1. Workplace Violence Prevention

2. © Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law. 2 Defining Workplace Violence Forms and types of workplace violence Workplace violence injury statistics Prevalence and risk factors Developing a general Workplace Violence Prevention program Overview

3. © Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law. 3 Definition “Any act of aggression that causes physical or emotional harm, including assault (any attempt to inflict physical harm on a worker), threat, verbal abuse, sexual harassment and racial or religious harassment” (OPSEU) “Attempted, threatened or actual conduct of a person that endangers the health and safety of the worker including any threatening statement, harassment or behaviour that gives a worker reasonable cause to believe that his/her safety is at risk (N.S. H&S Advisory Council)”

4. © Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law. 4 Ontario Health Care & Community Services Data Source: WSIB Injury Analysis by SWA Snapshot Period: July 2005 Workplace Violence/Client Aggression - 2004 LTI’s

5. © Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law. 5 Workplace Violence/Client Aggression - 2004 LTI’s Data Source: WSIB Injury Analysis by SWA Snapshot Period: July 2005

6. © Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law. 6 “Workplace violence is one of the most complex and dangerous occupational hazards facing nurses” (McPaul & Lipscomb, 2004) Health and community care workers exposed to a variety of violent/aggressive individuals Many still do not agree that the issue is real Many consider violence “part of the job” Many organizations do not have a strong violence prevention program No protective regulations addressing workplace violence Prevalence

7. © Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law. 7 Many papers describing and explaining the issue of workplace violence however, few intervention studies exist (Arnetz & Arnetz, 2000) Assault rates for residential-care, nursing and personal-care workers more than ten times the rate than that of private non-health (Hewitt & Levin, 1997) British Columbia study suggested that health care workers face similar level of risk to that of police (Boyd 1995) Prevalence

8. © Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law. 8 Traditional Approaches to Aggression Prevention Focus on methods to manage, contain or reduce the impact of the aggressive act Rely on physical methods to deal with the situation Focus on body containment techniques – based on a philosophy of care that focuses on pathologies which reinforces negative perceptions of persons with dementia as being assaultive, violent, dangerous and the passive recipients of care! Do not seek to understand the underlying reason for the responsive behaviors (Jones, 1999) Focus on containment and control of aggressive individuals (dictated care regimes, use of physical or chemical restraints)

9. © Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law. 9 Not tailored for the learning needs of front-line staff in long-term care homes Are in direct contrast to the shift in culture that has occurred in dementia care in last decade - movement toward person - or relationship - centered care Have inappropriate response techniques that may have a pervasive and profound negative impact on residents with cognitive impairment, leading to excess disability and a wounded spirit (Taft, 1995; Dawson, Wells & Kline, 1993; Rader, 1995) Increase the risk of staff injury Do not equip staff with the necessary knowledge and point-of-care practices to decrease risk Traditional Approaches to Aggression Prevention

10. © Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law. 10 Threats of violence Verbal and emotional abuse Harassment based on sex, religion, sexual orientation, disability, race Use of, or threats to use force Inappropriate suggestions, inference, comments, or behavior Carrying a weapon Intimidation and aggressive behavior Domestic Violence Forms

11. © Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law. 11 Type I (Criminal Intent): Perpetrator has no relationship to the workplace Type II (Client/Customer): Perpetrator is a client who becomes violent towards a worker or another client “Majority of threats and assaults against caregivers come from patients/families/visitors” (Arnetz & Arnetz, 2000) Type III (Worker-to-worker): Perpetrators are employees or past employees Type IV (Personal Relationship): Perpetrator usually has a relationship with an employee (e.g. domestic violence in the workplace) Types (Cal/OSHA 1995)

12. © Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law. 12 Environmental, Ergonomic & Administrative: Crowded, noisy conditions Overcrowded resident areas Lack of staff education/training Lack of security controls Assigning staff to work alone, work in remote locations, and/or high crime areas Understaffed areas Lack of worker experience contributing to quality issues General Risk Factors

13. © Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law. 13 Client’s Physiological Conditions: Systemic disorders: fluid/electrolyte imbalance, anemia, thyroid disorders, diabetes, hepatic disorders, neurological disorders, epilepsy, degenerative diseases Toxic levels of medications Psychiatric Conditions: psychotic symptoms & paranoia, psychogeriatric illness Substance Abusers General Risk Factors

14. © Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law. 14 A Guide to the Development of a Workplace Violence Prevention Program Book one: Implementing the Program in Your Organization Book two: Developing Crisis Prevention & Communication Strategies Book three: Developing Human Resources Strategies for Managing Workplace Violence Book four: Preventing Client Aggression Through Gentle Persuasive Approaches ™

15. © Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law. 15 A Guide to the Development of a Workplace Violence Prevention Program Book one: Implementing the Program in your Organization Step 1 Secure management commitment Assess your program needs Develop program components Step 2 and 3 Implement program Step 4 and 5 Evaluate program

16. © Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law. 16 Management commitment is: The foundation of an effective program Necessary to ensure that other resources are available to develop, implement and maintain the program (budget, human resources, materials, equipment, training, etc.) Step 1 Secure Management Commitment

17. © Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law. 17 Initial tasks: Enlist senior management commitment to program Appoint a program leader Appoint a multidisciplinary steering committee Determine whether committee will be an ad hoc or standing committee Step 1 Secure Management Commitment

18. © Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law. 18 Community workplace violence issues Internal documents: Security, emergency response, unusual occurrence, client abuse, EAP Employee incidents/accidents Physical environment Work setting and clients Point-of-care work practices Employee perceptions Step 1 Assess Your Needs

19. © Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law. 19 Workplace Violence Documentation Analysis tool Appendix D Unit Workplace Violence Incident/Accident Analysis Collection tool Appendix E Organizational Workplace Violence Incident/Accident Summary tool Appendix F Environmental Assessment toolAppendix G-1 Community Workplace Assessment toolAppendix G-2 Step 1 Assess Your Needs

20. © Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law. 20 Work Setting and Client Risk Factors Checklist Appendix H Checklist of Risk Factors for Aggressive Behaviour Appendix I Point-of-care Staff Work Practice Assessment Appendix J Workplace Violence Employee Survey Appendix K Appendices from OSACH“Guide to the Development of a Workplace Violence Prevention Program” and included in Participants’ Manual Step 1 Assess Your Needs

21. © Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law. 21 Step 1 Develop the Program A comprehensive Workplace Violence Prevention program includes: Workplace violence prevention policy Associated procedures

22. © Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law. 22 Step 1 Develop the Program Develop a Violence Prevention Policy that includes: Employer commitment Policy purpose and statement Applicable definitions Roles and responsibilities Reporting and investigation Risk assessment Emergency response Employee training Program audit, review and revision

23. © Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law. 23 Step 1 Develop the Program Violence Prevention Procedures include: Reporting Emergency response Investigation Environmental and security controls Administrative controls Work practices Travel- Appendix S

24. © Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law. 24 Step 2 and 3 Implement the Program Critical steps: Ensure development of Workplace Violence Prevention policy and procedures Develop a communication and marketing plan Develop and present staff training Launch the program

25. © Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law. 25 Type of TrainingAttendees Program DevelopmentMultidisciplinary committee/ steering committee Security & Emergency Response Procedures Emergency response team Security personnel General Workplace Violence Prevention Training All staff Job-Specific TrainingUnit/department specific staff Step 2 and 3 Implement the Program

26. © Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law. 26 Step 4 and 5 Evaluate the Program Goals of program evaluation: Create and maintain a safe working environment without the threat of violence Review, revise, enhance and improve program components based on: program self-audit results of qualitative and quantitative evaluation procedures Maintain the program Continuously improve Workplace Violence Prevention program

27. © Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law. 27 Book two: Developing Crisis Prevention and Communication Strategies Staff training in crisis intervention Recognizing and responding to stages of violence Crisis response team Effective communication skills Environmental conditions during crisis interventions Cultural sensitivity Emergency response Employee’s needs during and after crises A Guide to the Development of a Workplace Violence Prevention Program

28. © Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law. 28 Book three: Developing Human Resources Strategies for Managing Workplace Violence Prevention of violence among employees Harassment Domestic violence Threats Weapons Hiring and Termination practices A Guide to the Development of a Workplace Violence Prevention Program

29. © Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law. 29 Resources The following OSACH Resource may be purchased from our website – http://www.osach.cahttp://www.osach.ca

30. © Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law. 30 Questions? Concerns? Comments?