Nursing homes are potentially one of the most dangerous workplaces in the country. Nursing assistants in long-term care facilities have the highest incidence of assaults of all American workers, with one study showing that 27 percent of all workplace violence occurs in nursing homes.
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Three-quarters of the attacks happen while performing tasks involving close contact with a resident, such as turning and repositioning patients, helping them dress, feeding and bathing. The assailants are often diagnosed with Alzheimer's or other organic brain syndromes. The violence ranges from grabbing, pinching and hair pulling, to hitting, punching and kicking.
Combined with the other safety and health hazards that come with working in residential care facilities, it's little wonder that nursing homes are on the Occupational Safety and Health Administration's (OSHA) priority hit list for safety inspections.
Residential-care facilities, including nursing homes, must have violence prevention polices in place. At the top of the list of reasons is that all employers, under the General Duty clause of the Occupational Safety and Health Act, are required to provide their employees with a workplace free from hazards that are likely to cause serious physical harm or death.
But there are other reasons: Having an effective, zero-tolerance policy against violence helps improve employee morale and productivity, while reducing workers' compensation costs, staff turnover, absenteeism and burnout.
Your facility's policy should be written and understood by everyone affected. To help ensure that your nursing home's policy is up to snuff, here are the main elements of an effective safety program.
Training: This is critical and all employees and management should be involved. Employees should be taught how to prevent or diffuse volatile situations and resolve conflicts. Staff members should also be taught self-defense measures and learn how to recognize and nonviolently deal with agitated and aggressive patients. Also, consider offering courses in stress management and relaxation techniques.
Control: Assess all units in the facility during different shifts with an eye toward problem areas. Talk with employees about the hazards they face and encourage them to report all incidents. Many nursing home employees don't report violence, particularly when no serious injuries result.
Once you assess the hazards, take steps to minimize them. There are many ways to control violence, generally falling under two categories:
1. Engineering/Design
In general, all work areas should be secure and well-lighted. Depending on the nature of the facility, here are some other physical control mechanisms:
- Use security devices such as surveillance cameras, alarm systems, panic buttons, beepers and card-key access systems.
- Install curved mirrors at hallway intersections or concealed areas.
- Provide 'time out" or seclusion rooms where agitated patients can be separated from staff, other residents and visitors.
- Protect nursing stations with enclosures that prevent residents and visitors from molesting, throwing objects or reaching into the station. The barriers should not restrict communication.
In addition, rooms can be made safer for employees by taking these steps:
- Furnish them minimally and with items that are lightweight, have no sharp corners and are arranged to prevent patients from using them to trap employees. In some cases, furniture can be fastened to the floor.
- Remove clutter and materials that can be thrown or used as a weapon.
- Install secondary doors for escape.
High standards of maintenance are integral to safety policies. It is crucial that burned out lights and broken windows or locks are promptly repaired or replaced. As well, room temperatures should be kept comfortable.
2. Administration/Management
- Increase staffing where assaults by patients are likely.
- Make patients and their relatives aware that the facility has a zero-tolerance policy toward violence.
- Obtain a patient's entire history to determine if there is a record of past violent behavior.
- Set up a system that ensures complete information on incidents and assaults is passed on from one shift to another. Patients prone to violence should have that clearly noted on their charts.
- Manage workloads so that they are predictable and allow for rest between shifts. This helps avoid fatigue that can diminish an employee's ability to identify and control a crisis.
- Require employees to have a companion when they enter the rooms of residents who are prone to violence or outbursts.
- Ensure that managers are always available to help with difficult individuals or situations, provide advice and make decisions.
More information about containing violence in nursing homes is available on OSHA's website.
(In a future article, we'll discuss ways to protect staff from other health and safety hazards.)
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