Should patients who assault staff be prosecuted?

The impact of workplace violence on job satisfaction, job burnout, and turnover intention: the mediating role of social support

BACKGROUND

Workplace violence (WPV) is a global public health problem and has caused a serious threat to the physical and mental health of healthcare workers. Moreover, WPV also has an adverse effect on the workplace behavior of healthcare workers. This study has three purposes: (1) to identify the prevalence of workplace violence against physicians; (2) to examine the association between exposure to WPV, job satisfaction, job burnout and turnover intention of Chinese physicians and (3) to verify the mediating role of social support.

METHODS

A cross-sectional study adopted a purposive sampling method to collect data from March 2017 through May 2017. A total of nine tertiary hospitals in four provinces, which provide healthcare from specialists in a large hospital after referral from primary and secondary care, were selected as research sites based on their geographical locations in the eastern, central and western regions of China. Descriptive analyses, a univariate analysis, a Pearson correlation, and a mediation regression analysis were used to estimate the prevalence of WPV and impact of WPV on job satisfaction, job burnout, and turnover intention.

RESULTS

WPV was positively correlated with turnover intention (r = 0.238, P < 0.01) and job burnout (r = 0.150, P < 0.01), and was negatively associated with job satisfaction (r = - 0.228, P < 0.01) and social support (r = - 0.077, P < 0.01). Social support was a partial mediator between WPV and job satisfaction, as well as burnout and turnover intention.

CONCLUSIONS

The results show a high prevalence of workplace violence in Chinese tertiary hospitals, which should not be ignored. The effects of social support on workplace behaviors suggest that it has practical implications for interventions to promote the stability of physicians' teams.

TRIAL REGISTRATION

(Project Identification Code: HMUIRB2014005), Registered March 1, 2014.

Prosecution of physical assaults by psychiatric in-patients in Northern Ireland

Aims and Method

Assaults in healthcare settings have resulted in a range of national strategies aimed at reducing the incidence of violence. This study aimed to quantify the use of prosecution of assailants as a response, and to examine what other responses were used. the responses to violent incidents in three Northern Ireland psychiatric in-patient units in the year 2003 were ascertained retrospectively.

Results

Of 245 incidents meeting the legal definition of assault, police were contacted in 10, and 1 resulted in a prosecution. Seven in-patients accounted for 30.4% of assaults. of the assaults, 46.5% were dealt with by staff using de-escalation alone.

Clinical Implications

These results demonstrate the infrequent reporting of such assaults to the police. A more structured approach should be taken to this important decision. Factors relating to the prosecution of assaults in psychiatric in-patient units are discussed.

Inpatient Violence

Inpatient violence constitutes a major concern for staff, patients, and administrators. Violence can cause physical injury and psychological trauma. Although violence presents a challenge to inpatient clinicians, it should not be viewed as inevitable. By looking at history of violence, in addition to clinical and other historical factors, clinicians can identify which patients present the most risk of exhibiting violent behavior and whether the violence would most likely flow from psychosis, impulsivity, or predatory characteristics. With that information, clinicians can provide environmental and treatment modifications to lessen the likelihood of violence.

Coping with Workplace Violence against General Practitioners and Nurses in Heilongjiang Province, China: Social Supports and Prevention Strategies

The study’s objectives were to: 1) use social support theory to examine factors influencing healthcare workers’ opinions about workplace violence (WPV) prevention strategies, and 2) to determine the types of support that general practitioners (GPs) and general nurses sought and expected to use after WPV exposure. A cross-sectional survey was used to assess a sample of 448 GPs and 412 general nurses from 90 township hospitals located in Heilongjiang province, China. Results revealed that workers exposed to physical, psychological or both WPV types had a strong opinion about the necessity of improving diagnosis/treatment competence, developing violence prevention guidelines and plans, using protective equipment, and reinforcing staff by providing back-up support. The last two strategies were also selected by tertiary hospital workers in our previous study. In addition, workers with high anxiety selected the following prevention strategies as most effective: improving doctor-patient communication skills; installing cameras on wards; keeping work areas bright; improvements in violence reporting, statistics, and interventions; security patrols in the key departments; reinforcing staff; and correcting inaccurate media perspectives and reports. The last four strategies were also selected by tertiary hospital workers. All respondents expected to receive organisational and social support. In conclusion, these prevention strategies should be tailored to the different requirements of specific populations. Furthermore, it is necessary for organisations, the public, and policymakers to provide powerful support in WPV prevention.

Coping with Workplace Violence in Healthcare Settings: Social Support and Strategies

A cross-sectional survey of healthcare professionals from 19 hospitals in six cities of Heilongjiang Province, China was conducted. This study had two objectives: (1) to examine the factors influencing healthcare workers' opinions of strategies to prevent workplace violence, using social support theory, and (2) to encourage healthcare organisations and the larger society to offer greater support to healthcare workers. The respondents exposed to workplace violence expected to receive organisational and social support. Those exposed to psychological violence had a strong opinion of the need for target training to strengthen their competence in responding to violence (OR = 1.319, 95% CI: 1.034-1.658) and enacting workplace violence legislation (OR = 1.968, 95% CI: 1.523-2.543).Those exposed to physical violence thought it might be useful to reinforce staff with back-up support (OR = 3.101, 95% CI: 1.085-8.860). Those exposed to both types of violence and those with high anxiety levels need greater support at both the organisational and societal levels.

Conceptualizing structural violence in the context of mental health nursing

This article explores how the intersections of gendered, racialized and neoliberal dynamics reproduce social inequality and shape the violence that nurses face. Grounded in the interviews and focus groups conducted with a purposeful sample of 17 registered nurses (RNs) and registered practical nurses (RPNs) currently working in Ontario's mental health sector, our analysis underscores the need to move beyond reductionist notions of violence as simply individual physical or psychological events. While acknowledging that violence is a very real and disturbing experience for individual nurses, our article casts light on the importance of a broader, power structure analysis of violence experienced by nurses in this sector, arguing that effective redress lies beyond blame shifting between clients/patients and nurses. Our analysis illustrates how assumptions about gender, race and care operate in the context of global, neoliberal forces to reinforce, intensify and create, as well as obscure, structural violence through mechanisms of individualization and normalization.

Violence against care workers in psychiatry: is prosecution justified?

The number of (severe) violent incidents against staff caused by psychiatric inpatients is high. Victims often do not report these incidents to the police, because of various reasons. But if they do report these incidents, the judicial authorities are often reluctant in prosecuting and convicting these patients. The central question in this article is 'in which cases is it appropriate to prosecute assaultive psychiatric patients?' In order to identify the influential factors in the decision in respectively reporting, prosecuting and convicting psychiatric patients who assault staff, a literature review has been performed. On the basis of this literature it is advised to report and investigate a case when the incident resulted in severe injury, the incident is a sexual offence, or when a patient repetitively causes violent incidents. Moreover, it appears that, although large amount of studies has been published on violence in psychiatry, the prosecution of violent psychiatric patients has hardly received any attention in the international literature. Empirical studies on this subject are suggested, in order to develop a uniform policy, which is embraced by all parties involved.

Workplace violence among Iraqi hospital nurses

PURPOSE

To investigate (a) the occurrence and frequency of physical workplace violence among Iraqi hospital nurses as well as the complaints and responses of nurses to such violence; (b) measures and policies in the workplace to deal with violence; and (c) factors that contribute to the workplace violence and the strategies to prevent them from Iraqi nurses' perspective.

DESIGN AND METHODS

A descriptive exploratory survey was used. The structured interview technique was used for collecting data from a purposive sample of 116 Iraqi nurses. An adapted version of the original instrument that was developed by the International Labor Office (ILO), the International Council of Nurses (ICN), the World Health Organization (WHO), and the Public Services International (PSI) on Workplace Violence in the Health Sector was used.

RESULTS

Forty-nine of 116 participants reported that they have been physically attacked at work. Few employers had specific policies on workplace violence.

CONCLUSIONS

The results of the study indicated the importance of adopting hospital policies for dealing with incidents of violence and legislation to subject aggressors to judicial punishment.

Forensic psychiatric aspects of inpatient violence

Inpatient aggression jeopardizes the safety of psychiatric clinicians and patients. A minority of psychiatric inpatients is responsible for most of inpatient assaults; this subset of repetitively assaultive patients warrants greater attention in the form of systematic study. In developing treatment approaches for assaultive inpatients, it is important to characterize the primary motivation driving aggressive behavior. There are many pharmacologic agents and psychotherapeutic approaches available to address inpatients who engage in impulsive and psychotic violence, but the treatment of inpatients with antisocial or psychopathy personality remain limited, and further study is needed. To protect the safety of patients and staff, criminal prosecution of inpatient assaults is clinically justified if an assailant continues to be aggressive despite appropriate clinical interventions or commits an act of planned aggression so egregious that prosecution is the only reasonable alternative.

The nurse's role in the management of aggression

Although research into the phenomenon of aggression within psychiatric inpatient settings has established a strong casual link with mental illness, there is widespread agreement that diagnostic or demographic characteristics cannot accurately predict such behaviours. In addition, studies have consistently failed to establish how nursing management responses influence the course of aggression within these environments. Therefore, an assumption can be made that specific contextual factors are significant, and that management responses have an effect on outcomes. This review examines the nurses' impact on inpatient aggression and how management strategies affect the therapeutic value of intervention.