Tag Archives: Emergency room

Responding to violence in U.S. hospitals

By Kevin R. Betts

For several years, I worked at a psychiatric hospital as a mental health technician. For the most part, I found this job to be very fulfilling. Watching patients who arrived in disarray leave feeling content left me feeling that what I was doing was worthwhile, and the occasional thank you card or call from a previous patient didn’t hurt either. However, there were certainly challenges inherent to this job. One such challenge concerned how best to react to patients who became angry or aggressive. When confronted by such a patient, a common response among the staff was to corral other staff members in an attempt to intimidate the patient into submission. In contrast to staff expectations, however, these attempts were often met by the patient with obstinance, and they sometimes even appeared to encourage further aggressive behaviors.

The media has recently given increased attention to violence in U.S. hospitals like that captured in my account above. Events such as the recent shooting at John Hopkins Hospital in Baltimore, as well as a recent Joint Commission report about increasing rates of violence in hospital emergency rooms, has earned the attention of health care workers and the general public alike. Unfortunately, one thing that can be gathered from these reports and my account above is that most hospital staff members receive only limited training in how to respond to angry or aggressive patients.

Research on the interindividual-intergroup discontinuity informs us that corralling other staff members to confront an angry patient who is alone, as often occurred at my workplace, will likely be ineffective in reducing that patient’s anger or aggression. The interindividual-intergroup discontinuity suggests that interactions between groups, or between groups and individuals, will be more competitive and aggressive than interactions between individuals alone (Meier, Hinsz, & Heimerdinger, 2007). There are three mechanisms that are believed to be responsible for this effect. One mechanism suggests that we fear and distrust other groups more than other individuals. A second mechanism suggests that group members can provide social support for antisocial actions, whereas individuals cannot. The third mechanism concerns identifiability, meaning that our (antisocial) actions are more identifiable when we act alone than when we act in a group. What is the implication of this research for health care workers? When it can be safely done, angry or aggressive patients should be confronted one-on-one.

Read more:

Violence in U.S. hospitals (CNN)

Violence on the rise in U.S. health care centers (Businessweek)

Meier, B.P., Hinsz, V.B., & Heimerdinger, S.R. (2007). A framework for explaining aggression involving groups. Social and Personality Psychology Compass, 1, 298-312.

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Does isolation reduce violent behavior among psychiatric inpatients?

By Kevin R. Betts

The Joint Commission, an independent health care oversight group, recently expressed alarm over violence in U.S. hospitals. Russell L. Colling, a consultant who advised the Joint Commission said, “The reality is, there is violence every day in the emergency department.” On inpatient units in psychiatric hospitals, violent behavior among patients is often met with forced isolation. A primary goal of isolating these patients is to ensure their safety, as well as that of other patients and staff. However, isolation is also thought by many to act as a deterrent for potential future acts of violence. Having been directly involved in this process as a mental health technician, I often pondered the effectiveness of isolation as a way to combat violent behavior among patients.

Perhaps counterintuitively, research on social ostracism suggests that isolation may promote later aggressive acts (Williams, 2007). In order to understand why this may be the case, imagine yourself in the position of a patient involuntarily committed to an inpatient unit at a local psychiatric hospital. Disagreeing with your involuntary admission, you verbally express your anger to the staff. Told that you may not leave, you become even angrier, perhaps trying to access locked doors. You feel an utter lack of control over your situation. Making matters worse, the staff expresses concern that you may become violent as a result of your distress and “for your safety,” escorts you to a locked room so that “you may reflect on your acting out behavior.” You are in isolation. Your anger further increases and you find yourself behaving in ways you could not previously imagine, yelling “let me out” and banging on the only door in a windowless room. You think to yourself, “They will regret this once they let me out of here.” What you (and many other patients placed in similar situations) are experiencing is an impaired sense of belonging, self-esteem, control, and meaningful existence―direct consequences associated with social ostracism (Williams, 2007). In the eyes of an isolated patient, these needs may wrongly be perceived as restorable through aggressive means.

If isolation can promote violent behavior, what should be done to combat violence among distressed psychiatric inpatients? Solutions that prevent violent behavior in the first place may be most successful. Listening to patient complaints in a timely manner is essential. Empathizing with these complaints, helping patients manage their distress, and ensuring patients that their distress is temporary should also be effective.

Read more:

http://www.businessweek.com/lifestyle/content/healthday/639936.htmlViolence on the rise at U.S. health care centers (Businessweek)

http://www3.interscience.wiley.com/journal/120185263/abstractWilliams, K.D. (2007). Ostracism: The kiss of social death. Social and Personality Psychology Compass, 1, 236-347.

View other posts by Kevin R. Betts

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