BackgroundAlthough international scientific research on health issues has been dealing with the problem of aggression and violence towards those employed in health care, research activities in Germany are still at an early stage. In view of this, the aim of this study was to examine the frequency and consequences of aggressive behaviour towards nurses and health care workers in different health sectors in Germany and to assess the need for preventive measures.MethodsWe conducted a cross-sectional retrospective survey. Nurses and health care workers from two nursing homes, a psychiatric clinic and a workshop for people with disabilities were interviewed using a standardised questionnaire. The sample covered 123 individuals (response rate 38.8%). The survey assessed the frequency, the type and the consequences of aggressive behaviour, and social support in connection with coping with aggression in the workplace. Odds ratios (OR) and 95% confidence intervals (CI) for putative risk factors which may influence the stress induced by aggression at the workplace were calculated using conditional logistic regression.ResultsDuring the previous twelve months 70.7% of the respondents experienced physical and 89.4% verbal aggression. Physical aggression more frequently occurred in nursing homes (83.9% of the employees) and verbal aggression was more common in the psychiatric clinic (96.7% of the employees). The proportion of the individuals affected in the workshop for people with disabilities was lower (41.9% and 77.4% respectively). The incidents impaired the physical (55%) and emotional well-being (77.2%) of the employees. The frequency of incidents (weekly: OR 2.7; 95% CI 1.1-6.4) combined with the lack of social support (OR 2.8; 95% CI 1.2-6.6) increased the probability of higher stress due to aggression.ConclusionsThis study corroborates previous reports of frequent physical and verbal aggression towards care workers in the various areas of health care. The present study highlights differences between various areas of health care in Germany and the aggravating effect of prevention neglect such as missing social support at the workplace. Therefore our data suggest the need for improved target group specific prevention of aggressive incidents towards care workers and the need for effective aftercare in Germany.

ObjectivesIn this study, the frequency and consequences of aggressive assaults on employees in the German healthcare and welfare system were investigated.DesignA retrospective cross-sectional study.SettingEmployees in the German healthcare system and their experiences of violence and aggression were examined in this study.ParticipantsThe sample consisted of 1973 employees from 39 facilities (6 facilities for the disabled, 6 hospitals and 27 outpatient and inpatient geriatric care facilities) who have regular contact with patients or clients.Main outcome measuresThe frequency of physical and verbal violence towards employees and the consequences of aggressive assaults were analysed.Results56% of respondents had experienced physical violence and 78% verbal aggression. The highest frequency of physical violence was in inpatient geriatric care (63%) (p=0.000). Younger workers run a higher risk of being affected by physical violence than older colleagues (OR 1.8, 95% CI 1.3 to 2.4). There is also an increased risk of experiencing physical violence in inpatient geriatric care (OR 1.6, 95% CI 1.2 to 2.0). Around a third of workers feel seriously stressed by the violence experienced. The better the facility trained employees for dealing with aggressive and violent clients, the less risk employees ran of experiencing either verbal aggression (OR 0.5, 95% CI 0.4 to 0.7) or physical violence (OR 0.7, 95% CI 0.6 to 0.9). Training by the facility has a positive effect on experienced stress (OR 0.6, 95% CI 0.4 to 0.8).ConclusionsViolence towards nursing and healthcare personnel occurs frequently. Every third respondent feels severely stressed by violence and aggression. Occupational support provisions to prevent and provide aftercare for cases of violence and aggression reduce the risk of incidents and of perceived stress. Research is needed on occupational support provisions that reduce the risk of staff experiencing verbal and physical violence and the stress that is associated with it.

For many people working in the care sector, aggression and violence are part of their everyday working life. In order to obtain an overview of the occurrence of violence and aggression in care-related jobs, the current literature on this topic has been analysed. Most published studies are in English and refer to psychiatric facilities. There are fewer analyses of facilities that provide care for the elderly, and facilities that look after people with disabilities have been analysed even less frequently. The German as well as the English literature provides no clues as to the valid prevalence rates in the various fields of the health sector. It is particularly difficult to comment on the prevalence rates because different tools have been used to collect the information. In addition, the definitions of violence and aggression used differ from study to study. In the present article, we introduce fourteen tools that have been developed to record aggressive behaviour towards others. The choice of the tools should be based on the choice of the target group. There are hints indicating that the Staff Observation Aggression Scale-Revised (SOAS-R) is the most suitable tool to record aggressive behaviour prospectively across all fields in the health care sector.