VIOLENCE In the WorkPlace

1. VIOLENCEIn the WorkPlace

2. Objectives: After completion of the presentation, the participant will be able to: • Identify 4 signs of a potentially violent situation. • Identify 3 methods of controlling disruptive behavior. • Describe how to report an incident at GBMC. • Describe 5 security measures you and/ or the facility can take to prevent violence.

3. Introduction: Violence is a serious problem. It occurs EVERYWHERE... .............Even in the WorkPlace! GBMC HealthCare, Inc. has developed this program to address this issue. This self learning packet will provide you with the knowledge to prevent and de-escalate disruptive and potentially violent situations in the workplace. Policy # 807 is found in the safety manual. It can also be found on the GBMC Intranet under Employee Health policies. FAMILIARIZE yourself with the policy: ZERO TOLERANCE is the position of our management at GBMC.

4. HOMICIDE IS THE LEADING CAUSE OF WORKPLACE DEATH FOR WOMEN AND THE SECOND LEADING CAUSE OF DEATH FOR ALL WORKERS (Center for Workplace health and safety, Inc.)

5. Incidence: • One in 6 violent crimes occur on the job. • Highest incidences occur in places: • where cash is regularly handled • where employees work alone (late @ night) • where there is regular contact with prisoners • AND.......................

6. Incidence cont. WHERE THERE MAY BE HIGHLY EMOTIONAL SITUATIONS, SUCH AS HOSPITALS AND SOCIAL WORK/ SOCIAL SERVICES ORGANIZATIONS.

7. Incidence cont. INTENSIVE CARE UNITS, ORs, MEDICAL-SURGICAL FLOORS, NURSERIES, NURSING HOMES, AND COMMUNITY HEALTH SETTINGS HAVE ALL BEEN THE SCENES OF VIOLENT ACTS!

8. OF 1209 EMERGENCY DEPARTMENT NURSES RESPONDING TO A RETROSPECTIVE SURVEY, 97.7% HAD EXPERIENCED SOME TYPE OF VICTIMIZATION (Journal of Emergency Nursing, 1991)

9. Causes of Violence • Robbery is the number 1 cause in the workplace. BUT, Violence occurs from: • Coworkers, visitors, outsiders, and customers under emotional stress • A relative, friend, or acquaintance entering the premise to do harm (Domestic Violence situations) • Individuals under the influence of a substance • Prolonged waiting

10. PREVENTION: “UNIVERSAL PRECAUTIONS FOR VIOLENCE” It should be expected but can be avoided or mitigated through preparation

11. Self: Alert security of unusual behavior Identify visitors Wear ID badge Store briefcase and purse locked and out of site Do not walk alone at night Facility: Visitor registration Lighted hallways & stairwells Lighted garage Cameras Panic buttons (garage) Safety surveillance security; plant operations; safety committee; management Security Procedures:

12. Security Procedures cont. • Facility Layout • Unit Layout: location doors, windows, furniture • Identify items that may cause injury: chairs, small equipment • Identify items that could help protect: mattress, pillows, sheets

13. RECOGNITION OF POTENTIALLY VIOLENT SITUATIONS TAKE THREATS OF INTIMIDATION SERIOUSLY!! DO NOT IGNORE! Threats may be: verbal, written, physical, over the phone, or through e-mail

14. Signs of Potential Violence • Threats • Tantrums- may be sign of more violent behavior • Withdrawn • Angry • Blames others • Becomes verbally/ Physically Abusive • Talks about guns

15. MORE SIGNS! • Unreciprocated romantic obsession • Expressions of hopelessness or heightened anxiety • Violence towards inanimate objects

16. 1. Anxiety, discomfort, anger 2. Defensive- Verbally Threatening 3. Physically Acting Out 4. Stimulation/ Stress Reduction 1. Supportive/ Reassurance 2. Directive: Set reasonable, consistent, clear limits 3. Proper physical control 4. Staff establish Rapport Levels of Disruptive Behavior ACTION:

17. Setting Effective Limits • Explain which behavior is inappropriate • Explain why the behavior is inappropriate (focus on behavior; not person!) • Give the individual reasonable choices • Allow time for the individual to make a choice • Enforce Limits

18. Setting EffectiveLimits Remember: • Speak in calm, soft voice • Do NOT intervene alone! • Adopt a supportive posture (no arms across chest; no hands in pockets!) • Be aware of personal space: Don’t allow yourself to be backed into a corner! • Do not convey negative feelings • Listen, Listen & Listen!

19. Methods of Controlling Disruptive Behavior • Verbally • Chemically (medications) • Physical Control Techniques

20. Disruptive Behavior Causes: FEAR AND ANGER TO THOSE IN THE ENVIRONMENT

21. TRAINING: Will assist staff in: • control of actions and emotions • Provide framework to develop emotional support and • provide a team for physical safety

22. If you find yourself in an escalating situation: MAKE NO HEROIC ATTEMPTS TO SUBDUE OR CONTROL PATIENT/ INDIVIDUAL! INSTITUTE PROCEDURE AND GET HELP!

23. GBMC Procedure: POLICY # 807: SAFETY MANUAL

24. If incident occurs which includes threats: • Report threat or act to supervisor IMMEDIATELY! • Complete Employee Medical Referral Form and seek appropriate medical treatment (ER or EHS based on extent of injury and hours) • Consider use of Employee Assistance Program (410-938-3200 or 1-800-823-1337)

25. Employee Situation Human Resources Security Employee health and Safety Management Visitor*/ Patient Security (may call BCPD) EHS if employee involvement/ injury management *Visitor may be friend or acquaintance of employee Manager will contact:

26. Employee Situations are taken Seriously! Employee who threatens/ acts violently will: • Be evaluated by EAP to determine if threat to workplace • Remain off work until healthcare provider authorizes release • Need to undergo treatment/ counseling if recommended by Healthcare Professional.

27. Staff will: • Be supportive to each other • Be supported by management • Offered EAP services (EAP will determine if debriefing necessary)

28. SUMMARY: WORKPLACE VIOLENCE IS A REALITY! PROPER TRAINING AND PREPARATION, AS WELL AS SUPPORTING SYSTEM PROCESSES AND PROCEDURES CAN MINIMIZE THE THREAT OF VIOLENCE. BE PREPARED! DON’T BE A VICTIM!

29. Resources: • Human Resourcesx2204 • Employee Healthx2239 • Securityx2222