Affiliations: [a] Clinical Director of Forensic Psychiatry, University of Cincinnati, Cincinnati, OH, USA | [b] Department of Psychology, Xavier University, Cincinnati, OH, USA
Correspondence:
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Corresponding author: Scott Bresler, Forensic Psychiatry, 260 Stetson St., Suite 3200, University of Cincinnati, ML 0559, P.O. Box 670559, Cincinnati, OH 45219, USA. Tel.: +1 513 558 3951; Fax: +1 513 558 3823; E-mail:Scott.Bresler@uc.edu
Abstract: Workplace violence in healthcare settings is a complex
topic with many different environments in which aggression is sometimes
expressed by patients toward those entrusted with providing their
healthcare. The assessment of violence risk in a nursing home containing
many patients with organic brain syndrome is quite distinct from assessment
in forensic psychiatric units, inner city emergency rooms, or outpatient
pain clinics. Three cases are presented that are composite summaries of
actual assaults which took place across different hospital settings, all
within an urban Midwestern city in the United States: (1) an emergency
department; (2) a psychiatric emergency services (PES) center; (3) a short
stay (typically 72 hours to 5 days) civil psychiatric inpatient unit. These
case studies exemplify specific risk factors that violent patients have,
depending upon the specific healthcare setting where the patient presents.
Research is cited relevant to all three case studies and how one should
assess their risk. Lastly, the complexity of this issue is highlighted by a
brief discussion of the pitfalls entailed in profiling ``the dangerous
patient.'' It is demonstrated that when violence is expressed by a patient
toward a healthcare provider, it is usually a maladaptive response, one in
which characteristics of that setting and behavior of those who work within
it must be carefully considered when determining what factors precipitated
the patient's violent act.
