My late grandfather was evicted from two separate senior living centers for assaulting his caretakers. No where else would take him, and he spent the last week of his life sedated at my aunt and uncle’s home. He had late-stage Alzheimer’s disease and thought his caretakers were trying to hurt him—especially those who helped him bathe.
While some might argue that “labeling” my grandfather could have led to discrimination or bias, I believe proactive communication would have given providers the information they need to care for him carefully and compassionately—ultimately preventing them from getting hurt and leading to a more positive experience for both my grandfather and our family, who had to rush to find new care settings for him when he was evicted. During these times of high stress, we were also at-risk for his violent outbreaks.
What Are the Risk-Factors Associated with Violence?
Patients may have a right to quality care, but providers have a right to a safe work environment, too. Nearly half of emergency physicians have been physically assaulted at work and 76 percent of nurses experience violence, with emergency nurses experiencing a significantly greater number of instances. Knowing the characteristics and risk factors associated with violent incidents helps keep everyone safe.
Altered mental status, including that associated with dementia or being under the influence of drugs or alcohol, is the most common characteristic associated with perpetrators of workplace violence. A 2015 study in the Journal of Advanced Nursing identified three overall causal themes regarding patient violence towards hospital workers: patient behavior, patient care, and situational events.
Patient behavior refers to patients as a direct cause for violence and includes cognitive impairment and demanding to leave the premises. Patient care covers incidents that occur while providing care or working closely with patients and includes needles, pain or discomfort, and physical transfers. Situational events include situations where a patient’s freedom of mobility is infringed such as in the case or restraints or intervening.
Past violence is also an indicator of whether a patient poses a risk for future violent incidents. Identifying patients with prior assaultive behavior can help keep physicians, nurses, and other healthcare providers safe.
How Does Collective Medical Help Providers Prevent Violence?
While profiling is used to identify individuals at risk for committing violent acts and prevent incidents, there are concerns that this can lead to discrimination against individuals or types of patients. How do providers keep staff safe without allowing bias to disrupt treatment?
With Collective Medical, safety and security events can only be added by past or current providers who have interacted with the patient and experienced an encounter that constitutes a real safety threat. Of course, every facility should define its own protocol regarding when, why, and by whom an event should be recorded.
Typically, when a Collective notification is delivered to a provider about a potential security risk, the patient will never know about it. Knowledge of historical safety and security events is meant to be used proactively and exclusively by the provider(s) involved, when involved, allowing physicians and staff to be aware of the situation or, when necessary, call security personnel to the area. By notifying staff about potential risks up front, violent outbreaks can be prevented—protecting the dignity of the patient and ensuring better patient outcomes.
Returning to my opening example, with better care collaboration, the staff at my grandfather’s skilled nursing facility would have known about his confused mental state. They could have been told that water was one of his triggers, and warned them that he could get violent if upset. The staff could have then worked with my grandfather to avoid these triggers, saving him from hurting others—often when he didn’t mean to—and preventing others from getting hurt. This would have meant a smoother transition of care for all involved.
Many physicians and nurses are taught to avoid bias by limiting discussions about social issues like violence, substance use disorder, mental health problems, or social determinants of health. However, in today’s world, this is all critical information that needs to be shared in order to create a culture of safety. Learn how five different providers on the Collective Network use safety and security notifications to prevent workplace violence while continuing to improve patient care.
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