12/19/22 12:18 1

 Violence is defined by the World Health Organization in the

World Report on Violence and Health as “the intentional use of
physical force or power, threatened or actual, against oneself,
another person, or against a group or community, that either
result in or has a high likelihood of resulting in injury, death,
psychological harm, maldevelopment or deprivation.”

 This definition emphasizes that a person or group must intend to

use force or power against another person or group for an act to
be classified as violent.

12/19/22 12:18 2
 Verbal abuse is the most common type of abuse directed toward
nurses in health‐care settings. It is three times more likely to
occur than physical violence. Behaviors such as swearing,
shouting, or cursing have been identified as the most common
form of verbal abuse and have also been reported as the most
violent type of verbal aggression.

Physical abuse often co‐exists with verbal abuse, suggesting that

the latter might act as a predictor for potential physical abuse.
these behaviors, “being pushed or hit” has been identified as the
most common type of physical abuse, while the use of lethal
weapons has been shown to occur mostly during night hours.
12/19/22 12:18 3
 Emergency departments as locations where violent incidents are
likely to be significantly underreported; the reasons given are:
(a) Nurses are not satisfied with how their previous violent events
were handled as some cases weren’t treated with appropriate
seriousness
(b) Nurses’ belief that violence is part of the job
(c) Nurses are discouraged from reporting such events as even if
they do, there are no policies guaranteeing justice
(d) Insufficient time
(e) Nurses' belief that no harm was inflicted on them and they can
handle it
(f) Nurses' ability to defend themselves by changing how they treat
that particular patient.
12/19/22 12:18 4
 Triggers of Violence and Aggression

  Every day Nurses are exposed to physical assault, the

threat of assaults, and verbal abuse. The abuse
healthcare workers face can take many forms. Violence
against healthcare workers is usually consumer-related
violence, harassment from patients, or relationship
violence.

12/19/22 12:18 5
 Triggers of Violence and Aggression
 Hospitals are now consistently seeing a correlation
between increased workplace aggression and the
increase in the lack of nursing staff . 

 It typically occurs if a patient is demanding to leave and

no longer wants to be cared for if they are experiencing
pain or discomfort from treatment, if a patient is being
restrained, or if a staff member intervenes among
patients during an altercation. All these scenarios are
pervasive and put nurses at high risks for violence.

12/19/22 12:18 6
 Triggers of Violence and Aggression

 Violence in the workplace is a significant health and

safety issue for all healthcare workers. In addition to the
fear of coming into work that may occur, healthcare
workers and nurses have also reported expressing post-
traumatic stress disorder symptoms following incidents
of violence at their facilities.

 Depression is also frequented by many following their

years as healthcare workers.

12/19/22 12:18 7
 Triggers of Violence and Aggression

 Nurses are exposed to verbal and sometimes physical

abuse daily in their line of work. Unfortunately, it has left
many nurses desensitized to violence. Nurses should be
able to speak truthfully on what for the patient but not be
subjected to aggression.

 Violence has become an expected & accepted part of the

job, which is unfortunate for the nurses who feel as
though their lives are in danger when they step into work.

12/19/22 12:18 8
 Risk Factors Of Workplace Violence In Healthcare
Settings

 Attitudes and behaviors of patients, family members,

friends, or visitors who are often under intense emotional
charge and expectations
 healthcare workers and work factors which include
shortage of staffs, inexperienced or anxious staffs, poor
coping mechanism and lack of training
 system or environmental factors (overcrowded areas,
long waiting hours, inflexible visiting hours, lack of
information as well as difference of language & culture)

12/19/22 12:18 9
 Effect of workplace violence in healthcare settings

A. Negative physical and psychological well-being of healthcare

workers
 Demoralization
 Depression
 Loss of self-esteem
 Ineptitude
 Post-traumatic stress disorders
 Sleeping disorders
 Irritability
 Difficulty concentrating
 Emotionally upset

B) Decline in quality of care delivered

 Effect to delivery of health care services
 Increased absenteeism
12/19/22Early
 12:18 retirement or leaving service 10
 Management of Workplace Aggression and Violence in
Nursing

  The detrimental effects, mainly the psychological impact of

workplace violence on affected healthcare employees, are one of
the most critical reasons it must be handled before it escalates to
higher absenteeism rates or further affects healthcare workers'
overall performance.

 It will have even more negative implications for the healthcare

sector when staffing is already scarce, and patient loads continue
to rise inexorably.

12/19/22 12:18 11
 Management of Workplace Aggression and Violence in
Nursing
  There is an essential need to have a strong collaborative effort,
support, and commitment from top management and the workers
to protect themselves. There is no single guideline that is suitable
for all settings. Hence, the management of each healthcare
setting needs to create or adapt and establish a practical,
acceptable and sustainable workplace violence prevention
program.

 In non-emergency settings, interventions to prevent violence

against healthcare professionals focus on techniques to better
manage aggressive patients and high-risk visitors while in
emergency circumstances, interventions are more focused on
assuring the physical security of healthcare facilities
12/19/22 12:18 12
 Management of Workplace Aggression and Violence in
Nursing
 Among some of the prevention and control measures in the
sequence of effectiveness include;
1. Substitution by transferring a client or patient with a history of
violent behaviour to a more suitable secure facility or area
2. Engineering control measures which include installing barrier
protection, metal detectors and security alarm systems, allocating
conducive patients or visitors areas and clear exit routes
3. Administrative and work place practice controls which include
implementing workplace violence response and zero-tolerance
policies ability to resolve conflict situation establishing
mandatory timely reporting system flowchart for assessing and
response in emergency situations
12/19/22 12:18 13
 Management of Workplace Aggression and Violence in
Nursing
4. Post-incident procedures and services that include
trauma-crisis counselling, critical-incident stress
debriefing and employee assistance programs
5. Safety and health training in order to ensure that all staff
members are aware of potential hazards and how to
protect themselves and their co-workers through
established policies and procedures
6. Remove yourself from the situation: If you can't escape
the situation, then use your cell phone to call for
assistance either to hospital security, the charge nurse,
Yell loud enough to get help.
12/19/22 12:18 14
 Management of Workplace Aggression and Violence in
Nursing
7. Create distance: Put space between you and the person yelling
or coming at you. When entering a room of someone upset,
make sure to leave the door open and keep your body positioned
so you are able to leave the space. Don't back yourself into a
corner of the room. Respect the person's personal space and
keep it at a 3-4ft distance.
8. Defend yourself if the event turns physical: You have a right to
defend yourself. You are allowed to meet the attacker with
equal force to get them to stop.
9. Report the incident: Notify your supervisor, security, or facility
leadership of any threats or violence towards you or other team
members.

12/19/22 12:18 15
 Management of Workplace Aggression and Violence in
Nursing

10. Use your words appropriately to de-escalate or diffuse

a situation: When a patient gets agitated or violent,
you may want to avoid direct eye contact not to
convey that you are a threat. Be concise in your words,
and don't dismiss what the person is saying to you..
11. Get support and seek professional help: We all handle
situations differently, but we need to recognize that
violence in the workplace is not okay and shouldn't be
tolerated.

12/19/22 12:18 16
Management of Workplace Aggression and Violence
in Nursing

 Many factors cause workplace aggression &

violence. Hospitals are now seeing a correlation
between an increase in workplace aggression and
an increase in staff shortage.

 If nurses do not adequately deal with these issues,

the result could be a decline in patient care, tense
clinical relationships, & moral distress.

12/19/22 12:18 17
Management of Workplace Aggression and Violence
in Nursing

The overwhelming shortage of nurses and other

healthcare professionals has caused tensions to run high in
facilities. An increase in patient morbidity rate, exposure
to violent patients, and the absence of violence protection
programs in the workplace are all aiding the rise of
workplace violence.

12/19/22 12:18 18
Management of Workplace Aggression and Violence
in Nursing
 Some nurses have experienced grabbing, hitting, punching, and
sometimes spitting, kicking, pushing, and other destructive
behavior. It seems to be a more significant issue among those
who work in the public sector rather than those who work in the
private or not-for-profit sectors.

 Many nurses are often put in situations where emotions run high,
and tension can boil over to the workplace. This can be caused
by patients feeling neglected by their healthcare staff which is
mostly a result of a lack of staff in the workplace.

12/19/22 12:18 19
Management of Workplace Aggression and Violence
in Nursing
The pandemic has created additional challenges for workplace
violence. Nurse shortages and improper patient ratios make
burnout and fatigue a higher risk. Managing and identifying these
issues are the first steps to determining how to avoid creating a
hostile environment for healthcare workers and their patients.

Risk factors will vary from hospital to hospital, but studies have
shown violence occurring most frequently in psychiatric units,
emergency departments, waiting for areas, and long-term care
units. Worker safety must be of top priority, especially in these
high-risk units.

12/19/22 12:18 20