Conectar
To explore hospital staff experiences and perceptions of patient-perpetrated violence.
Descriptive qualitative study.
Twelve semi-structured interviews (June–August 2022) were held with a diverse sample of hospital nurses, doctors, allied health professionals, security and a non-clinical manager. The framework approach was used to organise and analyse data, using Attribution Theory as a theoretical lens.
Three themes were identified: violence as (un)predictable, violence as (un)preventable and the cumulative toll of violence. In making sense of why patients become violent, participants described different ‘types’ of aggressive patients and variably attributed behaviours to situation, disposition or a combination of both. Regardless of perceived causal factors, staff overwhelmingly appeared to view violence as predictable. Participants also reflected on the wider structural problems underpinning violence, frequently alluding to their sense of relative powerlessness to initiate change. The cumulative toll of violence was a common thread, with staff describing their acquisition of ‘resilience’ and reflecting on its role in their responses to escalating situations.
Many hospital staff are resigned to the inevitability of violence. The concept of staff ‘resilience’ following violence is not unproblematic, having the potential to serve as a guise for acceptance and as an additional variable for which staff are held accountable. When designing strategies, organisations should ensure that accountability for violence reduction is distributed across multiple levels. This study makes a novel contribution by exploring the perspectives of multiple staff groups working across diverse hospital settings, and adds to a sparse literature on this subject in the UK.
Efforts to address violence against healthcare staff need to be power-conscious, ensuring that accountability is distributed across multiple levels.
This study is reported in line with the Consolidated Criteria for Reporting Qualitative Studies (COREQ).
No patient or public contribution.
To map the evidence on post-incident strategies for workplace violence in global hospital settings, define current literature gaps and provide direction for future research.
Scoping review guided by Joanna Briggs Institute methodology.
A narrative synthesis, framed by the Haddon Matrix, categorised post-violence strategies by focus on staff (victims), aggressors (vectors), or the physical/social environment.
Six databases (MEDLINE, Embase, Web of Science, CINAHL, PsycINFO, Health Management Information Consortium) and Google Scholar were searched in January 2024.
Twenty-seven articles were included. Post-violence strategies addressed: (1) staff support through debriefs and psychological, clinical and procedural assistance; (2) behaviour management, individualised plans, alerts and accountability measures for aggressors; and (3) system-level responses via incident investigations, feedback processes and integrated monitoring. These strategies were typically embedded within larger multicomponent workplace violence programmes, with limited disaggregation of their specific effects.
The evidence base for tertiary prevention of workplace violence remains sparse. Most articles in this review equated success with violence reduction, reflecting a traditional (Safety-I) focus on risk mitigation, with limited attention to broader outcomes such as staff perceptions of safety or job-related affect. This underscores the need for a clearer focus on the mechanisms by which such interventions are expected to create change, providing an opportunity to refine theory and practice.
The post-violence period offers a key juncture for mitigating incidents' ripple effects. As frontline staff are often the primary ‘recipients’ of interventions, future research and service improvement initiatives should focus more closely on outcomes relevant to staff experiences.
Incorporating a Safety-II perspective, which emphasises resilience and adaptive performance, could enable hospitals to strengthen ongoing operational capabilities in the aftermath of violence and help to redress the conditions that facilitate its recurrence.
PRISMA-ScR.
None.
FreshRSS 