Proceedings of the first International Conference on Workplace Violence in the Health Sector Together, Creating a Safe Work Environment Ian Needham Mireille Kingma Linda O’Brien-Pallas Kevin McKenna Rick Tucker Nico Oud 2 Workplace Violence in the Health Sector Design and production: DM Creatieve Communicatie, www.dmhaarlem.nl 4 Dr. Ian Needham Dr. Mireille Kingma Prof. Dr. Linda O’Brien-Pallas Mr. Kevin McKenna Mr. Rick Tucker Mr. Nico Oud Editors Workplace Violence in the Health Sector Proceedings of the first International Conference on Workplace Violence in the Health Sector - Together, Creating a Safe Work Environment 22 – 24 October 2008 Congress Centre “De Meervaart” Meer en Vaart 300 1068 LE Amsterdam The Netherlands 5 ©2008 Kavanah, Dwingeloo & Oud Consultancy, Amsterdam Publisher KAVANAH The Netherlands Oud Consultancy & Conference Management Hakfort 621 1102 LA Amsterdam The Netherlands Telephone: +31 20 409 0368 Telefax: +31 20 409 0550 [email protected] www.oudconsultancy.nl ISBN-13: 978-90-5740-0889 All Rights Reserved. No part of this publication may be produced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning or otherwise, without the permission in writing of the copyright owner (Oud Consultancy) and the concerned author. 6 Preface It is now universally acknowledged that violence is a major challenge within the health care sector. This is a rather disturbing finding considering that the function of the health care sector is to provide care to those experiencing health difficulties. Not only does violence diminish the quality of the working life of staff and the care experience of service recipients, but also imposes very significant costs on health services in terms of human and financial resources. Violence in the health care sector can be categorized as either ‘Vertical’ occurring between health care professionals and the care recipients, or ‘Horizontal’ occurring among health care professionals or among care recipients. Vertical violence may be from care recipients toward carers or, to a lesser but more disturbing degree, from carers toward care recipients. Horizontal violence has become an overtly discussed issue within the last decades for example in the concept of bullying. There is a lack of universal consensus as to what constitutes violence within the health sector context and demarcation lines between violence and related concepts such as aggression, hostility, or sexual intimidation are often poorly defined. For the purpose of this conference we will refer to ‘violence’ in a very general and broad manner to encompass all these terms. This broad understanding will encompass numerous manifestations of violence which can range from mild verbal hostility to potentially fatal assaults. Considering the complexity and diversity of the problem, and the need for integrated responses, the conference has been structured to provide a comprehensive exploration of key issues which have been organized into eight conference sub-themes: • Economical aspects and implications of workplace violence (chapter 2). • Gender aspects and implications of workplace violence (chapter 3). • Legal and/or ethical aspects and implications for the employer and employee of workplace violence (chapter 4). • Nature, epidemiology, patterns and trends of workplace violence (chapter 5). • Policies and Operational Strategies regarding workplace violence: local, national, international and global guidelines, standards, reporting, prediction, risk assessment, prevention, management, after care and rehabilitation (chapter 6). 7 • Scientific, methodological, operational aspects and instruments regarding workplace violence (chapter 7). • Social and psychological theoretical perspectives on workplace violence (chapter 8). • Staff training and education issues regarding workplace violence (chapter 9). There are very considerable regional, national and cultural variations in how the problem is understood and managed. Notwithstanding these variations, the participation of presenters and participants from the world’s five continents clearly demonstrates that violence is a global issue in health care settings. This global representation presents the opportunity to incorporate cultural and regional variations in broadening the debate, and exploring solutions in a manner which will help the participants come closer to achieving the three general aims of the conference: • To sensitize stakeholders to the issue of workplace violence. • To understand the manifestations and the human, professional and economic implications of workplace violence. • To promote effective policies and strategies to create safe work environments We therefore hope and wish that the conference in Amsterdam will give us all the opportunity to exchange ideas, network with international colleagues and, most importantly, to consider strategies and solutions which will inform efforts in delegates respective homelands in the creation of safer places of service in which to receive or provide services. With this desire in mind we would like to wish everyone a fruitful conference “Together, Creating a Safe Work Environment”. The steering committee Dr. Ian Needham (Switzerland) Dr. Mireille Kingma, International Council of Nurses (Switzerland) Prof. Dr. Linda O’Brien-Pallas, Sigma Theta Tau International (Canada) Mr. Kevin McKenna, Dundalk Institute of Technology Dundalk Ireland, Project Facilitator Health Service Executive (Ireland) Mr. Rick Tucker, Consultant (UK) Mr. Nico Oud, Oud Consultancy, (The Netherlands) 8 Acknowledgements We would like to thank the following cosponsors for their encouraging and friendly support of the conference: • International Council of Nurses (ICN) • Sigma Theta Tau International (STTI) • Global Health Workforce Alliance (GHWA) • Dundalk Institute of Technology (DkIT) • International Labour Organisation (ILO) • International Hospital Federation (IHF) • Public Services International (PSI) • Centre of Psychiatry Rheinau (Switzerland) • CONNECTING, Partnership for Consult & Training (Netherlands) We are also deeply indebted to the following organizations which generously provided financial support for the “Waive the fee fund” to help enable conference presenters from financially less wealthy regions to attend the conference: • Global Health Workforce Alliance (GHWA) • CONNECTING, Partnership for Consult & Training • Sigma Theta Tau International (STTI) • Public Services International (PSI) • Oud Consultancy 9 Many thanks go also to the members of the scientific committee: Dr. Ian Needham, chair of the organization and scientific committee(Switzerland) Ms. Vicky Carroll, RN, MSN (USA) Dr. Bernard Beech (UK) Dr. Brodie Paterson (UK) Dr. Charmaine Hockley (Australia) Dr. Helge Hoel (UK) Dr. Jon Richards (UK) Dr. Mireille Kingma (ICN)(Switzerland) Dr. Patricia Rowell (USA) Dr. Phil Leather (Rapporteur)(UK) Dr. Richard Whittington (UK) Dr. Susan Steinman (South Africa) Dr. Vittorio Di Martino (FR) Mr. Kevin McKenna (Ireland) Mr. Rick Tucker (UK) Ms. Christiane Wiskow (France) Prof. Dr. Cary L. Cooper (UK) Prof. Dr. Duncan Chappell (Canada) Prof. Dr. Henk Nijman (Netherlands) Prof. Dr. Jonathan Shepherd (UK) Prof. Dr. Linda O’Brien-Pallas (STII)(Canada) Prof. Dr. Ståle Einarsen (Norway) Prof. Dr. Vaughan Bowie (Australia) 10 Content Preface ....................................................................5 Acknowledgements . 7 Chapter 1 - Keynotes ......................................................29 Chapter 2 - Economical aspects and implications of workplace violence . 67 Chapter 3 - Gender aspects and implications of workplace violence..........75 Chapter 4 - Legal and/or ethical aspects and implications for the employer and employee of workplace violence..................91 Chapter 5 - Nature, epidemiology, patterns and trends of workplace violence......................................................115 Chapter 6 - Policies and Operational Strategies regarding workplace violence: local, national, international and global guidelines, standards, reporting, prediction, risk assessment, prevention, management, after care and rehabilitation.................................................195 Chapter 7 - Scientific, methodological, operational aspects and instruments regarding workplace violence . .267 Chapter 8 - Social and psychological theoretical perspectives on workplace violence . .293 Chapter 9 - Staff training and education issues regarding workplace violence......................................................305 Announcement...........................................................381 11 Chapter 1 - Keynotes. 29 Creating work environments that are violence free ..........................30 Linda O’Brien-Pallas, Sping Wang, Laureen Hayes, Dan Laporte Faculties of Nursing and Medicine, University of Toronto, Canada Establishing an organizational response to the problem of work related aggression and violence within the health service sector at national level: an opportunity for real partnership working . 43 Pat Harvey Health Service Working Group on work related aggression and violence, Dublin, Ireland From training to institutional programs to politics . .45 Susan Steinman Workplace Dignity Institute, Wilropark, South Africa From workplace violence to wellness .......................................47 Mireille Kingma International Council of Nurses, Geneva, Switzerland Guidelines on workplace violence in the health sector anno 2008............49 Christiane