Violence also includes:
•Emotional abuse such as: making a person feel worthless; telling them they are the problem; that they invite violence or they need psychological help; humiliating them in front of others; not allowing them to visit friends or family; showing extreme jealousy; withholding documents like immigration or refugee papers; threatening deportation, or depriving someone of their freedom whether in their public or private life.
•Verbal Abuse such as: telling a person they’re stupid; yelling, screaming, name-calling, or using sarcasm and put-downs; threatening to hurt a person.
•Sexual Harassment such as: unwanted and suggestive comments or actions of a sexual nature; slurs, jokes, gestures regarding sexuality; unwanted physical contact; requests for sexual favours; or comments about an individual’s sexual orientation or identity.
•Economic abuse such as: controlling money or stopping a person from getting a job or education.
The Impact of Workplace Violence on Workers
Workplace violence may result in physical and/or psychological injuries to the worker as follows:
Workers
Physical injury/Psychological injury:
•Grief, denial, self-blame
•Depression, anger, disbelief
•Anxiety, shock, apathy
•Dependency, helplessness
•Symptoms of PTSD (post-traumatic stress disorder)
•Fear of future threats or injury
•Self-doubt
•Powerlessness
•Fear of returning to work
•Decreased job performance
•Changes in relationships with co-workers/families
•Extended time off
•Physical illness
•Sleep pattern disturbances
•Headaches
•Impaired stress management and substance abuse
Co-workers
Psychological impact:
•Denial, self-blame
•Blaming of victim, leading to conflict or distrust among co-workers
•Anger, increased stress
•Fear for their own safety
•Lower workplace morale
•Re-distribution of the workload due to the worker’s leave as a result of physical and/or psychological injury
Editorial Comment: You may notice that many of the statistics quoted throughout this manual are related to nursing in British Columbia, Canada. From a purely statistical standpoint they can easily be dismissed as being too small of a number to generalize as to the incidence of violence in a worldwide nursing profession. It is not the intent of this book to provide up to date statistics that are applicable to the reader’s geographical region. If these statistics are important to you I suggest that you research your respective Occupational Health & Safety organizations and Workers Compensation Boards.
Having said that, the intent of this manual is to serve as a resource to you in providing practical techniques in dealing with workplace violence.
Assault/Abuse Directed Towards Care-Giver
An Overview
•Assaults include both physical and verbal aggression.
•Assaults include: punching, kicking, throwing objects, spitting, biting and severe verbal abuse.
•Assaults may be either unprovoked as staff perform their duties or sustained as direct result of staff interventions.
The severity of injuries varies greatly. Three degrees of injury have been identified: (physical contact must have taken place)
•First degree: no physical injury detectable.
•Second degree: includes minor injuries such as bruises, abrasions and small lacerations.
•Third degree: large lacerations, fractures and loss of consciousness, as well as injuries resulting in permanent physical disability or death.
Let’s look at the concept of assault a little closer and try to define it.
•Assaults include both physical and verbal aggression.
Proactive Tip: We tend to think of assault in just physical terms, someone hurting us, but yelling, swearing, threatening, name calling can be just as devastating, especially if the person is capable of following through on the threats. Later we explore the act of “horizontal violence” which includes the afore mentioned actions but from a surprising source.
•Assaults include: punching, kicking, throwing objects, spitting, biting and severe verbal abuse.
Editorial Comment: Throughout my career I’ve been involved in situations where I have been punched, kicked and almost had my thumb bitten off. I have had ashtrays; books; glasses; chairs; coffee; and pop thrown at me. I’ve been spit at, and on and called every profanity that I was aware of and some that I wasn’t.
•Assaults may be either unprovoked as staff perform their duties or sustained as direct result of staff interventions.
Editorial Comment: I've known fellow workers that have been hit with canes and walkers. While I was working with mentally challenged adults with major psychosis, one of my fellow female coworkers experienced a patient attempting to use her head as a battering ram, trying to knock the bricks out of a concrete wall. While working on a psychogeriatric ward I reached under one elderly fellow’s sheets to see if he was dry and got a “knuckle sandwich” in the face for my efforts.
Let’s look at injuries resulting from these assaults.
The severity of injuries varies greatly. Three degrees of injury have been identified: (physical contact must have taken place)
•First degree: no physical injury detectable.
You might have been pushed or shoved, maybe shaken up, but with no visible injury resulting.
•Second degree: includes minor injuries such as bruises, abrasions and small lacerations.
•Third degree: large lacerations, fractures and loss of consciousness, as well as injuries resulting in permanent physical disability or death.
Proactive Tip: One study indicated that after being assaulted some staff members reported experiencing fright, anger, and apprehension. Sleep disturbances, intrusive memories, and hyper vigilance were also reported. The example that I gave earlier of the young woman who was used as a battering ram would certainly be an example of this. She had headaches and nightmares for a year or so after the incident.
These symptoms have been identified as being associated with Post Traumatic Stress Symptoms (PTSD). PTSD is discussed later in this book.
Definitions of Violent and Aggressive Behaviour
Before we look at the definitions it might be helpful to draw from the area of interpersonal communication known as “assertiveness.”
Behaviorally speaking,