1. Effective Leadership and Management in Nursing CHAPTER EIGHTH EDITION Preventing Workplace Violence 23

2. Effective Leadership and Management in Nursing, Eighth Edition Eleanor J. Sullivan Learning Outcomes 1.Discuss what health care organizations can do to prevent violence. 2.Identify threats and threatening behaviors. 3.Describe how to recognize escalating violence.

3. Effective Leadership and Management in Nursing, Eighth Edition Eleanor J. Sullivan Learning Outcomes 4.Discuss how to respond to a violent incident. 5.Describe how to handle the follow-up to a violent incident.

4. Effective Leadership and Management in Nursing, Eighth Edition Eleanor J. Sullivan Workplace Violence Any violent act, including physical assaults and threats of assault, directed toward persons at work or on duty

5. Effective Leadership and Management in Nursing, Eighth Edition Eleanor J. Sullivan Examples of Violence Violence includes: –Threatening actions  Waving fists, throwing objects, or threatening body language –Verbal or written threats

6. Effective Leadership and Management in Nursing, Eighth Edition Eleanor J. Sullivan Violence Examples Violence includes: –Physical attacks  Slapping, hitting, biting, shoving, kicking, pushing, beating –Violent assaults  Rape, homicide, and attacks with weapons, such as knives, firearms, or bombs

7. Effective Leadership and Management in Nursing, Eighth Edition Eleanor J. Sullivan Consequences of Violence Affects staff morale Increases staff stress Causes mistrust of administration Exacerbates hostile work environment Increases costs because of absenteeism, turnover, and additional health costs for injured workers

8. Effective Leadership and Management in Nursing, Eighth Edition Eleanor J. Sullivan Factors Contributing to Violence Patients with head trauma, seizure disorders, dementia, alcohol or drug withdrawal, or who are homeless Crime victims and perpetrators Family members' stress and fear, long waits Absence of visible, armed security personnel

9. Effective Leadership and Management in Nursing, Eighth Edition Eleanor J. Sullivan Violence Risk Factors Working understaffed Long waiting times Overcrowded waiting rooms Working alone Inadequate security Unlimited public access Poorly lit corridors, rooms, and parking lots

10. Effective Leadership and Management in Nursing, Eighth Edition Eleanor J. Sullivan Preventing Violence Health care organizations: –Required to provide safe work environment –Must develop adequate policies to address violence in the workplace –Inadequate policies may result from lack of awareness

11. Effective Leadership and Management in Nursing, Eighth Edition Eleanor J. Sullivan Zero-Tolerance Policies Anyone who becomes violent or who exhibits threatening behavior must be removed from the setting and the authorities contacted

12. Effective Leadership and Management in Nursing, Eighth Edition Eleanor J. Sullivan Reporting and Education Educate staff to recognize warning signs of violence and potential assailants or agitators Educate staff about conflict resolution skills and de-escalation tactics

13. Effective Leadership and Management in Nursing, Eighth Edition Eleanor J. Sullivan Environmental Controls Adequate lighting Security devices Bullet-resistant barriers (emergency department) Curved mirrors in hallways

14. Effective Leadership and Management in Nursing, Eighth Edition Eleanor J. Sullivan Environmental Controls Adequate staffing Judicious use of restraints or seclusion Alerting staff about patients with history of violent behavior, dementia, or intoxication

15. Effective Leadership and Management in Nursing, Eighth Edition Eleanor J. Sullivan Threatening Behaviors Clenched fists Blank stare Fighting stance Arms raised in fighting position Standing too close or advancing Holding weapon of any kind Overt intent Movement toward exit

16. Effective Leadership and Management in Nursing, Eighth Edition Eleanor J. Sullivan Escalating Violence Verbal threats often precede a physically violent event Abuser might be encouraged by a crowd or afraid to lose face Watch body language and keep distance Use clear, direct words or silence Keep tone calm

17. Effective Leadership and Management in Nursing, Eighth Edition Eleanor J. Sullivan Responding to a Violent Incident Notify security immediately Never try to disarm someone If person is not armed, enlist staff to help in restraining violent person Put a barrier between violent person and yourself

18. Effective Leadership and Management in Nursing, Eighth Edition Eleanor J. Sullivan Post-Incident Follow-Up Be certain everyone is safe Arrange treatment for injured Complete injury and incident reports Follow up with Human Resources Contact security Contact injured employee at home to express concern and answer questions