1. FHM TRAINING TOOLS
This training presentation is part of FHM’s commitment to creating and keeping safe workplaces.
Be sure to check out all the training programs that are specific to your industry.

2. Workplace Violence in Healthcare
Recommended Facilitator Notes: (read the following text out-loud to participants while showing this slide)
Welcome to the Workplace Violence in Healthcare presentation.
Please make sure you are comfortable and able to concentrate as we work our way through this presentation.

3. Learning Objectives Objectives: Recognize risk factors
Knowledge of prevention strategies
Recommended Facilitator Notes: (read the following text out-loud to participants while showing this slide)
We have very specific learning objectives for you during this presentation.
At the conclusion of this presentation, you will:
Recognize the risk factors for workplace violence, and
Have knowledge of prevention strategies.

4. Agenda Agenda: Workplace violence in the healthcare setting
Risk factor for violence
Prevention strategies
Safety tips
Recommended Facilitator Notes: (read the following text out-loud to participants while showing this slide)
Our presentation today will involve the following agenda:
Section One will discuss Workplace Violence in the Healthcare Setting.
Section Two will review the Risk Factors for Violence.
Section Three will discuss Prevention Strategies.
Section Four will provide Safety Tips for Healthcare Employees.

5. Workplace Violence in Healthcare Settings
Section 1
Workplace Violence in Healthcare Settings
Recommended Facilitator Notes: (read the following text out-loud to participants while showing this slide)
Section 1 will cover workplace violence in the healthcare setting.

6. Violence in the Healthcare Workplace
Workplace violence:
Exposed to many safety and health hazards
At high risk for experiencing violence in the workplace
Hospital workers are assaulted at rates 4 times the average for other private-sector industries
Recommended Facilitator Notes: (read the following text out-loud to participants while showing this slide)
More than 5 million U.S. workers perform many different occupations in the healthcare industry.
They are exposed to many safety and health hazards, including violence.
Studies have indicated that healthcare workers are at high risk for experiencing violence in the workplace.
According to estimates performed by the Bureau of Labor Statistics (BLS), hospital workers are assaulted at rates approximately four times the average for other private-sector industries.

7. Activities Related to Violence
Meal times
Visiting hours
Patient transportation
May occur when:
Denied service
Involuntary admission
Limiting the patient
Recommended Facilitator Notes: (read the following text out-loud to participants while showing this slide)
Studies indicate that violence often takes place during times of high activity and interaction with patients, such as at meal times and during visiting hours and patient transportation.
Assaults may occur when service is denied, when a patient is involuntarily admitted, or when a healthcare worker attempts to set limits on eating, drinking, or tobacco or alcohol use.

8. What is Workplace Violence?
Examples:
Threats, expressions of intent to cause harm
Physical assaults
Muggings
Recommended Facilitator Notes: (read the following text out-loud to participants while showing this slide)
Workplace violence ranges from offensive or threatening language to homicide.
NIOSH defines workplace violence as violent acts (including physical assaults and threats of assaults) directed toward persons at work or on duty.
Examples of violence include the following:
Threats: Expressions of intent to cause harm, including verbal threats, threatening body language, and written threats.
Physical assaults: Attacks ranging from slapping and beating to rape, homicide, and the use of weapons such as firearms, bombs, or knives.
Muggings: Aggravated assaults, usually conducted by surprise and with intent to rob.

9. Case Reports Examples: An elderly patient verbally abused a nurse
An agitated psychotic patient attacked a nurse
A disturbed family member walked into the emergency department and fired a small- caliber handgun
Recommended Facilitator Notes: (read the following text out-loud to participants while showing this slide)
Some examples of workplace violence in the healthcare setting include:
An elderly patient verbally abused a nurse and pulled her hair when she prevented him from leaving the hospital to go home in the middle of the night.
An agitated psychotic patient attacked a nurse, broke her arm, and scratched and bruised her.
And a disturbed family member whose father had died in surgery at the community healthcare walked into the emergency department and fired a small-caliber handgun, killing a nurse and an emergency medical technician and wounding the emergency physician.
These circumstances of healthcare violence differ from the circumstances of workplace violence in general.
In other workplaces such as convenience stores and taxicabs, violence most often relates to robbery.
Violence in healthcares usually results from patients and occasionally from their family members who feel frustrated, vulnerable, and out of control.

10. Who Is At Risk? Who? Anyone working in a healthcare setting
Nurses and aides
Emergency response personnel
Safety officers
Healthcare providers
Recommended Facilitator Notes: (read the following text out-loud to participants while showing this slide)
Although anyone working in the healthcare setting may become a victim of violence, nurses and aides who have the most direct contact with patients are at higher risk.
Other personnel at increased risk of violence include emergency response personnel, safety officers, and all healthcare providers.

11. Where May Violence Occur?
Psychiatric wards
Emergency rooms
Waiting rooms
Geriatric units
Recommended Facilitator Notes: (read the following text out-loud to participants while showing this slide)
Violence may occur anywhere in a healthcare facility, but it is most frequent in the following areas:
Psychiatric wards
Emergency rooms
Waiting rooms, and
Geriatric units.

12. The Effects of Violence
Minor physical injuries
Serious physical injuries
Temporary and permanent physical disability
Psychological trauma
Death
Recommended Facilitator Notes: (read the following text out-loud to participants while showing this slide)
The effects of violence can range in intensity and include the following:
Minor physical injuries
Serious physical injuries
Temporary and permanent physical disability
Psychological trauma
Death
Violence may also have negative organizational outcomes such as low worker morale, increased job stress, increased worker turnover, reduced trust of management and coworkers, and a hostile working environment.

13. Risk Factors for Violence
Section 2
Risk Factors for Violence
Recommended Facilitator Notes: (read the following text out-loud to participants while showing this slide)
In Section 2, we will discuss risk factors for violence.

14. Risk Factors for Violence
Working directly with volatile people
Working when understaffed
Transporting patients
Long waits for service
Recommended Facilitator Notes: (read the following text out-loud to participants while showing this slide)
The risk factors for violence vary from setting to setting depending on location, size, and type of care.
Common risk factors for violence include the following:
Working directly with volatile people, especially, if they are under the influence of drugs or alcohol or have a history of violence.
Working when understaffed-especially during meal times and visiting hours.
Transporting patients.
Long waits for service.

15. More Risk Factors Risk factors:
Overcrowded, uncomfortable waiting rooms
Working alone
Poor environmental design
Inadequate security
Recommended Facilitator Notes: (read the following text out-loud to participants while showing this slide)
Additional risk factors for violence include:
Overcrowded, uncomfortable waiting rooms.
Working alone.
Poor environmental design.
Inadequate security.
Lack of staff training and policies for preventing and managing crises with potentially volatile patients.

16. And Yet More Risk Factors
Drug and alcohol abuse
Access to firearms
Unrestricted movement of the public
Poorly lit areas
Recommended Facilitator Notes: (read the following text out-loud to participants while showing this slide)
And, our last set of risk factors includes:
Drug and alcohol abuse.
Access to firearms.
Unrestricted movement of the public.
And poorly lit corridors, rooms, parking lots, and other areas.

17. Prevention Strategies
Section 3
Prevention Strategies
Recommended Facilitator Notes: (read the following text out-loud to participants while showing this slide)
In Section 3, we will discuss prevention strategies.

18. Prevention Strategies
Environmental design
Administrative controls
Behavior modification
Recommended Facilitator Notes: (read the following text out-loud to participants while showing this slide)
To prevent workplace violence, employers should develop a safety and health program that includes management commitment, employee participation, hazard identification, safety and health training, and hazard prevention, control, and reporting.
Employers should evaluate this program periodically.
Although risk factors for violence are specific for each facility and its work scenarios, employers can follow general prevention strategies including:
Environmental Design
Administrative Controls, and
Behavior Modification.

19. Environmental Designs
Emergency signaling, alarms, and monitoring systems
Security devices
Cameras
Provide security escorts
Design waiting areas
Design public areas
Recommended Facilitator Notes: (read the following text out-loud to participants while showing this slide)
Environmental Designs include:
Develop emergency signaling, alarms, and monitoring systems.
Install security devices such as metal detectors to prevent armed persons from entering the facility.
Install other security devices such as cameras and good lighting in hallways.
Provide security escorts to the parking lots at night.
Design waiting areas to accommodate and assist visitors and patients who may have a delay in service.
Design the triage area and other public areas to minimize the risk of assault:
Provide staff restrooms and emergency exits.
Install enclosed nurses' stations.
Install deep service counters or bullet-resistant and shatterproof glass enclosures in reception areas.
Arrange furniture and other objects to minimize their use as weapons.

20. Administrative Controls
Designing staffing patterns
Restricting the movement of the public by card-controlled access
Developing a system for alerting security personnel when violence is threatened
Recommended Facilitator Notes: (read the following text out-loud to participants while showing this slide)
Administrative Controls include:
Designing staffing patterns to prevent personnel from working alone and to minimize patient waiting time.
Restricting the movement of the public by card-controlled access.
And developing a system for alerting security personnel when violence is threatened.

21. Behavior Modifications
Recognizing and managing assaults
Resolving conflicts
Maintaining hazard awareness
Recommended Facilitator Notes: (read the following text out-loud to participants while showing this slide)
Behavior Modifications may be achieved by providing all workers with training in recognizing and managing assaults, resolving conflicts, and maintaining hazard awareness.

22. The Consequences of Violence
Providing an environment that promotes open communication
Develop written procedures for reporting and responding to violence
Employers should offer and encourage counseling
Recommended Facilitator Notes: (read the following text out-loud to participants while showing this slide)
Violence may occur in the workplace in spite of preventive measures.
Employers should be prepared to deal with the consequences of this violence by providing an environment that promotes open communication and by developing written procedures for reporting and responding to violence.
Employers should offer and encourage counseling whenever a worker is threatened or assaulted.

23. Safety Tips for Healthcare Employees
Section 4
Safety Tips for Healthcare Employees
Recommended Facilitator Notes: (read the following text out-loud to participants while showing this slide)
In Section 4, we will discuss safety tips for healthcare employees.

24. Safety Tips for Healthcare Workers
Watch for signs of violence
Maintain behavior that helps defuse anger
Stay alert
Have an escape plan
Recommended Facilitator Notes: (read the following text out-loud to participants while showing this slide)
All healthcare workers should be provided with safety tips for violence prevention.
The safety tips can be categorized in four categories as follows:
Watch for signs of impending violence.
Maintain behavior that helps defuse anger.
Staying alert.
Have an escape plan.
Let’s review these categories.

25. Signals of Impending Violence
Verbally expressed anger and frustration
Body language
Signs of drug or alcohol use
Presence of a weapon
Recommended Facilitator Notes: (read the following text out-loud to participants while showing this slide)
Watch for signals that may be associated with impending violence including:
Verbally expressed anger and frustration.
Body language such as threatening gestures.
Signs of drug or alcohol use.
And presence of a weapon.

26. Behavior to Diffuse Anger
Presenting a calm attitude
Don't match the threats
Don't give orders
Acknowledge the person's feelings
Avoid behavior that may be interpreted as aggressive
Recommended Facilitator Notes: (read the following text out-loud to participants while showing this slide)
Maintain behavior that helps diffuse anger by:
Presenting a calm, caring attitude.
Don't match the threats.
Don't give orders.
Acknowledge the person's feelings (for example, "I know you are frustrated").
Avoid any behavior that may be interpreted as aggressive (for example, moving rapidly, getting too close, touching, or speaking loudly).

27. Alertness Alertness: Evaluate each situation for potential violence
Be vigilant throughout the encounter
Don't isolate yourself
Always keep an open path for exiting
Recommended Facilitator Notes: (read the following text out-loud to participants while showing this slide)
Staying alert is key:
Evaluate each situation for potential violence when you enter a room or begin to relate to a patient or visitor.
Be vigilant throughout the encounter.
Don't isolate yourself with a potentially violent person.
And always keep an open path for exiting - don't let the potentially violent person stand between you and the door.

28. Diffuse the Situation Quickly
Remove yourself from the situation
Call security for help
Report any violent incidents to your management
Recommended Facilitator Notes: (read the following text out-loud to participants while showing this slide)
Remember to take these steps if you can't defuse the situation quickly:
Remove yourself from the situation.
Call security for help.
And report any violent incidents to your management.

29. Successful Prevention Strategies
Security screening system
Violence reporting program
System restricting movement of visitors
Recommended Facilitator Notes: (read the following text out-loud to participants while showing this slide)
There have been many published prevention strategies that have worked to reduce violence in the healthcare setting. Consider the following:
A security screening system in a Detroit hospital included stationary metal detectors supplemented by hand-held units. The system prevented the entry of 33 handguns, 1,324 knives, and 97 mace-type sprays during a 6-month period.
A violence reporting program in the Portland, Oregon, VA Medical Center identified patients with a history of violence in a computerized database.* The program helped reduce the number of all violent attacks by 91.6% by alerting staff to take additional safety measures when serving these patients.
A system restricting movement of visitors in a New York City hospital used identification badges and color-coded passes to limit each visitor to a specific floor. The hospital also enforced the limit of two visitors at a time per patient. Over 18 months, these actions reduced the number of reported violent crimes by 65%.

30. Summary Summary: No universal strategy exists to prevent violence
Risk factors vary from facility to facility
Healthcare facilities should form multidisciplinary committees to identify risk factors
All workers should be alert and cautious
Workers should actively participate in safety training programs
Recommended Facilitator Notes: (read the following text out-loud to participants while showing this slide)
All healthcare employers should develop a comprehensive violence prevention program.
No universal strategy exists to prevent violence.
The risk factors vary from facility to facility and from setting to setting.
Facilities should form multidisciplinary committees that include direct-care staff as well as union representatives (if available) to identify risk factors in specific work scenarios and to develop strategies for reducing them.
All healthcare workers should be alert and cautious when interacting with patients and visitors.
They should actively participate in safety training programs and be familiar with their employers' policies, procedures, and materials on violence prevention.

31. Additional Information
Sources of additional information:
Violence: Occupational Hazards in Hospitals. National Institute of Occupational Safety and Health (NIOSH) Publication No , (2002, April)
OSHA e-tool on hospital workplace violence /hospital/hazards/workplaceviole nce/viol.html
Sources of additional information:
Violence: Occupational Hazards in Hospitals. National Institute of Occupational Safety and Health (NIOSH) Publication No , (2002, April)
OSHA e-tool on hospital workplace violence s/hospital/hazards/workplaceviol ence/viol.html
Recommended Facilitator Notes: (read the following text out-loud to participants while showing this slide)
Here are some sources of additional information on this important topic.
Please reference them to continue your learning on this subject.