Dealing with Stress and Violence in the Workplace

Dealing with Stress and Violence in the Workplace

HLT 418V

Grand Canyon University

Dealing with Stress and Violence in the Workplace

There is a level of stress involved with life and careers in general, although some careers are more stressful than others. Violence appears to be getting worse daily. Some career choices are exposed to more violent situations and stress in the workplace than many other professions. This can cause numerous adverse effects on the employee if dealt with in an unhealthy manor. Specific conditions should be met to know the employee has physically and mentally dealt with the situation to be able to complete further work duties. The goal for managing the critical violence or stressful crisis situations are to provide support and initial counseling for employees to return to their complete work functions in the healthiest state possible (Occupational safety and health administration, critical incident stress guide).

Reporting Incidents

In 2007, a cross sectional, self-reporting, postal surveys were sent to nurses in several sectors. It was found that the incidence of workplace violence is highest in public sector nursing (Hegney, Tuckett, Parker, & Eley, 2010). The perception of workplace safety was inversely related to workplace violence. Except for public sector nursing, nurses reported an inverse relationship with workplace violence and morale (Hegney, Tuckett, Parker, & Eley, 2010). This study brought attention to the fact that workplace violence has implications for individual nurses, other professionals in healthcare, and the employer. This brought a clearer picture on the incidence of workplace violence and how to keep staff safe.

Critical Incidence Stress

Employees responding to emergency events and or disasters will see and experience events that will strain their ability to function. These events, which include having to witness or experience tragedy, death, serious injuries and threatening situations are called “Critical Incidents” (Occupational safety and health administration, critical incident stress guide). Most instances of critical incident stress last between two days and four weeks, while post-traumatic stress syndrome lasts longer than four weeks (Occupational safety and health administration, critical incident stress guide). There are many signs to critical incidents stress, such as physical, cognitive, emotional, and behavioral reactions to stress (Occupational safety and health administration, critical incident stress guide). Some examples of physical signs are, chest pain, headaches, dizziness. Cognitive signs can be confusion, nightmares, poor attention span, and decision-making ability. Several examples of emotional critical examples of incidence stress are guilt, intense anger, apprehension and depression, irritability, and chronic anxiety. Antisocial behavior increased alcohol consumption, change in communications, and change in appetite are behavioral examples resulting from critical incidence stress. (Occupational safety and health administration, critical incident stress guide).

Careers Associated with Critical Incidents

Some careers tend to be more apt to be associated with stress, acts of violence or the aftermath of violence, life and death situations, terminal illness, pediatric cancer, child abuse cases, psychiatric evaluations, dementia, and suicide. These careers that see these traumatic events range from Emergency Medical Technicians, Emergency Room Nurses, Emergency Department physicians, and Radiographers or Forensic Radiographers. Exposure to human suffering can adversely affect even the most experienced professional (Tips for managing and preventing stress2007). The stress experienced by responders are addressed as an afterthought. With a little effort, however, there are steps to minimize the effects of stress (Tips for managing and preventing stress2007).

Critical Incident Stress Management Teams

Critical Incident Stress Management Teams (CISM) is unique in that its sole purpose is to address staff issues, their feelings, and their abilities to cope with stressful situations (Wuthnow, Elwell, Quillen, & Ciancaglione, 2016). CISM acknowledges the well-being of health care workers so they can continue to care for patients and families after adverse events occur. Recognizing that the well-being of staff members is of the utmost importance makes the CISM team a valuable too (Wuthnow, Elwell, Quillen, & Ciancaglione, 2016). If our healthcare professionals are not at the highest standard emotionally or physically, then their work duties are not at their highest standards as well. The CISM team reduces burnout, psychological stress, and high turnover of staff members (Wuthnow, Elwell, Quillen, & Ciancaglione, 2016). Crisis intervention teams or individuals have appropriate training to handle crisis situations and management.

Critical Incident Stress Debriefing

Critical Incident Stress Debriefing is an early intervention process that supports recovery by providing group support and linking employees to further counseling and treatment services if it becomes necessary after a critical incident or stressful situation occurs. Critical incident stress debriefing (CISD) first emerged in the literature after the first formal effort to debrief emergency services personnel following the Air Florida crash in Washington, DC (Maloney, 2012). Debriefing is a specific technique designed to assist in dealing with the physical or psychological symptoms associated with trauma exposure. Debriefing is a specific technique designed to assist in dealing with the physical or psychological symptoms associated with trauma exposure. Debriefing allows those involved with the incident to process the event and reflect on its impact. There are seven steps to debriefing which are usually handled by well trained personnel capable to deal with crisis support therapy.

Difficult Patients and Confidence

1. Introduction Phase: Team members introduce themselves and explain the purpose of the group. Creates a conducive environment to explain the debriefing intervention, and gains participants’ cooperation.
2. Fact Phase: Participants describe the traumatic event from their perspective and describe their role during the incident and what happened.
3. Thought Phase: The team asks participants to state what their first thought or most prominent thought was beginning the transition of thoughts to emotions.
4. Reaction Phase: Each member identifies the most personally traumatic aspect of his or her emotional reactions.
5. Symptom Phase: The team asks individuals to describe any affective, behavioral, cognitive, or physical reactions they may have encountered while working at the scene or after.
6. Teaching Phase: The teaching phase is a cognitive approach, designed to bring subjects further away from the emotional content in the reaction phase. Stress management strategies are discussed.
7. Re-Entry Phase: This allows for the opportunity to clarify issues, answer questions, and summarize the intervention. Re-entry into the work environment in a positive manner allowing closure (Maloney, 2012).

Stress results from frustration, conflict, or pressure. As a radiologic technologist it may appear that patients are being difficult, but what specific patient characteristics cause them to seem difficult and what can the technologist do to alleviate the situation as well? The patient is uncertain of what happens during imaging. The patient may have a disability, heavily medicated and need further explanation to understand the process. Allow a reasonable time to discuss the imaging procedure easing the patient of concerns regarding pain or discomfort. The patient did not know about the study and are concerned what it is for (Brusin, 2011; Hegney, Tuckett, Parker, & Eley, 2010). Check the physician orders and the patient ID once again to reassure the patient.

In the case of a demanding patient, the technologist may recognize that a general sense of anxiety or general poor health causing irritability, accounting for this behavior. Many times, with a pleasant explanation and answers to questions demeanor changes foregoing any abusive stressful acts for the technologist.

In summary, violence and stress are parts of the world today. We are not able to control much of the traumatic scenes we see in our careers. We can only help alleviate some of the aftermath from the incidents. We must be at a healthy point physically and mentally to do so. With the help of CISD, I feel many would be able to carry on work duties. I feel we can also generate a better understanding of patient attitudes. We have all been afraid, irritable, ill, and concerned of the unknown. Be confident in yourself and the patient will be confident in you.

References

Brusin, J. H. (2011). Ergonomics in radiology. Radiologic Technology, 83(2), 141-161. Retrieved from https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104639230&site=eds-live&scope=site

Hegney, D., Tuckett, A., Parker, D., & Eley, R. M. (2010). Workplace violence: Differences in perceptions of nursing work between those exposed and those not exposed: A cross-sector analysis. International Journal of Nursing Practice, 16(2), 188-202. doi:10.1111/j.1440-172X.2010.01829.x

Maloney, C. (2012). Critical incident stress debriefing and pediatric nurses: An approach to support the work environment and mitigate negative consequences. Pediatric Nursing, 38(2), 110-113. Retrieved from https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104551978&site=eds-live&scope=site

Occupational safety and health administration, critical incident stress guide. Retrieved from https://www.osha.gov/SLTC/emergencypreparedness/guides/critical.html

Tips for managing and preventing stress (2007). (Rev. 4/07. ed.). Rockville, Md.: U.S. Dept. of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services. Retrieved from http://purl.fdlp.gov/GPO/gpo13205

Whitley, G. G., Jacobson, G. A., & Gawrys, M. T. (1996). The impact of violence in the health care setting upon nursing education. Journal of Nursing Education, 35(5), 211-218. Retrieved from https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107375670&site=eds-live&scope=site

Wuthnow, J., Elwell, S., Quillen, J. M., & Ciancaglione, N. (2016). Implementing an ED critical incident stress management team. Journal of Emergency Nursing, 42(6), 474-480. doi:10.1016/j.jen.2016.04.008