Violence towards health care personnel : prevalence, risk factors, prevention and relation to quality of care

Abstract: This thesis investigates the prevalence and nature of violence towards health care personnel and its implications for quality of care. The research presented here is based on a comprehensive perspective of violence as an occupational issue that may have negative consequences for health care personnel, health care organizations, and for the quality of care that they provide. Data from a total of eleven different studies were used in the analyses. The first study was based on a representative national sample of registered nurses, the largest group of health care personnel in Sweden. The Örebro Regional Hospital (RSÖ) was the site of four surveys of the work environment of hospital staff, and three surveys of patients' views of the quality of care. A controlled, longitudinal intervention study concerning workplace violence was carried out at 47 health care work sites in the greater Stockholm area and was the source of three data sets. Two instruments have been developed within the framework of this thesis. The first is the Violent Incident Form (VIF), a practical instrument for the registration of violent incidents in health care environments. The second instrument is the Quality of Care Patient Questionnaire, which measures quality of care from the patient perspective, including patient's views of the staff s work environment. This thesis uses a broad definition of violence that includes verbal threats and aggression in addition to physical violence. Standard epidemiological methods of measurement were used to identify risk factors and risk groups for violence. Approximately 30% of nurses in the representative national sample had been victims of violence at some time in their nursing career. Those nurses working with psychiatric or geriatric patients were at increased risks for violence at work. Compared to this national sample, standardized prevalence ratios for violence were significantly higher for general hospital nursing personnel and physicians. Standardized incidence rates were highest for practical nurses. Experience with violence at work was significantly associated with lower staff ratings for mental energy, work efficiency, participation in work processes and decisions, and with higher work load/stress ratings. Staff experience with violence was also an important (inverse) predictor of a positive overall quality grade from patients. Results from the longitudinal, structured intervention project for dealing with violence indicate that regular registration and review of violent events may be an effective method for increasing understanding of violence in health care settings. Violence towards health care personnel may have significant implications for the quality of care that health care organizations provide. Improving the work environment of health care personnel and their influence over work processes may have an attenuating effect on violence, and a favorable impact on patient ratings of the quality of care.