First of all, we want to thank and commend the committee for looking at these very important issues, both human rights and occupational health issues, and also to thank you for asking us to testify.
I am Dr. James Brophy, and this is my partner, Dr. Margaret Keith. We both have Ph.D.s in occupational health from the University of Stirling in the U.K., where we hold appointments as visiting researchers.
We have recently published two studies. The first one focused primarily on violence against hospital staff, and the second on violence against long-term care staff.
I want to describe briefly how our research was carried out. Both studies were collaborative undertakings initiated by the Ontario Council of Hospital Unions affiliated with the Canadian Union of Public Employees. OCHU/CUPE has been very troubled by the pervasive threat to its members for several years.
Dr. Keith and I were asked to explore the issue and suggest potential solutions. As we were completing our study, OCHU/CUPE commissioned a poll to investigate the prevalence of violence perpetrated against hospital staff by patients. Almost 2,000 health care workers responded, providing results with a high level of statistical confidence.
According to the poll, 68% of registered practical nurses and personal support workers experienced at least one incident in the past year of physical violence; 20% experienced at least nine such assaults; 42% experienced sexual harassment and/or assault, 26% lost time from work due to workplace violence; and, despite the high number of incidents cited, only 57% said they had filed formal incident reports.
The research Dr. Keith and I conducted was qualitative rather than statistical. We designed our research to fully explore the issue of violence from the perspective of the health care workers themselves. We wanted to know exactly what they were experiencing, what they saw as the immediate and root causes of violence, and perhaps most importantly, what they believed needed to be done about it.
Both studies focused specifically on type 2 violence, in other words, violence against staff from a patient or family member. It is by far the most common type of workplace violence in the health care setting. Our first study was published a year and a half ago in the journal New Solutions, in an article entitled “Assaulted and Unheard: Violence Against Healthcare Staff.”
To gather first-hand experiential data, we talked to nurses and personal support workers, aides and porters, clericals, cleaners and dietary staff in communities across Ontario. This is what we heard. Violence is very widespread. Many of those we spoke with, especially those working in emergency departments, psychiatric units, forensics and dementia units told us that they regularly go into work fearing they will be assaulted.
They told us about their injuries, bruises, strains, scrapes, scratches, bites, torn ligaments, fractured bones, shattered faces, lost teeth and brain injuries inflicted by frustrated, angry, confused or intoxicated patients. Several said they suffered from ongoing emotional trauma that spills into their family lives. Most said that they are expected to quietly put up with aggression from patients and that it is just part of the job.
We learned that there are many modifiable risk factors for violence within the health care setting. In other words, prevention can be accomplished. Key among the recommended strategies was ensuring adequate staffing levels, a solution emphasized in much of the published scientific literature.
Engineering control, such as better building designs, can reduce risks.
Better communication, such as flagging aggressive patients and providing personal alarms, can convey protection for staff.
Increased high levels of security should be made available where needed. As well, wait times must be reduced to minimize anger, frustration and resulting aggression.
Also, patients need to be appropriately placed. For example, mental health patients should not be placed in acute care.
Zero tolerance policies must be enforced, including protection for those who are targeted because of race, gender or sexual orientation, and perpetrators of intentional violence against health care staff need to be held criminally responsible for their actions.
Dr. Keith will describe the second study and continue with some of our recommendations.