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Ferracuti, Stefano; Barchielli, Benedetta; Napoli, Christian; Giannini, Anna Maria; Parmigiani, Giovanna
2022 Journal of Aggression Conflict and Peace Research
doi: 10.1108/jacpr-07-2021-0615
Violence against health-care workers represents a public health issue that affects individuals, organizations and may have legal consequences. In Italy, workplace violence (WPV) constitutes a “sentinel event”, defined as a particularly serious, potentially avoidable adverse event, which may result in death or serious harm to health-care workers, and which leads to a loss of public confidence in the health-care system. In 2007, the Italian Ministry of Health issued Recommendation No. 8, “Preventing acts of violence against health workers”, inviting each Italian Hospital to develop procedures and guidelines for dealing with and preventing acts of aggression. This study aimed at investigating the appropriateness of the procedures and guidelines developed by the Italian hospitals.Design/methodology/approachProcedures on preventing violence against health-care workers published by 29 Italian Hospitals between 2007 and 2020 were collected retrospectively via Web searches and further evaluated according to their compliance with the 2007 Italian ministerial recommendations.FindingsA total of 9 documents out of 29 were fully compliant with the 2007 Ministerial Recommendation, 18 were partially compliant, while 2 were totally non-compliant. A total of 24 documents explicitly addressed the management of verbal and physical aggression, whereas 20 set appropriate training on de-escalation techniques for nurses and medical staff. Psychological support was fully considered in 11 procedures, partially considered in 14, while not included at all in 4.Originality/valuePublic procedures on preventing violence against health-care workers in Italian hospitals are scarcely compliant with the Ministerial Recommendations. The absence of specific instructions to address the needs at territorial level and the lack of support provided to health-care workers is a weak point in the effective management of WPV.
Mausz, Justin; Johnston, Mandy; Donnelly, Elizabeth Anne
2022 Journal of Aggression Conflict and Peace Research
doi: 10.1108/jacpr-06-2021-0607
Violence against paramedics is a complex – but underreported – problem. Extant research suggests organizational culture may play a role in sustaining cultural norms that downplay the significance and limit reporting. The purpose of this paper is to qualitatively explore paramedics’ experience with violence, with particular emphasis on understanding how organizational culture contributes to under-reporting.Design/methodology/approachThe authors surveyed paramedics from a single, large, urban service in Ontario, Canada, asking participants to describe their experiences with violence, including whether – and why or why not – the incidents were reported. Within a constructivist epistemology, we used inductive thematic analysis with successive rounds of coding to identify and then define features of organizational culture that limit reporting.FindingsA total of 196 (33% of eligible) paramedics completed the survey. Fully 98% of participants disclosed having experienced some form of violence; however, only a minority (40%) reported the incidents to management, or the police (21%). The authors defined a framework within which a lack of support from management, and consequences for offenders, implicitly positions the ability of paramedics to “brush off” violent encounters as an expected professional competency. Disclosing emotional or psychological distress in response to violent encounters invited questions as to whether the individual is personally suited to paramedic work.Originality/valueWhile the extant research has indicated that underreporting is a problem, the findings shed light on why – a critical first step in addressing what has been described as a serious public health problem.
Spelten, Evelien; van Vuuren, Julia; O’Meara, Peter; Thomas, Brodie; Grenier, Mathieu; Ferron, Richard; Helmer, Jennie; Agarwal, Gina
2022 Journal of Aggression Conflict and Peace Research
doi: 10.1108/jacpr-10-2021-0645
This study aims to investigate whether emergency health-care workers distinguish between different categories of perpetrators of violence and how they respond to different types of perpetrator profiles.Design/methodology/approachFive focus groups with emergency health-care workers were held in Canada. The participants were asked whether they identified different groups of perpetrators of violence and how that impacted their approach. The focus group responses were transcribed verbatim and analysed thematically using a phenomenological approach.FindingsParticipants consistently identified five groups of perpetrators and tailored their approach on their assessment of the type of perpetrator involved. The five categories are: violence or aggressive behaviour from family members or bystander and violence related to; underlying mental health/illness issues; underlying physical health issues; addiction and substance use; and repeat visitors/offenders. Violence with an underlying (mental) health cause was handled professionally and compassionately by the health-care workers, while less patience and understanding was afforded in those instances where violence was associated with (recreational) alcohol or illicit substance use.Originality/valueEmergency health-care workers can consistently distinguish between types of perpetrators of violence and aggression, which they then use as one factor in the clinical and situational assessments that inform their overall approach to the management incidents. This conclusion supports the need to move the focus away from the worker to the perpetrator and to an organisational rather than individual approach to help minimise violence against emergency health-care workers.
Bruton, Liam; Johnson, Hunter; MacKey, Luke; Farok, Aaron; Thyer, Liz; Simpson, Paul M.
2022 Journal of Aggression Conflict and Peace Research
doi: 10.1108/jacpr-08-2021-0630
Recent evidence indicates an increasing incidence of occupational violence (OV) towards paramedics. Body-worn cameras (BWC) have been posited as an intervention that may deter perpetrators, leading to a growing number of ambulance services introducing BWCs at a considerable financial cost. This study aims to investigate the impact of BWC on the incidence of OV towards paramedics.Design/methodology/approachA systematic review was conducted according to the JBI methodology. EMBASE, Cumulative Index to Nursing and Allied Health Literature, MEDLINE, Cochrane reviews, Cochrane Central Register of Controlled Trials, JBI systematic reviews, TROVE and Google Scholar were searched to identify primary research studies reporting on BWCs as an intervention against an outcome of OV incidence. Primary research papers, publicly-accessible government reports, peer-reviewed and grey literature, if published in English, were eligible.FindingsThe search identified 152 documents, of which 125 were assessed following the removal of duplicates. Following abstract screening then full-text review, there were no studies available to include in the review.Research limitations/implicationsThe introduction of interventions should be supported by evidence and an analysis of associated health economics. There is a need for ambulance services that have implemented BWC initiatives to make evaluation data available publicly for transparent review to inform decision-making elsewhere in the profession.Originality/valueTo the best of the authors’ knowledge, these findings represent the first investigation of BWCs as a strategy to reduce the incidence of OV towards paramedics. They highlight the need to apply research frameworks rigorously and transparently to OV reduction initiatives to ensure paramedics are protected by evidence-based strategies.
Rees, Nigel; Rees, Patrick; Hough, Lois; Parry, Dylan; White, Nicola; Bowes, Brady
2022 Journal of Aggression Conflict and Peace Research
doi: 10.1108/jacpr-07-2021-0620
Ambulance services staff worldwide have long been at risk of encountering violence and aggression directed towards them during their work. Verbal forms of violence and aggression are the most prevalent form, but sometimes incidents involve physical injury, and on rare occasions homicides do occur. Exposure to such violence and aggression can have a lasting negative impact upon ambulance staff and has been associated with increased levels of stress, fear, anxiety, emotional exhaustion, depersonalisation and burnout syndrome. Despite the significance of this issue, little progress has been made to tackle it. The purpose of this paper is to describe this multi-agency approach being taken in Wales (UK) to reduce such harms from violence and aggression directed towards ambulance services staff.Design/methodology/approachAn interpretative post-positivist narrative methodology and policy analysis approach was followed. Snowball methods of gathering data were used to construct this narrative involving meetings, telephone calls, review of policy documents, legislation and academic literature.FindingsThe authors report how tackling violence and aggression directed towards emergency workers has become a priority within Wales (UK), resulting in policy developments and initiatives from groups such as the UK and Welsh Government, the Welsh Ambulance Services National Health Services (NHS) Trust, Health Boards, the NHS Wales Anti-Violence Collaborative and the Joint Emergency Services Group (JESG) in Wales. This has included changes in legislation such as the Assaults on Emergency Workers (Offences) Act 2018 that came into force on 13th November 2018 and policy changes such as the obligatory responses to violence in health care and the JESG #WithUsNotAgainst Us campaign. Our study however reflects the complexity of this issue and the need for further high-quality research.Originality/valueThe experiences and activities of Wales (UK) reported in this paper adds to the international body of knowledge and literature on violence and aggression directed towards ambulance services staff.
Jacob, Alycia; McCann, Damhnat; Buykx, Penny; Thomas, Brodie; Spelten, Evelien; Schultz, Rebecca; Kinsman, Leigh; Jacob, Elisabeth
2022 Journal of Aggression Conflict and Peace Research
doi: 10.1108/jacpr-08-2021-0629
This paper aims to illustrate the complexity of understanding and managing violent behaviour in health care. The authors will show how different perceptions of the reasons for violent behaviour, and linkages between violent behaviour and illness have contributed to the creation of a wicked problem and added significant complexity to the management of violence towards staff within health-care settings. This paper will conclude with a call for strong multi-disciplinary action to address this ongoing issue.Design/methodology/approachA narrative review was undertaken to explore the ways that violence has been perceived in health care and the ways in which the concept of violence has moved from being seen as a criminal issue to being within the realms of disease. This paper will show the importance of understanding who is perpetrating violence in health care, why and in what settings. It will expound on the idea that considering violence as a consequence of disease necessarily adds a layer of complexity to both individual and organisational responses to violence towards health-care staff.FindingsUnderstanding the complexity in preventing and managing violence against health-care staff can assist policymakers and managers to develop multi-faceted approaches to violence prevention, including better recognition and understanding of perpetrators of violence.Originality/valueThis paper provides a unique perspective on thinking about violence in health care and the implications of its complexity.
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