Technology may also offer a solution to
predicting and preventing violence. New
Hampshire Hospital’s “Project Pause”
is a smartphone app for predicting
patient violence in the behavioral health
setting. Patients answer self-assessment
questions every two hours, and
researchers compare the data with
violent incident reports. For example,
the app asks, “Since the last time we
asked, have you been physically
aggressive toward anyone?”
Most violence perpetrated by patients is
unintentional. Dementia, psychosis, and
sudden or unexpected pain can all be
reasons a patient might become violent.
Danger from belligerent patients includes
punching, biting, and hurling objects.
Violence toward nurses is certainly not
limited to patients. Nurses must also
deal with angry family members, the
perpetrators of domestic violence
against their patients, and even violent
criminals. One nurse reports being
cornered in a room by a violent man
brandishing two knives. “I yelled for the
security officer, and he had to call for
more help from deputies who were
luckily just a few rooms away. One of the
deputies tased the man and disarmed
him. You need to remain alert,
constantly assessing patients and being
prepared to de-escalate the situation.”
Nurses in emergency departments are
disproportionately victims of workplace
violence, according to the Emergency
Department Violence Surveillance Study,
published by the Emergency Nurses
Association. The study found that 55.6%
of nurses reported they had experienced
physical violence, verbal violence or
both. Furthermore, the study found that
57.6% of nurses surveyed rated the
safety of their ED as a 5 out of 10
or lower (Emergency Nurses
Association, 2011).
Sadly, the majority of survey participants
who were victims of workplace violence
did not file a formal report for the
physical violence or the verbal abuse
they experienced. Writing for Hospitals
& Health Networks, Pamela Thompson,
RN says, “There is an underlying cultural
problem within the healthcare setting
regarding workplace violence—workers
tend not to report incidents, specifically
in the ED. Recent research indicates that
many healthcare workers underreport
violence because it is inconvenient, and
they accept such conditions as part of
the job” (Thompson, 2015).
How can we protect nurses? A frequent
answer is simply safety in numbers
through adequate staffing, but thoughtful
design of the patient care environment is
also a key to prevention. Facilities should
provide adequate lighting and visibility,
physical barriers and escape routes, and,
some sources say, patient care areas
with limited furnishings and other items
that could become projectiles.
Authorities say training should offer both
instruction and hands-on experience to
be effective.
The nursing shortage in this country
must be faced head-on, not only by
attracting more people to the
profession, but by retaining nurses for
the long-term. Increasing their one-on-
one time with patients, ensuring
appropriate breaks within and between
shifts, addressing nurse behavioral issues,
and protecting nurses from violence at
work will be a good start.
References:
Brown, T. (2010). “When the Nurse Is a Bully,” The New
York Times. Retrieved from https://well.blogs.nytimes.
com/2010/02/11/when-the-nurse-is-a-bully/
Colduvell, K. (2017). “Nurse Bullying: Stand Up and Speak
Out,” Nurse.org. Retrieved from https://nurse.org/
articles/how-to-deal-with-nurse-bullying/
Dressner, M. A. (2017). “Hospital workers: An assessment
of occupational injuries and illnesses,” Monthly Labor
Review, Bureau of Labor Statistics. https://www.bls.gov/
opub/mlr/2017/article/hospital-workers-an-assessment-
of-occupational-injuries-and-illnesses.htm
Emergency Nurses Association (2011). Emergency
Department Violence Surveillance Study. Retrieved from
https://www.ena.org/docs/default-source/resource-
library/practice-resources/workplace-violence/2011-
emergency-department-violence-surveillance-report.
pdf?sfvrsn=5ad81911_4
Esposito, L. (2017). “Nurses Face More Violence from
Hospital Patients,” US News. Retrieved from https://
health.usnews.com/wellness/articles/2017-01-18/
nurses-face-more-violence-from-hospital-patients
Meissner, J. (1999). “Nurses Are We Still Eating Our
Young?” Nursing. Retrieved from http://journals.lww.
com/nursing/Citation/1999/02000/Nurses_are_we_
still_eating_our_young__.18.aspx
Nolte, A. (2017). “Compassion Fatigue in Nurses: A
Metasynthesis,” Journal of Clinical Nursing. Retrieved from
http://onlinelibrary.wiley.com/doi/10.1111/jocn.13766/full
Occupational Health and Safety Administration (OHSA),
(2017). Preventing Workplace Violence: A Road Map for
Healthcare Facilities 2015. Retrieved from https://www.
osha.gov/Publications/OSHA3827.pdf
Safety+Health, The Official Magazine of the National Safety
Council Congress and Expo. (2017). “Survey of nurses
shows fatigue causing many to consider leaving current job.”
Retrieved from http://www.safetyandhealthmagazine.
com/articles/15838-its-time-to-care-for-the-caregivers-
survey-of-nurses-shows
Smokler, L. P. and Malecha, A. (2011). “The impact of
workplace incivility on the work environment, manager
skill, and productivity,” Journal of Nursing Administration.
Retrieved from https://www.ncbi.nlm.nih.gov/
pubmed/21799351
Sullivan, K. (2014). “US must produce 1.1 million nurses by
2022 to meet demand,” FierceHealthcare. Retrieved from
https://www.fiercehealthcare.com/healthcare/
us-must-produce-1-1-million-nurses-by-2022-to-meet-
demand
Thompson, P. (2015). “Addressing Violence in the Health
Care Workplace,” Hospitals & Health Networks.
Retrieved from https://www.hhnmag.com/articles/3365-
addressing-violence-in-the-health-care-workplace
Woelfle, C. and McCaffrey, R. (2007). “Nurse on Nurse,”
Nursing Forum. Retrieved from https://www.ncbi.nlm.nih.
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