Violence Prevention in Healthcare: Human Beings are Sensory Beings
May 24, 2018 10:11PM ● Published by Alyssa McGinnis
By Theresa Parish, OTR/L, CEES
Many healthcare and social service agencies look for ways to prevent injuries to their employees. Injury prevention training to reduce needle sticks, strain injuries, and falls are very common. However, trends in violence in the workplace has led to an increase in employee trainings to help contain this threat. In a recent article, by Michelle A. Dressner, 45.9% of injuries in state government hospitals, 14.8% in local government hospitals, and 11% in private hospitals were due to violence. In the state government hospitals, over half of the injuries were sub-classified as “intentional injuries by other person.”1
OSHA outlines five key components to a comprehensive workplace violence prevention program for healthcare and social service agencies. One of the key components is thorough and repeated training for staff so they are able to respond confidently and effectively. The main focus areas are: training for all workers; the most effective training methods including role-playing, simulations, and drills; as well as specific training topics. They recommend training topics that cover policies and procedures, de-escalation, and self-defense techniques with a hands-on component.2
Healthcare workers, who are very comfortable in their workplace, sometimes forget that a hospital or clinic can be a very stressful place to the general population. They may associate the hospital with a traumatic event such as a death of a family member, a childhood experience, or even their own mortality. They may feel the staff are keeping something from them, making them wait too long, or don’t care about them, and may react by lashing out. There are some populations that may even need more understanding due to their issues with a sensory processing disorder.
As an occupational therapist who specializes in sensory processing and working with individuals with intellectual and developmental disabilities, I see a need for training to increase awareness of the sensory needs of these populations, especially since often they unintentionally injure caregivers.
The need for training is increased when considering the high probability that healthcare and social service workers will come in contact with a patient or visitor who suffers from one of these issues. An estimated 4.6 million Americans have an intellectual or developmental disability3 and anxiety disorders affect 40 million adults age 18 and older.4 There are 5.7 million Americans living with Alzheimer’s.5 Many people with intellectual and developmental disabilities, or Alzheimer’s also deal with sensory processing disorders, which may lead to anxiety.
These individuals may have issues with transitions to new places, people, or tasks. Different smells, sights, and noises can increase the perception of a threat in their world and initiate the fight-flight response. This response releases hormones from the sympathetic nervous system, especially adrenaline, and sends a signal to the body for them to fight or flee. In a hospital or clinic setting, this can quickly become a combative or violent situation.
Knowing how to de-escalate is very important; however, with some sensory processing disorders, aggressive behaviors happen out-of-the-blue, with no warning, and no time to de-escalate. When an individual is in the fight-flight response, de-escalation is often not an option as the “survival brain” has taken over. This response can occur not only in someone with known sensory processing issues, such as autism, it can also occur in anyone under stress or a perceived stress.
As a preventive measure, the receptionist can be trained to identify individuals who may need extra help to keep their sensory system calm and organized. When an individual is identified, the receptionist could ask if it would be better for them to wait in a quiet room or if they would like a pager so they could walk around the facility. Having a “Calming Kit” with weighted items that can be washed easily or wiped down (blanket, neck wrap, lap pad), some fidget items that would be appropriate for adults and children, and some boredom buster items such as coloring books and crayons can be helpful.
We are all human beings, therefore we are all sensory beings. Taking steps to train staff on what sensory processing is; how it affects each and every one of us, especially in times of stress; and implementing protocols in the workplace to increase empathy and decrease environmental stressors can lead to decreased incidences of some violent behaviors.
Theresa Parish is an occupational therapist and a Ready Associate for the Ready Approach. She is an Ergonomics and Loss Control Specialist/Sensory Processing Specialist with RAS.
1Dressner, M. (2017). Hospital workers: An assessment of occupational injuries and illnesses. Monthly Labor Review. https://doi.org/10.21916/mlr.2017.17.
2Occupational Safety and Health Administration. (2015). Preventing Workplace Violence: A Road Map for Healthcare Facilities. Occupational Safety and Health Administration publication No. 3827. Retrieved from https://www.osha.gov/Publications/OSHA382.pdf
3The Arc. (2011). Introduction to intellectual disability. Retrieved from https://www.thearc.org/sslpage.aspx?pid=2448
4Anxiety and Depression Association of America. (n.d.). Facts and statistics. Retrieved from https://adaa.org/about-adaa/press-room/facts-statistics.
5Alzheimer’s Association (2018). Alzheimer’s disease facts and figures [Video File]. Retrieved from https://alz.org/index.asp.