2013年11月1日 星期五

some summary about workplace violence at Emergency Department


Workplace violence is violence or the threat of violence against workers. It can occur at or outside the workplace and can range from threats and verbal abuse to physical assaults and homicide, one of the leading causes of job-related deaths.
U.S. Department of Labor Occupational Safety and Health Administration (2002)


Workplace violence can be described as the intentional use of power, threatened or actual, against another person or against a group, in work-related circumstances, tat either results in or has a high degree of likelihood of resulting in injury, death, psychological harm, mal-development, or deprivation.
(Adopted by the 63rd WMA General Assembly, Bangkok, Thailand, October 2012)


A number of surveys have reported that those who work in emergency departments (EDs) experience high levels of violence and aggression.
Some suggest that 100% of emergency department nurses have, at some time, experienced workplace violence.
(Health Promot J Austr, van der Zwan, R.,2011)


Scene
As shown in previous research, most attacks occurred in the emergency room ; the wards and parking lot were next in frequency.
Gender
Women residents were more likely than men to call hospital security to intervene in a potentially violent situation
Seniority
junior residents (postgraduate years 1-4) were more likely to be attacked than senior residents (> or = 5 years) 
 (The Western journal of medicine) (1997, Barlow, C. B. Rizzo, A. G.)


Violence in the health care sector can be categorized as either
Vertical’ occurring between health care professionals and the care recipients
 ‘Horizontal’ occurring among health care professionals or among care recipients.
(workplace violence in the health sector,P6,2008)




Aggressions towards nurses in emergency departments: an international literature review
Verbal abuses varies from 50% to 100%
physical violence ranges between 16.7% and 72%.
Patients and relatives are the main perpetrators, followed by doctors, and, only in lower percentages, by nurses colleagues.
 Alcohol, drugs abuse, and overcrowding in EDs are acknowledged as motivating factors for violent events.
Under-reporting of aggressions is frequent up to the 80% of victims, and some papers report that nurses consider assaults as a normal part of their work.
(J Prof Inferm, Brunetti, L.Bambi, S. 2013)


Factors


 Among the many factors, the number-one issue, is the economy. “We are dealing with a far greater percentage of our population that’s under economic stress, and this is always a trigger for workplace violence and also for domestic violence, which can spring over into the workplace.
Other contributing factors include long waits in the emergency room, overcrowding of hospitals and the lack of beds and rooms available at any given time, along with intoxicated patients.
(Trained and Ready, PAUL ROTHMAN, MAY 15, 2013 )


Waiting room

The waiting room can be a potential time bomb if not handled properly
Communication with patients about waiting time and being aware of and dealing with potential problems are the key to preventing violence.
(1998 J Healthc Prot Manage) (Fitzpatrick, T. K.)



Pressure

The work process is marked by overload, individualization of responsibilities, time pressures and deadlines for making decision, little space for exchange and sharing, lack of support or guidance.
The strong pressure to provide care quickly causes conflict and aggression among users and the different professional teams. These situations arise from problems in work organization and users in excess of the ER service capacity.
CONCLUSION: The article recommends changes in the work process that can simultaneously improve both the quality of care for patients and provide protective measures for workers.
(Work)(Lancman, S.Mangia, E. F.Muramoto, M. T 2013)