Violence in emergency department

Against

It is the intentional use of POWER, threatened or actual, against another person or against a group in work-related circumstances results in or has a high degree of likelihood of resulting in psychological harm , injury, or death, .

J Interpers Violence OnlineFirst, published on June 3, 2009

AAWorkplace Violence

Any act or threat of physical violence Harassment

Intimidation

or other threatening and disruptive behavior at one’s place of employmen

Violence in the emergency

department (ED) is a significant

problem world wide

60% to 90%Stultz, 1996-97,Ondokuz Mayis University, Turkey

, Ondokuz Mayis University, Turkey

USABetween 1993 and 1999,

1.7 million violent workplace incidents were

recorded per year.

32% occur in the health care setting

surgical residents, of 334 attacks, the highest number events (173)

were reported to occur in the Emergency room.

Emergency departments are most problematic PLACE (Barlow & Rizzo, 1997).

•

Workplace violence is also occurring in

pediatric EDs. (Shaw, 2014).

Verbal Harassment

96.6% by patientS

86.6% by visitors

Physical violence

65.5%, by patient

11.8% by visitors

78.2% from a patient

55.5% by a visitor.

Verbal Threats

Threats

Sexual Harassment52.1% by a patient21.8% by a visitor

41.9% male 68.9% female

20.3% of the male 24.4% of the females

reporting

Affects nurses, physicians and workers

almost equally (Kowalenko, Hauff, Morden et al., 2012).harassed or assaulted in circumstances related to their Work, involving an explicit or implicit challenge to their safety, well-being or health(Norwegian Labour Inspection Authority, 2009).”

Frequency and severity of violence tend to

increase over time • (Fernandes, Bouthillette, Raboud et al., 1999).

51% of physicians reported being physically assaulted by a patient or visitor.4

20% of EDs, guns or knives are present daily or weekly,5

ED is the most frequent site for hospital

shootings

Touzet et al

(GET OUT)RUN

HIDE(LOCKDOWN)

FIGHT

Active Threat Response

Perceptions of health

professionals is an important

step towards minimizing this problem

EEGGIN ENGLAND

About half of the ED ( 50%) workers reported posttraumatic stress symptomatology. Workplace aggression affects mental health the workers (Gillespie, Bresler, Gates et al., 2013).

Psychological : bothersome memories, super-alertness and feelings of avoidance and futility(Zafar, Siddiqui, Ejaz et al., 2013I

ER VIOLENCE causes serious personal and professional sequalae (Bigham, Jensen, Tavares et al., 2014)

Most of the respondents experienced impaired job performance up-to 1 week after the incident.

73% expressed that they were Afraid of the

patients as a result of violence.

49% Hid their identities from the patients

74% had reduced job satisfaction.

Victims preferred to get support from their

colleagues rather than officials(Fernandes, Bouthillette, Raboud et al., 1999). I3% expressed that they were afraid of al., 1999).

United States USA STUDY 69 EDs

25% of staff felt unsafe in the ED.

Nurses were less likely to feel safe compared to other ED workers , (Kansagra, Rao, Sullivan et al., 2008).

Violence and weapons were common in the EDs and attacks towards staff occurred

No significanct differences were present between nurses, physicians and workers with regard to severity scores of sexual or physical violence (Kowalenko, Hauff, Morden et al., 2012).

Some hospital A & E departments have

been described as "war zones" on a

typical Friday or Saturday night.

Staff report having knives pulled on them and being punched, kicked and spat at

1988 USA STUDY 127 EDs

7% OF HOPITALS REPORTED violent death

80 % OF HOPITALS REPORTED INJURIED STAFF

Almost all residents

(96.6%) of residents :verbal harassment.

78% of residents : verbal threats FROM

PATIENTS.

55.5% verbal threats from a visitor.

65.5% of emergency medicine residents

surveyed reported having at least one

experience of physical violence committed

by a patient.

Health unions and patients' groups branded the

figures "shameful".Shadow Health Minister Mike Penning said the figures showed the Government's promises to tackle violence within the health service to be

"worthless".several murders and rapes at hospitals in

2006 and 2007

Italy

, it was reported that WPV was a Hidden fact and

there was a lack of policies for prevention. It was also found that

employees who experienced verbal violence had lack of perceived organizational justice and social

Support. (Magnavita & Heponiemi, 2012).

Pakistan revealed that the most common type attack in the EDs in this country was also verbal abuse. A different result of this study was

that 26.9% of these incidents involved a Weapon (Zafar, Siddiqui, Ejaz et al., 2013 ).

In Canadamost paramedics experience violence in the form of verbal abuse (Bigham, Jensen, Tavares et al., 2014).

In Australia

it has been reported that violent and aggressive behavior towards

healthcare providers widely occurred (Stanley & Goddard, 2002).

a study revealed that paramedics who are an important part of emergency settings in Australia, commonly experienced WPV,

predominantly in the form of verbal abuse.

it was also reported that, besides WPV, significant number of paramedics

complained about sexual harassment by work colleagues (Boyle, Koritsas, Coles et al., 2007).

Norway

it was reported that some EDs have applied many preventive

measures regarding workplace safety.

However, it was also reported that the difference these measures make

to the number of violent incidents was not exactly known (Morken & Johansen, 2013).

In Brazil

100% of nurses, 88.9% of nurse assistants and

85.7% of doctors have been victims of violence.

However, the workers stated that these assaults

were not documented (Cezar & Marziale, 2006).

• Violence Against Primary Health Care Workers

in Al-Hassa, Saudi Arabia

• About 28% were exposed to at least one violent event during the past year. Emotional and physical violence accounted for 92.1% and 7.9% of violent events, respectively

ThailandNurses are more frequently exposed to violence lack of institutional support and feeling of insecurity. (Kamchuchat, Chongsuvivatwong, Oncheunjit et al., 2008).

Turkey most commonly exposed to aggression were Emergency Physicians.

Emergency physician is always held responsible for every issue by the assailants and therefore becomes the first target of violence (Gülalp, Karcioğlu, Köseoğlu et al., 2009).

Lebanon

Reasons for violence were reported to be unmet expectations(Alameddine, Kazzi, El-Jardali et al., 2011).

Jordan

of a total of 227 participants, 75.8% was exposed to at least one type of violence, predominantly verbal assault (ALBashtawy,

2013).

Chinain March 2012, a patient suffering from ankylosing spondylitis & tuberculosis used a knife to attack several doctors in Harbin after the patient was refused a drug treatment that he had requested. One doctor who had not been involved in the patient's case died.

In August 2012, the family and friends of a patient who died in surgery in southern Nanchang started a "full-scale melee" that involved more than 100 hospital personnel; the hospital staff armed themselves with sticks and mace for self-protection.

In November 2013 several hundred doctors and nurses protested at the No. 1 People's Hospital in Wenling after a patient dissatisfied with his sinus surgery overpowered security personnel and stabbed three doctors.]

• .there has been only one previous study that focused exclusively on the resident experience with physician harassment, where McNamara et al

demonstrated nearly universal harassment (98%) with an associated increased risk of physician burnout.9

• For over 20 years, there has been no new research that focuses exclusively on violence against residents in the ED.

Health unions and patients' groups branded

The Figures "ShamefulShadow Health Minister Mike Penning said the figures showed

the Government's promises to tackle violence within

the health service to be "worthless".

The responses revealed several

murders and rapes at hospitals

in 2006 and 2007

• Violence in the emergency department (ED) is a significant problem world wide

Impact on the Health Professional

Directly and Indirectly Affects the Quality of

Patient Care & Satisfaction of Patients

Escalation of health care costs

• Violence in the emergency department (ED) is a significant problem world wide

what to do

Risk factors Patient

Staff

Situational and interaction factors

• Violence in the emergency department (ED) is a significant problem world wide

n

Only 16.8% of Residents

Confirmed Prior Training in

Violence Prevention program