VIOLENCE In the WorkPlace

Objectives: After completion of the presentation, the participant will be able to: u Identify 4 signs of a potentially violent situation. u Identify 3 methods of controlling disruptive behavior. u Describe how to report an incident at GBMC. u Describe 5 security measures you and/ or the facility can take to prevent violence.

Introduction: Violence is a serious problem. It occurs EVERYWHERE Even in the WorkPlace! GBMC HealthCare, Inc. has developed this program to address this issue. This self learning packet will provide you with the knowledge to prevent and de- escalate disruptive and potentially violent situations in the workplace. Policy # 807 is found in the safety manual. It can also be found on the GBMC Intranet under Employee Health policies. FAMILIARIZE yourself with the policy: ZERO TOLERANCE is the position of our management at GBMC.

HOMICIDE IS THE LEADING CAUSE OF WORKPLACE DEATH FOR WOMEN AND THE SECOND LEADING CAUSE OF DEATH FOR ALL WORKERS (Center for Workplace health and safety, Inc.)

Incidence: u One in 6 violent crimes occur on the job. u Highest incidences occur in places: –where cash is regularly handled –where employees work alone night) –where there is regular contact with prisoners –AND

Incidence cont. WHERE THERE MAY BE HIGHLY EMOTIONAL SITUATIONS, SUCH AS HOSPITALS AND SOCIAL WORK/ SOCIAL SERVICES ORGANIZATIONS.

Incidence cont. INTENSIVE CARE UNITS, ORs, MEDICAL-SURGICAL FLOORS, NURSERIES, NURSING HOMES, AND COMMUNITY HEALTH SETTINGS HAVE ALL BEEN THE SCENES OF VIOLENT ACTS!

OF 1209 EMERGENCY DEPARTMENT NURSES RESPONDING TO A RETROSPECTIVE SURVEY, 97.7% HAD EXPERIENCED SOME TYPE OF VICTIMIZATION (Journal of Emergency Nursing, 1991)

Causes of Violence u Robbery is the number 1 cause in the workplace. BUT, Violence occurs from: u Coworkers, visitors, outsiders, and customers under emotional stress u A relative, friend, or acquaintance entering the premise to do harm (Domestic Violence situations) u Individuals under the influence of a substance u Prolonged waiting

PREVENTION: “UNIVERSAL PRECAUTIONS FOR VIOLENCE” It should be expected but can be avoided or mitigated through preparation

Security Procedures: Self: u Alert security of unusual behavior u Identify visitors u Wear ID badge u Store briefcase and purse locked and out of site u Do not walk alone at night Facility: u Visitor registration u Lighted hallways & stairwells u Lighted garage u Cameras u Panic buttons (garage) u Safety surveillance –security; –plant operations; –safety committee; –management

Security Procedures cont. u Facility Layout u Unit Layout: location doors, windows, furniture u Identify items that may cause injury: chairs, small equipment u Identify items that could help protect: mattress, pillows, sheets

VIOLENT RECOGNITION OF POTENTIALLY VIOLENT SITUATIONS TAKE THREATS OF INTIMIDATION SERIOUSLY!! NOT DO NOT IGNORE! Threats may be: verbal, written, physical, over the phone, or through

Violence Signs of Potential Violence u Threats u Tantrums- may be sign of more violent behavior u Withdrawn u Angry u Blames others u Becomes verbally/ Physically Abusive u Talks about guns

MORE SIGNS! u Unreciprocated romantic obsession u Expressions of hopelessness or heightened anxiety u Violence towards inanimate objects

Levels of Disruptive Behavior 1. Anxiety, discomfort, anger 2. Defensive- Verbally Threatening 3. Physically Acting Out 4. Stimulation/ Stress Reduction 1. Supportive/ Reassurance 2. Directive: Set reasonable, consistent, clear limits 3. Proper physical control 4. Staff establish Rapport ACTION :

Setting Effective Limits u Explain which behavior is inappropriate u Explain why the behavior is inappropriate (focus on behavior; not person!) u Give the individual reasonable choices u Allow time for the individual to make a choice u Enforce Limits

Setting Effective Limits Remember: u Speak in calm, soft voice u Do NOT intervene alone! u Adopt a supportive posture (no arms across chest; no hands in pockets!) u Be aware of personal space: Don’t allow yourself to be backed into a corner! u Do not convey negative feelings u Listen, Listen & Listen!

Methods of Controlling Disruptive Behavior u Verbally u Chemically (medications) u Physical Control Techniques

Disruptive Behavior Causes: FEAR AND ANGER TO THOSE IN THE ENVIRONMENT

TRAINING: Will assist staff in: –control of actions and emotions –Provide framework to develop emotional support and –provide a team for physical safety

If you find yourself in an escalating situation: MAKE NO HEROIC ATTEMPTS TO SUBDUE OR CONTROL PATIENT/ INDIVIDUAL! INSTITUTE PROCEDURE AND GET HELP!

GBMC Procedure: POLICY # 807: SAFETY MANUAL

If incident occurs which includes threats: u Report threat or act to supervisor IMMEDIATELY! u Complete Employee Medical Referral Form and seek appropriate medical treatment (ER or EHS based on extent of injury and hours) u Consider use of Employee Assistance Program ( or )

Manager will contact: u Employee Situation –Human Resources –Security –Employee health and Safety –Management u Visitor*/ Patient –Security (may call BCPD) –EHS if employee involvement/ injury –management *Visitor may be friend or acquaintance of employee

Employee Situations are taken Seriously! Employee who threatens/ acts violently will: u Be evaluated by EAP to determine if threat to workplace u Remain off work until healthcare provider authorizes release u Need to undergo treatment/ counseling if recommended by Healthcare Professional.

Staff will: u Be supportive to each other u Be supported by management u Offered EAP services (EAP will determine if debriefing necessary)

SUMMARY: WORKPLACE VIOLENCE IS A REALITY! PROPER TRAINING AND PREPARATION, AS WELL AS SUPPORTING SYSTEM PROCESSES AND PROCEDURES CAN MINIMIZE THE THREAT OF VIOLENCE. BE PREPARED! DON’T BE A VICTIM!

Resources: u Human Resources x2204 u Employee Health x2239 u Security x2222