If you have ever waited for hours on end in a hospital you can probably understand why health-care workers are particularly vulnerable to assaults by members of the public.
People can become frustrated and agitated while waiting. Tension is increased when they're not given any indication when they will see the doctor or consultant. Moreover, it's likely that 10 or 20 patients may each have been told that their appointment was for 9.30 a.m. As lunch time looms or the few hours granted off work draw to a close with still no sign of seeing the doctor, even the most avid devotees of The Book of Calm are likely to lose their cool.
That health-care staff are particularly vulnerable to physical and verbal assault has been well documented. For instance, recent surveys in Ireland and Britain show that 50 per cent of nurses have been physically assaulted at work. Some 16 per cent sustained severe injuries and 62 per cent received no support after being involved in a violent incident.
In 1994, more than 50 per cent of health workers in Ireland said they were unaware of any safety statement in their workplace.
Health workers are particularly at risk in psychiatric facilities, accident and emergency departments, out patient departments and community welfare offices.
Health professionals also have frequent dealings with groups more prone to violence like some people suffering from acute psychosis, schizophrenia, mania and depressive or suicidal tendencies.
Certain neurological and medical conditions can leave sufferers more prone to violence. These include people suffering from trauma to the brain, epilepsy (after a seizure) and dementia. People who have been drinking heavily and drug abusers are also more likely to become violent.
A multimedia training pack launched earlier this year entitled "Sticks and Stones" details these and many related facts. It comprehensively addresses the vital issue of assault prevention for health workers and is valuable to managers and workers alike.
It advises managers how to design or improve public waiting areas to reduce the likelihood of violent assaults on staff. Aggression, threats and violence can be dramatically reduced by redesigning the layout of the waiting room. It should have pleasant lighting and decoration, use pastel colours, have comfortable seats, a television and toys for children. Newspapers, magazines and a drinks machine should be available.
Having a large number of people turn up for an appointment at the same time is poor management and is bound to induce frustration. Failing to inform people of when they are likely to be seen and neglecting to explain the reason for any undue delay is also poor management.
Sticks and Stones provides some techniques that should help workers reduce the likelihood of being attacked. For instance before private consultations, the health worker is advised to identify the nearest exit and never allow the client to stand between them and the door. Items like scissors or hot coffee should be removed from sight before a client enters the room, especially if the patient has any history of violence.
Mr Tom Kelleher, chief nursing officer with Kildare Mental Health Services, explains that everyone has thresholds of anger. When a sufficient number of triggers accumulate, people move to the so-called escalation phase or arousal. They are more likely to become aggressive and may do so unless a trained health professional intervenes.
If the person proceeds to the crisis stage and becomes violent, adrenalin surges through the body. It's difficult to reason with him and he is best left alone to calm down.
A plateau or recovery phase follows, during which more assaults can take place. The final phase is the post-crisis depression phase, when he can feel remorse and become depressed.
The training pack offers de-escalating tips like: don't touch the person; ask him to stop the aggressive behaviour; be respectful, assertive and offer to help.
Actions to be avoided include showing cynicism, arguing back, threatening the violent person or inviting him to carry out his threats.
For further information about Sticks and Stones: Assault Prevention for Health Workers A Trainer's Resource Pack contact Marese Hickey, Health Counsel, 30 Kincora Court, Clontarf, Dublin 3. Telephone: (01) 833 8792
