Nursing

Design Guidelines for High-Risk Patients in Hospitals

Nurse Leader Insider, April 21, 2016

Want to receive articles like this one in your inbox? Subscribe to Nurse Leader Insider!

Q: How big of a problem is patient violence from high-risk patients?

 Jeff Puttkammer: The unfortunate reality in this day and age is that hospitals and healthcare staff in particular are not in a neutral free zone. Hospitals are not immune to violence and because of that fact alone, the challenges to healthcare staff are unique and there are many. And they are challenges most other industries don't typically face. There's some very unique challenges or cultural challenges to healthcare employees that amplify a number of these challenges. For example, 'Do no harm' is just one example of an industry statement which can lead to confusion when it comes to providing patient care and also concerning staff safety or personal safety. And we've seen more than enough incidents where staff consider violence to be just part of the job. Where staff view the injuries sustained to them or even to their coworkers as unavoidable and they simply write it off due to the patient's medical or mental condition. The one unfortunate disconnect with this is that healthcare professionals are not typically trained to think in terms of their own personal safety and at the same time, focusing on providing patient care.

And so as an industry the trend is to think of healthcare providers as do no harm and prevention and nurses and doctors or caregivers and that they're the good guys. And that's the truth. And the good news is we are the good guys but as a whole, it's tough to appreciate the deeper understanding of the risks that are associated with managing high-risk patients and being able to avoid and manage aggressive and sometimes violent confrontational behavior.

And so as violence in healthcare continues to be on the rise across the country and in fact, globally, you know, we've had a number of opportunities to meet with healthcare leaders from a number of countries-Canada, Asia, Europe-and they all face similar challenges. This is not unique to the U.S. But the unfortunate truth is you don't have to look very hard to find a news story highlighting the issues of violence in healthcare. The good news though is that because of these news stories, a lot of organizations are paying more attention, and many organizations are starting to address these issues.

Q: What are the effects of aggression in healthcare on care providers?

JP: While we often focus on the aggressive act itself, we do sometimes lose sight of the impact that violence has in the workplace in terms of disruption to productivity and to employee morale. And the scars of aggression from just constant daily verbal attacks are no less real than they are from a physical attack. Certainly hospitals can and most of them do measure the financial impact from workplace violence; however, there are some less obvious negative outcomes which are also associated with workplace violence and may not be as easily measured.

What we're talking about here are things like the impact on relationships, both inside of work and outside of work, with your spouse, with your children, other relatives, impaired concentration of staff members on the job, and all of these things can lead to reduced focus on patient care. And of course, we see the measurable increases in absenteeism and turnover. In fact, one organization we work with, they're able to directly attribute nurse turnover; 25% of their nurses leave and they indicate such that they leave the organization because they don't feel safe working in the environment, which is a huge issue for this particular organization.

Q: What types of events and factors tend to put staff and facilities at risk?


JP: For the most part, emergency departments weren't originally designed to treat or house behavioral health patients, and that seems to be one of the bigger issues we're dealing with when it comes to high-risk or at-risk patients. These EDs weren't designed to house these patients for any length of time, and equally disturbing is the fact that many ER staff aren't trained to provide long-term care for behavioral health patients. What we're seeing across the country is a general trend where behavioral health patients are staying longer in the emergency department, and spaces, of course, aren't designed to house behavioral health patients for any length of time. This tends to present a unique problem for us and what we end up seeing in the current state is a combination of unsafe workplace practices, an unsafe workplace that relates to environmental design, and then that tends to lead to reactive tactics by staff who maybe lack the proper training or the appropriate training, and it goes back to the confidence question as well. Staff just don't have confidence in their own ability to manage. So they resort back to something, a technique perhaps that is ineffective in the emergency department environment when dealing with an at-risk or high-risk patient. The role conflict problem stems from really the internalization of patient care provider and personal safety specialist. So it's a combination of these four or five things that really bring us to our current state and provide a unique challenge for both staff and for our facilities.

This is an excerpt from the monthly healthcare safety resource Briefings on Hospital Safety. Subscribers can read the rest of the article here. Non-subscribers can find out more about the journal, its benefits, and how to subscribe by clicking here.



Want to receive articles like this one in your inbox? Subscribe to Nurse Leader Insider!

Most Popular