Aggression and Harassment: An Underrated Risk in the Health Care Workplace

After attending this presentation, attendees will appreciate the importance and under-valuation of workplace violence in the health care setting. This presentation will impact the forensic science community by demonstrating that violence occurring in a health care workplace environment is a serious, but unevaluated, problem that needs to be adequately addressed. Recommendations on how to confront this problem are suggested. “Workplace violence” is defined by the National Institute of Occupational Safety and Health (NIOSH) as “violent acts (including physical assaults and threats of assaults) directed toward persons at work or on duty.” Over the past years, the scientific community and the media have given significant attention to this phenomenon. It is estimated that about one-quarter of such violence takes place in the health care sector. Several studies are available in the literature that primarily concern aggression toward nurses, particularly emergency room nurses. This appears to be the most at-risk health care category. However, the exact extent of this phenomenon is difficult to define, given the tendency to not report these incidents. Often they are considered to be “part of the job” and “inevitable.” Violence against health care workers is present all over the world, in developing countries as well as industrialized ones. In one study that examined several countries (Brazil, Bulgaria, Lebanon, Portugal, South Africa, Thailand, and Australia), it was revealed that more than 50% of workers experienced at least one episode of physical or psychological violence in the 12 months preceding the survey. Psychological violence is much more prevalent than physical violence, particularly “verbal abuse.” The European Agency for Safety and Health at Work (EU-OSHA) reports that 15% of European health care workers experienced aggression over the course of 2010. In one American study involving 3,465 emergency room nurses, results showed that in the three years prior to the investigation, approximately 25% of the analyzed sample were victims of physical aggression more than 20 times, and almost 20% were the victims of 200 incidents of verbal abuse. In Italy, there are still very few studies concerning violence directed at health care workers. Only in the last few years has there been more attention paid to this issue: in one investigation performed every two years in a local Italian health unit between 2005 and 2011, 9% of the 1,411 study participants affirmed that they had been the victims of stalking. Moreover, estimates regarding the frequency of physical aggression over a one-year period vary between 3% and more than 7%. It is even more difficult to evaluate the frequency of non-physical aggression that, according to several studies, is reported to involve between 38% and 90% of hospital workers. For this reason, it is essential to monitor the issue of aggression, even through the use of incident-reporting forms. Not only violence perpetrated by patients but violence between workers must also be monitored using a standardized “reporting system” because such aggression represents a considerable source of work-related stress for hospital employees. Objectives: Examine the problem of aggression and harassment in the context of community health according to the professional category and workplace. The goal is to identify the subjects and the work environments that are most at risk and to formulate prevention and coping strategies to address the problem (e.g., best practice, mitigation action, and listening centers). Method: From one of the biggest hospitals in southern Italy, 107 workers (doctors, psychologists, nurses, auxiliary social workers, and social assistants) were recruited and 88 workers who have the same professional qualifications were recruited from local social-health care service centers. Instruments: After having obtained consent from all of the workers, a semi-structured, detailed questionnaire was administered that contained personal and epidemiological data, as well as information related to harassment or violence by patients or their family members, colleagues, or superiors. Final Considerations: Episodes of violence against health care workers may be considered sentinel events because they signal the presence of risk situations or vulnerability in the work environment that requires the adoption of appropriate prevention and protection measures for workers. In order to prevent violence in hospitals, employers must develop a safety and health plan that includes commitment by management, worker participation, identification of danger, security and health education, risk prevention, monitoring, and incident reporting. Employers should periodically evaluate this plan. Workplace Violence, Harassment, Health Care Workplace