title: Understanding patient-to-worker violence in hospitals: a qualitative analysis of documented incident reports.
abstract: OBJECTIVE
  To explore catalysts to, and circumstances surrounding, patient-to-worker violent incidents recorded by employees in a hospital system database.
  
  
  BACKGROUND
  Violence by patients towards healthcare workers (Type II workplace violence) is a significant occupational hazard in hospitals worldwide. Studies to date have failed to investigate its root causes due to a lack of empirical research based on documented episodes of patient violence.
  
  
  METHODS
  Qualitative content analysis.
  
  
  METHODS
  Content analysis was conducted on the total sample of 214 Type II incidents documented in 2011 by employees of an American hospital system with a centralized reporting system.
  
  
  RESULTS
  The majority of incidents were reported by nurses (39·8%), security staff (15·9%) and nurse assistants (14·4%). Three distinct themes were identified from the analysis: Patient Behaviour, Patient Care and Situational Events. Specific causes of violence related to Patient Behaviour were cognitive impairment and demanding to leave. Catalysts related to patient care were the use of needles, patient pain/discomfort and physical transfers of patients. Situational factors included the use/presence of restraints; transitions in the care process; intervening to protect patients and/or staff; and redirecting patients.
  
  
  CONCLUSIONS
  Identifying catalysts and situations involved in patient violence in hospitals informs administrators about potential targets for intervention. Hospital staff can be trained to recognize these specific risk factors for patient violence and can be educated in how to best mitigate or prevent the most common forms of violent behaviour. A social-ecological model can be adapted to the hospital setting as a framework for prevention of patient violence towards staff.
authors.affiliation: Wayne State University School of Medicine, Detroit, Michigan, USA; Uppsala University, Sweden.
authors.forename: Judith E
authors.initials: JE
authors.lastname: Arnetz
authors.forename: Lydia
authors.initials: L
authors.lastname: Hamblin
authors.forename: Lynnette
authors.initials: L
authors.lastname: Essenmacher
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Upfal
authors.forename: Joel
authors.initials: J
authors.lastname: Ager
authors.forename: Mark
authors.initials: M
authors.lastname: Luborsky
mesh_terms: D003695:Delivery of Health Care / Q000706:statistics & numerical data; D006760:Hospitalization; D006801:Humans; D007297:Inpatients / Q000523:psychology / Q000706:statistics & numerical data; D015146:Midwestern United States; D010564:Personnel, Hospital / Q000706:statistics & numerical data*; D011369:Professional-Patient Relations; D014754:Violence / Q000523:psychology / Q000706:statistics & numerical data*; D017132:Workplace / Q000706:statistics & numerical data
keywords: content analysis; healthcare workers; nursing; occupational health; work safety; workplace violence
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