Emergency primary care personnel’s perception of professional-patient interaction in aggressive incidents -- a qualitative study

Abstract

BackgroundIncidents of aggression and violence from patients and visitors occur in emergency primary care. Most previous studies have focused on risk factors such as characteristics of patient, health personnel or situation. This study aimed to explore professional-patient interaction in aggressive situations.MethodsA focus group study with eight focus groups was performed, including a total of 37 nurses and physicians aged 25–69 years. The participants were invited to talk about their experiences of violence in emergency primary care. Analysis was conducted by systematic text condensation. Results were then illuminated by Honneth’s theory The Struggle for Recognition.ResultsWe identified three main themes regarding the interaction between health personnel and patients or visitors in aggressive situations: (1) unmet needs, (2) involuntary assessment, and (3) unsolicited touch. In all interactions the aggressive behaviour could be understood as a struggle for recognition.ConclusionsAggression is more likely to arise in situations where the patients’ needs or personal borders are invalidated. The struggle for personal recognition during the interaction between patient and health professionals should be addressed in health professionals’ education. This knowledge might increase their awareness and help them to react in a more expedient manner.

Characteristics of aggressive incidents in emergency primary health care described by the Staff Observation Aggression Scale – Revised Emergency (SOAS-RE)

“…Nearly all reported aggressive incidents with involuntary assessment as the provoking factor included physical aggression. This confirms previous qualitative findings that have identified involuntary assessment of the patients as a high-risk situation for workplace violence [16]. Involuntary assessment must therefore be recognised as a risk situation were the likelihood for physical aggression is high, and awareness of this risk situation should be in focus as part of the safety training of health care personnel.…”

“…Next of kin, however, might also be aggressors. Qualitative research has shown that unmet needs might lead to frustrations, fear, and aggression in both patients and relatives [16]. Expectations and unmet needs might be related to a mismatch between the patient's expectations and the services offered at emergency primary health care.…”

The Staff Observation Aggression Scale – Revised (SOAS-R) – adjustment and validation for emergency primary health care

“…New options were added in each of the existing columns and an additional column was added based on findings from qualitative studies on factors influencing workplace violence in emergency primary health care [ 17 , 18 ]. In column 1 (Provocation of aggressive behaviour), the new options “the person had to wait”, “the person disagreed about assessment/advice” and “involuntary assessment of health condition” were added.…”

Reconhecimento Em Axel Honneth: Contribuições À Pesquisa Em Saúde

“…This theoretical framework has been explored in the area of health, 7 above all for discussing healthcare, [8][9][10][11][12][13][14] its policies 13 and the experiences of health workers. 15 The above-mentioned studies make frequent reference to the issue of recognition and the process of self-realization, in constant transformation, which drives issues of autonomy, self-esteem and equality, with a view to the notion of democracy in contexts marked by inequalities.…”