Responding to Violence and Aggression in the Workplace

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Published: 03 September 2018

No one should have to deal with aggression within the workplace, but healthcare professionals often do.

Violence towards healthcare workers is NOT ok and there should be zero tolerance for it.

Violent incidents are more likely to occur around staff who are directly involved in patient care, namely nurses, emergency room staff and paramedics.

Over the past five years, violent assaults against healthcare workers have increased by 55% in New South Wales, 50% in Queensland and 34% in Victoria (Egan 2021).

The rate of verbal abuse against healthcare professionals is also increasing, with as many as 95 to 100% of emergency department nurses experiencing this type of aggression (Pich et al., cited in ACT Health 2018).

The COVID-19 pandemic has been found to be a significant contributor to these escalating statistics (Larkin 2021).

Violence in the workplace can have many negative effects on an individual. It can affect their physical health, as well as their psychological and emotional wellbeing, resulting in decreased motivation, and anxiety or depression (WHO 2018).

Safe Work Australia (2017) has found that women are significantly more likely to experience workplace violence than men, and 15% of all mental disorder claims by workers are caused by exposure to workplace violence.

There are different strategies that can be used to protect healthcare workers against violence.

These approaches may be in the form of organisational policies such as codes, as well as training for workers who are at increased risk of experiencing some form of violence in their day-to-day work.

One of the ways to decrease violent and aggressive situations is to try to prevent them from occurring in the first place. This may include the use of risk assessments to identify those at higher risk of becoming aggressive or violent, as well as ensuring a calm and supportive environment is provided for patients (Gaynes et al. 2016).

It’s also important to remember that certain medical conditions can potentially cause a patient to become aggressive. These include:

  • Hypoxia
  • Hypoglycaemia
  • Cerebral insults such as stroke, tumour, seizure, encephalitis, meningitis or trauma
  • Conditions causing cognitive impairment such as dementia
  • Sepsis
  • Metabolic disturbances such as hyponatraemia, thiamine deficiency and hypercalcaemia
  • Organ failure (commonly liver or renal failure)
  • Withdrawal from alcohol, benzodiazepines or illicit drugs
  • Drug effects from medications and potential medication interactions.

(Fulde & Preisz 2011)

Man sitting in a chair with his hand on his face in shame

Responding to Aggression and Violence

If you are faced with an aggressive or threatening patient or visitor, here are some important points to consider:

Remember That Your Safety is the Number One Priority

It’s important to always remember your own safety. Call for help and remove yourself from the situation. If you’re interacting with a potentially violent person, make sure you have an unblocked exit route.

Call For Help

Generally, a Code Grey is a coordinated response to actual or potential aggression or violence, whereas a Code Black involves a weapon or serious threat to personal safety. However, it’s is important to note that these codes can vary from state to state in Australia. Always be familiar with the code criteria within the setting in which you are working.

It’s always better to call a code early and cause a false alarm than to call it too late. A code that’s called late often makes the situation a lot harder to get under control again. If there is any doubt about your safety, it’s always safer to call for help early and then remain at a safe distance until that help arrives (ANMF 2017).

Treat Any Suspected or Identified Underlying Conditions

Any medical problems that leave the individual as a danger to themselves or others need to be treated prior to treating the behavioural disturbance (Fulde & Preisz 2011).

Listen

Listen to the person. Active listening is an important component of the de-escalation process. The individual may be aggressive due to fear of their situation, or even due to the fact they have lost control of the situation, so listening to them is an important element of the communication process. Remember that when you are listening, you should avoid giving opinions on issues that are beyond your control (Fulde & Preisz 2011; Lowry 2016).

Acknowledge Their Anger

Make reflective comments and use the words that are spoken by the aggressive individual, but keep these comments brief. Don’t use statements that can be perceived as devaluing the person such as, ‘you shouldn’t be angry’. Instead, use statements like, ‘I can see you are angry’. This type of statement can also be a good opening to explore the person’s feelings, giving them a chance to speak about how they are feeling. When an individual has an opportunity to express their anger, it can often assist in lowering their level of anger, and therefore, decrease the risk of a violent outburst (Lowry 2016).

Don’t Speak

Resist the temptation to fill silences with words… it can be hard! A good strategy to implement is if the silence feels uncomfortable, slowly count down to ten. By doing this, you will often find that the other person will break the silence (Lowry 2016).

Body Language

Make sure you maintain eye contact that is appropriate for the individual and ensure your body language is open and relays both your interest and engagement to the person. For example, a slightly inclined head can show that you are interested and is a non-threatening posture (Lowry 2016).

Empathy

Paraphrasing what the person says to you demonstrates empathy to the patient, as it shows them that their concerns are being listened to and taken seriously. This can also be a strategy to ensure the information you are gathering from the patient is accurate (Lowry 2016).

Other Strategies

  • Offer the person food and drink and a place to sit
  • Avoid overstimulating the person
  • Remember that you can utilise the person’s family and friends to help if required.

(Fulde & Preisz 2011)

After an Incident

Following any sort of incident that involves violence and aggression, it’s important that any staff involved in the situation attend a debriefing session and are followed up with to monitor their physical, psychological and emotional wellbeing. It’s also important that the incident is reported to ensure accurate data collection and quality improvement (Lowry 2016; DoHHS 2017).


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