SINGAPORE: Amir* was trying to stop a patient from leaving his ward when a punch landed on his left cheek so hard that his nose started bleeding.
"I was shocked," said Amir, a health attendant at Singapore General Hospital (SGH) who said he had not 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 got agitated when there was a delay in the discharge process and he tried to leave without his medication.
Healthcare workers were aware that the patient had mental health issues when he was admitted for an acute medical condition.
"After he punched him, he (the patient) was also stunned," Sheila said. "He just stare(d) ... and kept quiet, doing nothing. He did not continue to be aggressive or violent.”
The hospital's security officers were called in.
As for Amir, he went to the accident and emergency department where an X-ray and scan showed that he was fine. He told CNA in a phone interview that he has since put the incident behind him.
With patients who have a known history of mental health issues, Sheila said she and her colleagues will be more careful not to trigger them. And while she has never been physically assaulted, she said such incidents are "quite common".
"Physical abuse happens because patients are not in the right state of mind," she said.
UPWARD TREND IN CASES
Such incidents are not unheard of among public healthcare workers.
Health Minister Gan Kim Yong said in a written reply to a parliamentary question earlier this month that based on data from public healthcare institutions, the number of abuse and harassment cases increased from 1,080 in 2018 to 1,300 last year.
Over the same period, the number of such cases involving on-duty public healthcare workers that were reported to the police under the Protection of Harassment Act increased from 40 to 58.
In line with the numbers, SGH has seen an increase in the number of abuse cases faced by frontline employees, said the hospital's chief communications officer Jennifer Wee. In SGH alone, there were nearly 200 cases last year, almost three times the number in 2016.
Common reasons behind intentional abuse and harassment are unreasonable demand for extra services such as requests for staff members to purchase carbonated drinks or give preferential treatment, Ms Wee said, noting that there are also cases of unexplained aggression where there was no obvious provocation.
Ms Wee said that some forms of such abuse and harassment include shouting and threatening, and physical abuse like pushing and hitting. Victims are typically frontline staff like doctors, nurses, as well as healthcare assistants and attendants, especially those involved in direct patient care, she said.
SGH said that when its employees find themselves in an abusive situation, they will seek immediate assistance first from colleagues nearby.
“The supervisor is then informed and if it is safe to do so, the supervisor would approach and talk to the angry patient or next-of-kin. In the event that they cannot be calmed or reasoned with, and staff safety is at risk, our security will be alerted,” said Ms Wee.
“In most cases, our security officer or team will assess the situation first. In cases where the abuser cannot be calmed or reasoned with, or when staff and patients’ safety is at risk, we will call for police intervention.”
ABUSE BY OLDER PATIENTS WITH DEMENTIA, BEHAVIOURAL PROBLEMS
At Alexandra Hospital (AH), physical assault cases are common when it comes to older patients with dementia and behavioural problems, said senior nurse clinician Pauline Chong.
“These groups of patients may have impaired thought processes whereby they are unable to express their needs or discomfort. They tend to get frustrated and physical aggression may set in when their basic or emotional needs are unmet,” she said.
These needs include thirst, hunger and toileting. They are unable to respond well to unfamiliar people in a new environment as they lack a sense of security, she noted.
Nurses are also verbally abused by patients who refuse to cooperate and insist on going out of their wards to smoke despite being at risk of a fall, she added.
“In the course of our work, sometimes, we may come across patients who exhibit aggression or depression-triggered emotions. We have come across extreme cases who abuse our nurses verbally or throw them a punch or spit at them,” she said.
“Nurses under such circumstances may feel discouraged and down when they encounter such patients,” she added, noting that it is important during induction and refresher training to educate nurses on psychology and human behaviours.
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, have no next-of-kin support, and often, elderly with dementia, face entrenched social complexities which go beyond medical issues," Ms Chong said.
"We may refer one to a clinical psychologist of the care team of the hospital, and if psychotherapy and medication do not work, our care manager will try to find the source of the patient’s behaviour triggers before they are escalated."
It is not just the patients that nurses have to deal with. Visitors have also responded to restrictions on visitation with threats, Ms Chong said.
She added that sometimes, abuse may also come from next-of-kin.
“They may put forth unreasonable demands, pass sarcastic remarks, issue threats or talk down to nurses,” Ms Chong said.
The Health Minister said in his parliamentary reply that frontline healthcare staff are trained to assess and de-escalate potential conflicts in the first instance and manage abusive situations.
There are also measures in place to support those affected.
"This includes helplines for affected staff, anonymised counselling support services on and off campus by institutions and community providers, and peer support programmes for staff," Mr Gan said.
"Members of the public are reminded through prominently displayed signages 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 the SGH employees have been changed at the request of the hospital to protect their identities as they may need to continue interacting with the patient in future.