Covid-19 and laws for workplace violence in healthcare

Using a Mediator's Toolbox: Reducing Clinical Conflict by Learning to Reconceive the "Difficult" Patient or Family

Introduction

Given the prevalence of conflict between physicians and patients and families, it is crucial that trainees build the skills to manage clinical conflict. Mediators employ an approach that can be applied to clinical encounters to prevent conflicts from escalating. This workshop introduced trainees to techniques commonly used by mediators to manage disputes.

Methods

Medical students in a virtual workshop (cohort A) and clinical fellows in an in-person workshop (cohort B) were presented with a mediator's approach to interpreting patient and family behavior viewed as challenging. Trainees were introduced to two specific techniques designed to facilitate the resolution of clinical conflict. After an interactive large-group discussion of each method, small groups practiced applying the technique to a sample clinical case. Finally, participants completed an assessment of their perception of the workshop's effectiveness.

Results

In early 2022, 15 medical students (cohort A) participated in a virtual workshop and 10 clinical fellows (cohort B) participated in an in-person workshop on clinical conflict management. Eight medical students from cohort A completed the postworkshop assessment (response rate: 53%); six clinical fellows from cohort B completed the assessment (response rate: 60%). Cohort A gave the workshop an overall evaluation of 4.6 out of 5.0; cohort B gave the workshop an overall score of 4.7 out of 5.0.

Discussion

In both the virtual platform and the traditional in-person format, this workshop introduces a set of tools for navigating bedside conflicts with patients and their families that participants believed would better prepare them for such challenging interactions.

Collective Violence against Health Workers in the Context of the COVID-19 Pandemic

Concerns about violence against nurses and other medical personnel have increased during the COVID-19 pandemic. However, as of yet, limited systematic knowledge of such violence is available. Addressing this gap, we analyse the geographical distribution of, motivations behind, and contexts of collective attacks against health workers in the context of the COVID-19 pandemic. To do so, we systematically recorded and coded attack events worldwide from 1 March 2020 to 31 December 2021. We identify high-risk countries, attack characteristics, and the socio-economic contexts in which attacks tend to occur. Our results show that opposition against public health measures (28.5%), fears of infection (22.3%), and supposed lack of care (20.6%) were the most common reasons for attacks. Most attacks occurred in facilities (often related to a supposed lack of care) or while health workers were on duty in a public place (often due to opposition to public health measures). However, 17.9% of all attacks took place in off-duty settings. Democratic countries with high vaccination rates and strong health systems were relatively safe for nurses and doctors. Distrust in the skills of health workers and the science underlying health interventions is a major driver of collective attack risks and should be addressed before it turns violent. This study was not registered.

Association between high burn-out and workplace violence among healthcare workers in China: a WeChat-based survey

OBJECTIVES

This study is conducted to examine whether overall workplace violence (WPV) and its five types are associated with high burn-out among healthcare workers in China.

DESIGN

A WeChat-based cross-sectional survey. Snowball sampling was used in this study.

PARTICIPANTS

Front-line healthcare workers (N=3706) from 149 cities across 23 provinces in China responded to the survey, and 22 questionnaires were excluded because of incomplete data.

PRIMARY AND SECONDARY OUTCOME MEASURES

(1) The Chinese Maslach Burnout Inventory-General Survey was used to measure high burn-out. (2) WPV was assessed using the Chinese version of the Workplace Violence Scale. (3) An anonymous self-designed web-based questionnaire consisting of demographic, behavioural and occupational information was used to identify covariates.

RESULTS

A total of 3684 front-line healthcare workers (934 physicians and 2750 nurses) were included. Of all participants, 13.3% (491/3193) experienced high burn-out. Adjusted logistic regression revealed that experience of WPV in the past year was associated with high burn-out (OR 2.10, 95% CI 1.69 to 2.62). Healthcare workers who had suffered emotional abuse, threat or verbal sexual harassment were more vulnerable to high burn-out.

CONCLUSION

This study finds that healthcare workers with WPV, especially emotional abuse, threat and verbal sexual harassment, are more likely to experience burn-out. These types of WPV should be considered in interventions to reduce and prevent burn-out for healthcare workers.

Workplace violence against Chinese health professionals 2013-2021: A study of national criminal judgment documents

Objectives

Patient-initiated hospital violence is a global problem which threatens the safety of health professionals and is indicative of doctor-patient tensions, impeding health system quality and access. The current study aimed to improve the understanding of medical workplace violence (WPV) in China, using authoritative and nationally representative judgment records, and to approach violence prevention strategies.

Methods

All litigation records relating to violence against health professionals between 2013 and 2021 were extracted from the China Judgment Online System. Basic case information, victim characteristics, perpetrator characteristics and the nature of the violence were collated. The relationship between different treatment outcomes and violence was also explored.

Results

Numbers of cases of hospital violence gradually increased from 2013 to a peak in 2016 before gradually decreasing in the following years. The most common perpetrators were patients' relatives (58.2%), followed by patients themselves (38.2%). Only 9 perpetrators had a confirmed history of mental illness and only two were intoxicated with alcohol. More than half of the cases (52.5%) occurred in rural areas and this percentage is even greater for primary health care institutions (71.4%) and secondary hospitals (73.5%). On a departmental level, the highest incidence of medical WPV was found in the emergency (18.9%), pediatrics (13.2%) and obstetrics (11.5%) departments. Violent behaviors, such as stalking, mass occupation of the ward and sharp instrument injury were significantly related to cases not involving patient death (p < 0.05). Disruptive behavior, such as hanging banners, blocking hospital passages, placing flower wreaths and burning paper money were significantly correlated with cases involving patient death (p < 0.01). The interval between a patient's death and the ensuing violence was short, happening on the same day in 54.8% of cases.

Conclusions

A comprehensive overview of medical WPV in China is presented and may have utility for the formulation of prevention strategies.