Healthcare providers are extraordinarily vulnerable to violence for a variety of reasons. In view of news of on-going violence, it’s important to review practical aspects of threatened and actual violence included in a book,
The Gift of Fear, by Gavin de Becker.
The premise of Mr. de Becker’s book is that there is never violence that comes without warning. In fact, if caregivers learn to listen to their intuition, there are warning signs that are likely to prevent injury. This point is not intended to blame caregivers by saying that violence is their fault because they did not listen to their “gut,” but to encourage caregivers to pay attention to their instincts and to act upon them.
To illustrate this point, Mr. de Becker uses the example of a woman who was raped in her apartment. Her rapist said that he was going to the kitchen to get a drink of water and told her not to move. As he was leaving the bedroom, he closed an open window. The woman said that she knew instinctively at that moment that the rapist was going to kill her and wanted to minimize the sound of his crime. So, in what the woman describes as an “out of body” experience, she silently followed the rapist down the hall and slipped past him in the kitchen, out of the door to the apartment and into the apartment across the hall. As she left the apartment, she could hear the rapist rummaging in kitchen drawers looking for a large knife.
Mr. de Becker points out that many people who suffer violence say that it came “out of nowhere,” “out of the blue,” or that it was “random.” After some thought, however, the victims of violence are often able to identify that they felt uneasy with the perpetrator or that the criminal seemed suspicious. “I just knew,” many victims of violence say. These intuitive feelings must be balanced against the overwhelming tendency to deny that violence is possible. As Mr. de Becker points out:
It may be hard to accept its importance, because intuition is usually looked upon by us thoughtful Western beings with contempt. It is often described as emotional, unreasonable or inexplicable. Husbands chide their wives about “feminine intuition” and don’t take it seriously. If intuition is used by a woman to explain some choice she made or a concern she can’t let go of, men roll their eyes and write it off. We much prefer logic, the grounded, explainable, unemotional thought process that ends in a supportable conclusion. In fact, Americans worship logic, even when it’s wrong, and deny intuition, even when it’s right. [p. 12]
Mr. de Becker’s point is that there are almost always “pre-incident” indicators; detectable factors that occur before violent acts. Caregivers need to use their “radar” to identify these indicators and to act upon them in order to avoid violence.
Managers and supervisors may be tempted to minimize and deny caregivers’ concerns about potential violence, especially because they often do not have direct contact with patients and their families. Managers and supervisors should recognize that fearful caregivers have likely experienced some “pre-incident indicators” that are described in detail in Mr. de Becker’s book. They should help caregivers express their concerns, as opposed to denying them.
From a practical perspective, violence against providers may be minimized by encouraging staff to pay attention to their intuition about patients, their families and others they encounter in the workplace. In any event, Mr. de Becker’s book is a must-read for providers!
©2019 Elizabeth E. Hogue, Esq. All rights reserved.