Work Related Violence

This report analyzes the impact of work related violence on the Australian ambulance Victoria paramedics profession and other paramedic workforce. It investigates the factors that affect ambulance practice and pre-hospital care.

Running head: WORK RELATED VIOLENCE
WORK RELATED VIOLENCE
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Introduction
The ambulance service has a leading position in the healthcare service providers. Since
the past decade it has been analyzed that there is an increasing need for ambulance services and
transportation of patient by the emergency medical services. The EMS missions provide pre-
hospital care to the patients and transporting them to the medical facilities. The pre-hospital care
has changed rapidly during the Last decade. The business organization has transformed at a
faster rate from a transport organization into an integrated healthcare system. The rapid change
in the pre-hospital care and services has brought forth many challenges and problems to the
healthcare organizations. The emergency medical systems are required to carry out more
advanced patient assessment and other improved interventions rather than the old traditional
system of ‘load and go’ strategy and transporting to the nearest emergency institutions and
healthcare service department (Ambuel, et al., 2013). The healthcare organizations require
implementing a more advanced care for the ill and injured patients requiring pre hospital
treatments. The emergency medical systems needs to provide alternatives to the patients such as
providing them ways of self treating self care advice and transport to the primary care facility.
Therefore, a broad range of specialty people with clinical skills are needed for to handle and take
care of different kinds of patents. It requires high level of clinical reasoning and other decision
making skills. The purpose of this report is to critically analyze the factors that affects or
influences the ambulance practice and pre hospital care. It investigates the effect of work related
violence and aggression that might affect the Australian ambulance Victoria paramedics
profession and other paramedic workforce.

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Discussion
According to Hamberger, Rhodes and Brown, (2015), there are various researches
which relied on assumptions, definitions and other measures of workplace violence in the health
care organizations. Majority of the research and literature relies on the interpretation of different
meaning of violence as per different individuals. Violence is originated from both physical and
verbal abuse. The degree of violence exposure in the healthcare organizations varies
considerably across occupations and jobs. Various literatures investigates and researches on the
consequences of workplace violence in the health care professionals such as ambulance officers,
emergency hospital sectors, doctors and other general workers. It has been concluded by Bair-
Merritt et al., (2014), the experiences of workplace violence are highly associated with negative
psychological impacts such as burnout another post traumatic stress among the health care
professionals. It has been demonstrated by Campbell, Burg and Gammonley, (2015), the
health care worker are exposed to various verbal threats and other physical incidents of violence.
These are some of the findings that contribute to the literature relying on the measurements and
interpretations of physical assaults.
As per research and analysis, it has been identified that around 38% of the health care
professionals and pre hospital service professionals suffers some form of aggression or physical
violence at some point of time once in their career. Additionally, as stated by, d'Ettorre and
Pellicani, (2017), many of the health care professionals and the paramedics are threatened and
verbally abused perpetrated by the visitors and the patients themselves. This leads to situations of
conflicts and disaster. It is the health care professionals and the paramedics who become the
target of various political violence and collective violence. According to Lanctôt, and Guay,

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(2014), the paramedics, emergency room staffs and nurses directly or indirectly related to the
healthcare service are highly at risks. The work place violence and issues are unacceptable and it
negatively impacts the psychological and physical well being of the health care professionals and
the ambulance agencies. It was further stated by Lin, et al., (2015), the violence in the
workplace not only affects the well being of the personal and physical life but disrupts their job
motivation. As mentioned by Linsley, (2016), the workplace violence reduces the quality of care
provided by the health care professionals and puts the provision of health care highly at risk.
Additionally, it was stated by, it leads to immense loss of finance and well being of the health
care organizations. However, as mentioned by Magnavita, (2014), there are various
interventions which helps to prevent violence against the health care professionals and other
paramedics in the on emergency sector. It focuses on various strategies and techniques for the
emergency settings which focusing on the physical security of health care organizations and
other facilities. According to Miller, et al., (2015), there has been various research and literature
which evaluates the effectiveness of these interventions and program’s especially in the low
resource setting. The WHO, ICN, PSI has developed various framework guidelines for
overcome the issues regarding workplace violence in the health care sector. They support various
violence prevention policies in the health care service sector and especially in the non emergency
sector (Modi, Palmer and Armstrong, 2014). The WHO has developed frameworks and methods
to systematically collect data and other related information to attack on health workers, facilities
and patients.
This section of the essay understands the causes behind the workplace violence in the
healthcare sector. According to Paavilainen, Lepistö and Flinck, (2014), one of the significant

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factor behind the cause of workplace violence faced by the paramedics and the health care
professionals are societal changes. According to Ramacciati, et al., (2018), the changes in the
society, they have decrease community and family support. Another factor behind the cause of
workplace violence is the economy; there are various states which do not have mental health
hospitals and minimum funding for addiction programs. As argued by Roldán et al., (2013),
these have led to increase in the rate of patients affected with mental disorder and issues of
substance abuse. It has been researched that the patients and the relatives are the actual
perpetrators of violent incidents and the room of the patients in one of the common site. There
are various patients and visitor who are under the influence alcohol and drugs. There are patients
who exhibit their drug seeking behaviors and other diseases like dementia and those infected
with Alzheimer disease. According to Rudge, (2016), there are instances of ED crowding. There
are shortage of nurses and paramedics as well as longer waiting times and holding of patients in
the ED. There are various misconceptions about the behavior of staffs and there are is belief
among the patients and the staffs that they do not cooperate. Moreover as stated by Socías et al.,
(2014), there is a lack of visitor policy and it is poorly enforced. Other causes of workplace
violence include anger, regressive behavior anger, disorganized behavior, isolation and agitation
of the patients and the visitors. It is very unfortunate that there are incidents of violence
occurring inside and outside the health care premises. However, as mentioned by Vacaflor,
(2016), the violent behavior exposed against the healthcare workers and professionals are not
limited to mental illness, there are instances where the family members and the relatives assault
the healthcare workers and professions. There are other areas where the risk of violence is high;
it includes ICUs, Obstetric, neonatal units, and pediatric and other long term care facilities. As
per study by the US department of Justice, forty-eight percent of injuries and nonfatal violent

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crimes happened to the assistive personnel’s of the health care and the paramedics (Vezyridis,
Samoutis and Mavrikiou, 2015).
This section of the essay analyzes the effect of violence against the paramedic workforce.
According to Zhang et al., (2017), the acts of verbal and physical assaults and other violence
against the healthcare professionals and the paramedic workforce have significant impact on
their career and profession. As per the ENA study and surveys it has been identified that majority
of the Australian healthcare professionals and the paramedic violence do not feel adequately safe
in their work place environment due to increased rate of workplace violence. Furthermore, as
mentioned by Vezyridis, Samoutis and Mavrikiou, (2015), the professionals and the paramedic
workforce are not well prepared to handle the situations of violence in or outside the workplace
premises. In the same survey conducted by ENA, around 74% of the healthcare workers and
professionals have reported that the employer and the senior executives of the healthcare service
centers and healthcare organization do not have a protocol for responding to any incidents of
workplace violence (Ramacciati, et al., 2018). There have been around 45% of cases where no
actions have been taken against the violence act. It has been further analyzed that there is an
increased fear of retaliation among the pre-hospital workers and there is an inconvenience of
reporting (Modi, Palmer and Armstrong, 2014). These are some of the barriers to reporting
against the violence. Furthermore as mentioned by Miller, ET al., (2015), healthcare workers and
professionals are concerned about the reporting as it might adversely affect their customer
service scores. There are many healthcare professionals and staffs who are into the belief that
workplace violence is a part of their job. The other type of factors includes ambiguous reporting
rules and procedure, insufficient support and guidance from the administration and the instilled
belief among the workers and the professionals that reporting is a sign of weakness or

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incompetence. Lack of reporting or inadequate actions against the workers and the other
healthcare professionals indicate apparent acceptance of this kind of violence and unacceptable
behavior (Modi, Palmer and Armstrong, 2014). Therefore, changing the paradigm is considered
to be he major step towards resolving the issue. As per study and surveys by ENA the hospitals
and healthcare institutions who have no policy for the visitors and the patients against the
violence suffered 18% more violence as compared to the institutions and hospitals having rules
against violence and zero tolerance policy in the organization (Papa and Venella, 2013).
However, the paramedics and the first responders have undertaken program known as virtual
reality training in order to help them prevent workplace violence, the training is taken place with
the help of Australian government grants and it helps the paramedics to improve their tactical
skills. Under the program, paramedics are exposed to various situations such as occupational
harards and help them to deal with it tactfully.
According to Ramacciati, et al., (2018), the paramedics and the healthcare professionals
need to develop greater awareness of risks of violence and develop their potential for violence.
OSHA’s guidelines must be taken into considered as guidelines for preventing violence in the
healthcare Care and other social service workers and employees. As argued by Roldán et al.,
(2013), the executives and the management of the healthcare institutes must be committed
towards creating an environment in the workplace which is not conductive to the workplace
violence. The leaders and the managers of the business organization must undertake various
schemes and programs to develop awareness of the problem and it is also importance of the
management to adapt to zero tolerance policy. As argued by Hamberger, Rhodes and Brown,
(2015), this can reduce the amount of violence in the workplace of healthcare. Moreover, as

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commented by d'Ettorre and Pellicani, (2017), the employees of the healthcare institutes must
also consider getting involved with different communities for developing rules, policies and
procedures for ensuring a safe and violence free workplace. It has been further suggested by
Bair-Merritt et al., (2014), that the involvement of the employees can better help the healthcare
organizations and its employees to spread the awareness of the issues and incorporate change in
the culture of accepting violence in the healthcare organizations. According to Lanctôt, and
Guay, (2014), it is highly essential that staffs and healthcare employee involve with the managers
and the executives of the institutes to understand and incorporate change in the workplace
environment to encounter the threats and violence faced by the healthcare professionals and the
staffs of the healthcare organizations and pre-hospital staffs.
It has been analyzed that the female paramedics are higher and therefore there is a need
for gender specific interventions. The female paramedics have higher risks of occupational
violence as compared to the male paramedics. It is also been suggested by Paavilainen, Lepistö
and Flinck, (2014), that the healthcare officials and the professions must consider worksite
analyze. It is an important step involved in the process of evaluating the risks of the healthcare
institutions. Therefore, undertaking these steps and effective analysis of the potential risks can
help the organizations and the institutions to prevent risks and violence in the workplace. Further
as mentioned by Campbell, Burg and Gammonley, (2015), the comprehensive violence and risks
prevention program of the organization comprises of mainly three components that is
documenting and reporting for capturing and trending the data on various incidents and cases of
violence, the policy must record the strategies for addressing the incidents of violence, the
support of the staffs and the post event incident management and its impact are essential.
According to the healthcare organization must improve employee identification systems and

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access control (d'Ettorre and Pellicani, 2017).. The healthcare organizations and institutes must
improve its facility design in such a way that is ensures security and risk prevention. As
mentioned by Lanctôt, and Guay, (2014), they must take initiative for innovations and develop
inpatient psychiatric critical care areas. Additionally it was suggested by Papa and Venella,
(2013), that along with innovations and improvements, better resources, equipments and
educated workforce can help the staffs and the employees to handle the unstable patents and
typical inpatient psychiatric units. Further, according to Ramacciati, et al., (2018), the resources
and the new roles must be taken into consideration most importantly. As per the evidence of
Anecdotal, it suggests that there are many ambulance services who implemented programs to
minimize the risks of violence.b However as stated by, Lanctôt, and Guay, (2014), these risks
have increased gradually despite the efforts taken by the ambulance service providers and
paramedics.
According to Roldán et al., (2013), it is essential to consider the importance of education
which can improve the ability of the paramedics and nurse’s ability to identify violence
situations and respond to that accordingly. There are various courses such as crisis prevention
institute which helps to develop and improve the skills of the paramedics and the nurses. It also
helps to enhance the communication ability and skills, de escalation of techniques and other self
protection techniques in violent situations. As mentioned by Hamberger, Rhodes and Brown,
(2015), Anticipation is also one of the most important strategies that must be adapted by the
paramedics and nurses. The paramedics and ambulance agencies might consider developing
reliable interventions and work with the researchers in order to develop, implement and
document the outcomes of risks preventions. This strategy is considered to be highly effective as
there is no aggression without warning signs. It was argued by Lanctôt, and Guay, (2014), the

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patients must be dealt properly as there are most tensed and anxious most of the time which leads
to violence behavior and verbal abuse. The patients and their relatives feel anxious, trapped and
helpless which is the reason for increased awareness. According to Ambuel, et al., (2013), there
must be a safe distance maintained between the patients and the healthcare professionals,
especially when there are warning signs. In order to address the problem of workplace assault in
healthcare institutions, in Australia there are many paramedics, nurses, professionals and hospital
groups who have supported towards laws and legislations for assault on healthcare workers
(Miller, et al., 2015). Therefore, the paramedics and ambulance agencies must refuse to accept
the status quo. They must mobilize actions by working actively in the workplace and
communities to institute better practices.
Conclusion
Therefore, from the above analysis it has been identified that there has been increase in
the mental health patients including patients affected with dementia and Alzheimer disease.
There are increasing number of patients who tend to exhibit drug seeking behavior or are under
the influence of drugs and alcohol. Further, the waiting times and holding of patients in the ED is
longer and there are shortage of ambulance agencies and paramedics in the present scenario.
There are misconceptions about the behavior of the staffs and there is a belief that the staffs and
the employees do not provide sufficient care to the patients. Moreover, the visitor policy is
lacking in many of the healthcare institutes. These issues have led to such increase in the
violence situations. This adversely impacts the motivation of job profession among the health
care workers. It also impacts the quality of service provided to the patients by the healthcare
professionals who has been subjected to violence situations. Further, there has been a fear of

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retaliation among the staffs and the healthcare workers. These situations have also led to
insufficient availability of nurses and paramedics due to the fear of violence. There has been lack
of convenience in reporting and it adversely affects the customer service course. The essay has
focused on various strategies and techniques through which the nurses and the healthcare
professionals. It has been recommended to improve the employee identification systems and
access control. It can improve its design facility to ensure security and other risk prevention.

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