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SINGAPORE: Amir * was trying to prevent a patient from leaving his ward when a punch landed on his left cheek so hard that his nose started to bleed.
“I was shocked,” said Amir, a Singapore General Hospital (SGH) health aide who said he hadn’t experienced anything like this in his 15 years on the job.
Describing the incident in January, Sheila *, a nurse who helped Amir with the patient, said the man became agitated when there was a delay in the discharge process and tried to leave without his medication.
Health workers knew that the patient had mental health problems when he was admitted for an acute illness.
“After he hit him, he (the patient) was shocked too,” Sheila said. “He stared at (d) … and was silent, doing nothing. He did not continue to be aggressive or violent.”
Hospital security officers were called.
As for Amir, he went to the accident and emergency department where an X-ray and scan showed he was fine. He told CNA in a telephone interview that he has since put the incident behind him.
With patients who have a known history of mental health problems, Sheila said she and her colleagues will be more careful not to trigger them. And although she has never been physically assaulted, she said those incidents are “quite common.”
“Physical abuse happens because patients are not in the right state of mind,” he said.
UPWARD TREND IN CASES
These incidents are not unheard of among public health workers.
Health Minister Gan Kim Yong said in a written response to a parliamentary question earlier this month that, according to data from public health institutions, the number of cases of abuse and harassment increased from 1,080 in 2018 to 1,300 last year.
During the same period, the number of cases involving serving public health workers reported to the police under the Protection from Harassment Act increased from 40 to 58.
According to the figures, SGH has seen an increase in the number of abuse cases facing front-line employees, a spokesperson said. In SGH alone, there were almost 200 cases last year, almost three times more than in 2016.
The common reasons behind the abuse and intentional harassment are an unreasonable demand for additional services, such as requests for staff members to purchase carbonated beverages or to give preferential treatment, the spokesperson said, noting that there are also instances of unexplained assault where no there was an obvious provocation.
The spokesperson said that some forms of such abuse and harassment include yelling and threatening, and physical abuse such as pushing and hitting. Victims are typically front-line personnel such as doctors, nurses, as well as health care aides and aides, especially those involved in direct patient care, he said.
SGH said that when its employees find themselves in an abusive situation, they will first seek immediate help from close colleagues.
“The supervisor is then informed and, if it is safe to do so, the supervisor will come over and talk to the angry patient or their closest family members. In the event that they cannot calm down or reason with them and the security of the personnel is at risk, our security will be alerted, ”said the spokesperson.
“In most cases, our officer or security team will assess the situation first. In cases where the abuser cannot be calmed or reasoned with, or when the safety of staff and patients is at risk, we will request police intervention. “
ABUSE BY ELDERLY PATIENTS WITH DEMENTIA, BEHAVIORAL PROBLEMS
At Alexandra Hospital (AH), cases of physical assault are common when dealing with older patients with dementia and behavior problems, said lead clinical nurse Pauline Chong.
“These groups of patients may have impaired thought processes so they cannot express their needs or discomfort. They tend to get frustrated and physical aggression can appear when their basic or emotional needs are not met, ”he said.
These needs include thirst, hunger, and going to the bathroom. They can’t respond well to unfamiliar people in A New Environment because they lack a sense of security, he noted.
Nurses are also verbally abused by patients who refuse to cooperate and insist on leaving their rooms to smoke despite being at risk of falling, he added.
“In the course of our work, we can sometimes come across patients who exhibit aggressive emotions or those triggered by depression. We have come across extreme cases where our nurses are verbally abused or punched or spit upon, ”he said.
“Nurses in such circumstances can feel discouraged and depressed when they encounter these patients,” he added, noting that it is important during induction and refresher training to educate nurses in psychology and human behaviors.
Ms. Chong said that AH makes the distinction between patients who are angry, aggressive, and depressed and those who are mentally ill, under stress, or experiencing anxiety.
“These patients who live alone, do not have the support of their families, and often the elderly with dementia face entrenched social complexities that go beyond medical problems,” said Ms Chong.
“We can refer one to a clinical psychologist from the hospital care team, and if psychotherapy and medication don’t work, our care manager will try to find the source of the triggers for the patient’s behavior before they escalate.”
It is not just the patients that nurses have to deal with. Visitors have also responded to restrictions on visits with threats, Chong said.
She added that sometimes, abuse can also come from close family members.
“They can make unreasonable demands, make sarcastic comments, threaten or speak badly to the nurses,” Ms. Chong said.
The Health Minister said in his parliamentary response that front-line healthcare personnel are trained to assess and reduce potential conflicts in the first instance and handle abusive situations.
There are also measures to help those affected.
“This includes hotlines for affected staff, anonymized counseling support services on and off campus by community institutions and providers, and peer support programs for staff,” Gan said.
“Members of the public are reminded through prominently displayed signs that they are to treat our staff with respect and dignity, and that any form of verbal or physical abuse of our staff will not be tolerated.”
* The names of SGH employees have been changed at the hospital’s request to protect their identities as they may need to continue to interact with the patient in the future.
