Sources of Conflict and Prevention Proposals in User Violence Toward Primary Care Staff: A Qualitative Study of the Perception of Professionals

Abstract

BackgroundSome studies indicate that at least one in four cases of workplace violence occurs in the health sector, with a higher incidence in Emergency Departments, Mental Health Services or Primary Care. Unlike other professional groups, healthcare workers perceive this type of behavior mainly from users or patients. This is the reason why both the detection of conflict between users and professionals and the ways to face and reduce these conflicts has been and is one of the main fields of study in this population. The aim of this study was to delve into the sources of conflict between users and professionals in Primary Care from the perspective of the professionals themselves. In addition, the aim was to explore the proposals for intervention/prevention of this conflict that the professionals perceived as necessary to improve the work environment.MethodsThis study uses qualitative methodology conducting 8 focus groups with professionals related to Primary Health Care. The final sample was composed of 44 workers who were part of the regional management, labor unions, area coordinators, center coordinators and representatives of the professional groups of these centers (medicine, nursing and administration). Thematic analysis was used to extract topics and subtopics.ResultsThe results are divided into areas of conflict and intervention proposals. The professionals detect a lack of training or education in themselves, absence of functional multidisciplinary teams or competencies to improve the patient-professional relationship, among others. To address these shortcomings, they propose the creation of protocols for action in the face of aggression, the formation of spaces and channels of communication both among the center's own workers and between them and other organizations (e.g., hospitals), fostering a positive relationship with the user community and ongoing training in various topics such as self-safety, management of emotions, empathy or interpersonal communication.ConclusionsThis study allows to highlight specific areas of user-professional conflict in Primary Care. Furthermore, the inclusion of intervention proposals by the professionals allows to propose starting points for the development of complete plans.

Patient aggression towards receptionists in general practice: a systematic review

“…The types and rates of aggressive acts were retrospectively self-reported with only ethnographic qualitative studies using direct observations 7 15–17. Impacts were reported in a variety of ways, including the use of psychometric measures18–20 and qualitative impact statements 4 7 21–25. The majority of studies, especially in the early years, originated from the United Kingdom,4 7 17 18 22 26–31 four were from Australia,8 21 24 32 two from Spain,19 23 two from the USA15 16 and one from Ireland 33.…”

“…Impacts were reported in a variety of ways, including the use of psychometric measures18–20 and qualitative impact statements 4 7 21–25. The majority of studies, especially in the early years, originated from the United Kingdom,4 7 17 18 22 26–31 four were from Australia,8 21 24 32 two from Spain,19 23 two from the USA15 16 and one from Ireland 33. The direct ‘voice’ of the general practice receptionist was exclusively represented in eight studies, either via interviews or as a survey participant 7 15 17 18 27 30 32 33.…”

“…The direct ‘voice’ of the general practice receptionist was exclusively represented in eight studies, either via interviews or as a survey participant 7 15 17 18 27 30 32 33. The remainder of receptionists' experiences were reported by or aggregated with those of patients, administrators, managers, directors or doctors of the practice 4 8 16 19 21 23 24 26 28 29 31. Overall, 882 (21.5%) of the 4107 participants in the studies reviewed were or had recently been general practice receptionists.…”

“…The impact of patient aggression towards receptionists’ well-being was reported in 12 studies4 7 8 15–19 22 23 29 32 and operational impacts were described in five studies 8 21 24 32 33. Despite usually maintaining external composure during the incident, reception staff reported universally negative impacts, with patient aggression reported as the most difficult part of general practice reception work,15 making the role emotionally laborious 7 16.…”

“…Over the longer term, being directly and indirectly exposed to repeated patient aggression was reported to lead to burnout and fatigue,23 24 feelings of being inferior and peripheral,15 self-blame,29 32 low self-worth,19 32 requiring professional counselling support,8 18 33 disengagement from the work role,32 discomfort with the gatekeeping role4 and feeling desensitised to aggression 19 29. Receptionists in multiple studies had concerns about receiving and managing future aggression and hostility from patients,4 18 32 and felt psychologically under-prepared and unprotected 18 23. To further compound receptionists’ exposure to aggression and hostility, doctors were reported to also react poorly at times to requests from receptionists, such as undertaking a task or clarifying a message 15 17 22.…”