Professional abuse is "a pattern of conduct in which a person abuses, violates, or takes advantage of a victim within the context of the abuser's profession." [1] This typically involves a violation of the relevant professional organization's code of ethics. [2] Organizational ethics or standards of behavior require the maintenance of professional boundaries and the treatment of people with respect and dignity. [3]
Professional abuse involves those working in a facility were patients/clients are abused due to their vulnerability relying on professionals for assistance. [4]
They are taken advantage of because of this leaving them treated unethically. This type of abuse isn’t noticed as much as other abuse because of the trust that these patients think they have for the abuser and the manipulation antics used upon them.
These types of situations tend to happen in hospitals, nursing homes, rehabilitation centers, schools and many more health related facilities. It’s not just limited to these facilities however, It could also take place in offices that deal heavily with patients. [5]
There are many forms of abuse: discriminatory, financial, physical, psychological, and sexual.
Professional abuse always involves: betrayal, exploitation, and violation of professional boundaries.
Professionals can abuse in three ways:
In a working environment, the abuse of power against staff can manifest in various harmful ways. Often, abuse originates from an individual who holds power (i.e. the boss, executive or managers), but as the examples below demonstrate, abuse can also come from someone in a less powerful position.
There are numerous risk factors impacting both perpetrators and professionals who fall victim to assaults. In the context of healthcare settings, healthcare workers are more vulnerable to violence due in large part to the conditions under which care and services are provided. Extensive research conducted identifies that one critical aspect contributing to this heightened vulnerability is the nature of interactions between healthcare workers, patients, friends or visitors. [6] These individuals often find themselves emotionally charged, grappling with complex health issues, uncertainties and high expectations regarding the care and outcomes for their loved ones. This emotional intensity, combined with the perception of healthcare workers as authority figures responsible for the well-being of patients, can contribute to feelings of powerlessness or frustration among individuals receiving care. In some cases, this sense of powerlessness may manifest as aggression or violence towards healthcare.
Furthermore, the likelihood of violence is further increased by structural and environmental variables like crowded facilities, long wait times, strict visiting restrictions, a lack of information, and linguistic and cultural disparities.
In relation to healthcare workers themselves, they may be faced with shortage of staff, inexperience staff, or a lack of training. [6] Short-staffing not only places a heavier workload on existing personnel but also increases stress levels and reduces the ability of staff to effectively manage patient interactions. As a result, healthcare workers may find themselves stretched thin, forced to juggle multiple responsibilities simultaneously, and unable to provide the level of care and attention they desire. Moreover, the composition of healthcare teams may also play a role in increasing susceptibility to violence. Inexperienced or newly hired staff members, for instance, may lack the confidence, skills, and familiarity with institutional protocols necessary to navigate challenging situations effectively. This lack of experience can leave them feeling ill-equipped to handle confrontations or de-escalate tense interactions with patients or their families, potentially exacerbating conflicts and increasing the risk of violence.
The culture and structure within an organization are critical factors in determining whether the workplace is supportive or hostile. According to Perez Moroz and Brian Kleiner, where there exists a competitive organizational structure, power dynamics often favour a select few individuals who wield authority and influence. [7] This power dynamic can lead to the emergence of abusive behaviours within the organization as those in positions of authority may misuse their power to assert control or dominance over others. The objective of those in positions of power is to secure personal comfort and well-being. Consequently, to achieve this comfort, individuals commonly referred to as management, misuse their authority as a means to accomplish tasks.[ citation needed ]Bassman and London (1993) highlight the absence of standardized guidelines for handling mistreated subordinates by supervisors/managers in numerous organizations. The imperative to maintain their positions within an organization may drive these managers to mistreat their subordinates. [8]
However, managerial abuse may not solely arise from the fear of losing power but could also be influenced by personality disorders, job stress, and learned patterns of aggression. Such managers may engage in nepotism by promoting undeserving subordinates while leveraging company resources for personal gain. A manager displaying abusive tendencies might possess significant self-assurance and managerial skills to mask this unethical behaviour. Furthermore, the gratification derived from abuse may stem from a sense of control and superiority.
The impact of workplace abuse, particularly by supervisors or managers, extends beyond individual victims to affect the broader community and organizational culture. Gary Powell (1998) describes an abusive organization as displaying little regard for its employees' well-being, creating an environment where concerns for human needs are disregarded. [9] In such settings, workplace trauma is pervasive, leading to significant emotional and psychological distress among employees. Employees subjected to this emotional abuse, scrutiny, and intrusive surveillance experience diminished job performance and self-worth, while facing increased levels of stress and anxiety. This reduces the overall productivity of the workforce. According to studies, employees who experience abusive supervision have greater turnover rates, less favourable job attitudes, and increased conflict between work and family life among employees. Workplace abuse also perpetuates a cycle of dysfunction, contributing to communication breakdowns, reduced performance, and increased absenteeism.[ citation needed ]
There are several strategies available to organizations seeking to address professional abuse. A study, for instance, revealed that this problem often arises when there is an extreme power imbalance between the professional and the victim. A framework based on different grades of client empowerment and ways of strengthening it can help solve the problem. [10] Those who have been subjected to professional abuse could also pursue any of the following courses of actions: lodging a complaint; reporting abuse to the police; and, taking legal action. [3] There are also organizations that can help those who are victimized learn more about their rights and the options available to them.
An alternative to the solutions posed above is developing a plan of ‘zero tolerance’ which deals with any type or form of discrimination and workplace abuse. This policy would entail the establishment of clear guidelines aimed at addressing any instances or form of discrimination and abuse within the workplace. [11]
Education and training initiatives can also be deemed beneficial for addressing workplace abuse effectively. These programs would involve both managers and employees, being educated about acceptable conduct and behaviour in the workplace.[ citation needed ] For managers, such initiatives provide insights into recognizing the signs of abuse, understanding the impact it can have on individuals and the organization, and learning effective strategies for prevention and intervention. Similarly, education and training initiatives help employees understand their obligations, rights, and methods for reporting abuse.
Social work is an academic discipline and practice-based profession concerned with meeting the basic needs of individuals, families, groups, communities, and society as a whole to enhance their individual and collective well-being. Social work practice draws from liberal arts and STEM areas such as psychology, sociology, health, political science, community development, law, and economics to engage with systems and policies, conduct assessments, develop interventions, and enhance social functioning and responsibility. The ultimate goals of social work include the improvement of people's lives, alleviation of biopsychosocial concerns, empowerment of individuals and communities, and the achievement of social justice.
Empowerment is the degree of autonomy and self-determination in people and in communities. This enables them to represent their interests in a responsible and self-determined way, acting on their own authority. It is the process of becoming stronger and more confident, especially in controlling one's life and claiming one's rights. Empowerment as action refers both to the process of self-empowerment and to professional support of people, which enables them to overcome their sense of powerlessness and lack of influence, and to recognize and use their resources.
Abuse is the improper usage or treatment of a person or thing, often to unfairly or improperly gain benefit. Abuse can come in many forms, such as: physical or verbal maltreatment, injury, assault, violation, rape, unjust practices, crimes, or other types of aggression. To these descriptions, one can also add the Kantian notion of the wrongness of using another human being as means to an end rather than as ends in themselves. Some sources describe abuse as "socially constructed", which means there may be more or less recognition of the suffering of a victim at different times and societies.
Emergency psychiatry is the clinical application of psychiatry in emergency settings. Conditions requiring psychiatric interventions may include attempted suicide, substance abuse, depression, psychosis, violence or other rapid changes in behavior.
Workplace bullying is a persistent pattern of mistreatment from others in the workplace that causes either physical or emotional harm. It can include such tactics as verbal, nonverbal, psychological, and physical abuse, as well as humiliation. This type of workplace aggression is particularly difficult because, unlike the typical school bully, workplace bullies often operate within the established rules and policies of their organization and their society. In the majority of cases, bullying in the workplace is reported as having been done by someone who has authority over the victim. However, bullies can also be peers, and subordinates. When subordinates participate in bullying this phenomenon is known as upwards bullying. The least visible segment of workplace bullying involves upwards bullying where bullying tactics are manipulated and applied against "the boss," usually for strategically designed outcomes.
Workplace violence, violence in the workplace, or occupational violence refers to violence, usually in the form of physical abuse or threat, that creates a risk to the health and safety of an employee or multiple employees. The National Institute for Occupational Safety and Health defines worker on worker, personal relationship, customer/client, and criminal intent all as categories of violence in the workplace. These four categories are further broken down into three levels: Level one displays early warning signs of violence, Level two is slightly more violent, and level three is significantly violent. Many workplaces have initiated programs and protocols to protect their workers as the Occupational Health Act of 1970 states that employers must provide an environment in which employees are free of harm or harmful conditions.
Compassion fatigue is an evolving concept in the field of traumatology. The term has been used interchangeably with secondary traumatic stress (STS), which is sometimes simply described as the negative cost of caring. Secondary traumatic stress is the term commonly employed in academic literature, although recent assessments have identified certain distinctions between compassion fatigue and secondary traumatic stress (STS).
A health professional, healthcare professional, or healthcare worker is a provider of health care treatment and advice based on formal training and experience. The field includes those who work as a nurse, physician, physician assistant, registered dietitian, veterinarian, veterinary technician, optometrist, pharmacist, pharmacy technician, medical assistant, physical therapist, occupational therapist, dentist, midwife, psychologist, audiologist, or healthcare scientist, or who perform services in allied health professions. Experts in public health and community health are also health professionals.
Nursing is a health care profession that "integrates the art and science of caring and focuses on the protection, promotion, and optimization of health and human functioning; prevention of illness and injury; facilitation of healing; and alleviation of suffering through compassionate presence". Nurses practice in many specialties with varying levels of certification and responsibility. Nurses comprise the largest component of most healthcare environments. Shortages of qualified nurses are found in many countries.
Workplace aggression is a specific type of aggression which occurs in the workplace. Workplace aggression is any type of hostile behavior that occurs in the workplace. It can range from verbal insults and threats to physical violence, and it can occur between coworkers, supervisors, and subordinates. Common examples of workplace aggression include gossiping, bullying, intimidation, sabotage, sexual harassment, and physical violence. These behaviors can have serious consequences, including reduced productivity, increased stress, and decreased morale.
Workplace safety in healthcare settings is similar to the workplace safety concerns in most occupations, but there are some unique risk factors, such as chemical exposures, and the distribution of injuries is somewhat different from the average of all occupations. Injuries to workers in healthcare settings usually involve overexertion or falling, such as strained muscles from lifting a patient or slipping on a wet floor. There is a higher than average risk of violence from other people, and a lower than average risk of transportation-related injuries.
Emotions in the workplace play a large role in how an entire organization communicates within itself and to the outside world. "Events at work have real emotional impact on participants. The consequences of emotional states in the workplace, both behaviors and attitudes, have substantial significance for individuals, groups, and society". "Positive emotions in the workplace help employees obtain favorable outcomes including achievement, job enrichment and higher quality social context". "Negative emotions, such as fear, anger, stress, hostility, sadness, and guilt, however increase the predictability of workplace deviance,", and how the outside world views the organization.
Behavioral health outcome management (BHOM) involves the use of behavioral health outcome measurement data to help guide and inform the treatment of each individual patient. Like blood pressure, cholesterol and other routine lab work that helps to guide and inform general medical practice, the use of routine measurement in behavioral health is proving to be invaluable in assisting therapists to deliver better quality care.
Social undermining is the expression of negative emotions directed towards a particular person or negative evaluations of the person as a way to prevent the person from achieving their goals.
Patient abuse or patient neglect is any action or failure to act which causes unreasonable suffering, misery or harm to the patient. Elder abuse is classified as patient abuse of those older than 60 and forms a large proportion of patient abuse.
The nursing organization workplace has been identified as one in which workplace bullying occurs quite frequently. It is thought that relational aggression are relevant. Relational aggression has been studied amongst girls but rarely amongst adult women. According to a finding, 74% of the nurses, 100% of the anesthetists, and 80% of surgical technologists have experienced or witnessed uncivil behaviors like bullying by nursing faculty. There have been many incidents that have occurred throughout the past couple of years. OSHA, which stands for "Occupational Safety and Health Administration" stated that from 2011 to 2013, the United States healthcare workers experienced 15,000 to 20,000 significant injuries while in the workplace.
A “toxic workplace” is a colloquial metaphor used to describe a place of work, usually an office environment, that is marked by significant personal conflicts between those who work there. A toxic work environment has a negative impact on an organization's productivity and viability. This type of environment can be detrimental to both the effectiveness of the workplace and the well-being of its employees.
Abusive supervision is most commonly studied in the context of the workplace, although it can arise in other areas such as in the household and at school. "Abusive supervision has been investigated as an antecedent to negative subordinate workplace outcome." "Workplace violence has combination of situational and personal factors". The study that was conducted looked at the link between abusive supervision and different workplace events.
Patient-initiated violence is a specific form of workplace violence that affects healthcare workers that is the result of verbal, physical, or emotional abuse from a patient or family members of whom they have assumed care. Nurses represent the highest percentage of affected workers; however, other roles include physicians, therapists, technicians, home care workers, and social workers. Non clinical workers are also assaulted, for example, security guards, cleaners, clerks, technicians. The Occupational Safety and Health Administration used 2013 Bureau of Labor Statistics and reported that healthcare workplace violence requiring days absent from work from patients represented 80% of cases. In 2014, a survey by the American Nurses Association of 3,765 nurses and nursing students found that 21% reported physical abuse, and over 50% reported verbal abuse within a 12-month period. Causes for patient outbursts vary, including psychiatric diagnosis, under the influence of drugs or alcohol, or subject to a long wait time. Certain areas are more at risk for this kind of violence including healthcare workers in psychiatric settings, emergency or critical care, or long-term care and dementia units.
Violence against healthcare professional has occurred in the form of physical violence, verbal abuse, aggressive gestures, blackmail, and cyber-bullying. Violence against doctors has been observed in the United States, Australia, India, China, Pakistan, Nepal, Sri Lanka and others.