nursingforsocialjustice

When I reflect on situations that I have been that involve patient violence I cannot help but think about the different actions that I would take if I was in the same situation today, knowing what I know now. There is more and more talk about violence that is experienced by health care staff in popular media. There is more and more discussion of violence experienced by nurses within the profession. There are times when I feel like the discussion focuses on solutions that may only be quick fixes (or not really fixes at all). Sometimes I feel like the response may actually contribute more to the problem. I recognize that there is violence is health care, violence directed by patients and their families towards staff, violence of random people who walk into a hospital, violence between patient and patient, violence between staff and violence of staff towards patients and their families. I think that terms like “zero tolerance” of violence are hostile terms that may perpetuate reactive strategies rather than create productive solutions. I think it would be interesting for someone to do an ethnographic study about this, to sit in hospital waiting rooms with “zero tolerance” signage and observe what happens there.

I wonder, in hospital spaces where the stress level can be high (of both patients and staff), like in an Emergency Department waiting room, could there be more benefit from implementing strategies like hiring more social workers to act as liaisons for scared/angry/anxious/sad loved ones? Could there be benefit in designing separations in space where fewer people are corralled in, with more natural light? What if hospital waiting spaces were designed differently, not just utilitarian for the purpose of holding people for an unknown amount of time? What if they were pleasant, calming spaces?

I wonder about the ways that research is integrated into things like programming planning, unit design and staff training. For example, if we know that predictors of violence include factors like: a high proportion of patients certified under the Mental Health Act, high patient turnover, patient alcohol use, locked units, and higher staffing numbers of regulated staff, can (should?) violence prevention strategies include ways to somehow mitigate these factors? Evidence suggests that being more restrictive on patients exacerbates the problem of violence (Bowers, Allan, Simpson, Jones, Van Der Merwe, & Jeffery, 2009). Evidence also suggests that power differentials between staff and patients also contributes.

References

Bowers, L., Allan, T., Simpson, A., Jones, J., Van Der Merwe, M., & Jeffery, D. (2009). Identifying key factors associated with aggression on acute inpatient psychiatric wards. Issues in mental health nursing, 30(4), 260-271.