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a physician. “I’m tired of waiting. Let’s get this show box 12-4
on the road,” he screamed loudly as Ms. Jones walked
When an Assault Occurs:
by. “I’m sorry you have to wait, Mr. P., but the doctor Placing Blame on Victims
is busy with another patient and will get to you as
• Victim gender: Women receive more blame than men.
soon as possible.”She handed him a cup of juice she had • Subject gender: Female victims receive more blame
been bringing to another patient. He grabbed the cup, from women than men.
threw it in her face, and then grabbed her arm. • Severity: The more severe the assault, the more often
Slamming her against the wall, he jumped off the the victim is blamed.
• Beliefs: The world is a just place, and therefore the
stretcher and yelled obscenities at her. He continued to
person deserves the misfortune.
scream in her face until a security guard intervened. • Age of victim: The older the victim, the more he or she is
held to blame.
Be aware of clues that may indicate a potential for
Adapted from Lanza, M.L., & Carifio, J. (1991). Blaming the victim: Complex
violence (Box 12-3). These behaviors may occur in
(nonlinear) patterns of causal attribution by nurses in response to
patients, family members, visitors, or even other vignettes of a patient assaulting a nurse. Journal of Emergency Nursing,
staff members. Even patients with no history of 17(5), 299–309.
violent behavior may react violently to medication
violence in the workplace at your institution.
or pain (Carroll & Sheverbush, 1996; Lanza &
Preventing an incident is better than having to
Carifio, 1991).
intervene after violence has occurred.The following
In the health-care industry, violence is underre-
are suggestions to nurses about how to participate in
ported, and there are persistent misperceptions that
workplace safety related to violence (nursingworld.
assaults are part of the job and that the victim
org/osh/wp5/htm):
somehow caused the assault. Causes of underre-
porting may be a lack of institutional reporting ■ Participate in or initiate regular workplace
policies and employee fear that the assault was a assessments. Identify unsafe areas and the
result of negligence or poor job performance (U.S. factors within the organization that contribute
Department of Labor, 1995). Box 12-4 lists some to assaultive behavior, such as inadequate
of the faulty reasoning that leads to placing blame staffing, high-activity times of day, invasion of
on the victim of the assault. personal space, seclusion or restraint activities,
Actions to address violence in the workplace and lack of experienced staff. Work with
include (1) identifying the factors that contribute to management to make and monitor changes.
violence and controlling as many as possible and ■ Be alert for suspicious behavior such as verbal
(2) assessing staff attitudes and knowledge regarding expressions of anger and frustration, threatening
violence in the workplace (Carroll & Sheverbush, body language, signs of drug or alcohol use, or
1996; Collins, 1994; Mahoney, 1991). presence of a weapon. Assess patients or suspi-
When you begin your new job, you may want cious workers, patients, and visitors for potential
to find out the policies and procedures related to violence. Evaluate each situation for potential
violence. Keep an open path for exiting.
■ Maintain behavior that helps to defuse anger.
box 12-3 Present a calm, caring attitude. Do not match
threats, give orders, or present with behaviors
Behaviors Indicating a Potential
for Violence that may be interpreted as aggressive.
Acknowledge the person’s feelings.
• History of violent behavior
• Delusional, paranoid, or suspicious speech ■ If you cannot defuse the situation, then remove
• Aggressive, threatening statements yourself from it quickly, call Security, and report
• Rapid speech, angry tone of voice the situation to management.
• Pacing, tense posture, clenched fists, tightening jaw ■ Know your patients. Be aware of any history
• Alcohol or drug use of violent behaviors, diagnoses of dementia,
• Male gender, youth
• Policies that set unrealistic limits alcohol, or drug intoxication.
Adapted from Kinkle, S. (1993). Violence in the ED: How to stop it before it Box 12-5 lists some additional actions that can be
starts. American Journal of Nursing, 93(7), 22–24; Carroll, C., & Sheverbush,
J. (September 1996). Violence assessment in hospitals provides basis for taken to protect staff members and patients from
action. American Nurse, 18. violence in the workplace.