PURPOSE. To view the global impact of violence as a critical incident.
DATA SOURCES. Published literature, author's experience.
CONCLUSIONS. Psychiatric nurses can use the critical incident stress debriefing protocol to minimize adverse outcomes after a traumatic event. Workplace violence threatens the safety and well-being of nurses. Psychiatric nurses are more likely to encounter workplace violence than nurses in other settings and must prepare themselves using proactive health-promoting activities, for example the critical incident stress debriefing (CISD) model. This health-promotion model provides immediate emotional support and education about normal stress reactions, and may reduce the risk of chronic and disabling emotional and physical consequences.
Search terms: Critical incident, critical incident team, stress debriefing, workplace violence
Workplace violence is at epidemic levels and grips our society. Workplace murder is the leading cause of death in working women (35% of all female workplace deaths) and the second leading cause of death in working men (Toscano, 1995). Moreover, according to U.S. Bureau of Labor Statistics (BLS) figures released in 1995, 1,071 workers were murdered in the workplace in 1994 (Toscano). The incidence of workplace murders is one aspect of workplace violence.
In addition, there is growing recognition that all employees face some exposure to violence, by virtue of association with co-workers and client populations. Some data show an estimated 2 million people in the United States are assaulted each year by co-workers and 6.3 million are threatened by co-workers (Mathews, 1994).
This article focuses on the global impact of violence as a critical incident. In addition, it describes proactive strategies, such as critical incident stress debriefing (CISD), as a preventive health-promotion model that can be used to minimize adverse outcomes following a violent or traumatic event. The CISD model is part of the larger critical incident stress management (CISM) model (Everly, Flannery, & Mitchell, 2000; Everly & Mitchell, 1999). CISM is an integrated and comprehensive multi-component program whose goals involve a series of crisis intervention procedures to address the spectrum of psychological trauma and post-traumatic stress disorder (PTSD). In comparison, the CISD model is a single-structured intervention whose goal is to promote a sense of psychological closure with regard to a critical incident or traumatic experience.
Epidemiology of Workplace Violence
Nonfatal assaults account for the growing number of people exposed to violence in the workplace. According to the BLS (1996), almost 40% of nonfatal workplace assaults occurred in healthcare settings in 1994. In healthcare institutions, nonfatal assaults occurred primarily during interactions between clients and nursing staff.
Approximately two thirds of nonfatal assaults occurred in service facilities such as nursing homes, hospitals, and residential care settings (Bachman, 1994). Men and women in government settings experience a higher incidence of assaults than people working in the private sector. The annual rates of nonfatal assaults against women working in government agencies are 8.6 times higher than for women in the private sector; women working in local government facilities have a 5.5 times higher incidence of being assaulted than those in the private sector (Bachman). The incidence of workplace violence is well documented among nurses in vast work settings, including psychiatric, primary care, long-term care facilities, emergency rooms, community, and home based (Castillo & Jenkins, 1994; National Institute of Occupational Safety and Health [NIOSH], 1993, 1996).
Data from the BLS for 1993 confirmed that healthcare and social service providers have the highest incidence of assault injuries (BLS, 1996). …