The need for in-home care has grown since COVID-19 because many fear contracting the virus in hospitals and clinics, especially among the elderly population.
With no security like hospitals usually have, home visiting Nurses put themselves at risk whenever they enter a patient's home alone.
Ha Do Byon, Assistant Professor of Nursing at the University of Virginia School of Nursing mentions in a STAT news article, "Even before the pandemic struck, I heard Nurses’ stories of home visits — some during my time as a visiting Nurse, and others as part of a study I am conducting to understand violence faced by home visiting Nurses. They told me about patients who blared pornography, or being groped while administering care. About patients who waved handguns and hurled racial insults. About being bitten, punched, kicked, or slapped. About dealing with screaming fits, intoxicated family members, and dogs that bit them or threatened to."
According to a 2015 study by BMC Public Health, the threat of workplace violence was one of home health workers’ top concerns, ranking above transportation issues or environmental hazards.
Developing a safety program for your home care workforce is crucial in reducing health care worker stress and turnover.
The rate of patient-on-Nurse violence among home visiting Nurses is unknown.
An article in Home Care Magazine states, only one-fifth of violent incidents “are ever reported in part due to embarrassment, organizational culture, tolerance or excusing the behavior of ‘ill’ clients." Nurses have cited fear of retribution from supervisors, the complexity of the legal system and disapproval from administrators as barriers to reporting workplace violence.
Nurses and providers can take measures to prevent violent situations.
The National Institute for Occupational Safety and Health Centers for Disease Control and Prevention released a list of recommendations for employers and workers to ensure safety.
Some recommendations for Employers:
• Ask employees to report each incident, even if they think it won’t happen again or it might not be serious.
• Train employees to recognize the signs and body language associated with violent assault and how to manage or prevent violent behavior, such as verbal de-escalation techniques, management of angry patients, recognizing and protecting themselves from gangs and gang behavior.
• In the case of an unacceptable home environment, advise the patient on working with social service agencies, the local police department, or family members and neighbors to make the home less hazardous so care can continue.
• Provide cell phones to all staff on duty. Home healthcare workers consider cell phones to be lifelines.
• Consider other equipment, such as employer-supplied vehicles, emergency alarms, two-way radios, and personal bright flashlights to enhance safety.
• Establish a no-weapons policy in patient homes. If such a policy is not required, request at a minimum that, before service is provided, all weapons be disabled, removed from the area where care is provided, and stored in a secure location.
• If possible, visits in high-crime areas should be scheduled during daylight hours.
•Acknowledge the person’s feelings.
• Avoid behaviors that may be interpreted as aggressive (for example, moving rapidly or getting too close, touching unnecessarily, or speaking loudly).
• If possible, keep an open pathway for exiting.
• Trust your own judgment; avoid situations that don’t feel right.
• If you cannot gain control of the situation, take these steps: Shorten the visit. Remove yourself from the situation. If you feel threatened, leave immediately.
• Use your cell phone to call your employer or 911 for help (depending on the severity of the situation).
• Report any incident of violence to your employer.
• If you are being verbally abused, ask the abuser to stop the conversation.— If the abuser does not stop the conversation, leave the premises and notify your employer.
• Consider working in pairs in high-crime areas.
• Always let your employer know where you are and when to expect you to report back.
• During the visit, use basic safety precautions:— Be alert.— Evaluate each situation for possible violence.— Watch for signals of impending violent assault, such as verbally expressed anger and frustration, threatening gestures, signs of drugs or alcohol abuse, or the presence of weapons.
• Maintain behavior that helps to diffuse anger:— Present a calm, caring attitude.— Do not match threats.— Do not give orders.
We view Nurses and healthcare workers as heroes and we should appreciate the essential work that home visiting Nurses provide by making sure they can safely do their job and feel comfortable enough to notify management when they aren't safe.