title: Impacts of users' antisocial behaviors in an ophthalmologic emergency department--a qualitative study.
abstract: BACKGROUND
  Health-care workers in emergency departments are frequently exposed to risk of antisocial behavior and violence (ABV) by users. Underreporting of ABV by health-care professionals has been identified. In order to understand this phenomenon, we explored the experience of ABV in 30 health workers in an ophthalmology emergency department in the Rhône-Alpes administrative region of France.
  
  
  METHODS
  A grounded theory qualitative approach was followed. Data were collected from field observations, 30 semistructured individual interviews, violence report forms, and 364 patient satisfaction questionnaires. Qualitative thematic content analysis of the interviews was performed with qualitative data analysis software.
  
  
  RESULTS
  Third-party antisocial behaviors and violence were an everyday occurrence, with varying levels of seriousness: impoliteness, vulgarity, nonrecognition, insults, verbal threats, and aggressive gestures. Health-care workers adopted various strategies to adapt to such violence: proactive and reactive attitudes and avoidance. Several organizational factors concerning the political and economic context, hospital work organization, and health workers' behavior were identified as potentially contributing to ABV. Excessive waiting times, lack of user information, and understaffing emerged as factors contributing to users' ABV.
  
  
  CONCLUSIONS
  Antisocial behaviors by hospital users are underreported by professionals and under-recognized. They appear to be like continuous occupational exposure leading to delayed adverse consequences either on workers' health or motivation. However, violence in hospitals is not the result of only the action of users, and it may be related to work organization and workers' own behaviors. Only a grounded analysis of the causes of violence in the local work context can uncover relevant solutions.
authors.affiliation: UMR T 9405 (Unité Mixte de Recherche Epidémiologique et de Surveillance Transport Travail. Environnement: UMRESTTE), Université Claude Bernard Lyon 1.
authors.forename: Constance
authors.initials: C
authors.lastname: d'Aubarede
authors.forename: Philippe
authors.initials: P
authors.lastname: Sarnin
authors.forename: Pierre-Loïc
authors.initials: PL
authors.lastname: Cornut
authors.forename: Sandrine
authors.initials: S
authors.lastname: Touzet
authors.forename: Antoine
authors.initials: A
authors.lastname: Duclos
authors.forename: Carole
authors.initials: C
authors.lastname: Burillon
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Fassier
mesh_terms: D000223:Adaptation, Psychological; D000374:Aggression / Q000523:psychology; D000987:Antisocial Personality Disorder / Q000523:psychology*; D001291:Attitude of Health Personnel; D004636:Emergency Service, Hospital; D000069581:Exposure to Violence / Q000523:psychology; D005602:France; D066296:Grounded Theory; D006282:Health Personnel / Q000523:psychology*; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D016273:Occupational Exposure / Q000706:statistics & numerical data; D009885:Ophthalmology; D011369:Professional-Patient Relations; D036301:Qualitative Research; D017132:Workplace / Q000523:psychology*; D064450:Workplace Violence / Q000523:psychology*