Challenge of managing patients with COVID-19 and acute behavioural disturbances

Perceptions, challenges and experiences of frontline healthcare providers in Emergency Departments regarding Workplace Violence during the COVID-19 pandemic: A protocol for an exploratory qualitative study from an LMIC

INTRODUCTION

Workplace violence (WPV) against Healthcare Workers (HCWs) has emerged as a global issue. Emergency Department (ED) HCWs as front liners are more vulnerable to it due to the nature of their work and exposure to unique medical and social situations. COVID-19 pandemic has led to a surge in the number of cases of WPV against HCWs, especially against ED HCWs. In most cases, the perpetrators of these acts of violence are the patients and their attendants as families. The causes of this rise are multifactorial; these include the inaccurate spread of information and rumours through social media, certain religious perspectives, propaganda and increasing anger and frustration among the general public,ED overcrowding, staff shortages etc. We aim to conduct a qualitative exploratory study among the ED frontline care providers at the two major EDs of Karachi city. The purpose of this study is to determine the perceptions, challenges and experiences regarding WPV faced by ED healthcare providers during the COVID-19 pandemic.

METHODS AND ANALYSIS

For this research study, a qualitative exploratory research design will be employed using in-depth interviews and a purposive sampling approach. Data will be collected using in-depth interviews from study participants working at the EDs of Jinnah Postgraduate Medical Centre (JPMC) and the Aga Khan University Hospital(AKUH) Karachi, Pakistan. Thestudy data will be analysed thematically using NVivo V.12 Plus software.

ETHICS AND DISSEMINATION

The ethical approval for this study was obtained from the Aga Khan University Ethical Review Committee and from Jinnah postgraduate Medical Center (JPMC). The results of the study will be disseminated to the scientific community and to the research subjects participating in the study.The findings of this study will help to explore the perceptions of ED healthcare providers regarding WPV during the COVID-19 pandemic and provide a better understanding of study participant's' challenges concerning WPV during the COVID-19 pandemic.

Management of Agitation During the COVID-19 Pandemic

The coronavirus disease 2019 (COVID-19) pandemic caused by the coronavirus SARS-CoV-2 has radically altered delivery of care in emergency settings. Unprecedented hardship due to ongoing fears of exposure and threats to personal safety, along with societal measures enacted to curb disease transmission, have had broad psychosocial impact on patients and healthcare workers alike. These changes can significantly affect diagnosing and managing behavioral emergencies such as agitation in the emergency department. On behalf of the American Association for Emergency Psychiatry, we highlight unique considerations for patients with severe behavioral symptoms and staff members managing symptoms of agitation during COVID-19. Early detection and treatment of agitation, precautions to minimize staff hazards, coordination with security personnel and psychiatric services, and avoidance of coercive strategies that cause respiratory depression will help mitigate heightened risks to safety caused by this outbreak.