Institutional violence includes various institutionalized acts of aggression committed by societal agents (James & Gilliland, 2012). Healthcare workers, as people who play a frontline role during emergencies or crises, are more prone to victim aggression than other professionals are.
In recent years, a number of factors, namely, substance abuse, gender stereotypes, mental illness, and deinstitutionalization (James & Gilliland, 2012) have precipitated violence in various institutions, including schools. With regard to substance abuse, aggressive behavior has been attributed to intoxication and the use of illicit drugs.
Modern social institutions, including day care centers, operate in deinstitutionalized (less restrictive) environments. This has increased the likelihood of clients falling back to their “previous mental states” during the course of treatment (James & Gilliland, 2012, p. 132). On the other hand, mental disorders, including hallucinations and delusions, also make victims more impulsive and violent. Masculine stereotypes that require men to be competitive and aggressive also precipitate violent dispositions in male clients.
Social institutions, through their discriminatory policies and procedures, commit abuses against certain groups or individuals. In particular, human services institutions that require their personnel to follow strict procedure and protocols impede “personal introspection and criticism of institutional activities” (Allen & Sheen, 2005, p. 29).
The fact that everyone is following strict routines depicts the institution’s activities as conventional and legitimate. They require their agents to adhere to “standard operating procedures” as prescribed by the organization (Allen & Sheen, 2005, p. 27). This results in institutionalization of violence.
Institutions also foster violence through their bureaucratic reporting procedures and protocols. Besides subverting moral restraint, bureaucratic routines create a situation where no single person takes full responsibility for violence against a client. Such institutions evoke blind loyalty and obedience to the people in authority, which makes the staff less critical of the institution or its activities.
The medical staff members are expected to exhibit empathy and concern for their clients, in the assumption that the recipients will reciprocate (Bass & Yep, 2002). However, social workers should watch for signs of a potential assault as their actions or institutional systems can provoke the client. Patients afraid of a treatment or an intervention may act aggressively towards the staff members.
Additionally, overbearing staff members can make the patient to feel powerless and turn violent (Bass & Yep, 2002). Conversely, clients may act aggressively if the intervention entails seclusion or physical restraints.
Staff members also define appropriate behavior within a facility. While doing so, they should be firm, fair, and non-dictatorial to motivate the client to be cooperative and obedient. Denying clients certain privileges will only breed more violence (Bass & Yep, 2002).
The staff member’s disposition and attitude towards his or her client also determines the likelihood that he or she becomes a victim of assault. In general, those who exhibit indifference towards clients are more assaulted than those who do not (Gadon, Johnstone & Cooke, 2006). Inexperienced staff members are also more likely to be assaulted than experts are.
The medical staff, in some instances, may be held liable for their work-related actions. Criminal liability also includes the administrators of the institution. When a patient is injured, the staff and the directors are held legally liable for not performing their “duty of providing care owed to clients” (James & Gilliland, 2012, p. 127).
Lawsuits against medical staff usually involve misdiagnosis and incorrect procedures to control clients exhibiting aggressive behavior. On the other hand, directors are required to implement measures to prevent workplace violence, which is a serious health issue.
A medical staff member may also be legally liable for violence if he or she fails to inform others that the client is known to be aggressive (James & Gilliland, 2012).
A history of aggression is a strong predictor of future violence. In this regard, a medical worker should examine the client’s medical records to find out if the patient has a history of aggression and advise the others to take precaution. This will absolve him or her from legal responsibility in case the client becomes violent.
Model of Intervention
Intervening during a crisis requires careful planning and coordination to help the client and his or her family to overcome the problem. The popular model of crisis intervention entails nine steps. The first step entails building a trust relationship with the client. It requires the healthcare worker to be respectful, a good listener, sincere, and sensitive to the victim’s needs (Allen & Sheen, 2005). Respect helps build a good rapport with the client.
The second step involves encouraging the client to express his or her emotions. Feelings of “anger and frustration” reflect the client’s emotions towards the present crisis (Allen & Sheen, 2005, p. 41). Once a good rapport has been built, the client and the social worker discuss the crisis and how it happened. During this step, the client reveals the causes of the event and the measures his or her family undertook to mitigate the problem.
After the discussion, the healthcare worker assesses the “family needs and strengths” to deal with the crisis (Allen & Sheen, 2005, p. 42). In step five, the healthcare worker develops an explanation for the event or problem before working with the family to develop an appropriate solution to the problem.
After identifying the solution, he or she formulates an all-inclusive treatment plan that would ensure a holistic care for the client. The treatment plan terminates once the family is able to cope well, based on the healthcare worker’s assessment. However, regular follow-ups continue even after the intervention ends.
Allen, M. & Sheen, D. (2005). School-based Crisis Intervention: Preparing all Personnel to Assist. New York: Guilford Press.
Bass, D. & Yep, R. (2002). Terrorism, Trauma, and Tragedies: A counselor’s guide to preparing and responding. Alexandria, VA: American Counseling Association.
Gadon, L., Johnstone, L. & Cooke, D. (2006). Situational variables and institutional violence: A systematic review of the literature. Clinical Psychology Review, 26(5), 515-534.
James, R. & Gilliland, B. (2012). Crisis Intervention Strategies. Belmont, CA: Cengage Learning.