Prevention of Violence Toward Health Care Workers

1. Prevention of Violence Toward Health Care Workers Prof. Dr Yasemin Balcı Department of Forensic Medicine Eskisehir Osmangazi University ybalci@ogu.edu.tr

2. Health Care Workers and Violence • The role of health care workers in their struggle against violence • Health care workers as the injured parties of violence • Violence resulting from the environment of the health care sector

3. The Struggle against Violence • In order to avert the reflection of violence on society and its consequences on the individual: • Occupational responsibility • Humane responsibility

4. The effects of violence on individuals • Physical effects • Psychological effects Social results of violence • Increase in suicide rate • Increase in child abuse • Increase in hospital admissions • Decrease in productivity • Transition between generations

5. The causes of child mortality 1- Reasons related to conflict (war, refugee displacement, accidents, child abuse, honor/custom traditions). 2- Reasons related to poverty and inadequate health care (hunger, infection and others). 3- Pathological mortality (congenital malformation, SIDs and so on).

6. Groups susceptible to violence • Lone children • Vulnerable women • The elderly living alone • People with physical or psychological disabilities • Social or ethnic minorities and refugees • People connected to gangs

7. Health care workers cannot detach themselves from violence “In a new approach, violence is defined as the health of society. Traditionally, violence has been considered as a matter of criminal law by health care workers. Doctors, nurses and those who work in social service related services should view violence as being in their own area…” C. Everett Koop, 1991

8. Health care workers as victims of violence • Directly • Indirectly

9. Prevention of violence toward health care workers is important In health care workers: • Depression and intense stress • Physical and psychological problems • Problems created by the judicial process In providing service: • Decrease in worker efficiency • Negative approach to patients • Increase in mistakes made

10. Precautions against violence 1- Pre-violence preventative measures 2- First aid at the time of attacks 3- Post-violence treatment and rehabilitation

11. Pre-violence • There is a relationship between the feasibility of violence and • Etiology • Sociological • Ideological • Cultural • Psychopathological • Biological

12. Those exhibiting a greater tendency to violence toward health care workers • People forced to wait in crowded and uncomfortable conditions • People forced to wait for unduly long periods • Good Samaritans who help the injured or sick • People working with volatile substances • Those under the influence of alcohol or drugs • Unemployed people • Those with insufficient medical insurance

13. Vulnerable health care workers • Those working alone or with few colleagues • Those who work at night • Those working in high crime areas with inadequate security • Emergency service workers • Those working in the psychiatric services • People working in units with insufficient expert support and inadequate health support

14. Lack of communication and violence • Work related stress • Intense stress • Excessive tiredness • Role dilemma • Dissatisfaction • Uncertainties • Complex procedures A lack of communication VIOLENCE

15. Studies in Turkey regarding violence toward health care workers • Ayranci U, Yenilmez C, Günay Y,Kaptanoğlu C. Frequency of exposure to violence in various health institutions and health profession groups, Anatolian J Psychiatry 2002; 3(3): 147-54. • Hancı H, Boz B, Demirkan Ö, Kılıççıoğlu B, Yağmur F. Medical personnel subjected to violence in the emergency department-enquiry study. Acil Tıp Dergisi 2003; 3 (2): 16-20. • Ayranci U. Violence toward health care workers in emergency departments in western Turkey. The Journal of Emergency Medicine, 2005; 28 (3): 361-65. • Ayranci U, Yenilmez C, Balci Y,Kaptanoğlu C. Identification of Violence in Turkish Health Care Settings. Journal of Interpersonel Violence 2006; 21 (2): 276-96. • Erkol H, Gökdoğan MR, Erkol Z, Boz B. Aggression and violence towards health care providers- A problem in Turkey? Journal of Forensic and Legal Medicine 2007; 14 (7): 423-28.

16. Results • One in two health workers reported exposure to violence in the last year • Women, the young with less than 10 years work experience, general practitioners, assistants, nurses, emergency service workers, and lone workers • People having to deal with violent situations on their own are a majority • Education aimed at protecting oneself from violent attacks is out of the question

17. Prevention of violence in the work environment • Precautions relating to the physical environment: • Preventing the carrying of weapons onto the premises • Use of camera equipment • Operating a Helpline system • Planned use of manpower including security • First aid and emergency procedures • Education

18. Suggested personal precautions in the event of violent threat • If the violent hospital admission is likely to be carrying a weapon or behaving in a violent fashion: - Enlisting support of security staff - The nature of the examining room - Removal of potentially dangerous items

19. Suggested personal precautions in the event of violent threat • If threatened with a weapon during an examination • If the assailant attempts strangulation • If the attacker attempts to bite

20. During a violent attack • Urgent assistance • Health aid • Judicial aid • Notification of crime • Reporting and filing the outcome of the violence The rate of applications made to judicial bodies is approximately 10%

21. Relevant sections in TCK (Turkish Legal System) Section 86/3.If intentional injury is caused whilst the victim is in public service, complaint is not required, and punishment increases at half rate. Sections 125/3and 131/1. If the offence of insult to public service workers is committed as a result of them performing their duties, the minimum punishment may not be less than one year, and a condition of complaint is unnecessary for the matter to be investigated. Section 280.Health care workers not reporting incidents. Section 281.Destroying, concealing or altering evidence in a criminal case.

22. Filing the findings of violent incidents Judicial report Evaluation • History • Clinical examination • Defining the findings • Physical findings • Psychological findings • Evaluation of findings • Judicial report “What we didn’t record is what we didn’t do” Defining and recording History and clinical examination

23. Post-violence • Treatment and rehabilitation • Elimination of results of violence

24. Violence caused as a result of the health environment or system • Errors in medical application • Health environment becoming unsuitable • Unethical approaches • Inequality • Discrimination • Labeling • Fighting

25. Errors in medical application 52% of complaints made by patients about health care workers are unrelated to diagnosis or treatment.

26. Precautions • Suitable adherence to ethical standards • Well lit environment prior to examination • Examination, diagnosis and treatment up to accepted medical standards • Observation • Privacy Education-Education- Education

27. Final Comment In order to prevent violence and to guard ourselves from violence in all sectors of the health services, a realistic and feasible plan should be formulated.