Workplace violence against emergency health care workers: What Strategies do Workers use?

Abstract

Background Workplace violence by patients and bystanders against health care workers, is a major problem, for workers, organizations, patients, and society. It is estimated to affect up to 95% of health care workers. Emergency health care workers experience very high levels of workplace violence, with one study finding that paramedics had nearly triple the odds of experiencing physical and verbal violence. Many interventions have been developed, ranging from zero-tolerance approaches to engaging with the violent perpetrator. Unfortunately, as a recent Cochrane review showed, there is no evidence that any of these interventions work in reducing or minimizing violence. To design better interventions to prevent and minimize workplace violence, more information is needed on those strategies emergency health care workers currently use to prevent or minimize violence. The objective of the study was to identify and discuss strategies used by prehospital emergency health care workers, in response to violence and aggression from patients and bystanders. Mapping the strategies used and their perceived usefulness will inform the development of tailored interventions to reduce the risk of serious harm to health care workers. In this study the following research questions were addressed: (1) What strategies do prehospital emergency health care workers utilize against workplace violence from patients or bystanders? (2) What is their experience with these strategies? Methods Five focus groups with paramedics and dispatchers were held at different urban and rural locations in Canada. The focus group responses were transcribed verbatim and analyzed using thematic analysis. Results It became apparent that emergency healthcare workers use a variety of strategies when dealing with violent patients or bystanders. Most strategies, other than generic de-escalation techniques, reflect a reliance on the systems the workers work with and within. Conclusion The study results support the move away from focusing on the individual worker, who is the victim, to a systems-based approach to help reduce and minimize violence against health care workers. For this to be effective, system-based strategies need to be implemented and supported in healthcare organizations and legitimized through professional bodies, unions, public policies, and regulations.

What are the reasons for unfinished nursing care as perceived by hospitalized patients? Findings from a qualitative study

“…(3) Having evidence on perceived reasons for UNC among patients might help to inform them regarding the actual causes thus preventing violence and aggressiveness towards nurses when they are not able to ensure the care required. 42 However, our study suggests that patients have some difficulties indicating and detecting the reasons for UNC: the interviews were very short in duration, thus indicating that participants were having difficulty in identifying the reasons for the phenomenon. Moreover, some of their perceptions seem to be experienced directly (e.g., overlapping activities), whereas others seem to be experienced indirectly (e.g., a large number of admissions), as reported by (a) the same nurses (e.g., nurse shortages, lack of nurses at the weekend, emergencies) while they try to excuse themselves for the UNC;…”

“… 41 Having evidence on perceived reasons for UNC among patients might help to inform them regarding the actual causes thus preventing violence and aggressiveness towards nurses when they are not able to ensure the care required. 42 …”

“…In the field of patient complaints, the contributory factors leading to problems in care have been neglected, thus focusing their involvement instead on the underlying reasons or causing factors 41 Having evidence on perceived reasons for UNC among patients might help to inform them regarding the actual causes thus preventing violence and aggressiveness towards nurses when they are not able to ensure the care required 42 …”

An Analysis of Drug Use-Related Curriculum Documents for Paramedic Students in British Columbia

“…The increasing incidence of violence against paramedics and occupational risks has been described as a serious public health problem [34][35][36][37]. While paramedic safety should take utmost priority, curriculum developers must be mindful of their choice of language, being careful not to use language that generalizes or makes assumptions about an entire patient demographic [38,39].…”

Without more acute care beds, hospitals are on their own to grapple with emergency department crises

“…17 Emergency department personnel cannot be expected to simultaneously provide life-saving care, de-escalate people who threaten harm and protect themselves. 18 By embedding dedicated and integrated security personnel and mental health clinicians who are trained in trauma-informed de-escalation strategies in the emergency department, 24 hours a day, hospitals could decrease violence, enable safer care provision and retain staff. 19 Deputy ministers and ministers of health should arrange a site visit to a Canadian emergency department on one of the last remaining evenings or weekends of the summer and hear firsthand experiences from emergency department patients and providers.…”