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According to last year’s CBOS survey, the nurse is the second most respected profession. In the ranking, it surpasses the doctor and even the university professor. At the same time, however, in his daily work he experiences violence more often than a doctor. When dealing with an agitated, frustrated and enraged patient, she is on the front line, but no one cares about her safety.
- Joanna, a nurse working in a psychiatric ward, experienced a brutal attack from a patient. After an aggressive man attacked her, she suffered a spine injury. In her hospital, similar situations happen regularly
- Dorota, the head of the hospital emergency department, admits that aggressive behavior of people waiting for an emergency room is daily bread for the staff. “Insults, curses, slurs usually concern people who are desperate, angry that they have to wait” – he says
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From duty to emergency room
It was a Saturday in September. Joanna, a nurse with 18 years of experience, was on duty in her ward in a psychiatric hospital. Around 12 admitted a patient for whom direct coercion measures had to be applied. After two hours, she unfastened the security, because the patient was calm, he knew where he was. It was possible to communicate with him. The family with whom he normally spoke came to visit. But after the visit, the man began to behave strangely.
He was looking around as if he was afraid of something. I called the doctor on duty. At one point, the patient got up. He was about three meters from bed to desk. He slowly started walking towards us. I saw him out of the corner of my eye, but it never crossed my mind that he was going with the wrong intention. I was sure he was coming over to ask you something. And he suddenly grabbed my apron and tried to pull me towards him to bite my neck.
– I had nowhere to run. I tried to squat, but then he rolled over on me. We were both on the floor. The doctor and two other nurses tried to pull him away, but the patient’s grip was so strong that they pulled me along with him. The prison service saved me. Later it turned out that the same patient earlier, in the internal medicine ward, had bitten a piece of the nurse’s neck – says Joanna, who went straight to the HED during the unfortunate shift. The traumatic adventure ended for her with a whiplash injury. The police were not called because their superiors said that nothing big had happened. After all, this is a psychiatric ward, and the risk is inherent in the profession.
In the hospital where Joanna works, there is not a year in which such cases would not occur. Not so long ago, a male nurse suffered a concussion, and earlier a colleague from a neighboring ward had been strangled.
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What is PVV?
The phenomenon of aggression towards medical personnel is PVV (ang. patient and visitor violence). A 2012 study in Sweden, Ireland, Great Britain and Turkey showed that 9–24 percent. of personnel experiencing aggression at work encounter verbal aggression, and from 5–21% with mental aggression. The study found that nurses are more at risk of violence than other healthcare professionals. According to statistics, dangerous incidents occur most often in hospital emergency departments and psychiatric departments.
In 2014, the results of a survey conducted by scientists from the Faculty of Health Sciences of the Jagiellonian University were published. Of the more than 200 nurses who completed the survey, as much as 70 percent admitted aggression at work. 29 percent experienced an attempted physical attack – 10 people were attacked with a dangerous tool, such as a knife, bottle or needle. One person revealed that an attempt was made to rape her.
In 2017, the situation in the surgical ward and HED – from the municipal specialized hospital in Krakow was examined. From June to August, as many as 302 aggressive behaviors took place there. In 273 cases, it was about verbal aggression.
– The determinants of this problem are multifactorial. Aggression may be associated with a long wait for help, with the fear of whether the tests will hurt, whether it will detect something serious, or maybe – vice versa – it will not detect anything again. Faced with disease, patients may feel out of control, and their endurance can be lowered by pain. Some people experience an incorrect assessment of reality, related, for example, (but not only) to mental illness. The consequences may be felt by nurses who are on the front line, says psychologist Katarzyna Milska, assistant at the Department of Life Quality Research at the Medical University of Gdańsk, in an interview with Medonet.
– Besides, of course, there may be personality factors at play, both for the patients themselves and the medical staff. The disease situation requires empathy, acceptance, peace and self-control in the relationship with the patient. You must have a predisposition to practice as a nurse. It should be remembered that when staff do not meet the patient’s expectations, it is not always the fault of the staff themselves – these expectations may simply be excessive. The causes of aggression may also lie on the side of the system, because we have such and not other dates, a certain number of places, and not other salaries. Of course, this is not a justification for aggression, which – regardless of the circumstances – should not take place, but it points to an important problem that needs to be looked at – adds the psychologist.
Queues frustrate patients
The source of violent behavior is often the rules that apply in a given facility, e.g. TRIAGE rules at SOR departments. The TRIAGE system consists in determining the order of admitting patients according to five colors. Patients marked in blue or green, whose condition has been assessed as not requiring immediate intervention, can wait for the emergency department from several to several hours. With each passing hour, frustration grows.
Dorota – head of one of the hospital emergency departments – in an interview with Medonet admits:
– Aggressive behavior in emergency departments, insults, curses, slurs, they usually concern people desperate, angry that they have to wait. Benefits are not being delivered as they have imagined. There are verbal clashes with the family, explaining things that seem obvious from our point of view: that the order of entering the office is determined by the patient’s condition. The tension escalates, people waiting in the waiting room are taking photos, scaring them with the fact that they have connections, that they will describe us in the newspapers and show what is happening at SORs. But we are a non-profit profession, so there are some hallmarks of legal guardianship. Last year, due to the aggressive behavior of the patient, we called the police, they came, wrote a report, and that was it. I don’t know if it was continued in a civil court.
Aggression is happening more and more
Aggression towards medical staff is a problem that the system simply cannot cope with. A model of protecting hospital workers against attacks by patients has not yet been developed in Poland, although violence in ambulances and in hospital wards is a daily reality. It often turns out to be in emergency situations nurses, midwives and paramedics can only count on themselves. Meanwhile, in health care facilities it is getting more and more dangerous, there are brutal attacks, caused, among others, by through alcohol, drugs and designer drugs.
– We have the biggest problem with NPS patients. We cannot give any drugs because we never know how they will work in combination with these substances. We are only left with direct coercion and intravenous infusions. The challenge is just to put a cannula on such a patient. In the wards we have more and more people with personality disorders. Here, too, medicine is basically helpless. We are getting older and young girls do not come, which does not surprise me at all – says nurse Joanna.
Will there be changes in the law?
In 2012, the act on the nurses and midwives professions was amended. Since then, while performing official duties nurses and midwives enjoy the legal protection of public officials. This means that a person who insults them or violates their bodily inviolability must take into account the penalty of a fine, restriction of liberty or imprisonment. The problem, however, is that the regulation is dead – staff rarely report aggressive behavior due to a lack of knowledge of their own rights, but also due to bureaucratic procedures and a lack of proper response from medical facility management.
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