Elsevier

Aggression and Violent Behavior

Volume 13, Issue 6, November–December 2008, Pages 431-441
Aggression and Violent Behavior

Patient and visitor violence in general hospitals: A systematic review of the literature

https://doi.org/10.1016/j.avb.2008.07.001Get rights and content

Abstract

Patient and visitor violence (PVV) is a complex occupational hazard for health care staff working in general hospitals. In order to reduce the deficit of information regarding this kind of PVV, a systematic literature review that describes and summarizes the current scientific knowledge on this topic was conducted. The literature search identified 84 studies. These were analyzed for research quality and those with good or moderate research quality were selected (n = 31). In most studies, a retrospective self reported cross-sectional design and a broad definition of violence were employed. Additionally, most of the questionnaires applied were developed by the researchers and utilized different retrospective time frames. Unfortunately, information about the validity of the questionnaires was often lacking. Results of this review suggest that PVV is a serious problem for health care staff in general hospitals, especially those working in medical and surgical units. Workplace characteristics and the interaction between patients and staff are important contextual factors that can contribute to the development of violent incidents. Because the studies reviewed employed different methodologies, instruments, and definitions, comparison was difficult. We, therefore, recommend that future research use clearer conceptual frameworks and unique instruments.

Introduction

Work-related violence in the health care system is a complex and dangerous occupational hazard for health care staff that has increased continuously in recent years (Beech and Leather, 2006, Cooper and Swanson, 2002). Among all occupational groups, health care workers are ranked as one of the most likely groups to experience workplace aggression (Bourn, 2003, Chappell and Di Martino, 2006, Wells and Bowers, 2002). Unfortunately, the definitions of violence or aggression used in research on this topic are inconsistent. This hampers the comparison of research results (Chappell and Di Martino, 2006, Lau and Magarey, 2006, Rippon, 2000). Nevertheless, numerous studies have shown that work-related violence can negatively affect the psychological and physical well-being of health care staff (Needham et al., 2005, Richter and Berger, 2000, Stanko, 2002). It can also impact their job motivation and the quality of the care they provide (Arnetz and Arnetz, 2001, Needham et al., 2005). An additional important yet often forgotten impact of work-related violence is the financial loss ensued by the health care system (Bourn, 2003, McKenna, 2004, Philbrick et al., 2003).

While extensive efforts have been made to understand the processes involved in patient and patient's relatives or visitor violence (PVV) in psychiatric settings, relatively few attempts have been made to examine the problem in general health care settings (Cooper and Swanson, 2002, Duxbury and Whittington, 2005, Winstanley and Whittington, 2002) despite the fact that PVV in general hospitals is a serious problem for all staff categories in all clinical departments (Hegney et al., 2003, Hesketh et al., 2003, Winstanley and Whittington, 2004a). Little is known about the frequency of PVV, the context in which these events occur, and the effect of PVV on health care staff in general hospitals (O'Connell et al., 2000, Whittington et al., 1996, Winstanley and Whittington, 2004a). Most studies have focused on accident and emergency departments (Fernandes et al., 1999, Lau et al., 2006). To date, no literature review has summarized research results on PVV in general hospitals.

The main research questions in the present literature review were therefore: (1) How often does PVV against health care staff in general hospitals occur and what is known about the different forms of PVV?; (2) In which contexts does PVV occur in general hospital settings?; and (3) What are the patient, visitor, and staff characteristics that contribute to PVV?

In this study, violence was considered synonymous to aggression (Rippon, 2000). And PVV was defined as any verbal, non-verbal, or physical behavior that threatens others or property, or that actually harms others or property (Morrison, 1990).

Section snippets

Method

The following electronic databases were searched: Medline, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Physiotherapy Evidence Database (PEDro) and Midwifery and Infant Care (MIDIRS). The search was limited to articles with abstracts in German or English published in the last 16 years (from 1990 to August, 2006). The keywords used and the search results are listed in Table 1. In addition to the search, the references in the articles were

Methodology and study design

Of the 31 studies selected, 26 were retrospective cross-sectional surveys (RCS) that focused on staff experiences with different forms of PVV in general hospitals. In these RCS, 14 investigated nurses' experiences, 6 looked at medical doctors' experiences and another 6 focused on all health care staff (HCS). Ten studies in our selection had a sample size of over 500 and most studies had a high response rate of over 60%. The majority of the RCS used questionnaires developed by the individual

Discussion

The main results of this study demonstrate that PVV is a prominent professional risk for health care professions. On average, 50% have experienced verbal PVV and 25% have experienced physical PVV. Important factors contributing to PVV are the hospital organizational context, interactions between patients, patient visitors and HCS, and the health of the patient. Additionally, the results have shown that nurses are clearly at highest risk for PVV.

Health care professionals working in general

Conclusion and recommendations for further research

The results of this review demonstrate the complex interplay between the various factors that contribute to PVV. PVV occurs frequently in general hospitals and manifests predominately in the form of psychological violence. Organizational and workplace characteristics as well as patient–provider interactions are important contextual factors that can impact the incidence of PVV. Additionally, patients with a disturbed mental health state sometimes react violently during interactions with HCS.

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