, as well as any other show of coercion, control, and constraint on the part of service workers. Therefore, the health care specialists should always provide sympathetic treatment and care.
Employers, who work in health care, are responsible for both the service they provide to their patients, as their unconsidered actions can provoke the patients’ violent behavior, and for the service they provide to their employees as the lack of their informational support can lead the unpredictable hazards, as well (Crow & Hartman, 2005). The example of such legal liability is the lawsuit brought against the clinician of health care service by his coworker, who claimed that he was assaulted because the clinician did not provide him the information about the history of the client’s illness and, hence, he was not prepared to the possible hazard (James & Gilliland, 2013). Hereby, such lawsuits are often resolved in favor of claimers due to the increase of the workplace violence in health care institutions. The legal liability should stimulate the health care service providers to make appropriate records of the patients’ violent acts, to share this information among all the employees involved, as well as take measures to eliminate, or decrease the patients’ violent behavior.
Nine-stage Model of Intervention
While handling with the patients’ violence, the researchers differentiate three levels of the professional intervention. At the first level, the main task of health care providers is to prevent the possible escalation of the violence. The second level is directed on the reduction of the symptoms of the patients’ violence. At last, the third level contributes to the safety of both the patients and the staff. Hereby, according to the Piercy’s nine stage model of intervention these levels, in turn, include distinct interventional stages such as education, avoidance of conflict, appeasement, deflection, time-out, show of force, seclusion, restraints, and sedation (James & Gilliland, 2013). All the nine stages demand a large expertise and self-control on the part of employees. Hereby, while on the stage of deflection, the specialists should accept, acknowledge, and reflect the patients’ feelings, on the stage of “show of force” they should be more persistent but, at the same time, stay calm and positive.
Thus, the staff holds responsibility for their actions before their patients and coworkers. Collection of workers’ records and experience can be helpful in preventing the possible assault. Overall, the industry of health care should be reformed in such a way that the safety issues could be maintained at all the levels.
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