With Terry Kowalenko, MD
Stress from COVID-19 has likely exacerbated assaults on healthcare workers.
Terry Kowalenko, MD, a Professor and Chair of Emergency Medicine at the Medical University of South Carolina (MUSC) in Charleston, suspects that COVID stress, coupled with the stress on healthcare workers, creates a slightly lower threshold for igniting aggression.
“However, I am not sure there is anything fundamentally different about COIVD,” he said. “Violence in the healthcare field is such a prevalent problem that has been going on for decades. In fact, healthcare workers are 6 times more likely to suffer a physical assault than any other profession. And very little has changed.”
Furthermore, physical assaults on healthcare workers that likely result in some form of injury are underreported, according to Dr. Kowalenko, who has published multiple articles on workplace violence, primarily occurring in the emergency room. “We also know that people are pushed, shoved, punched, and spit on that do not require medical care,” he said.
Dr. Kowalenko said healthcare workers should be extremely alarmed about workplace violence. “They need to be aware, vigilant, and cautious at all times.”
Data collected by Dr. Kowalenko and colleagues from several years ago showed that physical threats to healthcare workers were perpetrated by males two-thirds of the time; physical assaults were about equally likely to be committed by men and women.
There are numerous ways to reduce assaults on healthcare workers: recognizing a potentially violent patient, de-escalating techniques, improving hospital security, re-designing a facility for enhanced safety, and enacting laws that protect healthcare workers.
“The issue with violence in the healthcare setting is that everyone has to learn,” Kowalenko said. “The security officer needs to recognize potentially violent patients by the patient’s own body language and speech. The clerical staff, the technicians, the nurses, and the doctors also need to become knowledgeable.”
According to Dr. Kowalenko’s research, providers suffer the least amount of violence, while those who spend more time in front of a patient, such as a technician or a nurse, have a higher incidence of being either verbally or physically assaulted. “We also know that patients who have psychiatric illness and patients who are intoxicated with whatever substance, or potentially the combination of the two, present the highest risk for assault,” he said.
One of the most effective de-escalating techniques is simply to determine what the patient or an accompanying person needs. “It might be keeping them informed,” Dr. Kowalenko explained. “A lot of times, people will escalate because they are waiting a long time for whatever they want, such as knowing the condition of the patient or pain medication.”
Offering a dark area with less stimulation or suggesting food can also calm a person.
“Attacks can happen anywhere,” said Howard Larkin, a freelance writer and editor from Willow Springs, Illinois, who often writes about the healthcare industry and is the author of a recent article in JAMA entitled “Navigating Attacks Against Health Care Workers in the COVID-19 Era.”1
Although Larkin contacted sources from several medical specialties to gauge the level of attacks, he “was surprised to find out there was not much current research,” he said. “All the studies I cite were published prior to the pandemic. This was a point of frustration for some of the researchers I spoke to as well. They sensed things were getting worse, but they did not have any hard data.”
Nonetheless, a guide published by the International Committee of the Red Cross (ICRC) notes “alarming incidents of health workers being stigmatized, ostracized, harassed, or threatened for allegedly spreading the virus.”
Online harassment has definitely increased. “There seems to be some fear of contagion,” Larkin said. “People are afraid that healthcare workers might be infected with COVID. Also, there is resentment in enforcing public health rules like masks and physical distancing.”
To combat online misinformation and spiteful responses, healthcare workers can join with others to educate and advocate for evidence-based mitigating solutions on social media.
Reporting attacks is important. “If it is not reported, it cannot be addressed,” Larkin emphasized. “Where and what types of violence are occurring? What happens in a psych unit is very different from what happens in a medical-surgical unit.”
Given that some research indicates that most violence occurs after 8 p.m., strictly enforcing hospital visiting hours can help.
Likewise, “basically anything that you can use to throw, or attack should not be available for patients to grab hold of,” Larkin said. “Some places have replaced wheeled intravenous IV poles with poles attached to beds, so they cannot be grabbed or used as weapons.”
Panic buttons can be downloaded onto a desktop computer or mobile device, including a smart watch. These devices can also be programmed to interface with security, local 911, incident command centers, or anyone with a smartphone.
Healthcare facilities should develop a violence prevention and mitigation program, Larkin advises.
“Be ready for these attacks, and get ready for them if you have not given it some thought,” he said.
By Bob Kronemyer
Reference:
1. Larkin H. Navigating Attacks Against Health Care Workers in the COVID-19 Era. JAMA. 2021;May 11;325(18):1822-1824. doi:10.1001/jama.2021.2701.
Disclosures:
Dr. Kowalenko reports no relevant financial interests.
Howard Larkin reports no relevant financial interests.