Identification of processes that mediate the impact of workplace violence on emergency department healthcare workers in the USA: results from a qualitative study

Abstract

ObjectivesViolence towards emergency department healthcare workers is pervasive and directly linked to provider wellness, productivity and job satisfaction. This qualitative study aimed to identify the cognitive and behavioural processes impacted by workplace violence to further understand why workplace violence has a variable impact on individual healthcare workers.DesignQualitative interview study using a phenomenological approach to initial content analysis and secondary thematic analysis.SettingThree different emergency departments.ParticipantsWe recruited 23 emergency department healthcare workers who experienced a workplace violence event to participate in an interview conducted within 24 hours of the event. Participants included nurses (n=9; 39%), medical assistants (n=5; 22%), security guards (n=5; 22%), attending physicians (n=2; 9%), advanced practitioners (n=1; 4%) and social workers (n=1; 4%).ResultsFive themes emerged from the data. The first two supported existing reports that workplace violence in healthcare is pervasive and contributes to burn-out in healthcare. Three novel themes emerged from the data related to the objectives of this study: (1) variability in primary cognitive appraisals of workplace violence, (2) variability in secondary cognitive appraisals of workplace violence and (3) reported use of both avoidant and approach coping mechanisms.ConclusionHealthcare workers identified workplace violence as pervasive. Variability in reported cognitive appraisal and coping strategies may partially explain why workplace violence negatively impacts some healthcare workers more than others. These cognitive and behavioural processes could serve as targets for decreasing the negative effect of workplace violence, thereby improving healthcare worker well-being. Further research is needed to develop interventions that mitigate the negative impact of workplace violence.

I do not even tell my partner: Nurses’ perceptions of verbal and physical violence against nurses working in a regional hospital

“…The frequency and severity of workplace violence found in this study are consistent with previous studies conducted in Englishspeaking countries such as the USA (Vrablik et al, 2019;Wong, Combellick, Wispelwey, Squires, & Gang, 2017), Ireland (Ryan & Maguire, 2006), UK (Ferns & Meerabeau, 2009) and Australia (Hegney et al, 2010;Hyland, Watts, & Fry, 2016;Pich et al, 2011;Roche et al, 2010). In these countries, physical violence was mainly perpetrated by patients rather than hospital visitors of family and friends.…”

A qualitative system dynamics model for effects of workplace violence and clinician burnout on agitation management in the emergency department

“…One member of the research team trained in qualitative SD modeling techniques (RH) conducted the modeling sessions while a second team member (NSS) wrote detailed field notes on a laptop computer and obtained still photographs of cognitive artifacts such as care timelines and diagrams drawn by hand during each session. We incorporated two datasets from our previously published findings on systems approaches to agitation and workplace violence [ 14 , 15 , 32 ] as well as current literature regarding burnout as a result of workplace violence [ 9 , 17 , 18 , 33 ], identifying interpersonal and psychological factors like mutual trust, perceptions of safety, and perceptions of team leadership that are likely to influence our outcomes of interest in measurable ways. All field notes and artifacts were entered into Microsoft Word (Microsoft Corporation, Redmond, WA) for coding and analyses.…”

A System Dynamics Model for Effects of Workplace Violence and Clinician Burnout on Agitation Management in the Emergency Department

“…Each structured session consisted of variable elicitation, derivation of behavior-over-time graphs, and illustration of variable connections via closed-loop diagrams. We incorporated two datasets from our previously published findings on systems approaches to agitation and workplace violence 14,15,33 as well as current literature regarding burnout as a result of workplace violence, 9,17,34,35 identifying interpersonal and psychological factors like mutual trust, perceptions of safety, and perceptions of team leadership that are likely to influence our outcomes of interest in measurable ways. We analyzed and interpreted data using principles of grounded theory in qualitative research.…”

“…16.21258632 doi: medRxiv preprint Recent studies demonstrated strong associations between ED clinicians' experiences of WPV and symptoms of burnout. 16,17 ED clinicians are particularly affected due to increased treatment of mental health conditions in emergency care and growing systems-level challenges, such as overcrowding and boarding of admitted patients. 18,19 As a result, increasing reports of burnout are appearing in the literature, ranging from 60 to 71% of respondents in survey-based studies with emergency physicians.…”