In my writing piece I will be discussing abuse and the different forms thereof. Violence In the workplace is considered an action: physical, written or verbal which is intended to cause serious bodily injury or death to oneself or others or destruction to property. Abusive behavior entails harassment, threats or intimidating others (Stockwell, 2018) Physical abuse is any act resulting in intentional physical injury. Verbal abuse includes harsh and insulting language directed at a person. Emotional abuse is any kind of abuse that is emotional rather than physical in nature, it entails verbal abuse and constant criticism to more subtle schemes, such as intimidation and manipulation. Lastly sexual abuse described by (Boissonnault et al., 2017) is any physical or verbal act of a perceived or explicit sexual nature which is inappropriate according to the social condition in which it is carried out is known as inappropriate sexual behavior (ISB).

Inappropriate patient sexual behavior is inappropriate sexual behavior carried out by a patient and aimed at a clinician or other patients in a health care facility. IPSB entails staring, sexual remarks, purposeful touching, indecent exposure and sexual assault.
According to (“Managing Challenging Situations Resource Guide”, 2018) unpleasant situations such as abuse most often occur as a result of a difference in values, expectations and assumptions as well as the patients’ background. In any challenging situation no two circumstances will be alike as different personalities are involved; hence the strategy for resolving them won’t be the same either.
A study by (Boissonnault et al., 2017) provides a multivariable analysis of personal, professional, patient and environmental factors in physical therapists to determine what factors are associated with risk of abuse especially IPSB. The factors include:
Clinical inexperience: The authors point out that education regarding abuse in academic physical therapy is needed as new clinicians and students are seen as vulnerable in the eyes of the abusive patient.
Working with patients with cognitive impairments: As these patients have impaired judgement. Such as patients’ with dementia, delirium and traumatic brain injury
Practitioner sex: Female professionals are found to be at greater risk of abuse especially IPSB
Stressful situations: Such as waiting long to be seen by the physiotherapist
Working in isolation: Healthcare practitioners working in isolation or in situations where they could be trapped without an escape route
Inadequate mental health personnel and security on site.

While reading up on this topic I realized I have had clinical experience where abuse namely emotional abuse and sexual abuse (IPSB) was experienced. In my Intensive unit care (ICU) rotation my clinician gave me a patient that was in the ICU for the second day, after introducing myself to the patient and explaining why I was there the patient told that he did not want to be seen by me the nurses or doctors and that he wanted to be left alone. After explaining the benefits of physiotherapy and the detrimental effects of not receiving physiotherapy I informed the patient that I would return the next day. The following day when I approached the patient he shouted at me and stated that I were to leave the room, he further went on saying that he didn’t want anyone’s help and that he wanted to be left in peace. My response to him was that if he didn’t want any medical care that he should inform the entire multidisciplinary team and leave the hospital as the aim of hospitalization is to those that want to be healthy and live and if those aren’t his wants then he needs to leave so that someone else that values their life could then get his bed. After saying this, the patient became quiet and avoided eye contact.

The following day the patient agreed to physiotherapy but seemed despondent. He did everything that was needed in the session but it wasn’t because it was something he wanted but rather so his bed wasn’t given away or to avoid death. I now realized that what I did was a form of emotional abuse as I used a subtle tactic to manipulate the patient into agreeing to physiotherapy. One needs to realize why patients refuse treatment and address the reasons for example demotivation pain etc. so they may be addressed.

IPSB was experienced when a patient seen by a different therapist told me that I was beautiful, to avoid a sense of awkwardness I thanked the patient and walked away. The following day the patient made a sexual remark. Whenever the patient would attend physiotherapy I would treat my patients in a different area. I knew the situation could have been handled better, my reasoning behind not addressing the problem was that I thought I was too friendly or that I took too long to lay a complaint.

Managing Challenging Situations Resource Guide, (2018) mentions a step by step process to address challenging situations such as IPSB:
Define the problem. Reflecting on your beliefs, values and expectations and how the problem are influencing them
Discuss the inappropriate behavior with the patient. Consider their values and experiences.
If the IPSB is still not resolved, seek external support which can be done by discussing the situation with your supervisor.
Document the conversation and plan for managing the situation
Provide enforceable consequences

I conclude that violence in the workplace is not only physical but written or verbal as well and abuse is not only expressed by the patient to the healthcare professional but also the healthcare professional that displays abuse toward the patient. No one likes to be involved in an unpleasant situation Managing Challenging Situations Resource Guide ( 2018) states that they are stressful and often leave healthcare professionals feeling uncertain or uncomfortable of their choices. The vast majority of encounters will be positive, conflicting situations do happen but how their addressed is vital. Nearly every situation offers the opportunity to learn something, either about how to handle similar situations or about one’s self. I’m relieved to say that I realized an important aspect of professional life is to engage in reflective practice.

 
References
Boissonnault, J., Cambier, Z., Hetzel, S., & Plack, M. (2017). Inappropriate Patient Sexual Behavior Directed Towards United States Physical Therapy Clinicians and Students; Prevalence and Risk. Physical Therapy. doi: 10.1093/ptj/pzx086

Managing Challenging Situations Resource Guide. (2018). Retrieved from http://cptnb.ca/old_html_site/2015Docs/Other/Guide%20-%20Managing%20Challenging%20Situations.pdf

Stockwell, S. (2018). Joint Commission Issues Alert Addressing Violence Against Health Care Workers. AJN, American Journal Of Nursing, 118(7), 14. doi: 10.1097/01.naj.0000541417.67605.8f