Healthcare settings and overall environment is also an important factor that can

contribute to violence. Several studies have found a direct correlation with multiple aspects

regarding the hospital setting and violent behavior. Hospital policy and staffing play vital roles in

properly addressing violence. Long waiting times, lack of security, lack of adequate staff, and

patient areas being open to the public are the highest contributing factors to violence. Other

contributing factors include lack of metal detectors, delayed response time by security officers,

working between 7 pm to 7 am, attending alone to patients or visitors, lack of violence

prevention training, and working long hours (Pitts, & Schaller, 2021). 

Implementing evidence-based findings

The violent behavior must be addressed urgently, first-line management should be

through de-escalation. However, safety precautions should be implemented before making any

attempts at de-escalation. This includes calling security and other members of staff to assist,

removing untrained individuals from the room or scene to decrease the risk of injury to medical

staff, and eliminating potential weapons from the room. Providing seclusion to a private room

with decreased stimuli will provide a sense of calm (Pitts, & Schaller, 2021).  While still

ensuring a safe exit from the room, staff should either sit or stand with an open stance. The

healthcare provider should make every effort to establish a good rapport and make the patient

feel respected. Asking open-ended questions and repeating the patient's concerns will help the

patient feel that all complaints have been adequately addressed. If the patient's aggression

improves with these techniques, medications should be discussed before administration to

prevent the re-escalation of violent behavior. If de-escalation techniques are unsuccessful,

pharmacological intervention and or including intramuscular medications and restraints may be

necessary (Pitts, & Schaller, 2021).

Anticipated challenges and overcoming them  

Patient disposition is a highly variable factor, depending on the origin of violent

behavior. 

If the cause of violent behavior is due to an underlying pathology such as brain structure

abnormality, a disease process, medications, alcohol, illicit drugs, and many types of psychiatric

conditions, treating the underlying pathology will restore appropriate and safe behavior (Worker

Safety in Hospitals - Preventing Workplace Violence in Healthcare | Occupational Safety and

Health Administration, 2022). Furthermore, staff may be tempted to become angry at aggressive

or violent patients, there may be a poor team response, and a failure to report incidences of

violence. Remaining calm and understanding that violent behavior often stems from a multitude

of contributing factors. Approaching patients with an open stance and de-escalation are key

components to preventing aggressive behaviors from becoming violent. Team training and a

team-based response to violent behavior will help to reduce episodes of violent behavior

resulting in injury to both healthcare workers and patients (Pitts, & Schaller, 2021).

References

Worker Safety in Hospitals - Preventing Workplace Violence in Healthcare | Occupational

Safety and Health Administration. (2022, May 18). OSHA. Retrieved May 18, 2022,

from https://www.osha.gov/hospitals/workplace-violence

Pitts, E., & Schaller, D. J. (2021). Violent Patients. In StatPearls. StatPearls Publishing.