Impacts of users’ antisocial behaviors in an ophthalmologic emergency department—a qualitative study

Abstract

avoidance. Several organizational factors concerning the political and economic context, hospital work organization, and health workers' behavior were identified as potentially contributing to ABV. Excessive waiting times, lack of user information, and understaffing emerged as factors contributing to users' ABV. Conclusions: Antisocial behaviors by hospital users are underreported by professionals and under-recognized. They appear to be like continuous occupational exposure leading to delayed adverse consequences either on workers' health or motivation. However, violence in hospitals is not the result of only the action of users, and it may be related to work organization and workers' own behaviors. Only a grounded analysis of the causes of violence in the local work context can uncover relevant solutions. (J Occup Health 2016; 58: 96−106) Key words: Antisocial behavior, France, Grounded theory, Health-care workers, Hospitals, Occupational hazards, Qualitative research, Workplace violence "Third-party violence" in the workplace is a term used to refer to threats and physical and psychological violence (e.g., verbal violence) by third parties such as customers, clients, or patients receiving goods or services 1) . Possible consequences for individual workers, teams, and organizations include impaired psychological well-being, mental and physical illness, absenteeism, impaired performance, and higher turnover 2,3) . Initiatives to address workplace violence come in at the political level (regulations, agreements, guidelines), organizational level (corporate policies, workplace risk assessment, and control), and the level of the individual worker (training, case management, and support). Health-care workers in emergency departments are frequently exposed to risk of antisocial behavior and violence (ABV) by users. Underreporting of ABV by health-care professionals has been identified. In order to understand this phenomenon, we explored the experience of ABV in 30 health workers in an ophthalmology emergency department in the Rhône-Alpes administrative region of France. Methods: A grounded theory qualitative approach was followed. Data were collected from field observations, 30 semistructured individual interviews, violence report forms, and 364 patient satisfaction questionnaires. Qualitative thematic content analysis of the interviews was performed with qualitative data analysis software. Results: Third-party antisocial behaviors and violence were an everyday occurrence, with varying levels of seriousness: impoliteness, vulgarity, nonrecognition, insults, verbal threats, and aggressive gestures. Healthcare workers adopted various strategies to adapt to such violence: proactive and reactive attitudes and

A qualitative meta-synthesis of emergency department staff experiences of violence and aggression

“…Cultural narratives, such as taking a 'stoic' stance to aggression appeared to influence staff in the Singapore study, and in one UK study 'every member of staff spoke of their commitment to working in the ED despite the aggressive incidents' [29]. However, on occasion, staff appeared to struggle to cope with violence and aggression, with some being unable to maintain their professionalism [33], and other staff appearing to minimise or attempt to forget episodes "You have to forget or you won't cope" [33]. Informal debriefing with colleagues was also used to cope with incidents which brought a sense of belonging "Outside the department no one seems to understand what it's really like but your colleagues do" [31].…”

“…Other staff reported psychological 'pain' described as "wounds" or 'wounded professionalism' related to particularly difficult incidents [33]. One staff member eloquently shared the long-term impact of violence and aggression:…”

Erfahrungen von Aggression und Gewalt gegen Augenärztinnen und Augenärzte

“…Als Gründe, die zu Aggressionen/Gewalt führten, wurden lange Wartezeiten, fehlende Patienteninformationen sowie Unterbesetzung genannt. Die Befragten waren sogar der Ansicht, dass das permanente Unterbrechen der Arbeit durch Patientenbeschwerden belastender sei als tatsächliche Gewalt [8].…”

“…Die Augenärzte sind in dieser Umfrage der Meinung, dass das nichtärztliche Personal mehr Aggressionen/Gewalt als Ärzte ausgesetzt sei. Dies war auch die Einschätzung in der Studie von d' Aubarede et al [8]. Eine Umfrage unter dem nichtärztlichen Personal in der Augenheilkunde mag daher ebenfalls empfohlen sein.…”

Emergency Medicine: Problems of Violence and Safety at Work

“…Ultimately, this leads to formation of burnout syndrome with the development of specific psychopathological and psychosomatic symptoms and signs of social dysfunction. Emotional burnout affects performance in the workplace and professional longevity, increases the risk of medical errors [1,2,3].…”