The National Institute for Occupational Safety and Health (NIOSH) defines workplace violence as violent acts directed toward persons at work or on duty. Workplace violence is any physical assault, threatening behavior, or verbal abuse occurring in the work setting. A work setting is defined as any location, either permanent or temporary, where an employee performs work-related duties. This comprises, but is not limited to, the buildings and surrounding perimeters, including the parking lots, field locations, clients’ homes, and traveling to and from work assignments. (Anderson, D. 2008).
Workplace violence ranges mostly, from unpleasant or threatening language to homicide. Elements of workplace violence includes beatings, stabbings, suicides, shootings, rapes, psychological traumas, threats or obscene phone calls, fear, irritation of any kind, as well as being confirmed at, shouted at, or followed. Nurses are at the most risk of workplace violence among health care providers .Violence inflicted on employees may come from many sources external parties such as robbers or muggers and internal parties such as coworkers and patients.( Boldt, A., & Schmidt, R. 2006) There are many risk factor of work violence which affecting in nursing in this essay will discuss type of violence and how to prevent the violence in work place.
The reasons for workplace violence and stress are identified at organizational, societal and individual levels, showing complex interrelationships. The accumulation of stress and tension in demanding health occupations ââ‚¬” under strain from societal problems and the pressure of health system reforms ââ‚¬” contribute to emerging violence. At an individual level, health workers tend to rank the personality of patients as the leading factor generating violence, followed by the social and economic situation in the country and, well behind, work organization and working conditions. (Duxbury, J. 2009). However, when categorized into individual, societal and organizational factors, all three contributing factors appear to be of equal importance in the analysis of risks of violence and stress, with organizational factors playing a key role.
Examples of violence in the workplace include the following: Verbal threats to inflict bodily harm, including vague or covert threats Attempting to cause physical harm: striking, pushing and other aggressive physical acts against another person Disorderly conduct, such as shouting, throwing or pushing objects, punching walls, and slamming doors Verbal harassment; abusive or offensive language, gestures or other discourteous conduct towards supervisors or fellow employees Making false, malicious or unfounded statements against coworkers, supervisors, or subordinates which tend to damage their reputations or undermine their authority (Contrera- L., & Moreno, M. 2004).
Type of violence affecting in nursing:
Nursing to nursing which nurse are often the first line of victims. This act of violence can include spousal abuse and child and elderly abuse. Other to nurse which violence toward health care professional is extensive, and nurse are frequency the victims. The perpetrators can include patient. Patient families and other health care worker. Nurse to nurse who is difficult for nurses to discuss violence against other nurse.horizantal aggression is define as aggressive behavior that one registered nurse commits against another in the work place.( Duxbury, J. 2009). The aggressive behavior may be verbal. Non verbal or physical. It may be expressed directly toward another person or indirectly toward their property or work. The behavior can be expressed openly or in more subtle manner. Other type is nurse to other: violence includes patient abuse and neglect with nurse as aggressor.
CATEGORIES OF WORKPLACE VIOLENCE
Workplace violence has many sources. To better understand its causes and possible solutions, researchers have divided it into four categories dependent upon the type of perpetrator like person committing the violence. The four types are: violence by strangers, violence by customers or clients, violence by co-workers, and violence by someone in a personal relationship( Felblinger, D. 2008).
Type I: Violence by a Stranger: In this type of workplace violence the perpetrator is a stranger and has no legitimate relationship to the organization or its employees. Typically, a crime is being committed in conjunction with the violence. The primary motive is usually robbery but it could also be shoplifting or criminal trespassing. A deadly weapon is often involved, increasing the risk of fatal injury.
Type I is the most common source of worker homicide. Eighty-five percent of all workplace homicides fall into this category
Workers who are at higher risk for Type I violence are those who exchange cash with customers as part of the job, work late night hours, and/or work alone. Convenience store clerks, taxi drivers, and security guards are all examples of the kinds of workers who are at increased risk for Type I workplace violence.( Gates, D., Fitzwater, E.etal. 2004)
Type II: Violence by a Customer or Client: In Type II incidents, the perpetrator has a legitimate relationship with the organization by being the recipient or object of services provided by the workplace or the victim. This category includes customers, clients, patients, students, and inmates. The violence can be committed in the workplace or, as with service providers; outside the workplace but while the worker is performing a job-related function. (Hughes, H. 2008).
Violence of this kind is divided into two categories. One category involves people who may be inherently violent, such as prison inmates, mental-health service recipients, or other client populations. Attacks from “unwilling” clients, such as prison inmates on guards or crime suspects on police officers, are examples of this type of workplace violence. The risk of violence to some workers in this category may be constant or even routine.
The other category involves people who are not known to be inherently violent, but are situation ally violent. Something in the situation induces an otherwise nonviolent client or customer to become violent. Provoking situations may be those that are frustrating to the client or customer, such as denial of needed or desired services or delays in receiving such services. (Hegney, D., Tuckett, A., Parker, D., & Eley, R. 2010).
Service providers, including healthcare workers, schoolteachers, social workers, and bus and train operators, are among the most common targets of type II violence. A large proportion of customer/client incidents occur in the healthcare industry, in settings such as nursing homes, hospitals, or psychiatric facilities. (Woodtli, M., & Breslin, E. 2006).
Type III: Violence by a Co-Worker, Type III violence occurs when an employee or past employee attacks or threatens co-workers. This category includes violence by employees, supervisors, managers, and owners. In some cases, these incidents can take place after a series of increasingly hostile behaviors from the perpetrator. The motivating factor is often one, or a series of, interpersonal or work-related disputes. The perpetrator may be seeking revenge for what is perceived as unfair treatment. (Hughes, H. 2008)
Type IV: Violence by Someone in a Personal Relationship, In Type IV workplace violence, the perpetrator usually has or has had a personal relationship with the intended victim and does not have a legitimate relationship with the workplace. The incident may involve a current or former spouse, lover, relative, friend, or acquaintance. The perpetrator is motivated by perceived difficulties in the relationship or by psychosocial factors that are specific to the situation and enters the workplace to harass, threaten, injure, or kill. Victims of type IV violence are devastatingly, but not exclusively, female.( Opie, T., Lenthall, S., etal 2010)
This type of violence is often the spillover of domestic violence into the workplace. In some cases, a domestic violence situation can arise between individuals in the same workplace. These situations can have a substantial effect on the work environment. They can visible as high absenteeism and low productivity on the part of a worker who is enduring abuse or threats, or the sudden, prolonged absence of an employee fleeing abuse. (Woodtli, M., & Breslin, E. 2006).
Healthcare and social service workers face an increased risk of work-related assaults stemming from several factors. These include:
The prevalence of handguns and other weapons among patients, their families, and friends The increasing use of hospitals by police and the criminal justice system for criminal holds and the care of acutely disturbed, violent individuals The increasing number of acute and chronic mentally ill patients being released from hospitals without follow-up care (these patients have the right to refuse medicine and can no longer be hospitalized involuntarily unless they pose an immediate threat to themselves or others) The availability of drugs or money at hospitals, clinics, and pharmacies, making them likely robbery targets Factors such as the unrestricted movement of the public in clinics and hospitals and long waits in emergency or clinic areas that lead to client frustration over an inability to obtain needed services promptly (Lisboa, M., de Moura, F., & Reis, L. 2006). The increasing presence of gang members, drug or alcohol abusers, trauma patients, or distraught family members Low staffing levels during times of increased activity such as mealtimes, visiting times, and when staff are transporting patients Isolated work with clients during examinations or treatment Solo work, often in remote locations, with no backup or way to get assistance like , communication devices or alarm systems, this is particularly true in high-crime settings Lack of staff training in recognizing and managing hostile and high-risk behavior as it escalates Poorly lit parking areas. (Nelson, H., & Cox, D. 2004)
WORKPLACE VIOLENCE PREVENTION PROGRAM
A workplace violence prevention program demonstrates an organization’s concern for employee emotional and physical safety and health. The program encompasses the following elements: Management commitment and a system of accountability Employee involvement Worksite analysis Hazard prevention and control Training and education, Recordkeeping and evaluation of the program
The first two elements, management commitment and employee involvement, are complementary and essential to a successful workplace violence prevention program. Management commitment provides the motivating force for dealing effectively with workplace violence. (Whitley, G., Jacobson, G., & Gawrys, M. 2007). Employee involvement enables workers to develop and express their commitment to safety and health. Employee involvement should include:
Understanding and complying with the workplace violence prevent program and other safety and security measures Participating in employee complaint or suggestion procedures covering safety and security concerns Reporting violent incidents promptly and accurately Participating in safety and health committees or teams that receive reports of violent incidents or security problems, make facility inspections and respond with recommendations for corrective strategies Taking part in a continuing education program that covers techniques to recognize escalating agitation, high risk behavior or criminal intent and discusses appropriate responses A key element of the workplace violence prevention program is the threat assessment team, or safety committee. (Whitley, G., Jacobson, G., & Gawrys, M. 2007). The primary function of the team is to provide a thorough workplace security/hazard analysis and establish prevention strategies. An effective team will assess the organization’s vulnerability to workplace violence, make recommendations for preventive actions, develop employee training programs in violence prevention, establish a plan for responding to acts of violence, and evaluate the overall workplace violence prevention program on a regular basis (Stanley, K. 2010).
Violence in the healthcare workplace threatens the delivery of effective, quality care and violates individual rights to personal dignity and integrity. Assaults on nurses and other healthcare workers occur in all areas of practice and constitute a serious hazard. Current literature suggests that to ensure a safe and respectful workplace environment, mandatory protections must be provided such as zero-tolerance policies against violence in the workplace, as well as comprehensive prevention programs, reporting mechanisms and disciplinary policies. (Woodtli, M., & Breslin, E. 2006). Under occupational health and safety laws, all health care facilities are required to have in place strategies to proactively, prevent and manage occupational violence. An occupational health and safety risk management framework, consistent with, occupational health and safety legislation, Work Safe guidelines and contemporary knowledge, will assist health care facilities, to achieve legislative compliance. (Nelson, H., & Cox, D. 2004). Violence and Abuse Prevention Task Force members that
A Workplace Violence Prevention Program is one step in the process of protecting nurses and other, healthcare