Violence In Health Care Research Articles

It shouldn't take a murder: A call to action against sexual violence in healthcare.

It shouldn't take a murder: A call to action against sexual violence in healthcare.

Understanding the Experience of Workplace Violence in Hospitals as Documented by Nursing Staff: Using the READ Approach.

Background: Workplace violence has a significant impact on patients, families, and staff safety. Workplace violence can produce traumatic results for those involved; the importance of preventive measures needs to be paramount in health service policy and process. Health care staff are required to document their experiences of violent incidents after every occasion, usually via an incident reporting system, which allows for a free text description of the event. There is a lack of understanding of how health care staff document reports of violence and how they explain the events. Methods: This study aims to determine the circumstances surrounding workplace violent events as documented by health care staff. The four-step Review, Extract, Analyze, and Document (READ) approach to document analysis was used to examine workplace violence incident reports over 12 months (September 2021-September 2022) in a tertiary referral hospital. Findings: Six categories of workplace violence were found: (a) "Escalation Dynamics"-patterns and progression of how violence incidents intensify; (b) "Warning Behaviors"-verbal or non-verbal signals that may foreshadow physical violence if not addressed; (c) "Authoritative Institutional Interventions"-how aggression correlates to protocols involving security personnel or law enforcement; (d) "Care Delivery Methods"-how certain treatment procedures and approaches might inadvertently elicit violence; (e) "Situational Stressors"-external circumstances or changes that act as triggers for violence; and (f) "Unprovoked triggers"-sudden and seemingly unprovoked violent outbursts. Conclusions and application to practice: Workplace violence in health care is a multifaceted interplay of events with the nurse involved in all aspects of the process. These findings can be used by occupational health nurses in education and policy development. The findings can be used to focus education on how violent incidents may escalate and provide more opportunities for de-escalation by health care staff.

Monitoring violence in healthcare. A lesson from the pandemic

Abstract Introduction Violence against healthcare workers is a serious, underreported, and underestimated problem. Only a few healthcare companies have efficient violence monitoring systems and risk assessment is often entrusted to non-validated algorithms. The monitoring system implemented in 2005 in a public health company allowed for an accurate analysis of the phenomenon. Methods For the entire observation period (2005-2023), the one-year prevalence of violent incidents (physical assaults, threats, and harassment) has been reported by all during the periodic medical examination in the workplace. Furthermore, after each periodical inspection of workplaces, the occupational doctor requested a detailed description of violent events that occurred in the department, using the Violent Incident Form distributed online anonymously. Results In 2005/6 the one-year prevalence of physical assaults was 8.2%. Prevention efforts led to a moderate reduction in the rate (7.8% in 2011/12). A collapse in rates was observed in 2021 (3.2%). In 2022, physical violence rose again to 5.6%. Harassment affected 19.6% of workers in 2005/6, falling to 7.2% in 2021 and rising again to 21.6% in 2022. Physical violence perpetrated by patients was more frequent in psychiatric services (OR 25.7, CI95% 11.1; 59.6) and violence perpetrated by visitors in emergency and urgence services (OR 8.8, CI95% 3.8; 20.5) than in general services. Workers attributed the drop in attacks primarily to the filtering of access to work areas, which limited the presence of visitors and relatives. The lower demand for services had also resulted in an optimal ratio between staff and patients, improving the quality of care. Furthermore, in the very first pandemic phase, health workers enjoyed a very favorable consideration from the population, which had further reduced the causes of conflict. Conclusions The pandemic has shown that better relationships between patients/visitors and staff are effective in reducing violence. Key messages • Monitoring of violence against healthcare workers shows that it has decreased during the pandemic. • HCWs believe that (i) limiting visitor access (ii) better balancing demand for services and (iii) better opinion towards HCWs were the causes of the reduced rate of violence.

Politics of Violence in Healthcare

Violence against healthcare workers (HCWs) has surged globally, extending beyond conflict zones into areas of relative peace. This editorial examines the epidemic of such violence, which has been exacerbated by recent pandemics. Historical and contemporary instances, such as the 1830s cholera riots, the 2013/14 Ebola outbreak, and recent attacks in Kolkata, highlight how political instability, public mistrust, and socio-economic inequalities fuel aggression against HCWs. A comprehensive analysis reveals that 50-75% of HCWs experience workplace violence, with a significant portion facing sexual abuse. Contributing factors include inadequate security, poor governance, and societal intolerance of HCWs. Possible solutions offer hope, including workplace safety, legal protections, and public awareness of the problem. The editorial calls for a multi-faceted approach involving legislation, better reporting, and global cooperation to address the root causes of violence and improve the safety of HCWs.

Educating a new generation of nurses about workplace violence using an innovative virtual simulation module

Workplace violence (WPV) continues to be a pervasive and burdensome issue. Nurses spend more time with patients and families increasing their WPV risk. Unfortunately, nursing programs do not routinely provide education or training on de-escalation or management of WPV. Future and current nurses should acknowledge and receive education for the prevention and mitigation of WPV as well as frequent reviews and updates on current trends and strategies. The purpose of this study was to evaluate the impact of education on knowledge of WPV among pre-nursing students at a Midwestern university. This study used a pre-and post-tests, quasi-experimental design with 99 students. A brief knowledge test was completed by participants both before and after the intervention. Pre- and post-test scores were collected across sections. Analysis of paired sample t-tests demonstrated a 20% average increase in post-test scores with a statistically significant increase from pre-test scores (t=-11.357, p<0.001). Results indicated that the innovative, virtual simulation module increased participants’ knowledge of workplace violence in healthcare. Increased knowledge of and preparation for the WPV workplace would strengthen students’ safety readiness for practice with the persistence of WPV against nurses. Prevention and response of WPV education must be an essential component of every undergraduate nursing program following licensure.

The paradox of workplace violence in the intensive care unit: a focus group study

BackgroundConflicts with patients and relatives occur frequently in intensive care units (ICUs), driven by factors that are intensified by critical illness and its treatments. A majority of ICU healthcare professionals have experienced verbal and/or physical violence. There is a need to understand how healthcare professionals in ICUs experience and manage this workplace violence.MethodsA qualitative descriptive analysis of four hospitals in Sweden was conducted using semi-structured focus-group interviews with ICU healthcare professionals.ResultsA total of 34 participants (14 nurses, 6 physicians and 14 other staff) were interviewed across the four hospitals. The overarching theme: “The paradox of violence in healthcare” illustrated a normalisation of violence in ICU care and indicated a complex association between healthcare professionals regarding violence as an integral aspect of caregiving, while simultaneously identifying themselves as victims of this violence. The healthcare professionals described being poorly prepared and lacking appropriate tools to manage violent situations. The management of violence was therefore mostly based on self-taught skills.ConclusionsThis study contributes to understanding the normalisation of violence in ICU care and gives a possible explanation for its origins. The paradox involves a multifaceted approach that acknowledges and confronts the structural and cultural dimensions of violence in healthcare. Such an approach will lay the foundations for a more sustainable healthcare system.

Perceptions of patients and their relatives about schadenfreude towards doctors

BackgroundViolence in healthcare is a global issue that healthcare professionals experience. The concerning increase in violent incidents in Turkiye particularly makes it a significant problem to explore by examining the underlying psychological factors. In this sense, this study focuses on the concept of Schadenfreude, the malicious joy of someone else's misfortune, towards doctors, which is an under-researched topic in healthcare violence. Particularly, there is a lack of research on patients' and relatives' perceptions of doctors. ObjectiveThis study aims to determine the level of schadenfreude in Turkish society towards the violence experienced by doctors and to develop a model revealing the underlying causes. MethodsUsing a convenience sampling method, we recruited 402 participants, who are not first-degree relatives of healthcare professionals, for this quantitative study. For data collection, we developed a survey instrument to measure the level of schadenfreude and six different psychological factors including empathy, sympathy, anger, aggression, and deservingness. For data analysis, we used structural equation modeling. ResultsThe results showed that the lower the levels of empathy and sympathy towards doctors were, the higher the levels of both schadenfreude and aggression were. Envy had no significant effect on either schadenfreude or aggression, while deservingness directly affected aggression. The perceptions of participants regarding doctors that they deserve violence increased their aggression levels. Schadenfreude had a positive and significant effect on anger and aggression. ImplicationsThe examination of underlying factors of violence towards doctors points to a lack of mutual understanding between patients and doctors. The results of this study indicate a need for increasing empathy towards health professionals by creating societal awareness of their experiences. Local authorities and healthcare organizations can create environments that bring together the public and health professionals to share their experiences with each other or conduct campaigns to draw public attention to the issue. Moreover, training sessions on effective communication can be offered for health professionals to help improve patient-doctor relationships and healthcare outcomes.

Healthcare Violence and the Potential Promises and Harms of Artificial Intelligence.

Currently, the healthcare workplace is one of the most dangerous in the United States. Over a 3-month period in 2022, two nurses were assaulted every hour. Artificial intelligence (AI) has the potential to prevent workplace violence by developing unique patient insights through accessing almost instantly a patient's medical history, past institutional encounters, and possibly even their social media posts. De-escalating dialog can then be formulated, and hot-button topics avoided. AIs can also monitor patients in waiting areas for potential confrontational behavior.Many have concerns implementing AIs in healthcare. AIs are not expected to be 100% accurate, their performance is not compared with a computer but instead measured against humans. However, AIs are outperforming humans in many tasks. They are especially adept at taking standardized examinations, such as Board Exams, the Uniform Bar Exam, and the SAT and Graduate Record Exam. AIs are also performing diagnosis. Initial reports found that newer models have been observed to equal or outperform physicians in diagnostic accuracy and in the conveyance of empathy.In the area of interdiction, AI robots can both navigate and monitor for confrontational and illegal behavior. A human security agent would then be notified to resolve the situation. Our military is fielding autonomous AI robots to counter potential adversaries. For many, this new arms race has grave implications because of the potential of fielding this same security technology in healthcare and other civil settings.The healthcare delivery sector must determine the future roles of AI in relationship to human workers. AIs should only be used to support a human employee. AIs should not be the primary caregiver and a single human should not be monitoring multiple AIs simultaneously. Similar to not being copyrightable, disinformation produced by AIs should not be afforded 'free speech' protections. Any increase in productivity of an AI will equate with a loss of jobs. We need to ask, If all business sectors utilize AIs, will there be enough paid workers for the purchasing of services and products to keep our economy and society a float?

Aggression and violence in the emergency department: A qualitative study exploring the perspectives of frontline healthcare professionals

BackgroundAggression and violence towards frontline healthcare professionals represents a rapidly increasing strain on hospitals, impacting clinician mental health and the provision of patient care. Little is known about the perceptions of healthcare professionals on current aggression management practices. AimThis study aimed to investigate the perceptions of frontline healthcare professionals on aggression and violence in hospital emergency departments. MethodsEight semi-structured focus groups consisting of 6–10 participants from five hospital emergency departments were held. Participants included medical doctors, nurses, and work health safety staff. Focus groups were audio-recorded and transcribed prior to undergoing thematic analysis. FindingsFour main themes were identified: (1) workplace aggression and violence in healthcare is increasing in frequency and difficulty to manage, (2) local strategies in place to manage workplace aggression and violence are perceived to be insufficient, (3) systemic issues exacerbate the consequences of workplace aggression and violence, (4) staff feel inadequately equipped to manage the impact of workplace aggression and violence on their own wellbeing. DiscussionThere are substantial perceived barriers to the effective management of workplace aggressive and violent behaviour within Australian hospital emergency departments. Participants suggest perceived increases in the prevalence of aggressive incidents and systemic issues surrounding incident reporting and follow-up exacerbate existing deficiencies in workplace aggression and violence management. ConclusionFurther research into risk reduction strategies, investigation of targeted interventions to better prepare staff, and improved reporting processes and pathways are needed to mitigate fallout of workplace exposures to aggression and violence in the emergency department.

Advancing health equity for Indigenous peoples in Canada: development of a patient complexity assessment framework.

Indigenous patients often present with complex health needs in clinical settings due to factors rooted in a legacy of colonization. Healthcare systems and providers are not equipped to identify the underlying causes nor enact solutions for this complexity. This study aimed to develop an Indigenous-centered patient complexity assessment framework for urban Indigenous patients in Canada. A multi-phased approach was used which was initiated with a review of literature surrounding complexity, followed by interviews with Indigenous patients to embed their lived experiences of complexity, and concluded with a modified e-Delphi consensus building process with a panel of 14 healthcare experts within the field of Indigenous health to identify the domains and concepts contributing to health complexity for inclusion in an Indigenous-centered patient complexity assessment framework. This study details the final phase of the research. A total of 27 concepts spanning 9 domains, including those from biological, social, health literacy, psychological, functioning, healthcare access, adverse life experiences, resilience and culture, and healthcare violence domains were included in the final version of the Indigenous-centered patient complexity assessment framework. The proposed framework outlines critical components that indicate the presence of health complexity among Indigenous patients. The framework serves as a source of reference for healthcare providers to inform their delivery of care with Indigenous patients. This framework will advance scholarship in patient complexity assessment tools through the addition of domains not commonly seen, as well as extending the application of these tools to potentially mitigate racism experienced by underserved populations such as Indigenous peoples.

Is Being an Emergency Service Professional a Risk Factor for Violence in Healthcare

Aim: Violent incidents have become an increasing problem in our hospitals. Many violent incidents cause devastating damage to healthcare personnel. In this study, we aimed to examine the etiological differences between physical and verbal violence in violent incidents seen in hospitals, and especially whether being an emergency service professional has an effect on physical and verbal violence. Materials and Method: Four-year white code case records between 2018 and 2022 in a tertiary hospital were retrospectively reviewed. The type and setting of violence, the gender, and the occupation of the perpetrator were recorded. The cases were divided into two groups: physical violence and verbal violence. The collected data were compared between the groups. Results: During the indicated period, 231 cases of code white were reported. While 51.9% of those affected by violence were men, the mean age was 33 (28-40). Physicians were the most common professional group affected by violence, with 102 individuals (44.2%). The most common site of violence was the emergency service, at 54.5%. The rate of physical violence in the emergency department was found to be higher than verbal violence (63.9%-51.2%), although it was not statistically significant. In cases of physical violence, the proportion of the individual exposed to violence being male was statistically significantly higher than in cases of verbal violence (43/61(70.5%), 77/170(%47) <0,001). The proportion of female perpetrators of verbal violence was statistically significantly higher than that of physical violence (35/170(20.6%), 3/61(4.9%), <0,001). Conclusion: In our study, it was found that those exposed to physical violence were mostly men. It has been determined that women use verbal violence more than physical violence. Physicians were more exposed to verbal violence. In addition, although the propotion of emergency room location in physical violence incidents was higher than in verbal violence incidents, the difference was not found to be statistically significant. Keywords: Physical violence, verbal violence, code white, emergency service

Identifying quality indicators to measure workplace violence in healthcare settings: a rapid review

Structured summaryBackgroundWorkplace violence (WPV) in healthcare is a growing challenge posing significant risks to patient care and employee well-being. Existing metrics to measure WPV in healthcare settings often fail to provide decision-makers with an adequate reflection of WPV due to the complexity of the issue. This increases the difficulty for decision-makers to evaluate WPV in healthcare settings and implement interventions that can produce sustained improvements.ObjectiveThis study aims to identify and compile a list of quality indicators that have previously been utilized to measure WPV in healthcare settings. The identified quality indicators serve as tools, providing leadership with the necessary information on the state of WPV within their organization or the impact of WPV prevention interventions. This information provides leadership with a foundation for planning and decision making related to addressing WPV.MethodsOvid databases were used to identify articles relevant to violence in healthcare settings, from which 43 publications were included for data extraction. Data extraction produced a total of 229 quality indicators that were sorted into three indicator categories using the Donabedian model: structure, process, and outcome.ResultsA majority of the articles (93%) contained at least 1 quality indicator that possessed the potential to be operationalized at an organizational level. In addition, several articles (40%) contained valuable questionnaires or survey instruments for measuring WPV. In total, the rapid review process identified 84 structural quality indicators, 121 process quality indicators, 24 outcome quality indicators, 57 survey-type questions and 17 survey instruments.ConclusionsThis study provides a foundation for healthcare organizations to address WPV through systematic approaches informed by quality indicators. The utilization of indicators showed promise for characterizing WPV and measuring the efficacy of interventions. Caution must be exercised to ensure indicators are not discriminatory and are suited to specific organizational needs. While the findings of this review are promising, further investigation is needed to rigorously evaluate existing literature to expand the list of quality indicators for WPV.

Anger Level of Patients in Outpatient Waiting Area and Related Factors

Aim: In this study, we aimed to detect the anger level of patients in the outpatient waiting area and related factors. We also aimed to contribute to the studies to be carried out to prevent violence in health caused by uncontrolled anger. Methods: Volunteer patients aged 18 and over who applied to outpatient clinics were included in the study. A survey consisting of 34 questions prepared by the researchers and Spielberger's State Anger Scale consisting of 10 questions were used. Results: In our study, it was detected that there was a statistically significant increase in state anger scale scores of patients who resorted to violence in health before, who are troubled with the priority patient practice, who cannot communicate with the doctor adequately, who cannot sit in the outpatient waiting area and those who wait for a long time, who have trouble making an appointment, who smoke and who have low income and education level. Conclusion: We believe that establishing effective communication between health professionals and patients, increasing the number of healthcare workers, organizing work environments, and creating an efficient appointment system will contribute to a decrease in patient anger and a reduction in violence in healthcare. Keywords: outpatient health services, anger, violence

The prevalence of harassment of diagnostic radiography and radiation therapy students whilst on clinical placement in the Republic of Ireland

Objective To determine if student radiographers and radiation therapists experience harassment (verbal, physical or sexual) while on clinical placement and their awareness of policies in place to report such incidents. Methods An online questionnaire developed from the World Health Organisation’s questionnaire on workplace violence in healthcare and the higher education authority (HEA) national survey of student experiences of sexual violence and harassment in Irish HEIs was used. Undergraduate and postgraduate diagnostic radiography and radiation therapy students in the Republic of Ireland to be included and have completed a minimum of four weeks of clinical placement. Our of 256 students, 98 filled out the survey. Results Forty-one per cent (n = 40) of students reported experiencing at least one incident of harassment. Thirteen per cent reported experiencing two forms of harassment, and 2 students reported experiencing verbal, physical and sexual harassment. Verbal harassment (n = 33) and sexual (n = 16) were the most common form of harassment while physical harassment was experienced 7 participants. Ninety-one per cent (n = 88) of participants reported they don’t believe they have received sufficient training in dealing with incidents of physical, verbal or sexual harassment. Conclusion Harassment of student radiographers and radiation therapists is occurring while on placement. Male patients are the modal perpetrator, and most incidents go unreported. Students are not empowered to report an incident of harassment and are sometimes unaware of how to report harassment.

Critically examining health complexity experienced by urban Indigenous peoples in Canada by exploring the factors that allow health complexity to persist: a qualitative study of Indigenous patients in Calgary, Alberta

ObjectivesThis study aims to identify and critically examine the components of health complexity, and explore the factors that allow it to exist, among urban Indigenous peoples in Canada.DesignQualitative exploration with...

Assessing the pharmacy workforce's preparedness for a workplace violence event.

The purpose of this article is to describe the planning, implementation, and findings of a "person with a weapon" exercise for an inpatient pharmacy department. There has been an increased focus on workplace violence in healthcare within the last few years. The health-system pharmacy workforce should take an active role in planning for workplace violence events by completing a risk assessment analysis and performing tabletop and functional exercises. This study provides an example of how health-system pharmacists collaborated with an emergency management team, security, and communications to carry out a person with a weapon exercise in an inpatient hospital pharmacy. Areas for improvement were identified for pharmacy, communications, and security during education sessions and the tabletop and functional exercises, demonstrating the importance of a multidisciplinary approach when planning for a person with a weapon event. As a result of this exercise, there was increased awareness of the "run, hide, fight" tactic, an increase in workplace violence education and staff awareness, and an enhancement of security measures, including technology improvements. This workplace violence exercise provides an example of how the pharmacy workforce can engage in emergency preparedness planning and risk mitigation for a workplace violence event. Other health systems can use the action plan, findings, and improvements to raise awareness and train about workplace violence events and support the safety of the pharmacy workforce.

Workplace Violence in Healthcare Service

Violence in the workplace is an act or threat of violence against workers, both inside and outside the workplace, ranging from insults, threats, intimidation, and physical assault to murder. Although violence in the workplace has become a global concern, the true extent of this problem is still underreported due to low awareness and lack of awareness of the issues within the body. Therefore, if violence in the workplace is not addressed, especially in the health sector, it will become a global phenomenon that will disrupt the peace and stability of the working community and pose a risk to the health and welfare of society. Therefore, this review aims to identify the risk factors and impacts of workplace violence in health care and demonstrate the collaborative efforts needed to support managing and preventing violence in the workplace. Keywords: Violence, workplace, Healthcare worker.

Utilization and effects of security technologies in mental health: A scoping review.

Violence in healthcare is an urgent and increasing issue. Mental health settings are particularly affected, with severe negative impacts on staff, patients, and organizations. Security technologies could help maintain and improve safety in this field. However, knowledge of their utilization and effectiveness in mental health is lacking. A scoping review was conducted using the methodology recommended by the Joanna Briggs Institute to map research on the utilization and effects of security technologies in mental health, identify how research is currently performed, and highlight gaps in the existing knowledge. Literature search for peer-reviewed publications was performed on PubMed, CINAHL, PsycInfo, Embase, and Scopus. Following the screening process and the eligibility criteria, 22 articles were included in this review. The publication range was 2002-2020, many studies were surveys, and European countries were the most investigated, especially the United Kingdom. Overall, the use of 10 different technologies was reported 46 times. The most represented category was alarms, followed by video cameras, other technologies (such as wearable sensors), and metal detectors. More than half of the included papers reported positive effects of these measures on safety. This review indicates that several security technologies are available in mental health settings, with encouraging positive safety outcomes for both patients and healthcare professionals, especially nurses. However, research on the topic is still emerging, with a limited number of sources and a few high-quality designed studies. Therefore, future research should focus on producing evidence on the availability and effectiveness of these measures in mental health settings across countries.

Workplace Violence Against Nurses in Canada: A Legal Analysis.

Workplace violence against nurses is a significant global occupational health problem, with incidents of violence increasing in frequency since the COVID-19 pandemic began. In this article, we provide a review of recent legislative amendments meant to bolster workplace safety in health care in Canada, analyze legal cases where nurses were the victims of violence, and discuss what these legal reforms and decisions reveal about how nurses' work is treated within the Canadian legal system. Under criminal law, the limited number of cases we could find with oral or written sentencing decisions show that, historically, the fact a victim was a nurse was not always considered an aggravating factor on sentencing. Recent legislative amendments make this a specified aggravating factor and it is important to track the impact of these amendments when judges exercise their discretion in sentencing. Under employment law, it appears that, despite the government's efforts to increase the deterrence factor under legislation with significantly increased fines for employers who fail to protect their employees from injury, courts remain reluctant to impose such sanctions. In these cases, it is also important to track the impact of harsher penalties. We conclude that combating the widespread normalization of workplace violence in health care, and specifically against nurses, is acutely needed to help ensure that these ongoing legal reforms aimed at improving the safety of health workers are effective.

Identifying Type II workplace violence from clinical notes using natural language processing.

Type II workplace violence in health care, perpetrated by patients/clients toward home healthcare nurses, is a serious health and safety issue. A significant portion of violent incidents are not officially reported. Natural language processing can detect these "hidden cases" from clinical notes. In this study, we computed the 12-month prevalence of Type II workplace violence from home healthcare nurses' clinical notes by developing and utilizing a natural language processing system. Nearly 600,000 clinical visit notes from two large U.S.-based home healthcare agencies were analyzed. The notes were recorded from January 1, 2019 to December 31, 2019. Rule- and machine-learning-based natural language processing algorithms were applied to identify clinical notes containing workplace violence descriptions. The natural language processing algorithms identified 236 clinical notes that included Type II workplace violence toward home healthcare nurses. The prevalence of physical violence was 0.067 incidents per 10,000 home visits. The prevalence of nonphysical violence was 3.76 incidents per 10,000 home visits. The prevalence of any violence was four incidents per 10,000 home visits. In comparison, no Type II workplace violence incidents were recorded in the official incident report systems of the two agencies in this same time period. Natural language processing can be an effective tool to augment formal reporting by capturing violence incidents from daily, ongoing, large volumes of clinical notes. It can enable managers and clinicians to stay informed of potential violence risks and keep their practice environment safe.