جنسیت، آزار جنسی، خشونت محل کار و ارزیابی ریسک :: ادراکات کارکنان روانپزشکی همگرایی اطراف امنیت شخصی

Abstract This paper reviews literature in sexual harassment, workplace violence, and risk assessment as it relates to staff in psychiatric and forensic work environments. These three areas of research overlap in their applicability to psychiatric staff in that each addresses the understanding and management of types of violence to which many staff, particularly women, are likely to be exposed while working. Employee well-being, encompassing mental and physical health, job satisfaction, and morale, has been shown to be closely tied to organizational productivity and cost. In addition, gender has been shown to be an important factor in perceptions and decision-making, and prior work has suggested that female staff often have qualitatively different experiences in traditional male workplaces such as inpatient and forensic settings. Despite these findings, research to date on psychiatric staff has typically focused only on number of assaults by patients. It has not addressed how staff's gender may impact their perceptions of personal safety and judgments of risk from patients, nor have any empirical studies been performed in naturalistic settings to investigate this issue. Given the high correlation between organizational productivity and employee well-being, it is mutually beneficial to both employers and staff to examine current understanding of how certain staff variables such as gender may influence their feelings of safety and judgments of risk from patients.

Introduction Workplace violence, sexual harassment, and risk assessment are currently three large and active areas of research in the law and psychology fields. Each of these areas addresses the understanding and management of violence in a particular context. Workplace violence typically encompasses attacks or attempted attacks that are precipitated by an employment organization's actions (as opposed to simply being directed at the organization) and that involve current or past employees (Neuman & Baron, 1998). Sexual harassment, defined in 1980 by the U.S. Equal Employment Opportunity Commission (EEOC) as either quid pro quo harassment (eliciting sexual cooperation using threats of job consequences) or as a hostile environment (sexually related physical or verbal actions that are offensive and unsolicited), is typically conceptualized as a type of sexual violence consisting of unwanted sexualized actions of employees toward their peers or subordinates. Risk assessment refers to attempts by clinicians to predict future violence, recidivism, treatment amenability, and appropriate disposition in the context of civil commitment or criminal offenders. These three areas of research overlap in their applicability to staff in forensic settings, yet little empirical work has recognized this connection. Consequently, employers and employees alike are potentially missing out on valuable information generated by researchers and policy-makers as to enhanced perceptions of safety, job satisfaction, and worker health. A large number of staff work in forensic mental health settings and they face an inherent risk of personal safety from patients and offenders on a daily basis. Arguably, their positions place them at risk for violence from patients and require them to engage in ongoing risk assessments on a daily basis. Female staff in particular are at added risk for sexual harassment from both patients and peers. Because of the risk of either intentional assault/threat on staff or unintentional injury due to a patient or offender's violent outburst, forensic settings should be considered in studies of workplace violence. Because of the disproportionately high concentration of antisocial, sex offending, and psychopathic individuals in such environments, unwelcome sexualized attention is a frequent possibility and may elicit the same negative psychological and physical reactions in staff that the sexual harassment literature has identified in other work settings. Finally, because the risk for patient or offender violence is present daily, staff must engage in constant appraisals of their own safety — a type of risk assessment that differs from traditional definitions — but a risk assessment nonetheless. However, staff perceptions of risk to themselves from patients and offenders has yet to be considered in the workplace violence, sexual harassment, or risk assessment literature. In particular, the question of whether staff gender influences their perceptions of personal risk is worth considering, given the obvious physical size differential often present between men and women and the increased likelihood of women encountering sexualized communications and/or negative reactions in male-dominated settings. This article reviews some key areas of research regarding staff safety, workplace violence, sexual harassment, and risk assessment as they apply to psychiatric and forensic settings, as well as the work done to date on how clinician gender impacts their decision-making. The aim of the paper is to call attention to the similarities between psychiatric and forensic staff's experiences and the issues addressed in studies of workplace violence, risk assessment, and sexual harassment in hopes of encouraging future research to elucidate workers' perceptions regarding their own safety and whether it is influenced by gender. Added clarity on this issue could invoke empirically driven policy improvements that would benefit employers and their staff.

. Conclusions This paper has reviewed extant literature in several areas as it relates to the issue of gender and its impact on perceptions of personal safety in forensic and psychiatric settings. Somewhat disparate literatures were presented for various reasons. Research on assault frequency showed that although female staff are at lower risk compared to male staff in psychiatric facilities, issues such as pregnancy often heighten subjective concerns of assault or threat. Challenges to females' credibility and professional competence as noted in the sexual harassment literature likely highlights the perceived risks for women in male-dominated workplaces. Studies on sexual harassment also emphasized the importance of understanding the victim's perceptions of situations in addition to documenting incidence rates, a notion that is equally relevant to patient dangerousness toward staff. The workplace violence research indicated that worker safety is a major issue that has received attention from the federal government as well as from the research community. Injuries and other such disruptions sustained by employees can have a significant impact on their physical and psychological well-being, which in turn impacts worker productivity. It is therefore to the mutual benefit of employers and staff to examine level of patient dangerousness to staff. Studies on clinical judgment and decision-making were reviewed to demonstrate methodological problems with past investigation of gender effects. These studies have been criticized for being rife with inconsistency Abramowitz & Dokecki, 1977 and Wright et al., 1980 primarily due to over-reliance on analog stimuli. Collectively, this body of work suggests that gender effects in decision-making are relatively small, and that future efforts to investigate them must employ naturalistic settings rather than vignettes or other analog methods. Finally, the risk assessment literature illustrated how studies to date have exclusively examined patients' risk to others and have not considered the type of informal and automatic appraisals of personal safety that psychiatric and forensic staff must engage in on a daily basis. The literature to date has examined the issue of how gender of the clinician impacts his or her work as a mental health care provider from several directions, but the work is far from complete. Future directions for research should include naturalistic field study of whether male and female health care workers use and weight risk cues differently when assessing whether they feel threatened by a patient. Other questions that could be addressed are whether level of exposure to patients is related to use and weighting of certain risk cues (i.e., do technicians and nurses, who have the most exposure to patients, attend to different aspects of a patient than clinicians, who have less exposure), and whether past assault or threat victimization is associated with using a different set of risk cues compared to a history of no assaults or threats. Finally, an important question that has been neglected thus far is what aspect of gender drives differences in perceptions and decision-making. Specifically, it is unknown whether such differences between men and women are attributable to biology, or to attitudes toward men and women that are shaped by our society. It is also unknown whether one's sex role identity — the extent to which one identifies with “masculine,” “feminine,” or “androgynous” characteristics and behaviors as described by Bem (1974) — affects our judgments about personal safety. The contextual factors involved in staff perceptions of risk from patients are similar to those identified for victims of sexual harassment and/or workplace violence: personal safety, job satisfaction, psychological and physical health, worker productivity, and quality of relationships with peers in the workplace. As studies have shown, these issues are inextricably tied to the employment organization's financial costs and functioning and therefore provide compelling justification for future research pursuits in this area.