Protecting healthcare workers from violent attacks

According to the World Health Organization, between eight and 38 per cent of healthcare workers suffer physical violence at some point in their careers and many more are threatened or exposed to verbal aggression.¹ An Australian study of 9,951 doctors across all professions and stages of training revealed that 70.6 per cent reported experiencing verbal or written aggression and 32.3 per cent experienced physical aggression in their previous 12 months of practice.²

The Australian Institute of Criminology ranked healthcare facilities as the most violent workplaces in the country as far back as 1999. Worryingly, one study found that 44 per cent of nurses don’t report physical violence because they consider it just part of the job.³

In an audit of violence conducted towards healthcare workers in Victoria, some of the incidents that were categorised as ‘mild’ or ‘no harm’ included attempted strangulation, kicking a pregnant woman in the stomach, and being punched. It’s concerning that violence against healthcare workers has reached such a state that these events are categorised as ‘mild’.⁴

Physical injuries as a result of attacks may be serious enough to stop a healthcare worker from being able to do a job they love and that provides fulfilment as well as an income. And, regardless of the extent of physical injuries, the lingering emotional impacts of these attacks can lead to post traumatic stress disorder (PTSD), which is becoming more common in healthcare workers.

Violence in patients and their visitors occurs for any number of reasons. There may be an underlying or acute mental health issue at hand. The patient or their family members may feel frustrated with the medical process. Often, drugs are involved. Sometimes, the violent behaviour is the result of the patient’s medical condition and is therefore involuntary. Regardless of the cause of the violence, the outcome is the same.

While hospitals tend to have the highest rates of violent behaviour compared with general practice, for example, there are other situations where healthcare workers can be at significant risk. Home visits and after-hours work carries a high risk and, of the doctors surveyed in the Australian study, only 43 per cent had instituted any form of protective strategy when undertaking an after-hours home visit.⁵

It’s increasingly common for patients to receive home visits from health professionals including nurses, allied health professionals, and community caregivers.

The healthcare workers visiting people in their homes often work alone without the support of a colleague. In a hospital setting, security guards and other personnel are on hand to assist when violence erupts. Hospitals usually have duress buttons or even a mobile duress tag that staff can wear to sound the alarm if they’re attacked. These mobile duress tags show the staff member’s location in the hospital so help can find them sooner.

This doesn’t necessarily mitigate the impact of the violence but it can mean that healthcare workers aren’t exposed to that violence for an extended period of time. By contrast, when working alone in someone else’s home, it can be difficult to call for help.

This is especially true if the patient is acting in a threatening manner with intent to escalate to violence. Healthcare workers in this situation may be afraid to intensify the situation by calling for help or ringing the police, for example.

Addressing the escalating scourge of violence in the community at large and against healthcare workers in particular is a complex challenge without a clear answer. Therefore, it’s essential for workers who will visit patients in their homes to protect themselves proactively, making sure they feel as safe as possible when making home visits.

These protective measures can include, at a minimum, mobile phones and personal duress alarms for every worker, a procedure for contacting police in an emergency, and a system to monitor visits and ensure that staff return safely even after hours and on weekends.

A comprehensive solution goes further than these mandatory basics. It should include a dedicated alarm button that staff can press on their purpose-built smartphone that lets first responders track their location and find them faster.

The device should include an automatically-activated alarm if the device is not moving or is detected running or lying flat for pre-programmed time periods, as this inactivity or excessive activity could indicate that a violent attack is in progress. The automatic alarm eliminates the need for the healthcare worker to proactively notify authorities that they’re under threat or attack, which can help avoid escalating the situation with an unstable attacker.

The solution should be smart enough to understand whether it’s in or outside a facility, and notify the proper authorities accordingly. If the worker is attacked inside the facility, the device can notify on-site security. Attacks outside the grounds would automatically notify police.

Once a duress alarm is activated, the device should start automatically live-streaming video and audio to let first responders assess the situation remotely, and gather evidence if needed. However, to avoid detection by the aggressor, the screen should immediately go blank after duress has been activated. The device can let the caregiver know that help is on the way via low-intensity vibrations.

Because seconds can make a difference when a person is under attack, it’s also crucial that the solution be able to accurately locate the person even inside a building. This means first responders don’t have to waste valuable time trying to locate the person’s precise whereabouts.

And, finally, the solution needs to include an escalation so that, if the responders notified first don’t acknowledge that they’ve been contacted, the call for help is rerouted to a secondary responder. This ensures calls for help won’t go unanswered.

Providing healthcare services for people in their homes is a noble and valuable service that shouldn’t be degraded by the potential for violence. By providing healthcare workers with a comprehensive personal safety solution, organisations can serve their patients while maintaining worker safety.

Alan Stocker is the health practice lead at Wavelink.

¹ https://www.who.int/violence_injury_prevention/violence/workplace/en/
² https://www.racgp.org.au/afp/2017/december/occupational-violence/
³ https://www.ausmed.com.au/cpd/articles/nurses-and-violence-in-the-workplace
⁴ https://www.parliament.vic.gov.au/file_uploads/20150506-Occ-Violence_gccfNRDF.pdf
⁵ https://www.racgp.org.au/afp/2017/december/occupational-violence/

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