Do We Normalize Violence?

In the following post, SafeCare BC explores the prevalence of violence in continuing care as well as the ways, “we normalize it.”

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You wouldn’t accept it in an office, you wouldn’t accept it on a construction site, so why is it that when it comes to violence in continuing care, “we normalize it”[1]?

A recent report titled, Injury Trends Profile By Organization Size, published by SafeCare BC found “Acts of Violence and Force” to be a major contributor to accidents and injuries in the continuing care workplace. On average, “Acts of Violence and Force” accounted for 11.1% of accidents in the workplace, making it the second-most common cause of staff injuries.

Click Here for report: Injury Trends Profile By Organization Size
Click image for report: Injury Trends Profile By Organization Size

So when we talk about “Acts of Violence” what are we referring to? Being pinched, poked, pushed, and punched as well as being hit, scratched, and bitten are all common forms of physical violence. Other examples also include having one’s hair pulled or wrist twisted.


It is important to note that most incidents of violence in continuing care settings do not stem from malicious intent. Instead, they are often responsive and the result of an unmet need or a protective behaviour on the part of the person receiving care. Oftentimes, the person in care’s ability to communicate their needs or how they perceive their environment is drastically altered due to cognitive impairment. As a result, responsive behaviours due to pain, hunger, constipation, or fear can result in care staff being struck, grabbed, or hit. When it comes to these types of incidents, resident-to-staff violence is the most prevalent during direct care activities including bathing, dressing, feeding, and toileting, all routine parts of a care aide’s work day.[2]

A Daily Occurrence

In a study comparing the prevalence of violence in the Canadian and Scandinavian continuing care sectors, front-line care workers were asked how often they were subjected to violence in the workplace from either a resident or a family member. Of those surveyed, 43% of Canadian care workers indicated they were subject to violence on a daily basis and 23% indicated they experience violence weekly.[1] A participant in a focus group described encountering resident-to-staff violence daily:

focus group quote“I’ve been punched in the face several times. I’ve been punched in the jaw several times. Getting hit. Having your wrists twisted…Pulling and shoving at you. I mean that’s a day to day thing…violence is an everyday occurrence.”[1]

Of those surveyed in the study, one-third also reported they had been criticized or had been “told off” by a resident or relative. Continuing care staff participating in the study further indicated experiencing “unwanted sexual attention” particularly during bathing; However, there are often tendencies to rationalized or downplay these types of incidents, attributing them to catching a resident on a “bad day” as described by a focus group participant.[1]

“I wouldn’t classify it as violence. Basically like groping or if you happen to get them on a bad day when maybe their pain control isn’t met through medication, they strike out at you.” [1]

It’s Just Part of the Job…

paperworkPerhaps of greater concern is the chronic under-reporting of violence amongst continuing care staff. It is speculated that a vast majority of violent resident-to-staff encounters go unreported. The report cites “excessive paperwork” as a common deterrent to the reporting process.[1] Furthermore, the author explains how continuing care workers often face scrutiny and blame when an incident is reported. “If you get hit it’s, ‘What did you do?’ It’s always your fault,” said one focus group participant.[1]

These factors are symptomatic of the normalization of resident-to-staff violence in the workplace. “We normalize it. I think that’s what happens,” said one care worker participating in a focus group. “We’ve been told it’s part of our job,”[1]

How Does This Affect Quality of Care?

The study highlights systematic and structural issues that increase the likelihood of resident-to-staff violence. These issues result in higher distress among continuing care staff and diminished care for residents. The study shows that continuing care workers in Canada believed they were unable to provide the quality of care they were capable of due to the prevalence of violence in the workplace.[1]

Innovative Approaches

Akasha Ma'at, RN was instrumental in the development & teaching of the "Purple Wave" program
Akasha Ma’at, RN was instrumental in the development & teaching of the “Purple Wave” program

So where do we go from here? A number of SafeCare BC members are taking proactive approaches to curb violence in the workplace, from participating in our Violence Prevention Workshop and exploring our Tools and Resource section to developing their own innovative programs. Recently we brought you the story of Broadway Pentecostal Lodge, a 114 bed complex care home in the Vancouver False Creek area that was faced with an increase in challenging behaviour among residents with dementia. Management and staff decided to implement their innovative Purple Wave initiative to curb the rising stress amongst staff and allow for “…more harmonious relationships with elders and a safer environment for both elders and staff,” as Akasha Ma’at, a key developer of the program, describes it.

Other examples of innovative approaches to reduce resident-to-staff violence include Delta View Habilitation Centre’s Hugs Not Drugs philosophy. The program, which was developed by Jane Devji at her family owned and operated care home in the Fraser Valley, favours freedom of movement and understanding of the resident in order to reduce the frequency of violence and challenging behaviour.

The numbers show that resident-to-staff violence is a pressing issue in our sector. Furthermore, the number of Canadians living with cognitive impairment due to Alzheimer’s disease and other dementias is forecasted to increase from 747,000 to 1.4 million by 2031, according to statistics from the Alzheimer Society of Canada.[3] With the growing prevalence of dementia among an ageing population it is important for us to ensure our continuing care staff are well educated on how to provide care to those exhibiting challenging behaviour. Through effective training along with innovative approaches such as the Purple Wave and Hugs not Drugs, we as a sector can reduce the number of violent interactions and empower our continuing care staff to deliver care at their full potential.

Learn How to Make Your Workplace Safer

SafeCare BC is pleased to offer the Provincial Violence Prevention Core Classroom Course. This 8 hour classroom session is led by an expert health care facilitator. The session builds on concepts in the e-learning modules, providing you with the opportunity to practice and apply your knowledge in various scenarios…Click here for upcoming dates.

SafeCare BC members also have access to a wide array of useful and practical online tools and resources for safe workplaces. From hand books to e-modules, click here for resources on preventing violence in the workplace.

[1] Banerjee, Albert, Tamara Daly, Pat Armstrong, Marta Szebehely, Hugh Armstrong, and Stirling Lafrance. “Structural Violence in Long-term, Residential Care for Older People: Comparing Canada and Scandinavia.” Elsevier 74, no. December (2012): 390-98.

[2]Robinson, K., & Tappen, R. (2008). Policy recommendations on the prevention of violence in long-term care facilities. Journal of Gerontological Nursing, 34(3), 10e14.

[3] “What Is Dementia?” Dementia – Signs, Symptoms, Causes, Tests, Treatment, Care. Web. 20 Mar. 2015. <>.

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