Nursing Profession and Workplace Violation

Afza.Malik GDA

Work Place Violation in Health Care

Nursing Profession and Workplace Violation

Nursing Profession and Workplace Violation , Violation Workplace Violence  Its Types, Psychological Aspects, Violent Behavior of Patient,Steps At National Level

    Workplace violence is defined as "violent acts (including physical assaults and threats of assaults) directed toward persons at work or on duty" (National Institute of Occupational Safety and Health (NIOSH), 2002). Most workplace violence falls into one of four categories:


Type 1 (Criminal Intent): Results while at criminal activity ( eg , rubbery) is being committed and the perpetrator has no legitimate relationship to the workplace.

Type 2 (Customer/Client): The perpetrator is a customer or client at the work place ( eg , health care patient) and becomes violent while being served by the worker.

Type 3 (worker-on-worker): Employees or past employees of the workplace are the perpetrators in this case.

Type 4  (Personal Rel leading cause of occupational injury death. among all workers and the leading cause among women. Workplace homicides have declined from a high of 1,080 in 1994 to 609 in 2002; on average 846 workers per year have died as a result of homicide since 1992 Notably, 80% of workplace homicides involve the use of a firearm (NIOSH, 1996).

Steps At National Level

    Nonfatal assaults are much more common than fatal assaults. Although both share many of the same risk factors ( eg , contact with the public, working with volatile people, working in small numbers, and working in community-based settings) health care. rather than retail workers represent the majority of victims of nonfatal workplace violence. According to the Department of Justices 

National Crime Victimization Survey (NCVS), 1.9 million incidents of workplace violence occurred in the workplace each year from 1992-1996 ( Warchol , 1998). Twelve percent of all victims reported physical injuries; 6% of the workplace crimes resulted in injury that required medical treatment, and only 44% of all incidents were reported to the politics.

Statistics of Past

    Workplace violence is a documented occupational hazard in the health care and service sectors (NIOSH, 2002; Lipscomb & Love, 1992; Warchol , 1998). The health care sector leads all other industries in nonfatal workplace assaults. In 2000, 48% of all nonfatal injuries resulting in days away from work from violent acts and assaults occurred in the health and social service sector (BLS, 2001), 

The incidence rate for violent acts and as saults resulting in days away from work was 9.3 per 10,000 full-time workers for health services workers compared to an overall private sector injury rate of 1 per 10,000 full-time workers (BLS), Among victimizations reported in the NCVS, mental health professionals had an incidence rate of 79.5 per 1,000 workers compared with an overall rate of 14.8 per 1,000 workers. 

Nurses had an incidence rate of 24.8 per 1,000 workers, the highest rate in the "medical" category ( Warcholl . Violence in mental health has an extensive history, with the first documented case of a patient fatally assaulting a psychiatrist in 1849 (Bernstein, 1981 ).

Until the 1990s, most studies that examined the risk of violence to psychiatrists and other therapists focused on the victim's role, the assaultive patient's characteristics, and contextual factors surrounding the assault.Only recently have environmental risk factors been a focus of research and nurses and aides the subjects of study.

    Bentley and colleagues (1997) compared the number of workers compensation claims from a Washington State psychiatric hospital, formal incident reports, and the number of incidents of assault reported on a survey measuring attitudes and experiences related to assaults. She found that 73% of staff surveyed reported at least a minor injury related to a patient assault in the past year. 

Only 43% of those reporting moderate, severe, or disabling injuries related to assault filed a workers compensation claim. The survey found an assault incidence rate of 437 per 100 employees per year, a rate that underestimated incident reports of assaults by a factor of more than five ( Bensley et al.).

    Environmental and organizational factors have been associated with patient assaults, including understaffing (especially during times of increased activity such as meal times), workplace security, time of day, unrestricted access to movement and transporting patients (NIOSH, 2002).

    SS Lee, Gerberich , Waller, Anderson, and McGovern (1999) found that among 105 nurses who had filed a workers compensation claim for work-related assault injuries, the presence of security personnel reduced the rate of assault while the perception that administrators. 

    Considered assault to be part of the job, having received assault prevention training, a high patient/personnel ratio, working primarily with mental health patients, and working with patients who had a long stay in hospital increased the risk of assault.

Violent Behavior of Patient 

    The one patient characteristic that has been singled out as a strong risk factor for violence is a history of violent behavior. A number of studies have documented that a small number of patients are responsible for the majority of assaults ( Hillbrand , Foster, & Spitz, 1996).

     Drummond, Spart, and Gordon (1989) examined an intervention designed to identify patients with a history of violence and found that flagging charts of patients with histories of assaultive or disruptive behavior reduced assaults against staff by 91%.

Psychological Aspects

    Many psychiatric settings now require that all patient care providers receive annual training in the management of aggressive patients. However, few studies have examined the effectiveness of such training. Those that have generally found improvement in nurses knowledge, confidence, and safety after taking an aggressive behavior management program ( Hurlebaus & Link, 1997). 

    Carmel and Hunter (1990) examined the relationship between participation in training and aggressive behavior by inpatients on 27 inpatient wards in a California State hospital and found that wards with higher staff attendance at the training experienced lower rates of injury. Lehmann et al. (1983) found significantly higher knowledge and confidence in trained staff.

Research Results

    Runyan, Zakocs , and Zwerling (2000) re viewed 137 papers mentioning violence prevention intervention and found that only ten of the papers reflected databased intervention. 

    All interventions took place in health care; five studies evaluated violence prevention training interventions (including Lebmann and colleagues, and Carmel & Hunter), three examined post incident psychological debriefing programs, and two evaluated administrative controls to prevent violence. All were quasi-experimental, without a formal control group and with equivocal findings.

Research Evaluation

    Research evaluating intervention directly at the primary, secondary, and tertiary prevention of violence across health care settings is critically needed to reduce workplace violence and ultimately improve patient care. A secure and healthy work environment is essential to a positive environment of care.

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