Preventing Interpersonal Violence in Emergency Departments: Practical Applications of Criminology Theory

Article excerpt

Over the past two decades, rates of violence in the workplace have grown significantly. Such growth has been more prevalent in some fields than others, however. Research shows that rates of violence against healthcare workers are continuously among the highest of any career field. Within the healthcare field, the overwhelming majority of victims of workplace violence are hospital employees, with those working in emergency departments (EDs) experiencing the lion's share of violent victimization. Though this fact is well-known by medical researchers and practitioners, it has received relatively little attention from criminal justice researchers or practitioners. Unfortunately, this oversight has severely limited the use of effective crime prevention techniques in hospital EDs. The goal of this analysis is to utilize techniques of situational crime prevention to develop an effective and easily applicable crime prevention strategy for hospital EDs.

Keywords : hospital ; situational crime prevention ; victimization ; violence ; workplace

In the last two decades, violence in the workplace has become a major problem, both in the United States and abroad. In a press release, the Bureau of Labor Statistics (2006) reported that 5.3% of industries experienced at least one incident of workplace violence in 2005, with 62.7% of industries in which employees work directly with the public experiencing violence in the workplace. According to the Bureau of Justice Statistics, violence in the workplace accounted for 18% of all violent crime that occurred in the United States between 1993 and 1999 (Duhart, 2001). Simple and aggravated assault were the most common forms of violence, accounting for 93.8% of all violent crime in the workplace. Understandably, police officers experienced the highest rates of violent victimization, accounting for 11.2% of all workplace violence (Duhart, 2001). More surprisingly, however, is the significant rate of workplace violence against those in the healthcare field. Workplace violence against nurses, alone, accounts for 3.5% of workplace violence in the United States (Duhart, 2001).

Several researchers argue that, outside of the criminal justice system, individuals in the healthcare industry are among the few that are almost guaranteed to experience violent victimization and/or harassment at some point in their careers (Smith-Pittman & McKoy, 1999). Like the police, healthcare professionals-especially hospital staff-often come into contact with drunk, high, and/or mentally ill individuals. They also frequently deal with gang members, drug addicts, and other types of criminal offenders. Unlike the police, however, healthcare professionals rarely have the training or means necessary to subdue, restrain, or divert these individuals, in an effort to prevent potential violence.

VIOLENCE IN HOSPITAL EMERGENCY DEPARTMENTS

Violence often occurs across a wide array of healthcare settings-including nursing homes, psychiatric facilities, and medical clinics. However, one setting that sees an alarming rate of workplace violence is the hospital emergency department (aka emergency room or accident and emergency room; Barlow & Rizzo, 1997; Crilly, Chaboyer, & Creedy, 2003; Fernandes et al., 1999; Landau & Bendalak, 2008; McKenna, Poole, Smith, Coverdale, & Gale, 2003). In 1997, the Health Services Advisory Committee (HSAC) found that 50% of violent incidents against healthcare workers in the United Kingdom occurred in hospital emergency departments (ED; Saines, 1999). Individuals who go to ED are often confused, frustrated, and in pain (Landau & Bendalak, 2008). To make matters worse, many incoming patients are also intoxicated with drugs or alcohol (Cork & Ferns, 2008; Ferns & Cork, 2008; Gates, Ross, & McQueen, 2006). All too often, these and other influential variables produce very volatile situations for ED staff.

Reporting Issues

The high rates of victimization for ED staff are undoubtedly due to their increased exposure to large numbers of potentially violent individuals within the ED setting (Landau & Bendalak, 2008). …