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Bellman V, Thai D, Chinthalapally A, Russell N, Saleem S. Inpatient violence in a psychiatric hospital in the middle of the pandemic: clinical and community health aspects. AIMS Public Health 2022; 9:342-356. [PMID: 35634028 PMCID: PMC9114790 DOI: 10.3934/publichealth.2022024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/06/2022] [Accepted: 02/13/2022] [Indexed: 11/18/2022] Open
Abstract
Healthcare workers are at a high risk of violence all over the world. The hostility toward nurses, physicians, and hospital staff has reached the point that it can be considered a public health problem. In this paper, we focus on the harassment, aggression, and violence that many healthcare workers have encountered while treating unstable psychiatric patients in the middle of the COVID-19 pandemic. We present a case with a history of violence toward mental health workers, review psychopathological and clinical aspects, and discuss how both the COVID-19 pandemic and current challenges in psychiatric hospital settings increase the frequency and severity of these attacks and how this affects the team on inpatient psychiatric units. We used the CARE guidelines to provide the most accurate and transparent information about the patient and relevant psychosocial aspects. We also pooled more than 20 unique sources to cover all aspects of violent behaviors in all psychiatric settings for all age groups. We concluded that a lack of nursing staff, the mental burden imposed by difficult patients, and poor communication between team members are some of the factors contributing to patient violence. An incomplete understanding of the problem creates barriers to change on both personal and systematic levels. Constant violence and abuse against healthcare workers cause stress, decreased productivity, and work dissatisfaction. To improve the safety of healthcare professionals, especially in inpatient psychiatric settings, several system-based changes should be implemented.
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Affiliation(s)
- Val Bellman
- UMKC, Department of Psychiatry, Kansas City, MO
| | - David Thai
- Kansas City University of Medicine and Biosciences, Kansas City, MO, USA
| | | | | | - Shazia Saleem
- UMKC, Department of Psychiatry, Kansas City, MO
- University Health - Truman Medical Center, Kansas City, MO, USA
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Mohamad O, AlKhoury N, Abdul-Baki MN, Alsalkini M, Shaaban R. Workplace violence toward resident doctors in public hospitals of Syria: prevalence, psychological impact, and prevention strategies: a cross-sectional study. HUMAN RESOURCES FOR HEALTH 2021; 19:8. [PMID: 33413470 PMCID: PMC7791675 DOI: 10.1186/s12960-020-00548-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 12/15/2020] [Indexed: 05/03/2023]
Abstract
INTRODUCTION Workplace violence (WPV) against healthcare workers is a common and daily problem in hospitals worldwide. Studies in different countries indicated that exposure to WPV potentially impacts the psychological status of healthcare workers. However, there is a paucity of studies approaching this issue in the Syrian healthcare system. OBJECTIVES This study had three objectives: (1) to estimate the prevalence of violence against resident doctors in Syria, (2) to examine the association between WPV and resident doctors' psychological stress, sleep quality, depression, and general health and (3) to suggest approaches to tackle this problem from the resident doctors' perspectives. METHODS A cross-sectional study was conducted in 8 out of 14 provinces, and covered 17 out of 56 accessible functioning hospitals in Syria. Data were collected using anonymous, self-administered questionnaires during February 2020. A total of 1226 resident doctors volunteered to participate in the study. Finally, 1127 valid questionnaires were used in the final data analysis. The overall response rate was 91.92%. RESULTS A total of 955 participants (84.74%) reported exposure to WPV in the 12 months prior to the study. In specific, 84.74% exposed to verbal violence and 19.08% to physical violence. Patients' associates were the predominant aggressors in both verbal and physical violence (n = 856; 89.63%, n = 178; 82.79%, respectively). Most resident doctors (87.31%) suggested enacting more legislation to protect doctors as the best solution to reduce WPV. Verbal and physical violence showed a significant positive correlation with each item of depression and stress, and a significant negative correlation with both subjective sleep quality and subjective health. CONCLUSION Workplace violence against resident doctors in Syria is highly common. Therefore, policymakers, hospital managers, and supervisors should work collaboratively in order to minimize WPV and ensure resident doctors' safety and psychophysical stability.
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Affiliation(s)
- Okbah Mohamad
- Faculty of Medicine, Tishreen University, Latakia, Syria
| | | | | | | | - Rafea Shaaban
- Faculty of Medicine, Al-Andalus University for Medical Sciences, Tartus, Syria
- Faculty of Medicine, Tartus University, Tartus, Syria
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Workplace violence: Examination of the tensions between duty of care, worker safety, and zero tolerance. Health Care Manage Rev 2020; 45:E13-E22. [PMID: 32358237 DOI: 10.1097/hmr.0000000000000286] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Workplace violence (WPV) remains an international problem. This raises challenges for staff in meeting their duty of care to consumers while enforcing zero tolerance for violence directed toward them. PURPOSE The aim of the study was to expose the values and beliefs underpinning practice and reveal any flawed assumptions or evidence, upon which decisions related to WPV are made. By increasing staff awareness, the secondary aim is to decrease staff stress when confronted with conflicting policies and duty of care responsibilities. METHODOLOGY Explanatory research as part of a larger descriptive study was used. Semistructured interviews with a sample of managers and staff (n = 99) in Victorian Health Services (Australia) were performed. Initial descriptive analysis identified a tension between duty of care, worker safety, and zero tolerance. This article reports the secondary analysis to examine these relationships in depth. FINDINGS Feeling obligated and providing care for aggressive patients was difficult while maintaining own safety: "You cannot do both." Although there were contrasting views about the merits of zero tolerance, policies were rarely enacted: "We cannot refuse to treat." Incongruency between legislative requirements creates confusion for decision-making: "Which Act trumps what?" CONCLUSION Despite policies supporting zero tolerance, staff do not enact these because they prioritize duty of care to consumers before duty of care to self. Zero tolerance, with incongruent legislation, compounds this tension and impairs decision-making. PRACTICAL IMPLICATIONS This article exposes the underlying values, beliefs, and flawed assumptions underpinning practice related to WPV. Managers need to amend policies to reduce staff confusion, adopt a trauma-sensitive and resilience approach, and develop a clearly written framework to guide decision-making related to duty of care to consumers and staff safety. Incident reports and staff well-being/satisfaction surveys need to evaluate the effects of zero tolerance on staff and consumers. Regulators need to ensue legislative requirements are congruent with staff safety and well-being.
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Amini R, Mohammadi N, Karaji F, Tapak L. Frequency of the Type of Workplace Violence Against Hamadan Medical Emergency Technicians and Its Relationship with Individual and Occupational Variables, 2018. ACTA ACUST UNITED AC 2020. [DOI: 10.30699/ajnmc.27.6.381] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Workplace violence by specialty among Peruvian medical residents. PLoS One 2018; 13:e0207769. [PMID: 30496220 PMCID: PMC6264828 DOI: 10.1371/journal.pone.0207769] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 11/06/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To determine the prevalence of workplace violence among Peruvian medical residents and to evaluate the association between medical specialty and workplace violence per type of aggressor. METHODS This was a cross-sectional secondary analysis that used data from the Peruvian Medical Residents National Survey 2016 (ENMERE-2016). The outcome of interest was workplace violence, including physical and verbal violence, which were categorized according to the perpetrator of violence (patients/relatives and worker-to-worker). Primary exposure was the medical specialty, categorized as clinical, surgical, and other specialties. To evaluate the associations of interest, we estimated adjusted prevalence ratios (PR) with their respective 95% confidence intervals (95% CI) using Poisson regression models with robust variances. RESULTS A total of 1054 Peruvian medical residents were evaluated. The mean age was 32.6 years and 42.3% were female. Overall 73.4% reported having suffered of workplace violence sometime during the residency, 34.4% reported violence from patients/relatives, and 61.1% reported worker-to-worker violence. Compared with clinical residents, surgical residents had a lower prevalence of violence from patients/relatives (PR: 0.71; 95% CI: 0.59-0.87), but a higher prevalence of worker-to-worker violence (PR: 1.11, 95% CI: 1.01-1.23). CONCLUSION Nearly three quarters of medical residents reported having suffered workplace violence sometime during their residency. Compared with clinical residents, surgical residents had lower rates of violence from patients/relatives, but higher rates of worker-to-worker violence; while residents from non-clinical and non-surgical specialties had a lower prevalence of both types of violence.
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Fallahi-Khoshknab M, Oskouie F, Najafi F, Ghazanfari N, Tamizi Z, Afshani S. Physical violence against health care workers: A nationwide study from Iran. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2016; 21:232-8. [PMID: 27186199 PMCID: PMC4857656 DOI: 10.4103/1735-9066.180387] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Background: Workplace violence is a serious and problematic phenomenon in health care settings. Research shows that health care workers are at the highest risk of such violence. The aim of this study was to address the frequency of physical violence against Iranian health personnel, their response to such violence, as well as the contributing factors to physical violence. Materials and Methods: A cross-sectional study was conducted in 2011, in which 6500 out of 57,000 health personnel working in some teaching hospitals were selected using multi-stage random sampling. Data were collected using the questionnaire of “Workplace Violence in the Health Sector” developed by the International Labor Organization, the International Council of Nurses, the World Health Organization, and the Public Services International. Results: The findings revealed that 23.5% of the participants were exposed to physical violence in the 12 months prior to the study. Nurses were the main victims of physical violence (78%) and patients' families were the main perpetrators of violence (56%). The most common reaction of victims to physical violence was asking the aggressor to stop violence (45%). Lack of people's knowledge of employees' tasks was the most common contributing factor to physical violence (49.2%). Conclusions: Based on the results, legislating appropriate laws in order to prevent and control violence in the workplace is necessary. Moreover, developing educational programs to manage the incidence of physical violence should be on health centers' agenda.
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Affiliation(s)
| | - Fatemeh Oskouie
- Department of Nursing, Center for Nursing Care Research, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Fereshteh Najafi
- Department of Nursing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | | | - Zahra Tamizi
- Department of Nursing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Shahla Afshani
- Deputy of Nursing, Ministry of Health and Medical Education, Tehran, Iran
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Sato K, Yumoto Y, Fukahori H. How nurse managers in Japanese hospital wards manage patient violence toward their staff. J Nurs Manag 2014; 24:164-73. [PMID: 25545669 DOI: 10.1111/jonm.12281] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2014] [Indexed: 01/10/2023]
Abstract
AIM This study explores nurse managers' experiences in dealing with patient/family violence toward their staff. BACKGROUND Studies and guidelines have emphasised the responsibility of nurse managers to manage violence directed at their staff. Although studies on nursing staff have highlighted the ineffectiveness of strategies used by nurse managers, few have explored their perspectives on dealing with violence. METHODS This qualitative study adopted a grounded theory approach to explore the experiences of 26 Japanese nurse managers. RESULTS The nurse managers made decisions using internalised ethical values, which included maintaining organisational functioning, keeping staff safe, advocating for the patient/family and avoiding moral transgressions. They resolved internal conflicts among their ethical values by repeating a holistic assessment and simultaneous approach consisting of damage control and dialogue. They facilitated the involved persons' understanding, acceptance and sensemaking of the incident, which contributed to a resolution of the internal conflicts among their ethical values. CONCLUSIONS Nurse managers adhere to their ethical values when dealing with patient violence toward nurses. Their ethical decision-making process should be acknowledged as an effective strategy to manage violence. IMPLICATIONS FOR NURSING MANAGEMENT Organisational strategies that support and incorporate managers' ethical decision-making are needed to prevent and manage violence toward nurses.
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Affiliation(s)
- Kana Sato
- Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoshie Yumoto
- Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroki Fukahori
- Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Swain N, Gale C. A communication skills intervention for community healthcare workers reduces perceived patient aggression: A pretest-postest study. Int J Nurs Stud 2014; 51:1241-5. [DOI: 10.1016/j.ijnurstu.2014.01.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 01/29/2014] [Accepted: 01/30/2014] [Indexed: 11/26/2022]
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Rittenmeyer L, Huffman D, Hopp L, Block M. A comprehensive systematic review on the experience of lateral/horizontal violence in the profession of nursing. ACTA ACUST UNITED AC 2013. [DOI: 10.11124/jbisrir-2013-1017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Sato K, Wakabayashi T, Kiyoshi-Teo H, Fukahori H. Factors associated with nurses’ reporting of patients’ aggressive behavior: A cross-sectional survey. Int J Nurs Stud 2013; 50:1368-76. [DOI: 10.1016/j.ijnurstu.2012.12.011] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Revised: 12/14/2012] [Accepted: 12/16/2012] [Indexed: 10/27/2022]
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Bataille B, Mora M, Blasquez S, Moussot PE, Silva S, Cocquet P. [Training to management of violence in hospital setting]. ACTA ACUST UNITED AC 2013; 32:165-9. [PMID: 23474002 DOI: 10.1016/j.annfar.2012.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 12/10/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Evaluate the typology of violence in hospital setting, study the psychophysiological state of care givers dealing with the aggression and provide appropriate training. STUDY DESIGN Single centre, observational. PATIENTS AND METHODS A first anonymous questionnaire was given to a sample of emergency and intensive care providers in Narbonne Hospital. The parameters studied included: demographics data, the Trait Anxiety Inventory test, the typology of aggressions, and the psycho-physiological state of subjects dealing with the aggression. Robert Paturel, an instructor of French Special Forces (Recherche-Assistance-Intervention-Dissuasion [RAID]), has provided training for the management of violence. A second questionnaire assessed satisfaction for proposed formation. RESULTS Forty-one questionnaires were returned. The rates of verbal and physical violence touching care givers were respectively 97 % and 41 % (median of 7years [1-36] experience on the job). Eighty-five percent of care givers wanted training in psychology of conflict and 93 % wanted a formation with a self-defense aspect. The first reason of violence was drugs and alcohol abuse. The "tunnel effect" during stress was identified in 34 % of care givers, and 20 % were unaware of its nature. Twenty-one percent of care givers spontaneously adopting a safe distance of more than 1m during a conflict had been physically assaulted versus 63 % for those staying less than 1m (P=0.03). The proposed formation, including psychology of conflict and self-defense, was satisfactory to all care givers who participated (median score 9/10 [7-10]). CONCLUSION The verbal and physical violence affecting emergency departments is a common phenomenon warranting appropriate training. The proposed formation included the comprehension of the conflict causality, self-defense and self-control.
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Affiliation(s)
- B Bataille
- Pôle urgence-réanimation-Smur, centre hospitalier de Narbonne, boulevard Dr-Lacroix, 11100 Narbonne, France.
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Lamont S, Brunero S, Bailey A, Woods K. Breakaway technique training as a means of increasing confidence in managing aggression in neuroscience nursing. AUST HEALTH REV 2012; 36:313-9. [PMID: 22935124 DOI: 10.1071/ah11001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Accepted: 11/03/2011] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The objective of this paper was to evaluate breakaway technique training with neuroscience nursing staff as a measure of increased confidence and safety in managing aggression. METHODS A quasi experimental design was used in a sample of neuroscience nursing staff (n=31), participating in 2×1h breakaway technique workshops. The workshops consisted of supervised skills training in safe breakaway techniques. A pre- and postintervention-matched questionnaire measuring confidence and safety around managing aggressive patients, and exposure to and confidence in dealing with breakaways, was self administered. RESULTS Statistically significant increases in confidence and safety in working with aggressive patients, and confidence levels for safe breakaways were reported. Qualitative comments demonstrated a desire for ongoing skills workshops. CONCLUSIONS This study provides early evidence of the importance of incorporating breakaway training into existing training programs which aim to minimise and manage aggression and violence in generalist settings.
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Affiliation(s)
- Scott Lamont
- Mental Health Liaison Nursing, Prince of Wales Hospital, Barker St, Randwick, NSW 2031, Australia.
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McLaughlin S, Bonner G, Mboche C, Fairlie T. A pilot study to test an intervention for dealing with verbal aggression. ACTA ACUST UNITED AC 2010; 19:489-94. [PMID: 20505614 DOI: 10.12968/bjon.2010.19.8.47638] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Verbal aggression has been defined as communication with an intention to harm an individual through words, tone or manner, regardless of whether harm occurs. It includes verbal threat to harm, ridicule, openly hostile remarks, unjust persistent criticism, shouting or yelling insults, as well as more covert actions such as spreading hurtful rumours (Cox, 1987; Farrell et al, 2006). Receiving verbal aggression from a patient has been closely associated with psychological distress which may negatively affect work performance. A verbal aggression work book was developed to help nursing staff to deal with verbal aggression from patients in clinical practice. This was piloted over a six-week period with 18 nurses working on one acute psychiatric inpatient ward. Findings revealed that the intervention had some promising effects. However, much more attention needs to be paid to changing attitudes towards verbal aggression.
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Affiliation(s)
- Sue McLaughlin
- Thamas Valley Univesrity and Berkshire Health Care Foundation Trust, UK
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Paniagua H, Bond P, Thompson A. Providing an alternative to zero tolerance policies. ACTA ACUST UNITED AC 2009; 18:619-20, 622-3. [DOI: 10.12968/bjon.2009.18.10.42492] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Erkol H, Gökdoğan MR, Erkol Z, Boz B. Aggression and violence towards health care providers--a problem in Turkey? J Forensic Leg Med 2007; 14:423-8. [PMID: 17720594 DOI: 10.1016/j.jflm.2007.03.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2006] [Revised: 02/19/2007] [Accepted: 03/05/2007] [Indexed: 10/23/2022]
Abstract
Health care providers are increasingly concerned about the escalating incidence of verbal and physical abuse to healthcare staff. Factors, such as long wait in hospital areas, which lead to client frustration over an inability to obtain needed services promptly, are influencing these situations. Nonetheless, incidents of this nature can cause immense psychological harm as well as physical damage among medical employees. The current study aimed to ascertain from staff members aggressive experiences in the workplace, and the effects on the individual. The results of this study mirrored those of similar surveys in Turkey. Non-reporting was revealed as a major problem. Respondents believed they were treated less seriously than similar incidents involving private citizens. Accordingly, staff criticized hospital managers, the police, and the courts for their attitude about assaults towards hospital employees. They reported feeling vulnerable to abuse and there was a general desire for training in preventing and protection. These include teaching staff breakaway techniques, increasing the number of trained security officers on duty, issuing personal alarms, and encouraging staff to officially report all incidents.
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Affiliation(s)
- Hayri Erkol
- Abant Izzet Baysal University, Izzet Baysal Faculty of Medicine, Department of General Surgery, Bolu, Turkey
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Middleby-Clements JL, Grenyer BFS. Zero tolerance approach to aggression and its impact upon mental health staff attitudes. Aust N Z J Psychiatry 2007; 41:187-91. [PMID: 17464698 DOI: 10.1080/00048670601109972] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE A natural study design provided an opportunity to investigate the effect of zero tolerance to aggression policy on health staff attitudes. METHOD This study compared a training programme used to train health service staff in aggression minimization (group 1) with a highly similar training programme that differed in that it emphasized a zero tolerance approach to aggression minimization in the health workplace (group 2). Prior to training and at follow up 117 health staff (57 from group 1, and 60 from group 2) completed a series of evaluations examining rigid attitudes toward managing aggression, tolerance for aggression and confidence and skills in dealing with aggression. RESULTS The groups were equivalent with respect to age, sex and occupation. Prior to training the two groups did not differ with regard to rigidity, tolerance, confidence and skills. Both training interventions were effective in increasing confidence and skills. However, group 1 significantly decreased rigid attitudes toward the management of aggression, whereas group 2 significantly evidenced increased rigid attitudes and decreased tolerance toward aggression. CONCLUSION Zero tolerance for aggression had a negative impact on health staff attitudes in relation to managing aggression in the health workplace.
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Affiliation(s)
- Jane L Middleby-Clements
- Illawarra Institute for Mental Health and South Eastern Sydney and Illawarra Area Health Service, NSW, Australia
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