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"The most prominent incidents you read about are
the deaths, stabbings and shootings," said Donna
Nowakowski, MS, RN, executive director of the Emergency
Nurses Association. "But there are other forms
of violence."
Nurses are easy targets for patients who hit, shove,
kick, bite and spit. They are also the caregiver that
patients and their relatives are mostly likely to scream
at, threaten and verbally harass.
Nurses have the greatest exposure to patients, and
they perform the uncomfortable procedures, said Ronald
Charles, MD, medical director of the Lyndon B. Johnson
General Hospital in Houston and a faculty member of
the University of Texas-Houston Health Science Center.
"It's also a respect issue," Charles said.
"The patient is more apt to strike out at a nurse
because they know if they target the doctor, they're
not going to get what they need."
A national survey of registered nurses sponsored by
NURSEWEEK and the American Organization of Nurse Executives
found that 28 percent of the nurses who responded had
experienced episodes of violence in the workplace within
the past year.
A study published in the Journal of Emergency Nursing
in June 2000 found that 82 percent of emergency department
nurses had experienced physical violence sometime in
their careers.
Researchers Lisa Erickson and S. Alicia Williams-Evans
interviewed 55 emergency nurses in two Tennessee hospitals
and found that more than half, 56 percent, had experienced
violence in the previous year and 29 percent of those
incidents went unreported. Only two of the 55 nurses
said they felt safe all the time at work, and 73 percent
said being assaulted is part of the job.
While the sample surveyed is small, the results support
other anecdotal evidence that nurses have started to
view violence as part of the job and that some don't
report incidents unless they need medical attention.
"It's sad that the abnormal becomes normal,"
said Mary Alexander, MSN, RN, director of emergency
services at Gnaden Huetten.
Since Reed's attack, she said, everyone has become
more cautious. When patients come in who have been using
alcohol or drugs or who have been involved in any kind
of resistance with police, Alexander recommends they
be put into four-point restraints.
When someone is attacked, she said, it's important
for a hospital to offer follow-up support with debriefing
sessions and the vigorous pursuit of criminal prosecution.
Alexander said she has worked in hospitals where people
didn't want to prosecute a violent patient because they
felt too guilty about sending someone to jail.
Nowakowski encourages nurses to report incidents and
document violence. There's no one best way to prevent
these outbreaks, she said. Hospitals are using more
physical barriers, electronic surveillance, security
guards and metal detectors, but, she said, training
is the first line of defense.
Many hospitals now require staff members to attend
violence management training, where they learn how to
diffuse potentially dangerous situations and, if need
be, how to defend themselves.
A training film may have saved Lori Cline, MNSc, RN,
from serious injury. Cline, now on the faculty of the
University of Arkansas for Medical Sciences College
of Nursing, worked 15 years as a psychiatric nurse.
Three times, she had been attacked by children with
kicks, punches, bites and, once, scratches severe enough
to require medical treatment. But she was unprepared
when an 80-year-old Alzheimer's patient tried to strangle
her.
The woman had no history of violence at her nursing
home, but had been agitated. Cline thought she was asleep
for the night and leaned over the bed to check her breathing.
But the woman wasn't asleep.
"She sat straight up in the bed and put her hands
around my neck and started choking me," Cline recalled.
Fortunately, Cline had been through a violence prevention
training course and remembered a film that demonstrated
how to release yourself from a strangling grasp. Cline
slipped both her hands between the woman's hands and
applied pressure on the inside of both her attacker's
wrists. That move gave her the leverage to break the
woman's hold on her throat and call for help.
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