Factors associated with Workplace Violence

Healthcare workers are exposed to a variety of factors that increase their risk for physical and verbal workplace violence from patients and visitors. The National Institute for Occupational Safety and Health (31) reported several risk factors, including working with the public, handling

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money, transporting or delivering passengers or items, working with people who are more likely to be violent, working in the community setting or high crime areas, working during nighttime or early morning hours, guarding valuables, and working alone. These factors which can be associated with the perpetrator, worker, and setting/ environment are described below.

Regarding the perpetrators, mental health disorders such as dementia, schizophrenia, anxiety, acute stress reaction, suicidal ideation, and alcohol and drug intoxication have often been identified in people who have committed workplace violence (10-13, 29, 97). A study revealed that organic mental disorders notably dementia accounts for 87% of physical assaults on nursing home assistants (11). This was further supported by another study which revealed that dementia was linked to 11% of violent events while other psychiatric diseases were linked to another 25%

(6). However, it has been suggested that the perceived relationship between dementia and workplace violence in nursing homes such as that reported by Gates and his colleagues (11) could have resulted from the fact that a large proportion of the residents had dementia.

Another leading perpetrator-related factor for verbal or physical violence is the influence of drugs or alcohol (4, 10, 12, 13, 94, 97-102). A study revealed that 35% of healthcare workers believed that the violent perpetrator was under the influence of drugs or alcohol before the violent event (55) while another study indicated that participants believed that perpetrators were under the influence of drugs or alcohol in 50% of all verbally violent events and in 96% of all physically violent events (98). The study conducted by Azodo et al in Nigeria revealed that alcohol intoxication accounted for 9.1% of the violence (29).

Patients’ and visitors’ inability to deal with a crisis situation is another perpetrator risk factor for workplace violence (10, 12, 13). For example, the stress experienced during an emergency department (ED) visit may create a crisis during which patients or visitors are no longer able to deal with a situation as they normally would (103). This stress may increase verbal or physical

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violence. Crises can occur when there are disagreements with the medical plan, denials of a service or request, conflicts with healthcare workers, excessive waiting times for assessments and interventions, inability to focus beyond oneself, perceptions that a healthcare worker is rude or uncaring, grief over the death of a child, and inability to change a healthcare outcome (12, 95, 97, 100, 102, 104, 105).

Furthermore, some studies have also revealed that the gender and age of a perpetrator were risk factors for violence against healthcare workers (88). Researchers found that the majority of verbally violent perpetrators were men in 73% of cases and between the ages of 35-65 in 54%.

Physical violence was most often enacted by men (59%) and persons 66 years or older (64%).

Children 17 years and younger represented the smallest group of perpetrators; 5.3% for physical violence and 5.7% for verbal violence. The occurrence of violence from children is minimal compared to adult perpetrators, but it is important to note that they also perpetrate violence.

The presence of weapons on patients has also been associated with an increase in the risk of violence to workers. A study by Peek-Asa et al. (2002) noted that in 2000, patients were more likely to carry guns and knives when being treated in the healthcare setting than in 1990 (106).

Another author also reported that 11% of perpetrators used a weapon during the commission of violent events against healthcare workers (55).

Certain characteristics, including the worker’s gender, age, years of experience, hours worked, marital status, and previous workplace violence training have been found to increase the risk of workers being targets of workplace violence in the healthcare setting.

Contradictory evidence about whether a worker’s gender poses a risk for being verbally or physically assaulted by patients and visitors exists. Most researchers reported that men experienced workplace violence significantly more often than women (89, 107-109). However, another study identified more women as victims of verbal and physical violence compared with

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men (82), although the difference was reported not to be significant. Some other authors reported that the gender of clinical and nonclinical mental health workers did not significantly affect the number of verbally or physically violent events they endured (75). This is similar to what was found in some Nigerian studies (28, 29). However, a greater percentage of female physicians have been found to report a fear of future violence compared with male physicians (110). Previous observations regarding gender have therefore been inconsistent.

Healthcare workers younger than 40 years old were most frequently the victims of violent events (82, 94). This may be as a result of older worker being more adaptable, patient, and empathetic and moving more slowly during interactions with their patients (111). Contrary to this observation, a study provided evidence that nurses reporting physical violence were significantly older than nurses who denied an event of physical violence (95). No relationship was found between age and the occurrence of violence among Hispanic nurses (107). The differing observations may partly be accounted for by methodological differences. While some studies reported observations based on lifetime incidence, other reported findings based on observations over a 12-month period. The lifetime incidence of violence will generally be greater for older workers as compared with younger workers because the accumulative number of violent events will increase as each year passes. In contrast, when studying the number of violent events during a 12-month period, the number of violent events per person per year will likely be less for older workers (1).

Another healthcare worker characteristics associated with an increased risk of workplace violence includes the number of hours worked per week. A study from the United States reported that part-time employees experienced reduced risk of physical assault compared with full-part-time employees (109). However, a study from Australia reported that part-time employees experienced a significant increase in violent events from 2001 to 2004 (92).

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Marital status has also been reported to be associated with the risk of workplace violence. Studies have previously reported that unmarried workers were significantly more likely to experience workplace violence compared with married workers (9, 102), probably due to married workers being accustomed to working with others toward a mutual understanding or agreement.

Previous observations regarding the effect of violence-prevention training on workplace violence are largely contradictory. One group of researchers found that participants who had not attended violence-prevention training were at greater risk for workplace violence than workers who did attend training (95). However, another group of researchers reported that violence training increased the likelihood of being a victim of physical violence (112). Four possible reasons have been put forward for the contradictions. First, workplace violence-prevention training may only be provided in settings in which violence is more common (113). Second, the training may increase awareness of the need to report violent events (113). Third, victims of violence may be more likely to recall previous training (113) and fourth, workers who receive violence-prevention training may be more likely to intervene during violent events, whereas their untrained counterparts may be more likely to remain passive (112). A study in Nigeria did not however identify any difference in the reported violence between those who had attended violence training and those who had not (28).

Certain environmental factors that have been shown to reduce the risk of physical assault against healthcare professionals include controlled access to patient areas, reduced waiting times, security personnel presence, and escorting workers to their vehicles (10, 12, 88, 98, 112, 113).

There is an evidence that the likelihood of a health worker being physically assaulted at work was reduced when there was presence of security personnel, video monitors were used, and organizational policies that addressed assault prevention are put in place (82, 113). In contrast, some authors have ascertained that health workers’ risks for experiencing physical assault were

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actually increased when employers used video monitors, metal detectors, or panic buttons (88).

They did not, however, provide an explanation for this finding, but it may be the result of an increased awareness of violence leading to increased reporting or an increase in employer efforts to make environmental changes for improved worker safety in response to violent events.

Other researchers have identified that violence is more likely to occur during certain times of the day. Up to 70% of violent events was found to take place between 4 pm and 8 am in a study (95), which was supported by some other researchers (12, 13, 98). Increased rates of violence during evening and nighttime hours may be attributed to the types and conditions of patients who seek treatment during later hours, such as patients who are intoxicated and injured due to violence. In long-term care setting, violent events were most likely to occur during daytime and evening hours with few events occurring during nighttime hours (105, 114). This difference may be due to the setting. Long-term care patients who are aggressive may be asleep during nighttime hours and, therefore, unable to enact violence against others.

In document Physical Violence (Page 31-36)