Patient kicked me in the face

The nurse tried to convince a patient with failing kidneys to go for urgent dialysis, but he refused.

Instead, the patient, who was on a hospital bed, struggled and wanted to go home.

When the nurse, Sally (not her real name), 24, tried to restrain him, he kicked her in the face.

Recounting the incident, which occurred last year, she said: "My jaw hurt for the next three days. But I didn't report the incident as it's so common nowadays.

"Physical abuse cases (against hospital staff) can happen once every two months; verbal (abuse) cases once a month. Most are unreported."

Another hospital nurse, 21, told The New Paper she had been slapped by a patient with dementia last year.

"I was going to change her diapers, but out of the blue, her hand reached out and hit my face," she said.

"I was taken aback. But I figured she thought I was going to harm her."

These nurses' experiences are not isolated cases. Hospitals report seeing more cases of physical and verbal abuse committed against health-care workers.

Even the Khoo Teck Puat Hospital (KTPH), which has been open for just over a year, has not been spared.

One of its female doctors was nearly strangled by a male patient suffering from paranoia, said KTPH.

On another occasion, a nurse was slammed against a wall by a patient, had her head banged against the wall and her hair pulled.

Another bad-tempered patient slapped an assistant nurse, and threw a cup at two other staff members.

The Singapore General Hospital (SGH) saw 47 cases of abuse last year, up from 18 in 2008. Its employees, who included nurses, patient care assistants and counter staff, were hit by patients and had to cope with objects thrown at them as well as threatening gestures.

At the National University Hospital (NUH), frontline staff have been seeing more cases of verbal abuse. Its spokesman said some patients and relatives now tend to have higher, sometimes unrealistic, expectations.

The spokesman said: "Despite their best efforts, our staff are increasingly faced with the threat of media attention or complaints to higher authorities when they cannot meet such unrealistic expectations."

For example, some family members insist on being given updates on a patient's condition hourly or on demand, though the condition has been very stable.

Others may refuse to accept explanations from the hospital despite many rounds of engagement.

"Part and parcel of their work"

NUH's number of physical abuse cases has remained stable at about 35 cases a year.

Changi General Hospital (CGH) said it has seen a steady number of physical and verbal abuse cases - about 17 a year, in recent years.

A CGH spokesman said: "These incidents... while unpleasant are viewed by our staff as part and parcel of their work."

Meanwhile, Tan Tock Seng Hospital does not have a formal system in place to track such incidents.

Its spokesman said when they do surface, the hospital will deal with the matter accordingly and amicably.

Ms Penny Seet, president of the Singapore Nurses Association (SNA) and a nurse of 30 years, said staff in the accident and emergency departments face confrontations almost daily.

"Shouting, finger-pointing and shoving generally result from the intolerant or impatient patients and their significant others, but explanations generally calm them down.

"On weekend nights, we sometimes get the drunks and the disorderly, but a hot drink and a place to sleep usually does the trick."

But the recalcitrant ones may need police intervention, she said.

Nurses in community nursing homes have also reported that patients often pinch them or spit at them. But they dare not retaliate for fear of being accused of abuse instead.

Ms Isabel Yong, director of service quality at SGH, said the abuse cases are usually caused by patients who:

• Insist on getting more benefits than they are entitled;
• Suffer from some form of mental disorder (including anger management issues); or
• Have a low threshold for pain.

Ms Yong added that SGH has been running a training programme since 2009 which uses role-playing to teach its frontline staff how to handle abusive situations.

SGH, KTPH and NUH said they understand that patients may sometimes feel helpless when unwell and family members may feel anxious for their loved ones.

But the three hospitals stressed that their health-care workers deserve a safe working environment and should be treated with respect and understanding.

Appeal for calm

Ms Chua Gek Choo, deputy director of nursing at KTPH, said: "It saddens us when patients vent their frustrations on our staff.

"We hope that patients and their families can share their concerns with us in a calm manner."

As for health-care workers who suffer from emotional distress, CGH has a peer support programme, run by a professional staff counsellor, to provide emotional support and practical help.

Ms Seet said the SNA can also provide a listening ear to nurses. It has 19 chapters that hold service programmes where nurses can discuss how to manage abusive patients.

So far, abuse cases have not been officially reported to the SNA, said Ms Seet.

SGH, CGH and NUH said abuse cases can sometimes be referred to the police.

An NUH spokesman said that in 2008, one of the hospital's female frontline staff was slapped by a patient's mother suddenly and for no obvious reason. The incident was witnessed by her colleagues and patients and the patient's mother was convicted in court, the spokesman said.

Verbal abuse

Dr Genaro Castro-Vázquez from the Nanyang Technological University told TNP that the issue of verbal abuse is subjective, and might be because medical staff are not used to patients who challenge their decisions.

But the assistant professor, who teaches a course in medical sociology, acknowledged that patients now have higher expectations of health-care staff.

This could be because patients tend to see themselves as clients and medical staff as health-care providers, he said.

"In a consumerist world, patients expect more since they are paying for it. They feel they deserve something, and when they don't get it, they may get violent.

"But even if patients feel entitled to something, it doesn't give them the right to be violent."

Still, most nurses do not let abuse affect them.

"I just take the abuse in my stride. I became a nurse to help people, and sometimes it is the people who are abusive who need the most help from us," said Sally, illustrating that nurses are patient people.

This article was first published in The New Paper.