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2© Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law.
• Defining Workplace Violence
• Forms and types of workplace violence
• Workplace violence injury statistics
• Prevalence and risk factors
• Developing a general Workplace Violence Prevention program
Overview
3© Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law.
Definition
• “Any act of aggression that causes physical or emotional harm, including assault (any attempt to inflict physical harm on a worker), threat, verbal abuse, sexual harassment and racial or religious harassment” (OPSEU)
• “Attempted, threatened or actual conduct of a person that endangers the health and safety of the worker including any threatening statement, harassment or behaviour that gives a worker reasonable cause to believe that his/her safety is at risk (N.S. H&S Advisory Council)”
4© Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law.
Health Care40%
Industrial12%
Forestry0%
Services10%
Transportation5%
Construction0% Education
9% Electrical0%
Farm3%
Municipal21%
Treatment Clinics & Specialized Services
8%
Professional Offices & Agencies
2%
Schedule 211%
Nursing Homes27%
Retirement Homes1%
Hospitals26%
Nursing Services3%
Group Homes22%
Ontario Health Care & Community Services
Data Source: WSIB Injury Analysis by SWASnapshot Period: July 2005
Workplace Violence/Client Aggression - 2004 LTI’s
5© Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law.
Workplace Violence/Client Aggression - 2004 LTI’s
0
50
100
150
200
250
2000 2001 2002 2003 2004
Nursing Homes Retirement Homes Hospitals
Nursing Services Group Homes Treatment Clinics & Specialized Services
Professional Of f ices & Agencies Schedule 2
Data Source: WSIB Injury Analysis by SWASnapshot Period: July 2005
6© Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law.
“Workplace violence is one of the most complex and dangerous occupational hazards facing nurses” (McPaul & Lipscomb, 2004)• Health and community care workers exposed to a variety of violent/aggressive individuals• Many still do not agree that the issue is real• Many consider violence “part of the job”• Many organizations do not have a strong violence prevention program • No protective regulations addressing workplace violence
Prevalence
7© Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law.
• Many papers describing and explaining the issue of workplace violence however, few intervention studies exist (Arnetz & Arnetz, 2000)
• Assault rates for residential-care, nursing and personal-care workers more than ten times the rate than that of private non-health (Hewitt & Levin, 1997)
• British Columbia study suggested that health care workers face similar level of risk to that of police (Boyd 1995)
Prevalence
8© Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law.
Traditional Approaches to Aggression Prevention
• Focus on methods to manage, contain or reduce the impact of the aggressive act
• Rely on physical methods to deal with the situation• Focus on body containment techniques – based on a
philosophy of care that focuses on pathologies which reinforces negative perceptions of persons with dementia as being assaultive, violent, dangerous and the passive recipients of care!
• Do not seek to understand the underlying reason for the responsive behaviors (Jones, 1999)
• Focus on containment and control of aggressive individuals (dictated care regimes, use of physical or chemical restraints)
9© Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law.
• Not tailored for the learning needs of front-line staff in long-term care homes
• Are in direct contrast to the shift in culture that has occurred in dementia care in last decade - movement toward person - or relationship - centered care
• Have inappropriate response techniques that may have a pervasive and profound negative impact on residents with cognitive impairment, leading to excess disability and a wounded spirit (Taft, 1995; Dawson, Wells & Kline, 1993; Rader, 1995)
• Increase the risk of staff injury• Do not equip staff with the necessary knowledge and
point-of-care practices to decrease risk
Traditional Approaches to Aggression Prevention
10© Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law.
• Threats of violence
• Verbal and emotional abuse
• Harassment based on sex, religion, sexual orientation, disability, race
• Use of, or threats to use force
• Inappropriate suggestions, inference, comments, or behavior
• Carrying a weapon
• Intimidation and aggressive behavior
• Domestic Violence
Forms
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Type I (Criminal Intent): • Perpetrator has no relationship to the workplace
Type II (Client/Customer): • Perpetrator is a client who becomes violent towards a worker or
another client “Majority of threats and assaults against caregivers come from patients/families/visitors” (Arnetz & Arnetz, 2000)
Type III (Worker-to-worker): • Perpetrators are employees or past employees
Type IV (Personal Relationship): • Perpetrator usually has a relationship with an employee (e.g.
domestic violence in the workplace)
Types (Cal/OSHA 1995)
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Environmental, Ergonomic & Administrative:• Crowded, noisy conditions • Overcrowded resident areas• Lack of staff education/training• Lack of security controls• Assigning staff to work alone, work in remote locations, and/or high crime areas• Understaffed areas• Lack of worker experience contributing to quality
issues
General Risk Factors
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Client’s Physiological Conditions:• Systemic disorders: fluid/electrolyte imbalance,
anemia, thyroid disorders, diabetes, hepatic disorders, neurological disorders, epilepsy, degenerative diseases• Toxic levels of medications • Psychiatric Conditions: psychotic symptoms & paranoia, psychogeriatric illness• Substance Abusers
General Risk Factors
14© Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law.
A Guide to the Development of a Workplace Violence Prevention
Program
Book one: Implementing the Program in Your Organization
Book two: Developing Crisis Prevention & Communication Strategies
Book three: Developing Human Resources Strategies for Managing Workplace Violence
Book four: Preventing Client Aggression Through Gentle
Persuasive Approaches™
15© Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law.
A Guide to the Development of a Workplace Violence Prevention
Program
Book one: Implementing the Program in your Organization
Step 1• Secure management commitment
• Assess your program needs
• Develop program components
Step 2 and 3• Implement program
Step 4 and 5• Evaluate program
16© Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law.
Management commitment is:
• The foundation of an effective program
• Necessary to ensure that other resources are available to develop, implement and maintain the program (budget, human resources, materials, equipment, training, etc.)
Step 1 Secure Management
Commitment
17© Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law.
Initial tasks:
• Enlist senior management commitment to program
• Appoint a program leader
• Appoint a multidisciplinary steering committee
• Determine whether committee will be an ad hoc or standing committee
Step 1 Secure Management
Commitment
18© Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law.
• Community workplace violence issues
• Internal documents:• Security, emergency response, unusual occurrence,
client abuse, EAP
• Employee incidents/accidents
• Physical environment
• Work setting and clients
• Point-of-care work practices
• Employee perceptions
Step 1 Assess Your Needs
19© Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law.
Workplace Violence Documentation Analysis tool
Appendix D
Unit Workplace Violence Incident/Accident Analysis Collection tool
Appendix E
Organizational Workplace Violence Incident/Accident Summary tool
Appendix F
Environmental Assessment tool Appendix G-1
Community Workplace Assessment tool Appendix G-2
Step 1Assess Your Needs
20© Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law.
Work Setting and Client Risk Factors Checklist
Appendix H
Checklist of Risk Factors for Aggressive Behaviour
Appendix I
Point-of-care Staff Work Practice Assessment
Appendix J
Workplace Violence Employee SurveyAppendix K
Appendices from OSACH“Guide to the Development of a Workplace Violence Prevention Program” and included in Participants’ Manual
Step 1Assess Your Needs
21© Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law.
Step 1 Develop the Program
A comprehensive Workplace Violence Prevention program includes:
• Workplace violence prevention policy
• Associated procedures
22© Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law.
Step 1 Develop the Program
Develop a Violence Prevention Policy that includes:• Employer commitment• Policy purpose and statement• Applicable definitions • Roles and responsibilities• Reporting and investigation • Risk assessment• Emergency response• Employee training• Program audit, review and revision
23© Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law.
Step 1 Develop the Program
Violence Prevention Procedures include:• Reporting
• Emergency response
• Investigation
• Environmental and security controls
• Administrative controls
• Work practices
• Travel- Appendix S
24© Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law.
Step 2 and 3Implement the Program
Critical steps:
• Ensure development of Workplace Violence Prevention policy and procedures
• Develop a communication and marketing plan
• Develop and present staff training
• Launch the program
25© Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law.
Type of Training Attendees
Program Development Multidisciplinary committee/ steering committee
Security & Emergency Response Procedures
Emergency response team
Security personnel
General Workplace Violence Prevention Training
All staff
Job-Specific Training Unit/department specific staff
Step 2 and 3Implement the Program
26© Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law.
Step 4 and 5Evaluate the Program
Goals of program evaluation:• Create and maintain a safe working environment without
the threat of violence • Review, revise, enhance and improve program
components based on:• program self-audit • results of qualitative and quantitative evaluation
procedures• Maintain the program• Continuously improve Workplace Violence Prevention
program
27© Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law.
Book two: Developing Crisis Prevention and Communication Strategies• Staff training in crisis intervention• Recognizing and responding to stages of violence• Crisis response team• Effective communication skills• Environmental conditions during crisis interventions• Cultural sensitivity• Emergency response• Employee’s needs during and after crises
A Guide to the Development of a Workplace Violence Prevention
Program
28© Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law.
Book three: Developing Human Resources Strategies for Managing Workplace Violence
• Prevention of violence among employees
• Harassment
• Domestic violence
• Threats
• Weapons
• Hiring and Termination practices
A Guide to the Development of a Workplace Violence Prevention
Program
29© Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law.
Resources
The following OSACH Resource may be purchased from our website – http://www.osach.ca
30© Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law.
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