Violence In Hospital Settings Research Articles

Exploring staff experiences and perceptions of patient-perpetrated violence in hospital settings: A qualitative study.

To explore hospital staff experiences and perceptions of patient-perpetrated violence. Descriptive qualitative study. Twelve semi-structured interviews (June-August 2022) were held with a diverse sample of hospital nurses, doctors, allied health professionals, security and a non-clinical manager. The framework approach was used to organise and analyse data, using Attribution Theory as a theoretical lens. Three themes were identified: violence as (un)predictable, violence as (un)preventable and the cumulative toll of violence. In making sense of why patients become violent, participants described different 'types' of aggressive patients and variably attributed behaviours to situation, disposition or a combination of both. Regardless of perceived causal factors, staff overwhelmingly appeared to view violence as predictable. Participants also reflected on the wider structural problems underpinning violence, frequently alluding to their sense of relative powerlessness to initiate change. The cumulative toll of violence was a common thread, with staff describing their acquisition of 'resilience' and reflecting on its role in their responses to escalating situations. Many hospital staff are resigned to the inevitability of violence. The concept of staff 'resilience' following violence is not unproblematic, having the potential to serve as a guise for acceptance and as an additional variable for which staff are held accountable. When designing strategies, organisations should ensure that accountability for violence reduction is distributed across multiple levels. This study makes a novel contribution by exploring the perspectives of multiple staff groups working across diverse hospital settings, and adds to a sparse literature on this subject in the UK. Efforts to address violence against healthcare staff need to be power-conscious, ensuring that accountability is distributed across multiple levels. This study is reported in line with the Consolidated Criteria for Reporting Qualitative Studies (COREQ). No patient or public contribution.

Effects of vertical violence on the work of nurses in hospital settings: An exploratory study

Introduction : more than 39.7% of nurses report being victims of psychological harassment in the workplace. In 60% of cases, the abuse is vertical, involving a person in a position of authority.Context : few studies have examined this phenomenon without conflating it with other forms of workplace violence.Objective : the purpose of this study was to shed light on cases of vertical violence experienced by nurses working in hospitals.Method : data was collected by means of semi-structured interviews with six nurses working in hospitals in the province of Quebec (Canada). Descriptive phenomenology was used to analyze the collected data.Results : the overall effects of the vertical violence experienced by nurses in hospital settings resulted in less diligent and individualized nursing care.Discussion : it is recommended that organizational policies against vertical violence put in place in hospital be enforced in a rigorous and transparent manner. Further investigation is needed to identify the organizational factors that contribute to vertical violence in hospital settings.

A systems analysis of work-related violence in hospitals: Stakeholders, contributory factors, and leverage points

Work-related violence in hospitals is a growing problem that has significant personal, societal, and economic costs and adversely impacts the quality of patient care. The complex and multi-factorial nature of the issue is such that it is extremely difficult to understand and manage, and interventions have had varying levels of success. Systems thinking and associated analysis methods are useful when attempting to understand and respond to complex issues; however, they have not previously been applied to work-related violence in hospital settings. This study involved the application of three systems thinking methods in conjunction with healthcare stakeholders to analyse the problem of work-related violence in hospital settings in New South Wales, Australia. The ActorMap method was used to identify the stakeholders who share the responsibility for the issue and the AcciMap method was used to identify the contributory factors which interact to create work-related violence incidents. PreventiMaps were then developed to show where interventions could be used to better prevent or mitigate work-related violence. The findings show a complex and diverse set of contributory factors beyond patients and healthcare workers and suggest that fundamental system reform is required. Nine key areas of hospital practice are proposed as the most suitable targets for intervention moving forward.

Workplace Violence Against Doctors in Bangladesh: A Content Analysis.

Workplace violence in healthcare settings is a common global problem, including in Bangladesh. Despite the known presence of workplace violence in healthcare environments of developing countries, there is limited understanding of factors that lead to hospital violence in Bangladesh. This study aims to explore factors that influence incidents of violence against healthcare professionals in Bangladesh, as reported by doctors via social media forum. Content analysis was conducted on 157 reported incidents documented on “Platform,” the online social media most used by medical students and doctors in Bangladesh. Posts by doctors detailing experiences of physical or verbal violence at their workplace between July 2012 and December 2017 were included in this study. The majority of reported incidents were reported by male doctors (86%) and from government hospitals (63.7%). Findings showed that primary healthcare centers experienced more violence than secondary and tertiary facilities. This may largely be due to insufficient human and other resources in primary care settings to meet patient demand and expectations. Most of the events happened at night (61%), and as a result, entry-level doctors such as emergency duty doctors and intern doctors were commonly affected. Six themes were identified as vital factors in workplace violence against doctors: patients’ perspectives, delayed treatment, power practice, death declarations, extreme violence, and care-seeking behaviors. Most incidents fell under the categories of delayed treatment and power practice at 26.8 and 26.1%, respectively. This study identified possible factors for reported violence in hospital settings. To address and reduce these incidents, hospital administrators should be aware of risk factors for violent behavior and design appropriate measures to prevent workplace violence. Further qualitative and quantitative research is needed to appropriately address the consequences of violence on healthcare workers and implement measures to mitigate these events.

Trends in Workplace Violence Involving Health Care Professionals in China from 2000 to 2020: A Review.

The safety of health care workers in China has received an increasing amount of attention owing to numerous incidents of hospital-based violence against medical professionals. When pictures and videos of violent injuries are posted on the internet with real-time data, such as gender or location, researchers can access the information to learn about the incident, its causes, and/or threats to survival. We examined the causes and risk factors for workplace violence by analyzing relevant data retrieved from reports by Chinese internet media for all incidents from 2000 to 2020. We present frequency data on hospital-based violence against medical professionals. A total of 345 incidents occurred in health care settings. The person who committed the violent act was a patient or sick person in the workplace or a co-worker in 95.4% of the incidents; 54 of the incidents resulted in the victim’s murder. We provide the characteristics and risk factors of violent criminals. We describe China’s past and current clinical practices and health care policies, and we discuss the challenges faced by medical professionals who are victims of hospital-based violence from the perspectives of patients, physicians, hospital leaders, and the government. We conclude by making recommendations for preventing violence in hospital settings. It is urgent for the public to understand that the occupational safety of health care workers must be protected, and treatment should be provided to patients in a harmonious and safe environment. This review aims to describe the trends in workplace violence involving health care professionals in China from 2000 to 2020 and to discuss possible strategies for improving working conditions in hospitals and other health care settings.

Therapeutic institutions of violence: conceptualising the biographical narratives of mental health service users/survivors accessing long term “treatment” in England

Purpose This paper aims to conceptualise the residential and psychiatric hospital as a space where criminality and social harms can emerge. Because of recent media scandals over the past 10 years concerning privately-owned hospitals, this study examines the lived experiences of service users/survivors, family members and practitioners to examine historic and contemporary encounters of distress and violence in hospital settings. Design/methodology/approach The study consists of 16 biographical accounts exploring issues of dehumanising and harmful practices, such as practices of restraint and rituals of coercive violence. A biographical methodology has been used to analyse the life stories of service users/survivors (n = 9), family members (n = 3) and professional health-care employees (n = 4). Service users/survivors in this study have experienced over 40 years of short-term and long-term periods of hospitalisation. Findings The study discovered that institutional forms of violence had changed after the deinstitutionalisation of care. Practitioners recalled comprehensive experiences of violence within historic mental hospitals, although violence that may be considered criminal appeared to disappear from hospitals after the Mental Health Act (1983). These reports of criminal violence and coercive abuse appeared to be replaced with dehumanising and harmful procedures, such as practices of restraint. Originality/value The data findings offer a unique interpretation, both historical and contemporary, of dehumanising psychiatric rituals experienced by service users/survivors, which are relevant to criminology and MAD studies. The study concludes by challenging oppressive psychiatric “harms” to promote social justice for service users/survivors currently being “treated” within the contemporary psychiatric system. The study intends to conceptualise residential and psychiatric hospitals as a space where criminality and social harms can emerge. The three aims of the study examined risk factors concerning criminality and social harms, oppressive and harmful practices within hospitals and evidence that violence occurs within these institutionalised settings. The study discovered that institutional forms of violence had changed after the deinstitutionalisation of care. These reports of violence include dehumanising attitudes, practices of restraint and coercive abuse.

Safe and secure? The complexities of caring in hospitals

Safety in health care settings is a multidimensional construct involving factors such as patient safety, occupational safety and quality improvement, all designed to protect hospital staff and the public. Traditionally, harms in hospital care were most commonly associated with errors in medication administration and poor staffing levels, however, recently aggression and violence in hospital settings has become a significant challenge to the maintenance of patient and staff safety (Hahn et al., 2015).

Study on mitigation of workplace violence in hospitals

BackgroundA workplace is any location, permanent or temporary, where an employee performs work-related duty. Workplace violence includes threats, beating, stabbing, shooting, psychological trauma, suicides, near suicides, and harassment of any kind. We can see slow changes in attitude of care providers when they encounter violent behavior and incidents. It is a world-wide issue. Of late, in developing countries where out of pocket payment mode is the main healthcare financing option for a family, the medical professionals are being demonized as professional pick-pocketers by few sections of the society. Hence, we explored to garner opinion of the employees regarding what constitutes violence in hospital setting and identified the factors among doctors, nurses, environmental duty workers, which are contributing toward work-place violence by patients and visitors. The aim was to improve the work environment for healthcare givers. MethodsDescriptive, cross-sectional study with a close-ended questionnaire under sections of physical environment factors, patient processes, equipment factors, and types of events taking place was administered. A sample size was 540, including 120 doctors, 240 nurses, and 180 environment health workers. About 127 patients were also interviewed to understand their opinion about event leading to attacks on doctors and nurses. ResultsPatient attendants yelling at healthcare personnel, verbal threats of violence, and using offensive language against staff are the perceptions of hospital staff as incidents of workplace violence. Non-communicative staff, sudden death of patients, and non-satisfactory treatment lead to aggressive behavior as opined by patient families. ConclusionIn the process of providing safe work environment, each potential contributing factor needs to be addressed independently by administrators. The hospital has training programs to nurses on customer relationship management, interpersonal relations trainings.

Formation à la gestion des situations violentes en contexte hospitalier

ObjectiveEvaluate the typology of violence in hospital setting, study the psychophysiological state of care givers dealing with the aggression and provide appropriate training. Study designSingle centre, observational. Patients and methodsA 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. ResultsForty-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]). ConclusionThe 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.

A review of violent incidents in a multilevel secure forensic psychiatric hospital: is there a seasonal variation?

There have been several attempts made to reduce the occurrence of violence in hospital settings, with most professional organizations taking a stance. The impact of violent incidence on the therapeutic environment and the cost in human terms led to the declaration by the World Health Organization that violence is a public health problem. There are strategies for reducing violence that flow out of known trends. We sought to examine the trends in institutional violence in a contextual sense. We reviewed the records of all incidents of violence, categorized by severity, victims and trends over five years in a multilevel secure forensic hospital in Canada. The rate of violence perpetrated by female patients was significantly higher than for male patients. Higher occurrence of violence was recorded in the winter months compared with any other season and was related to unstructured activities. There is a window of opportunity to develop some engaging programmes during the long winter months and improve supervision at all times of unstructured activity. The reasons for increased women perpetration and the winter peak of violence require further investigation.

A coercive interactional style as an antecedent to aggression in psychiatric patients.

As with society at large, violence in psychiatric settings is a serious clinical problem. Despite a great deal of attention, however, very little is currently known about the underlying theory or interventions to reduce aggression and violence in hospital settings. In this study, some psychiatric patients were viewed as having a general, aggressive, interactional style, motivated by the traits of Intimidation and Interpersonal Control, which when combined were labeled Coercion. A causal model in which violence and aggression were hypothesized to be predicted by a coercive interpersonal style and negatively predicted by an accommodating interpersonal style was tested. These interpersonal styles were proposed to mediate antecedent variables, that is, history of violence, psychiatric diagnoses, and length of hospitalization. Data were collected in two hospitals on psychiatric patients (N = 156) and analyzed using multiple regression techniques. The results of theoretical model testing suggested that 60% of the variance in Aggression was explained by four model variables: (a) Intimidation and Interpersonal Control (Coercion) (beta = .44), (b) Length of Hospitalization (beta = .26), (c) History of Violence (beta = .27), and (d) Bipolar Affective Syndrome (beta = .21). The implications for clinical care are discussed.