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Chapter One

PROtect Yourself!

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A Practical Violence Prevention Manual for Healthcare Workers

INTRODUCTION

Once upon a time it was safe to go to work. Maybe that was just a fairy tale because the times have certainly changed. Increased violence has become part of our everyday life be it at home or at work. We read about it daily in the newspaper and are bombarded with violent stories from the television and radio.

As a group, healthcare workers tend to view people as being basically “good.” However, reality shows us that even good people do bad things at times. Under the right circumstances [or the wrong, depending on your point of view] any of us can lose control and become aggressive. As healthcare workers we have tended to recognize violence as only arising from our patients.

A fellow worker, a manager, a client or their family or even a visitor can become potentially hazardous to us. The “bad guys” aren’t always strangers to us. Working in the health care field, we regularly come in contact with people from all walks of life. It seems a grim irony that caregivers people concerned with the welfare of others should daily face the possibility of violence at the hands of the very people they are there to help. Yet, increasing evidence of the extent of the problem is emerging.

PROtect Yourself! has evolved over the past 20 years or so by me, Rae Stonehouse RN. Years ago, while working in a mid-sized psychiatric hospital, by virtue of being a male nurse I was automatically a member of the “Goon Squad”, a non-flattering term used to describe the emergency response team. I will readily admit that for the first couple of years working in psychiatry I was terrified of having to intervene physically. I was a talker, not a fighter! Now that I reflect back to those days, I can’t say that I was all that comfortable handling verbal aggression directed at me either.

Fortunately for me, I had the opportunity to attend a week-long workshop entitled “Crisis Intervention” that was provided inhouse. Throughout this course I learned many self- defense and physical restraining techniques that I was able to utilize in my role as a psychiatric nurse. The most important lesson learned was that the best weapons that I possessed for self- defense purposes were my brain and my mouth. I left the workshop with a greater sense of self-confidence.

Over the years I have met and worked with many people who were confident in various aspects of their lives but were terrified when it came to intervening in a crisis where there was the likelihood that it may turn physical. Even the possibility of physical aggression would trigger a fear response. I have worked alongside colleagues who would “conveniently” lock themselves in the bathroom at the first sign of a potential crisis. Others have had an “emergency” phone call that needed their attention, away from the action.

I recall Mary, a fellow nurse, who was an avid sky diver. Skydiving would be an activity that I would only undertake if I was pushed out of the airplane against my will. When situations arose that required physical intervention with a disturbed patient, she was crippled with fear. After taking the Crisis Intervention program and with further on the job practice to hone her skills, Mary was able to overcome her fears of physically intervening and became an effective responder in a crisis.

PROtect Yourself! has been developed for all the Marys out there. PROtect Yourself! provides an integrative, nonviolent approach to dealing with physical aggression and verbal threat. Its method of information delivery is intended to help you develop greater awareness and vigilance, hone observational and judgment skills and to learn communication techniques to defuse potentially volatile situations. Physical interventions such as restraining techniques and break-away techniques may be mentioned throughout this manual but will not be expanded upon as they are beyond the scope of this manual.

The term “healthcare workers”, encompasses a large group of people, from nurses and nursing support staff to office staff, laundry, dietary and housekeeping. If you work with people then PROtect Yourself! is for you.

PROtect Yourself! is a practical “how to” manual that will enable you to ...

•assess and identify disturbed/aggressive behaviour

•provide effective therapeutic interventions for the benefit of your clients

•develop winning attitudes to prevent aggressive behaviour

•utilize communication & leadership techniques to avoid client escalation and prevent disturbed behavior

•recognize the effects of your body language in resolving a crisis

•identify the influence that health care staff have on violence by a client

•take a proactive approach in developing worksite violence prevention protocols

•recognize a bully at work and develop strategies to minimize their damage

•recognize and support a colleague that is experiencing the effects of a critical incident

William Feather (1889 - 1981) is often quoted as saying “knowledge is power.” Mr. Feather is only partially correct. Knowledge is only power when it is used to achieve a goal. This program takes a proactive approach to minimizing the effects of violence towards those working in healthcare.

If the term proactive is a new concept to you it might be helpful to see where the word is derived.

Definitions:

Activism - the policy or practice of doing things with decision and energy and emphasizing activity.

Advocacy - from the Latin advocare, to summon for counsel 1) one who supports or defends a course 2) one who pleads in another's behalf.

Proactive - active in advance; anticipating trends and working to promote their development.

PROtect Yourself! follows the basic structure identified in personal protection literature i.e. the Three A’s (Awareness, Assessment, Action.)

We will be using the following icons as road maps to keep us focused on our journey together.

We begin with an overview of violent and aggressive behaviour within the healthcare field. We then explore methods and criteria for assessing the potential of violence. It progresses into Crisis! What Crisis? an exploration of the nature of crisis and systematically develops strategies to effectively diffuse a crisis.

We discuss a newly recognized form of workplace violence, that of bullying and horizontal/vertical violence. This develops into an exploration of two possible consequences of workplace violence: Post Traumatic Stress Disorder (PTSD) and “burnout”.

Finally, therapeutic communication skills are explored and we look at proactive techniques and resources that you can utilize in developing a violence prevention program for your particular worksite.

Throughout this manual I have used what I refer to as the “onion” method of instruction. That is, we look at a particular point, explore it, then peel back another layer and study it once again, perhaps from a different angle. It is important to note that many of us likely believe that violent behavior comes without warning and from the least expected source. This isn’t always true. The warning signs are there if we are tuned to them.

We need to be vigilant and proactive in our goal to prevent workplace violence. This is a practical manual in dealing with workplace violence. You will find extensive use of bulleted lists and checklists. Some of these lists are called “Quick Lists.” This has been done intentionally so that you can take them and use them as a tool in your work-site. Start talking about violence in your workplace. The silence has gone on for far too long!

Author’s Note* This manual has developed from many years of personal experience by the author. Much of the information has been gleaned from other sources and repackaged into a form that is practical, yet easy to use.

Whilst every effort has been taken to ensure accuracy in the preparation of the material in this manual, the author shall neither have liability nor responsibility to any person or entity with respect to any loss or damage caused or alleged to be caused directly or indirectly by the information contained within.

The purpose of this manual is to educate and suggest strategies to reduce the likelihood that you will be injured at work. It does not constitute a definitive or authoritative statement of the law. The information is offered as strategies you might like to consider and should not be held as expert.

Rae A. Stonehouse RN.