The Impact and effect of vulnerability on staff

1. The Impact and effect of vulnerability on staff Dr. Yafa Haron, Dror Tran Mazra Mental Health Medical Center, Israel

2. Background Vulnerability: The state of being subjected to injury (physical or emotional), unprotected from danger. Susceptible to attack; insufficiently defended. (The American Heritage Dictionary) Ironically, one of the most hazardous work settings for an employee of mental a health institution is his own department. (Caldwell M.F., Hospital Community Psychiatry, 1992) Unfortunately, Workplace violence is a virtually normativeexperience for the psychiatric staff, rather than a rare occurrence. (Lanza M.L., Zeiss R., Rierdan J. Mental Health Nursing, 2008)

3. Staff working in psychiatric departments were shown to experience severe psychological impact when exposed to violence or verbal abuse. (Makoto I. et al., Psychiatry and Clinical Neurosciences. 2006) Moreover, the media contributes to the notion that mental health nursing occupies an aberrant, secret and dangerous world and that its role remains one of custodial companionship. (De Carlo K., et al., Int. J. Mental Health Nursing, 2007)

4. Research Model Factors Influencing Staff vulnerability Factors from the legal System Family Behavior Patient Behavior Staff Vulnerability Beliefs andAttitudes of the General Public Factors from the Ministry of Health/ hospital management

5. Research Objectives To estimate the level of staff vulnerability that is related to the above mentioned various factors. To evaluate to what degree does the level of vulnerability affect the process of clinical decision making, during various situations?

6. Methods • Cross - sectional study • Questionnaire - 26 situations indicating daily life in the departments - 4 point scale. • Sample - personal from 9 departments; doctors, nurses, social workers, psychologists, and occupational therapists. A total of 150 (83%) respondents from a total staff of 180.

7. The Questionnaire: • Was based on a scale designed to measure staff perceptions regarding difficult psychiatric situations. Palmer G.A. et al., The Internet Journal of Mental Health, 2006.

8. A questionnaire evaluating discomfort, threat and continuous vulnerability Grade the following situations and your feelings of: Feeling of continuous vulnerability Discomfort Threat

9. A questionnaire evaluating how do certain situations influence the therapeutic treatment process Please grade the following situations:

10. Sample distribution (n=150)

11. Results

12. Situations Causing Greatest Discomfort (score 4) • Patient who threatens to harm me 3.18 • Patient who previously physically threatened me 3.0 • Patient family members who verbally threaten the staff 3.1 • Fear of lack of necessary senior staff support 3.06 • Lack of collaboration among various staff sectors 3.06 • Unfavorable/criticizing articles and media reports 2.9 Situations Causing Least Discomfort (or not at all) • Presence of Students in the ward 1.3 • Patient knowledgeable about illness 1.3

13. Extremely Threatening Situations (score 4) • Patient who threatens to hurt me 3.2 • Patient who previously physically hurt me 3.0 Least Threatening Situations (or not at all) • Presence of family during treatment 1.5 • Presence of a Lawyer 1.4 • Presence of Immediate supervisor and directors of other departments 1.4 • Present of a well informed patient 1.3 • Presence of students 1.26

14. Feelings of Continuous Vulnerability (mean) • Presence of a patient who threatens to hurt me 2.7 • Presence of a patient who previously physically harmed me 2.7 • Insufficient support from supervisor 2.7

15. Nurses Nurses presented the highest vulnerability feelings as compared to other sectors in the fallowing situations: • Racial insults of patients • Unfavorable/criticizing media reports or T.V. programs • Presence of a police investigator • Overly involved or verbally abusive family members who are present during treatment • Treating patient with a history of drug abuse

16. Doctors Doctors exhibited lower vulnerability feelings as compared to other sectors in the fallowing situations: • At the presence of a restrained patient • Patient who physically threatens them • Patient with delusional thoughts • Patient who physically attacked in the past • An over involved family • Family that threatens to file a complaint • Presence of a police investigator

17. Social Workers Social workers had the highest discomfort as compared to other sectors in the following situations • Patient who smokes in the ward • Presence of direct and indirect superiors • Presence of police investigators • Patient with delusional thoughts

18. Psychologists Psychologists had the highest average score as compared to other sectors in the following circumstances: Discomfort Threat Vulnerability Patient who threatens to harm me A restrained Patient Patient who verbally abuses Unsuitable or lack of suitable physical-setting Patient who previously physically attacked me racial insults of a patient

19. Situation Influencing staff feelings According to Gender: • Presence of a lawyer in the department • Various media articles • Presence of a police investigator • Present of a family during treatment Women Men • A patient has delusional thoughts about me • A patient has previously • physically attacked me

20. Situations that influence the staff to pay more attention during Treatment • Problematic composition of staff during shifts (doctors and nurses) • Staff fear they do not have supervisor support (30% of nurses) • Lack of cooperation among various staff sectors (30% of doctors) • Unsuitable or lack of suitable physical-setting • in the department (30% of nurses) • Criticizing articles and media reports (25% of staff)

21. Situations where staff refrains from being Involved in Treatment • Patient who threatens to harm me • Patient who has previously attacked me physically • Patient with delusions about me • Patient who racially insults me • Family members who express aggressive attitude towards the staff (especially nurses) • Family members who are over involved or threaten to file a complaint (especially nurses)

22. Conclusions • Organizational factors such as physical setting, lack of supervisory support and lack of collaboration among different staff sectors, lead to over-attention during treatment • Patient and family verbal violence leads to over-attention while physical violence encourages staff to avoid treatment • There is a difference among sectors in the way they respond in various situations • Verbal abuse leads to feelings of being threatened and to a feeling of continuous vulnerability

23. Conclusions • Fear of lack of supervisory support leads to feelings of discomfort, threat, continuous vulnerability, and causes over-treatment of patient • Presence of an over-involved family leads to continuous feeling of vulnerability and avoidance of providing treatment • Men are more effected by the presence of representatives of the law, family and media. While Women are more effected by patient’s thoughts and violence.

24. Implementations of research findings • In order to reduce the feeling of vulnerability, It is necessary to create workshops that include staff from all sectors, to emphasize the need for collaboration among all • Continues supportive-supervision from the management, will contribute to reduce the feelings of threat, discomfort and staff vulnerability • To educate staff to handle patients and family violence • To market the psychiatric staff and treatment procedures in a positive manner

25. Thankyou

26. Dr. Yafa Haron, Staff Chairperson • Dror Tran • Yaron Nachmias • Orit Ben Naftali • Svetlana Kazkor • Libi Mor • Ofer Grossan • Christina Yogev • Suliman Abbas • Geula Fenoloven