178 unit 3 | Professional Issues
a physician. “I’m tired of waiting. Let’s get this show
on the road,” he screamed loudly as Ms. Jones walked
by. “I’m sorry you have to wait, Mr. P., but the doctor
is busy with another patient and will get to you as
soon as possible.” She handed him a cup of juice she had
been bringing to another patient. He grabbed the cup,
threw it in her face,and then grabbed her arm.
Slamming her against the wall, he jumped off the
stretcher and yelled obscenities at her. He continued to
scream in her face until a security guard intervened.Be aware of clues that may indicate a potential for
violence (Box 12-3). These behaviors may occur in
patients, family members, visitors, or even other
staff members. Even patients with no history of
violent behavior may react violently to medication
or pain (Carroll & Sheverbush, 1996; Lanza &
Carifio, 1991).
In the health-care industry, violence is underre-
ported, and there are persistent misperceptions that
assaults are part of the job and that the victim
somehow caused the assault. Causes of underre-
porting may be a lack of institutional reporting
policies and employee fear that the assault was a
result of negligence or poor job performance (U.S.
Department of Labor, 1995). Box 12-4 lists some
of the faulty reasoning that leads to placing blame
on the victim of the assault.
Actions to address violence in the workplace
include (1) identifying the factors that contribute to
violence and controlling as many as possible and
(2) assessing staff attitudes and knowledge regarding
violence in the workplace (Carroll & Sheverbush,
1996; Collins, 1994; Mahoney, 1991).
When you begin your new job, you may want
to find out the policies and procedures related to
violence in the workplace at your institution.
Preventing an incident is better than having to
intervene after violence has occurred. The following
are suggestions to nurses about how to participate in
workplace safety related to violence (nursingworld.
org/osh/wp5/htm):
■Participate in or initiate regular workplace
assessments.Identify unsafe areas and the
factors within the organization that contribute
to assaultive behavior, such as inadequate
staffing, high-activity times of day, invasion of
personal space, seclusion or restraint activities,
and lack of experienced staff. Work with
management to make and monitor changes.
■Be alert for suspicious behavior such as verbal
expressions of anger and frustration, threatening
body language, signs of drug or alcohol use, or
presence of a weapon. Assess patients or suspi-
cious workers, patients, and visitors for potential
violence. Evaluate each situation for potential
violence. Keep an open path for exiting.
■Maintain behavior that helps to defuse anger.
Present a calm, caring attitude. Do not match
threats, give orders, or present with behaviors
that may be interpreted as aggressive.
Acknowledge the person’s feelings.
■If you cannot defuse the situation,then remove
yourself from it quickly, call Security, and report
the situation to management.
■Know your patients.Be aware of any history
of violent behaviors, diagnoses of dementia,
alcohol, or drug intoxication.
Box 12-5 lists some additional actions that can be
taken to protect staff members and patients from
violence in the workplace.box 12-3
Behaviors Indicating a Potential
for Violence- History of violent behavior
- Delusional, paranoid, or suspicious speech
- Aggressive, threatening statements
- Rapid speech, angry tone of voice
- Pacing, tense posture, clenched fists, tightening jaw
- Alcohol or drug use
- Male gender, youth
- Policies that set unrealistic limits
Adapted from Kinkle, S. (1993). Violence in the ED: How to stop it before it
starts. American Journal of Nursing, 93(7), 22–24; Carroll, C., & Sheverbush,
J. (September 1996). Violence assessment in hospitals provides basis for
action.American Nurse, 18.
box 12-4
When an Assault Occurs:
Placing Blame on Victims- Victim gender: Women receive more blame than men.
- Subject gender:Female victims receive more blame
from women than men. - Severity: The more severe the assault, the more often
the victim is blamed. - Beliefs:The world is a just place, and therefore the
person deserves the misfortune. - Age of victim:The older the victim, the more he or she is
held to blame.
Adapted from Lanza, M.L., & Carifio, J. (1991). Blaming the victim: Complex
(nonlinear) patterns of causal attribution by nurses in response to
vignettes of a patient assaulting a nurse.Journal of Emergency Nursing,
17(5), 299–309.