The Management of Workplace Violence against Healthcare Workers: A Multidisciplinary Team for Total Worker Health® Approach in a Hospital

Abstract

The risk of aggression against healthcare workers (HCWs) is a globally well-known topic. However, workplace violence (WV) is often considered as part of HCW’s job, leading to a general underreporting. This cross-sectional study aims at providing a descriptive analysis of aggressive acts against HCWs registered in a 34-month period in a pediatric hospital. According to a specific protocol, each aggressive act was analyzed by a multidisciplinary team using the “Modified Overt Aggression Scale” (MOAS), the “General Health Questionnaire-12” (GHQ-12), and the “Short Form-36 Health Survey” (SF-36) to build a report addressing improvement measures. A three-domain model of WV was also developed considering: (1) assaulted HCWs, (2) attacker-related issues, and (3) environmental context. Contributing factors to overt aggression were outlined and tested using univariate analyses. Statistically significant factors were then included in a multiple linear regression model. A total of 82 aggressive acts were registered in the period. MOAS scores registered a mean value of 3.71 (SD: 4.09). Verbal abuse was the most common form of WV. HCWs professional category, minor psychiatric disorder, emotional role limitation, type of containment used, and emotion intensity were significantly associated with overt aggression (p < 0.05), as well as the attacker’s role in the hospital (p < 0.05). The multiple regression analysis confirmed these findings (p < 0.001). Raising awareness on the aggression risk and contributing factors may lead to a relevant improvement of workplace environment, individual workers’ health, and organizational well-being.

Prevalence and Determinants of Workplace Violence Against Pediatric Emergency Healthcare Workers and Its Effect on Their Psychological Resilience

“…Similar studies in the literature have reported high levels of WPV among healthcare workers. 4,21 In a similar study in Turkey, it was determined that nurses working in the pediatric emergency department were exposed to WPV due to reasons such as crowded emergency departments, heavy workload, unmet expectations and concerns of parents, and intervention in medical procedures like intravenous access. 22 In a children's hospital in China, 68.6% of healthcare workers experienced at least one WPV incident involving non-physical and/or physical violence in the past year, and emergency service workers were exposed to physical violence (69.6%) more than other services.…”

“…Likewise, in similar studies, most of the physical and verbal abusers in pediatric healthcare workers were the caregivers/relatives of the patients. 4,5,36 Gillespie argues that all patients and their relatives should be treated as if they tend to commit violence. Employers should be aware of the impact of violence on employee and patient care and how essential it is to seek help when violence occurs and take measures to prevent violence.…”

“…The options of the scale are as follows: "Not at all appropriate" (1), "Not appropriate" (2), "Somewhat appropriate" (3), "Appropriate" (4), and "Fully appropriate" (5). The scale has reverse-coded items (2,4,6). As the total score obtained from the scale decreases, it indicates a low level of psychological resilience.…”

“…3 The most important risk factors for perpetrators of violence are personality and mental health problems. 4 Inappropriate working conditions, insufficient number of employees, and long working hours are risk factors for healthcare workers. 5,6 Workplace-related factors include wait times, excessive patient numbers, lack of security measures, and lack of violence prevention policies.…”

“…6,13 Violence against emergency department healthcare workers is mostly committed by patients and their relatives. 4 WPV is an increasing concern, according to research, and the emergency room is one of the most prevalent places for WPV to appear. 5,14,15 WPV affects the psychological (e.g., anger, anxiety, and depression) and physical health (e.g., injury, permanent disability, or in some cases death) of workers.…”