Workplace Violence Case
Factors That Contribute To Aggression
Mental illnesses are associated with aggressive behavior displayed by patients.
Schizophrenia, mood, personality, and drug abuse disorders are precursors to violent behavior
exhibited by patients. Delusion and hallucinations symptoms and psychotic conditions in general
have been linked to aggression and violence. Some of the above listed psychiatric disorders
present with disturbed interpersonal relations (Shea et al., 2017). For instance, patients admitted
under the influence of alcohol and other drugs develop violence at the time of admission.
However, the risk of aggression and violence behavior changes with time after admission.
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Inefficient resources contribute to aggressive behavior by patients. Under-resourced
clinical facilities increase the tensions between healthcare workers and patients. Similarly, there
are no facilities for supporting the implementation of preventive measures against patients and
families members displaying aggression in low resource settings.
Forced and long hospitalizations increase risk to aggressive behavior by patients. Some
psychiatric cases qualify for involuntary admission (Tonso et al., 2016).Some chronic conditions
require long admissions. Studies indicate that patients admitted against their resist against
admission. Aggression and violence are one of the ways patients use to resist involuntary and
prolonged admissions.
Poor communications strategies precipitate aggression. Communication within the
clinical areas entails responding to patient needs. Therefore, poor communications between the
hospital staff and patients implies that patients’ needs are not met sufficiently. Patients and their
relatives become aggressive when their needs have not been met due to poor communication
skills.
Factors That Contributed To Ben’s Escalating Behavior
Lack of proper communication from the hospital staff member to whom Ben presented
his complains.
The hospital staff member failed to assess the situation and identity the escalation and
respond appropriately.
Lack of institutional policy on the storage of patients’ and family member’s personal
belongings.
Lack of proper channels of addressing patients’ and their relative’s grievances led to
Ben’s confrontation with the hospital worker.
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Strategies or Behaviors to De-Escalate Ben
Education to staff members is an effective de-escalation strategy in healthcare. According
to a study done by Gerd et al., (2013), training equips healthcare workers with the needed proper
patients and staff communication skills to avoid aggression. In the same study, researchers found
out that staff education on communication increases the use of communication skills in de-
escalating aggression. The study compared staff members’ response to aggression before and
after training a session. The results of the study indicate that after the aggression management
education program, staff members were more aware of aggressive behavior from patients. On the
contrary, before undertaking the education program, staff members used counterproductive
strategies to respond to aggression. In a different but similar study, the researcher reported that
hospital staff members could critically reflect on how cumulative failure to respond to patient
needs ultimately led to aggression (Moylan, 2017). Prior to education on patient aggression and
its management, hospital staff members admitted that they did not prioritize patient’s needs over
their duty to offer healthcare services. Development of interpersonal skills is an effective strategy
in managing violence and aggression at the workplace. Hospital staff members who are capable
of speaking in calm and controlled manner are effective in managing violent and aggressive
patients as compared to workers who issue directive instructions. Proper communication taught
in de-escalation training helps achieve a collaborative approach between the service providers
and service users, and their families. The service provider who practices excellent
communication skills offers choices to solving the situation in a respectful manner and allows the
patients or their families to respond. Another study investigated the impact of staff training on
their attitudes on the causes and ways of responding to patients’ aggression (Hyland, Watts, &
Fry, 2016). The results showed that staff attitudes had substantially changed and viewed
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communication as an effective means of preventing and managing aggression, as opposed to
restriction. However, the study did not describe the training delivery methods, situational and
environmental-related factors in managing aggression.
Observation of aggressive behaviors is another de-escalation strategy in a health care
setting. Previous studies have observed that implementation of preventive strategies involves
skills on recognising early signs of aggression. Early detection of aggression includes, for
instance, identification of anxiety and distress among patients and visitors. Early identification of
signs of aggression is associated with high rates of reporting the cases of violence for preventive
actions. For example, hospital staff members who have been trained on detection of
circumstances, signs, and precursors of patient aggressiveness report to the hospital security
when escalation occurs. Hospital workers who can identify early signs of aggression no longer
view violence in the healthcare workplace as part of the healthcare provider’s work experience
(Partridge & Affleck, 2017). Reported cases of signs of aggression form the basis for developing
strategies for preventing the occurrence of such events in the future. Nurses and other healthcare
workers need to assess an escalating situation, such as Ben’s scenario. Healthcare workers who
successfully manage an escalating situation possess the skills to notice the situation and its risks
of causing harm to the concerned.
Authentic engagement is a strategy that could have been used to de-escalate aggression
portrayed by Ben. The strategy involves staying connected with the patients in a sincere manner.
Authentic engagement is the creation of positive relationships with patients and their families.
The strategy allows the healthcare provider or staff member to understand the patients’ situation.
Similarly, the patient or their families understand that aggression and violence are not
appropriate means of communication and expressing their emotions (Pich, Kable, & Hazelton,
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2017). Authentic engagement has been found to have more therapeutic impacts than other means
of responding to aggression and violence.
Establishment and implementation of health facility’s basic rules is necessary for de-
escalating the aggressive situation. Institutions should develop guidelines to guide the staff
members in responding to aggressive and violent patients and their family members. Effective
institutional de-escalation guidelines have been found to appreciate the differences in the service
providers’ and users’ expectations from a given situation (Egerton et al., 2016). An escalating
situation becomes worse as the time progresses in the process of collaborative reinforcement.
Appropriate de-escalation strategies involve basic principles such as sincerity, the attitude of
empathy, fairness, and concern and assessment of associated risks. The guiding principles further
pertain to sharing risk assessment information on the situation, early intervention, and self-
confidence. Hospital rules teach and emphasize on verbal and non-verbal communication skills
as effective (Hogarth, Beattie, & Morphet, 2016). Institutional policies on de-escalation ensure
that violence and aggression are addressed based on the specific factors that contribute to
violence and aggression by patients. Patients with different clinical diagnosis and demographic
characteristics exhibit different levels of aggression in various situations. Further, each
institution has its resources that could be used in managing such situations. The basic rules and
guideline de-escalating situations in a given health care facility reflect the available resources.
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References
Edward, et al., (2016). An Analysis of factors leading to aggression against Nurses. Journal of
clinical nursing, 25(3-4), 289-299. doi: 10.1111/jocn.13019
Egerton et al., (2016). The Perception within ED in Australian Hospital. The Australian Medical
journal. 204(4), 155-155. DOI:10.5694/mja15.00858
Gerdtz et al. (2013). The Impact of training on healthcare workers on aggression management in
ED. International journal of nursing studies. The Journal of Science in Nursing 50(11),
1434-1445. doi.org/10.1016/j.ijnurstu.2013.01.007
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Hogarth, Beattie, & Morphet, (2016). Nurse Reporting of Aggression, Journal of Emergency
Care of Australia 19(2), 75-81.
Hyland, Watts, & Fry . (2016). The Rate of Incidences of Aggression and Nurses Attitude.
Journal of Emergency Care of Australia. 19(3), 143-148.
Moylan, . (2017). Safety of Staff in practice and Violence in Practice. The Physician 46(12), 952.
Partridge, & Affleck, . (2017). Physical Abuse in ED; The incidence and Attitudes , Journal of
Emergency Care of Australia 20(3), 139-145. doi: 10.1016/j.aenj.2017.05.001.
Pich, Kable, & Hazelton . (2017). Precursors of Violence aggravated by Patients in ED and other
departments , Journal of Emergency Care of Australia , 20(3), 107-113.
Shea et al.,. (2017). Aggression as experienced by Hospital workers. Journal of Scholarship
Nursing, 49(2), 236-243.
Tonso et al.,. (2016). Within Mental Health Facility in Victoria. Journal of Mental health Care,
25(5), 444-451.
