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Violence Towards Health Care Staff: Risk Factors, Aftereffects, Evaluation and Prevention

Year 2010, Volume: 2 Issue: 2, 161 - 173, 01.06.2010

Abstract

There has been an increase in violence against physicians and healthcare staff in the health-care environment in recent years. The risk of violence remains stronger in people working in health institutions than the ones working in other businesses. Results of previous studies in this issue consistently confirmed the fact that violence in health care business is quite higher in frequency than the violence reported in other business environments. However it has also been reported that only attacks resulting in serious injuries have been considered as incidents of violence and other violence attempts are inclined not to be reported to legal authorities resulting in a much lower official rates. Not only patients but also the relatives of patients have been reported to expose violence against healthcare workers. Verbal violence were found to be more common than physical violence. Violence incidents happen most commonly in the emergency room settings, and psychiatric clinic settings. Health care staff exposed to violence usually suffer from anxiety and restlessness as psychological after-effects. Health care workers are not sufficiently trained about how to cope with acute and chronic effects of violent behavior. This issue should be handled within the framework of medical faculty and related schools' curriculum. All health care staff including physicians should get sufficient education to take immediate actions on such incidents. Unfortunately in Turkey, there is no specific legal regulation related to violence towards health employees. The verbal attacks, injuries, assault and murder of health workers are subject to general legal provisions. Both rapid changes in health care services, facilities and shortcomings in legal regulations cause gaps in violence prevention and employing safety issues in hospitals and related health care facilities. Training employees and hospital managers, and considering the creation and application of present and future regulations remain as main prerequisites for ensuring a safe environment for healthcare staff.

References

  • World Health Organization. Violence and Health: Task Force on Violence and Health. Cenevre, WHO, 1998.
  • Saines JC. Violence and aggression in A&E: recommendations for action. Accid Emerg Nurs 1999; 7:8-12.
  • Walter B. Aggression and violence: examine the theories. Nurs Stand 1998; 12: 36-37.
  • Mohr WK, Mohr BD. Brain, behavior, connections and implications: psychodynamics no more. Arch Psychiatr Nurs 2001; 15:171-181.
  • Volavka J. The neurobiology of violence: An update. J Neuropsychiatry Clin Neurosci 1999; 11:307-314.
  • Davidson R, Putnam KM, Larson CL. Dysfunction in the neural circuitry of emotion regulation- a possible prelude to violence. Science 2000; 289:591-594.
  • Bandura A. Social learning theory. London, Routledge, 1977.
  • Berkowitz L. On the formation and regulation of anger and aggression. Am Psychol 1990; 45:494-503.
  • Barrett S. Protecting against workplace. Public Manag 1997; 79:9-12.
  • Gates DM. Workplace violence. AAOHN J 1995; 43:536-543.
  • Warshaw LJ. Workplace violence: preventive and interventive strategies. J Occup Environ Med 1996; 38:993-1006.
  • Elliott PP. Violence in health care. What nurse managers need to know. Nurs Manage 1997; 28:38-41.
  • Ayranci U,Yenilmez C, Balci Y, Kaptanoglu C. Identification of violence in Turkish health care settings. J Interpers Violence 2006; 21:276-296.
  • Dalphond D, Gessner M, Giblin E, Hijazzi K, Love C. Violence against emergency nurses. J Emerg Nurs 2000; 26:105.
  • Fernandes C, Bouthillette F, Raboud JM, Bullock L, Moore C, Christenson JM, et al. Violence in the emergency department: a survey of health care workers. CMAJ 1999; 16:161-170.
  • Winstanley S, Whittington R. Aggression towards health care staff in a UK general hospital: variation among professions and departments. J Clin Nurs, 2004; 13:3-10.
  • Owen C, Tarantello C, Jones M, Tennant C. Violence and aggression in psychiatric units. Psychiatr Serv 1998; 49:1452-1457.
  • Ayrancı Ü, Yenilmez Ç, Günay Y, Kaptanoğlu C. Çeşitli sağlık kurumlarında ve sağlık meslek gruplarında şiddete uğrama sıklığı. Anadolu Psikiyatri Dergisi 2002; 3:147- 154.
  • Erkol H, Gökdoğan MR, Erkol Z, Boz B. Aggression and violence towards health care providers--a problem in Turkey? J Forensic Leg Med 2007; 14:423-428.
  • Gökçe T, Dündar C. Samsun Ruh ve Sinir Hastalıkları Hastanesinde çalışan hekim ve hemşirelerde şiddete maruziyet sıklığı ve kaygı düzeylerine etkisi. İnönü Üniversitesi Tıp Fakültesi Dergisi 2008; 15:25-28.
  • Ölmezoğlu ZB, Vatansever K, Ergör A. İzmir metropol alanı 112 çalışanlarında şiddet maruziyetinin değerlendirilmesi. Toplum ve Hekim 1999; 14:420-425.
  • Aktuğlu K, Hancı H. Acil servislerde şiddet tehdidi. 1999; www.ttb.org.tr/TD59/5911.htlm adresinden indirildi.
  • Gülalp B, Karcioğlu O, Köseoğlu Z, Sari A. Dangers faced by emergency staff: experience in urban centers in southern Turkey. Ulus Travma Acil Cerrahi Derg 2009; 15:239-242.
  • James A, Madeley R, Dove A. Violence and aggression in the emergency department. Emerg Med J 2006; 23:431-434.
  • Jenkins MG, Rocke LG, McNicholl BP, Hughes DM. Violence and verbal abuse against staff in accident and emergency departments: a survey of consultants in the UK and the Republic of Ireland. J Accid Emerg Med, 1998; 15:262-265.
  • Kennedy MP. Violence in emergency departments: under-reported, unconstrained, and unconsionable. Med J Aust 2005; 183:362-365.
  • Lau J, Magarey J, McCutcheon H. Violence in the emergency department: A literature review. Aust Emerg Nurs J 2004; 7:27-37.
  • Erickson L, William-Evans SA. Attitudes of emergency nurses regarding patient assaults. J Emerg Nurs 2000; 26:210-215.
  • Ergün FS, Karadakovan A. Violence towards nursing staff in emergency departments in one Turkish city. Int Nurs Rev 2005; 52: 154-160.
  • Arnetz JE, Arnetz BB, Petterson L. Violence in the nursing profession: occupational and lifestyle risk factors in Swedish nurses. Work Stress 1996; 10:119-127.
  • Ray CL, Subich LM. Staff assaults and injuries in a psychiatric hospital as a function of three attitudinal variables. Issues Ment Health Nurs 1998; 19:277-289.
  • Crilly J, Chaboyer W, Creedy D. Violence towards emergency department nurses by patients. Accid Emerg Nurs 2004; 3:1-7.
  • Winstanley S, Whittington R. Violence in general hospital: comparison of assailand and other assault- related factors on accident and emergency and inpatient wards. Acta Psychiatr Scand 2002; 106:144-147.
  • Barlow CB, Rizzo AG. Violence against surgical residents. West J Med 1997; 167:74- 78.
  • Wyatt JP, Watt M. Violence towards junior doctors in accident and emergency departments. J Accid Emerg Med 1995; 12:40-42.
  • Young GP. The agitated patient in the emergency department. Emerg Med Clin North Am 1987; 5:765-781.
  • Reid WH. Clinical evaluation of the violent patient. Psychiatr Clin North Am 1988; 11:527-537.
  • Novitsky MA, Julius RJ, Dubin WR. Non-pharmacologic management of violence in psychiatric emergencies. Prim Psychiatry 2009; 16:49-53.
  • Ericsson KI, Westrin CG. Coercion meassures in psychiatric care. Acta Psychiatr Scand 1995; 92:225-230.
  • McDonnell A, Jones P. The physical management of challenging behaviour. Clinical Psychology Forum 1999; 127:20-23.
  • Hewitt JB, Levin PE. Violence in the workplace. Annu Rev Nurs Res 1997; 15:81-99.
  • Flannery RB. The employee victim of violence: Recognizing the impact of untreated psychological trauma. Am J Alzheimers Dis 2001; 16:230-233.
  • Khun W. Violence in the emergency department: managing aggressive patient in a high-stress environment. Postgrad Med 1999; 105:143-148.
  • Dilbaz N. Şiddet riskinin değerlendirilmesi ve saldırgan hastaya yaklaşım. Klinik Psiki- yatri Dergisi 1999; 2:179-188.
  • Borum R, Swartz M, Swanson J. Assessing and managing violence risk in clinical practice. Prac Psych Behav Healt 1996; 2:205-222.
  • Staby AE. Handbook of Psychiatric Emergencies. Connecticut, Appleton and Large, 1994.
  • Hoag-Apel CM. Violence in the emergency department. Nurs Manage 1998; 29:60- 63.
  • Levin PF, Hewitt BJ, Misner TS. Insights of nurses about assault in hospital based emergency departments. Image J Nurs Sch 1998; 30:249-254.
  • Flannery RB. Violence in the workplace, 1970-1995: a review of the literature. Aggress Violent Behav 1996; 1:57-68.
  • Arnetz JE, Arnetz BB. Violence towards health care staff and possible effects on the quality of patient care. Soc Sci Med 2001; 52:417-427.
  • Meyer T, Wrenn K, Wright SW, Glaser J, Slovis CM. Attitutes toward the use of a metal detector in an urban emergency department. Ann Emerg Med 1997; 29:621- 624.
  • Eddinger C. Security dogs in the emergency department: One hospital’s solution to the crisis of violence. J Emerg Nurs 1991; 17:23-24.

Sağlık Çalışanlarına Yönelik Şiddet: Risk Faktörleri, Etkileri, Değerlendirilmesi ve Önlenmesi

Year 2010, Volume: 2 Issue: 2, 161 - 173, 01.06.2010

Abstract

Sağlık ortamında hekime ve sağlık çalışanlarına yönelik şiddet son yıllarda artış göstermektedir. Sağlık kurumunda çalışmak diğer iş yerlerine göre şiddete uğrama yönünden daha risklidir. Bu konuda yürütülmüş çalışmaların bulguları da sağlık alanında ortaya çıkan şiddetin diğer iş yerlerine göre oldukça fazla olduğu gerçeğini doğrulamış ve bu olayların sadece yaralanma gibi ciddi olanlarının şiddet olarak algılandığı, çok azının kayda alındığını göstermiştir. Hastalar kadar hasta yakınlarının da sağlık çalışanlarına şiddet uygulama eğiliminde oldukları görülmüştür. Sözel şiddetin sıklığı fiziksel şiddetten daha fazladır. Şiddet en sık acil servislerde, ikinci sıklıkta da psikiyatri kliniklerinde sergilenmektedir. Şiddete uğrayan sağlık çalışanlarında şiddetin ardından anksiyete ve huzursuzlukta artış gibi psikolojik etkiler görülmektedir. Sağlık çalışanları şiddet davranışı ile baş etme konusunda yeterli eğitim görmedikleri saptanmıştır. Tıp eğitiminde hasta-hekim ilişkisi konusunda verilen eğitim içerisindeki eksiklikler giderilmesi sorunun çözümü yolunda önemli bir adım olacaktır. Ülkemizde sağlık personelinin mağdur olduğu eylemlere ilişkin yasal düzenlemeler bulunmamaktadır. Sağlık personeline yapılan sözel saldırılar, yaralamalar, darp ve öldürmeye ilişkin hükümler genel hükümlere tabi tutulmaktadır. Gerek sağlık hizmetindeki hızlı değişimler gerek yasal uygulamalardaki eksiklikler şiddetin önlenmesinde ve çalışan güvenliği sağlama konusunda boşluklar bırakmaktadır. Güvenli ortamın sağlanmasında çalışanların eğitimi, mevzuatların düzenlenmesi, yöneticilerin üzerine düşen görevler gibi çok yönlü konular olmakla birlikte yasal düzenlemelerin de gerektiği kaçınılmazdır.

References

  • World Health Organization. Violence and Health: Task Force on Violence and Health. Cenevre, WHO, 1998.
  • Saines JC. Violence and aggression in A&E: recommendations for action. Accid Emerg Nurs 1999; 7:8-12.
  • Walter B. Aggression and violence: examine the theories. Nurs Stand 1998; 12: 36-37.
  • Mohr WK, Mohr BD. Brain, behavior, connections and implications: psychodynamics no more. Arch Psychiatr Nurs 2001; 15:171-181.
  • Volavka J. The neurobiology of violence: An update. J Neuropsychiatry Clin Neurosci 1999; 11:307-314.
  • Davidson R, Putnam KM, Larson CL. Dysfunction in the neural circuitry of emotion regulation- a possible prelude to violence. Science 2000; 289:591-594.
  • Bandura A. Social learning theory. London, Routledge, 1977.
  • Berkowitz L. On the formation and regulation of anger and aggression. Am Psychol 1990; 45:494-503.
  • Barrett S. Protecting against workplace. Public Manag 1997; 79:9-12.
  • Gates DM. Workplace violence. AAOHN J 1995; 43:536-543.
  • Warshaw LJ. Workplace violence: preventive and interventive strategies. J Occup Environ Med 1996; 38:993-1006.
  • Elliott PP. Violence in health care. What nurse managers need to know. Nurs Manage 1997; 28:38-41.
  • Ayranci U,Yenilmez C, Balci Y, Kaptanoglu C. Identification of violence in Turkish health care settings. J Interpers Violence 2006; 21:276-296.
  • Dalphond D, Gessner M, Giblin E, Hijazzi K, Love C. Violence against emergency nurses. J Emerg Nurs 2000; 26:105.
  • Fernandes C, Bouthillette F, Raboud JM, Bullock L, Moore C, Christenson JM, et al. Violence in the emergency department: a survey of health care workers. CMAJ 1999; 16:161-170.
  • Winstanley S, Whittington R. Aggression towards health care staff in a UK general hospital: variation among professions and departments. J Clin Nurs, 2004; 13:3-10.
  • Owen C, Tarantello C, Jones M, Tennant C. Violence and aggression in psychiatric units. Psychiatr Serv 1998; 49:1452-1457.
  • Ayrancı Ü, Yenilmez Ç, Günay Y, Kaptanoğlu C. Çeşitli sağlık kurumlarında ve sağlık meslek gruplarında şiddete uğrama sıklığı. Anadolu Psikiyatri Dergisi 2002; 3:147- 154.
  • Erkol H, Gökdoğan MR, Erkol Z, Boz B. Aggression and violence towards health care providers--a problem in Turkey? J Forensic Leg Med 2007; 14:423-428.
  • Gökçe T, Dündar C. Samsun Ruh ve Sinir Hastalıkları Hastanesinde çalışan hekim ve hemşirelerde şiddete maruziyet sıklığı ve kaygı düzeylerine etkisi. İnönü Üniversitesi Tıp Fakültesi Dergisi 2008; 15:25-28.
  • Ölmezoğlu ZB, Vatansever K, Ergör A. İzmir metropol alanı 112 çalışanlarında şiddet maruziyetinin değerlendirilmesi. Toplum ve Hekim 1999; 14:420-425.
  • Aktuğlu K, Hancı H. Acil servislerde şiddet tehdidi. 1999; www.ttb.org.tr/TD59/5911.htlm adresinden indirildi.
  • Gülalp B, Karcioğlu O, Köseoğlu Z, Sari A. Dangers faced by emergency staff: experience in urban centers in southern Turkey. Ulus Travma Acil Cerrahi Derg 2009; 15:239-242.
  • James A, Madeley R, Dove A. Violence and aggression in the emergency department. Emerg Med J 2006; 23:431-434.
  • Jenkins MG, Rocke LG, McNicholl BP, Hughes DM. Violence and verbal abuse against staff in accident and emergency departments: a survey of consultants in the UK and the Republic of Ireland. J Accid Emerg Med, 1998; 15:262-265.
  • Kennedy MP. Violence in emergency departments: under-reported, unconstrained, and unconsionable. Med J Aust 2005; 183:362-365.
  • Lau J, Magarey J, McCutcheon H. Violence in the emergency department: A literature review. Aust Emerg Nurs J 2004; 7:27-37.
  • Erickson L, William-Evans SA. Attitudes of emergency nurses regarding patient assaults. J Emerg Nurs 2000; 26:210-215.
  • Ergün FS, Karadakovan A. Violence towards nursing staff in emergency departments in one Turkish city. Int Nurs Rev 2005; 52: 154-160.
  • Arnetz JE, Arnetz BB, Petterson L. Violence in the nursing profession: occupational and lifestyle risk factors in Swedish nurses. Work Stress 1996; 10:119-127.
  • Ray CL, Subich LM. Staff assaults and injuries in a psychiatric hospital as a function of three attitudinal variables. Issues Ment Health Nurs 1998; 19:277-289.
  • Crilly J, Chaboyer W, Creedy D. Violence towards emergency department nurses by patients. Accid Emerg Nurs 2004; 3:1-7.
  • Winstanley S, Whittington R. Violence in general hospital: comparison of assailand and other assault- related factors on accident and emergency and inpatient wards. Acta Psychiatr Scand 2002; 106:144-147.
  • Barlow CB, Rizzo AG. Violence against surgical residents. West J Med 1997; 167:74- 78.
  • Wyatt JP, Watt M. Violence towards junior doctors in accident and emergency departments. J Accid Emerg Med 1995; 12:40-42.
  • Young GP. The agitated patient in the emergency department. Emerg Med Clin North Am 1987; 5:765-781.
  • Reid WH. Clinical evaluation of the violent patient. Psychiatr Clin North Am 1988; 11:527-537.
  • Novitsky MA, Julius RJ, Dubin WR. Non-pharmacologic management of violence in psychiatric emergencies. Prim Psychiatry 2009; 16:49-53.
  • Ericsson KI, Westrin CG. Coercion meassures in psychiatric care. Acta Psychiatr Scand 1995; 92:225-230.
  • McDonnell A, Jones P. The physical management of challenging behaviour. Clinical Psychology Forum 1999; 127:20-23.
  • Hewitt JB, Levin PE. Violence in the workplace. Annu Rev Nurs Res 1997; 15:81-99.
  • Flannery RB. The employee victim of violence: Recognizing the impact of untreated psychological trauma. Am J Alzheimers Dis 2001; 16:230-233.
  • Khun W. Violence in the emergency department: managing aggressive patient in a high-stress environment. Postgrad Med 1999; 105:143-148.
  • Dilbaz N. Şiddet riskinin değerlendirilmesi ve saldırgan hastaya yaklaşım. Klinik Psiki- yatri Dergisi 1999; 2:179-188.
  • Borum R, Swartz M, Swanson J. Assessing and managing violence risk in clinical practice. Prac Psych Behav Healt 1996; 2:205-222.
  • Staby AE. Handbook of Psychiatric Emergencies. Connecticut, Appleton and Large, 1994.
  • Hoag-Apel CM. Violence in the emergency department. Nurs Manage 1998; 29:60- 63.
  • Levin PF, Hewitt BJ, Misner TS. Insights of nurses about assault in hospital based emergency departments. Image J Nurs Sch 1998; 30:249-254.
  • Flannery RB. Violence in the workplace, 1970-1995: a review of the literature. Aggress Violent Behav 1996; 1:57-68.
  • Arnetz JE, Arnetz BB. Violence towards health care staff and possible effects on the quality of patient care. Soc Sci Med 2001; 52:417-427.
  • Meyer T, Wrenn K, Wright SW, Glaser J, Slovis CM. Attitutes toward the use of a metal detector in an urban emergency department. Ann Emerg Med 1997; 29:621- 624.
  • Eddinger C. Security dogs in the emergency department: One hospital’s solution to the crisis of violence. J Emerg Nurs 1991; 17:23-24.
There are 52 citations in total.

Details

Primary Language Turkish
Subjects Neurosciences
Journal Section Review
Authors

Bilge Annagür This is me

Publication Date June 1, 2010
Published in Issue Year 2010 Volume: 2 Issue: 2

Cite

AMA Annagür B. Sağlık Çalışanlarına Yönelik Şiddet: Risk Faktörleri, Etkileri, Değerlendirilmesi ve Önlenmesi. Psikiyatride Güncel Yaklaşımlar - Current Approaches in Psychiatry. June 2010;2(2):161-173.

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