Personal Safety for Health Care Workers

Pauline Bibby

• Publisher: Routledge
• Year: 2017
• ISBN:
  9781351911832
• Edition: 1
• Topic: Politik & Internationale Beziehungen
• Subtopic: Arbeits- & industrielle Beziehungen

This book is aimed at employers, managers and professional and administrative staff in the health care services. GP practices, home visits and the hospital are all covered. Despite growing evidence of violence against health care workers, some employers have been slow to acknowledge the risks faced in both primary and secondary health care settings. Personal Safety for Health Care Workers provides the tools to investigate the risks involved and to develop policy and practice to ensure staff safety. It also deals with the vexed question of under-reporting. Part I deals with the respective roles and responsibilities of employers and employees and offers guidance on developing a workplace personal safety policy. Workplace design and management are addressed and guidelines provided for health care workers when away from their normal work base. Part 2 gives detailed guidelines for use by individual workers in a variety of work situations. Part 3 considers training issues and contains a number of sample training programmes with handouts. The message of this book is that prevention is better than cure - proper attention to risk can reduce both the incidence of aggression and its development into violent acts. The aim is to achieve the dual effect of protecting health care workers, and also of providing services in a more sensitive way. Good practice implies a responsibility to ensure that health care can be delivered in conditions of safety for staff and patients alike.

Part 1
Background

1 Violence at work

Attacks on health care workers form part of a more general pattern of incidents of workplace violence ranging from verbal abuse and harassment to assault causing death. This chapter considers that wider context and the development of what has been called a culture of violence within society.

Whilst there is growing awareness of the problem of violence, it is not clear to what extent violent incidents have actually increased, and what part has been played by greater awareness and a willingness to report such incidents.

Over the past 10-15 years there has been growing awareness of the problems posed by violence and aggression in the workplace and in work-related situations. There have been a number of highly publicized incidents involving people who have been attacked in the course of their work. These have included teachers, social workers, estate agents, bank and building society staff as well as health service professionals.

The roots of violence are multi-causal, with the demands of modern life having their impact on frustration levels. The current recession, for example, has brought its own pressures. Threatened work closures, reduced budgets and redundancies affect not only those directly involved, but also their families, friends and daily contacts in a variety of situations. Poor housing and difficult working conditions and hours all have their part to play: feelings of insecurity, frustration and loss of control increase personal stress. This in turn can lead to lack of objectivity and oversensitivity. When fear, pain or anxiety about health are added to this dangerous cocktail of pressures, it is all too easy for minor frustration to escalate into anger, and aggression to lead to acts of violence.

It is important for employers arid staff to learn from violent incidents. All employers have a legal duty under Section 2(1) of the Health and Safety at Work Act 1974 to ensure, so far as is reasonably practicable, the health, safety and welfare at work of their employees. However, the benefits of developing an effective policy for preventing and dealing with violence at work extend far beyond any statutory requirements. Staff who are properly trained, confident and well-supported are better prepared to handle difficult situations, and are likely to be more effective in carrying out their work.

Strategies are needed to protect staff, and to reduce the likelihood of aggression developing into overt violence. Failure to develop a strategy to deal with violence at work can lead to litigation and negative publicity, compensation costs and higher insurance premiums. Some of the less obvious but very real costs arising from emotional stress are high sickness levels, absenteeism, high staff turnover, and reduced job satisfaction and morale. In turn these factors can contribute to difficulties in recruiting and retaining staff.

Physical attacks are clearly dangerous and can result in injury, disability, or even death. They also cause stress and anxiety. Similarly, serious or persistent verbal abuse and threats affect both individual effectiveness and personal morale. The costs of failure to address violence at work, and the personal, monetary and organizational benefits of effective action to combat violence, cannot be underestimated.

Employers face the challenge of developing policies and procedures which minimize the occurrence of violence, and providing measures for handling violent incidents which do arise.

The key to a successful strategy lies in an integrated approach by employers, trade unions and staff. Thus, a clear organizational policy statement on personal safety at work must be backed by awareness-raising at all levels, attention to the ways in which the setting itself can be adapted or better managed to reduce risk, training for managers and staff, and agreeing appropriate methods for responding to violent incidents and providing support to the staff involved.

Research by Phillips, Stockdale and Joeman for the Suzy Lamplugh Trust with the London School of Economics¹ concluded that:

• Violence at work is an issue for both employers and employees.
• It is widespread - not confined to 'women's work' or to the UK.
• Perceptions of risk do not always match reality.
• Anxiety is no substitute for action. Institutional provision is crucial to employees' safety - all too often action only follows a serious incident .
• Violence at work has high costs to both the individual and the organization.
• Young males are the group most vulnerable to physical attack in the course of work.

Some practical perspectives have emerged:

• Aggression and violence in the workplace is a people problem, not a gender problem - at least twice as many men as women suffer from assaults every year (and men are much less likely to report them).
• If women's needs are seen to be special as far as violence and aggression are concerned, it is likely that men will ignore their own problems with aggression as well as their attitudes and needs. They will continue to think of women as inferiors, instead of equal though different. Many of the external problems will go unchallenged.
• It must be assumed that men and women have equal but different problems with aggression and violence. They need to be allowed to tackle those problems without stigma, condemnation or surprise.
• Violence is not defined as solely assault, attack and rape - verbal abuse, sexual and racial harassment, bullying, innuendo and even deliberate silence can be the triggers which escalate a situation into something worse.
• Even if escalation does not take place and there is no overt aggression, most people are so badly affected by covert aggression that they feel, and therefore become, more vulnerable. Fear is very debilitating and can result in behaviour which signals vulnerability — muggers mug 'push-overs', that is, easy targets (once again men under-report).
• The majority of incidents of aggression or violence occur when people are out and about: at work, travelling to or from work, or during their personal lives. The most likely timing is late afternoon when the schools come out and the pubs close! Once again most attacks involve men aged 16-25. Eighty-five per cent of muggings on the London Underground are perpetrated by men on men.² Most attacks on women are by people they know. Most rapes occur in the home or on first dates.
• If remedial action is to be really effective, procedures, physical danger points and structural changes need to be considered by both employer and employee.

The implications of violence and the fear of violence are far-reaching. They impact on the ability of individuals and teams to carry out their professional duties. In 1991 a Department of Health review of findings from child death inquiries suggested the level of protection given to children may be affected by violence to social work staff by parents.³

Where threats have been made against social workers or against health care professionals, and especially where a parent has a history of violent behaviour, it is hardly surprising if the worker is fearful. The ability to share such fears, so that ways can be found of managing the situation, will be dependent on the worker feeling confident that supervisors and managers will respond in a supportive and helpful manner. Fear of violence can have a profound effect on the workers' personal lives.

The following chapters outline workplace safety issues and deal with those which are of particular relevance within health care settings, providing a systematic approach to developing personal safety strategies.

References

1 Phillips, C.M., Stockdale, J.E. and Joeman, L.M. (1989), The Risks of Going to Work, London: Suzy Lamplugh Trust.

2 Income Data Services (1990), Violence Against Staff, London: IDS Study 458.

3 Department of Health (1991), Child Abuse - A study of enquiry reports 1980-1989, London: HMSO.

2 The risks in perspective

The high-profile reporting of incidents of violence and the increased awareness of employers and employees of the risks at work have both positive and negative effects. On the one hand we all need to be aware of risks inherent in our life and work if we are to develop safe practices, but such knowledge and awareness can engender fear of violence that is out of all proportion to the risk. In assessing the risks we face we need to consider evidence from a range of sources, as well as look critically at our own working environment and practices, if we are to have a balanced view.

Research findings

In the 1980s the rise in the number of reported assaults of various kinds on employees in the course of their work outpaced the growth in violent crime in general. During the same period a series of publications based on the work of a variety of organizations and on research work served as evidence that violence at work was a growing source of concern. Employers' organizations, trade unions, professional bodies and others were all becoming increasingly aware of the problems of violence, and the need to prevent them wherever possible and deal with them effectively when they occur.

There is a general view that violence at work has been increasing. However, this is difficult to prove or disprove since there has been an absence of large-scale systematic record-keeping, and increases in recorded attacks could stem from the fact that reporting incidents has become more acceptable, rather than reflect an increase in violence.

The lack of data also makes it difficult to quantify either the levels of violence or any changes or differences from year to year, geographically or in particular occupational groups. Despite these limitations, the following pieces of work have contributed to a growing understanding of the nature, scale and effects of violence at work:

• In 1987 the Health and Safety Executive's Health Service Advisory Committee produced a report¹ which suggested that violence to health service staff was far more common than previously believed. In some areas of work violence to staff was a regular occurrence, A survey of 3 000 health service workers showed that in the previous year:
  • - 0.5 per cent had an injury requiring medical assistance;
  • - 11 per cent had a minor injury requiring first aid;
  • - 5 per cent had been threatened with a weapon;
  • - 18 per cent had been threatened verbally.
• The TUC's report on Violence to Staff² in 1988 highlighted the lack of a comprehensive body of data on violence at work. It then reviewed current initiatives on violence to staff in a range of employment sectors, and showed that awareness of the problem had increased but the nature and extent of the risks to employees was still unclear.
• The 1988 report of the Department of Health and Social Security Advisory Committee on Violence to Staff³ concluded that the issue should be considered in the wider context of service provision and against the legal background of the Health and Safety at Work Act 1974. The report made recommendations for all DHSS services and argued that central strategies alone are insufficient; initiatives must take into account local circumstances. Where strategies for combating violence have not been developed the report proposed urgent action, even in certain services or areas where violence is not perceived as a problem. The report's principal recommendations were:
  • - the development of local strategies which contain an assessment of the problem of violence;
  • - preventive measures;
  • - suitable responses;
  • - support to staff who are victims of violence;
  • - the importance of training in translating strategies into practical advice.
• In 1988 the British Crime Survey (BCS)⁴ found that teachers, welfare workers and nurses are three times more likely than the average employee to be verbally abused or threatened. Other occupational groups with a similarly increased risk of abuse include managers in the entertainment sector, transport workers, male security guards and librarians.
• Phillips, Stockdale and Joeman⁵ found that:
  • - 8 per cent of people are likely to suffer an assault on their journey to or from work;
  • - 20 per cent are likely to experience an unpleasant incident on their journey;
  • - 20 per cent face threatening behaviour;
  • - sexual harassment occurs most frequently, with 20 per cent of victims being women in professional occupations where they spend a substantial amount of time away from a base, or workers in shops and offices;
  • - the frequency of physical attacks ranges from a relatively low 4 per cent for female office workers to approximately 15 per cent for male professionals who often work away from the office;
  • - the incidence of experiencing threatening behaviour varies from 10 per cent among office-based professionals to 33 per cent for those who often meet clients.
• The British Crime Survey for 1988 showed that 25 per cent of crime victims said that the incident had happened at, or because of, work. Fourteen per cent of respondents said they had been verbally abused at work at least once in the previous year, and approximately 33 per cent of all threats of violence were received at work.
• Research published in 1987 by the Labour Resear...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Contents
• Foreword
• Introduction
• Part 1 – Background
• Part 2 – Guidelines for health care workers
• Part 3 – Training for safety
• Appendix A: Sample handouts
• Appendix B: Violent incident report form
• Select bibliography
• Useful organizations