Violence against emergency healthcare workers: different perpetrators, different approaches

Abstract

Purpose This study aims to investigate whether emergency health-care workers distinguish between different categories of perpetrators of violence and how they respond to different types of perpetrator profiles. Design/methodology/approach Five focus groups with emergency health-care workers were held in Canada. The participants were asked whether they identified different groups of perpetrators of violence and how that impacted their approach. The focus group responses were transcribed verbatim and analysed thematically using a phenomenological approach. Findings Participants consistently identified five groups of perpetrators and tailored their approach on their assessment of the type of perpetrator involved. The five categories are: violence or aggressive behaviour from family members or bystander and violence related to; underlying mental health/illness issues; underlying physical health issues; addiction and substance use; and repeat visitors/offenders. Violence with an underlying (mental) health cause was handled professionally and compassionately by the health-care workers, while less patience and understanding was afforded in those instances where violence was associated with (recreational) alcohol or illicit substance use. Originality/value Emergency health-care workers can consistently distinguish between types of perpetrators of violence and aggression, which they then use as one factor in the clinical and situational assessments that inform their overall approach to the management incidents. This conclusion supports the need to move the focus away from the worker to the perpetrator and to an organisational rather than individual approach to help minimise violence against emergency health-care workers.

Patient and visitor verbal aggression toward frontline health-care workers: a qualitative study of experiences and potential solutions

“…HCWs in this study responded differently given the source of verbal aggression, indicating both understanding and lack of tolerance. This is similar to research done with paramedics who categorized reasons for aggression among patients, accepting some, such as dementia, and rejecting others, including substance abuse (Spelten et al , 2022). Further, participants pointed to COVID-related frustrations increasing the frequency of verbal aggression both in-person and by phone.…”

“…Interestingly, some also indicated use of crisis management skills, indicating the value of training. This finding is similar to that of Spelten et al (2022), who reported paramedics believed their training helped them with de-escalation but differs from the work of Child and Sussman (2017), where emergency nurses questioned the efficacy of mandatory behavior modification courses.…”

“…Future research should be conducted with a larger group of HCWs from different organizations and explore ways to reduce the tendency to normalize aggression as part of the work. Furthering research conducted by Spelten et al (2022) to move away from training and interventions that use a “one-size-fits-all approach” (pg. 129) would be useful to develop interventions that are tailored to address different types of perpetrators.…”

Prevalence and Characteristics of Violence against Paramedics in a Single Canadian Site

“…Finally, our findings raise important questions about how society should respond to acts of violence perpetrated against paramedics and other healthcare providers or first responders. Although the paramedic context may be more amenable to measurement, the issue of violence in healthcare settings is in no way unique to paramedicine [39,40]. There have been calls from professional associations representing physicians [41], nurses [42], and other healthcare professionals to address growing reports of hostility toward healthcare providers during the COVID-19 pandemic [43].…”

Balancing structure and flexibility in the ambulance service: the pursuit of professional judgement in caring and learning

“…They also worry about specific emergency situations arising, e.g., assignments concerning children, lack of support from the colleague, and situations concerning threats and violence which they are unable to control [44,47]. Care situations where AS professionals are exposed to threats and violence are a growing concern [48] associated with varying patient encounters and situations [49].…”