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Patient aggression in intensive care: A qualitative study of staff experiences

Published:April 12, 2022DOI:https://doi.org/10.1016/j.aucc.2022.02.006

      Abstract

      Background

      Workplace violence comprises abuse, assaults, threats, and harassment. Reaching epidemic proportions in healthcare, workplace violence compromises staff and patient safety and service efficiency and effectiveness. Although workplace violence is a nontrivial problem in intensive care, little is known about circumstances in which violence occurs in this setting.

      Objective

      The objective of this study was to describe and reflect upon aggression towards staff in the intensive care unit (ICU) from the perspectives of staff members.

      Methods

      We investigated workplace violence in a qualitative study with data collected from semistructured interviews with 19 staff members of a 10-bed ICU, analysed using a framework approach.

      Findings

      All participants reported witnessing or experiencing physical and/or verbal aggression. While acknowledging that ‘any patient’ could become aggressive, participants differentiated ‘any patients admitted for treatment of somatic illnesses’ from ‘dangerous’ patients and interpreted violence differently dependent on characteristics of perpetrators. ‘Dangerousness’ was associated with patients who had a comorbid mental illness. Aggression of ‘dangerous patients’ was construed as intentional and/or ‘normal aberrant’ behaviour for the individual. Staff reported feeling ill-prepared to work effectively with this cohort and having difficulty responding empathically. Mental health services were considered ‘responsible’ for managing patients' drug use, personality, and psychiatric problems.

      Conclusion

      Perceived knowledge and skill deficits, as well as stigma when engaging with certain subpopulations, contribute to workplace violence in the ICU setting. ICU staff members seek education and support to improve management of patients and reduce risk of violence. However, effectiveness depends on robust service and organisational commitment and strategies to promote workplace health and safety.

      Keywords

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      References

        • Liu J.
        • Gan Y.
        • Jiang H.
        • Li L.
        • Dwyer R.
        • Lu K.
        • et al.
        Prevalence of workplace violence against healthcare workers: a systematic review and meta-analysis.
        Occup Environ Med. 2019; 76: 927-937
        • Vento S.
        • Cainelli F.
        • Vallone A.
        Violence against healthcare workers: a worldwide phenomenon with serious consequences.
        Front Public Health. 2020; 8: 570459
        • Lanctôt N.
        • Guay S.
        The aftermath of workplace violence among healthcare workers: a systematic literature review of the consequences.
        Aggress Violent Behav. 2014; 19: 492-501
        • Keys Y.
        • Stichler J.F.
        Safety and security concerns of nurses working in the intensive care unit: a qualitative study.
        Crit Care Nurs Q. 2018; 41: 68-75
        • Cheraghi ma
        • Noghan n
        • Moghimbeigi a
        • Bikmoradi a
        Analysis of intensive care nurses’ workplace violence.
        Iran J Crit Care Nurs (IJCCN). 2012; 5
        • Dafny H.A.
        • Beccaria G.
        I do not even tell my partner: nurses' perceptions of verbal and physical violence against nurses working in a regional hospital.
        J Clin Nurs. 2020; 29: 3336-3348
        • Pol A.
        • Carter M.
        • Bouchoucha S.
        Violence and aggression in the intensive care unit: what is the impact of Australian National Emergency Access Target?.
        Aust Crit Care: Off J Confeder Austr Crit Care Nurses. 2019; 32: 502-508
        • Yoo H.J.
        • Suh E.E.
        • Lee S.H.
        • Hwang J.H.
        • Kwon J.H.
        Experience of violence from the clients and coping methods among ICU nurses working a hospital in South Korea.
        Asian Nurs Res (Korean Soc Nurs Sci). 2018; 12: 77-85https://doi.org/10.1016/j.anr.2018.02.005
        • Mento C.
        • Silvestri M.C.
        • Bruno A.
        • Muscatello M.R.A.
        • Cedro C.
        • Pandolfo G.
        • et al.
        Workplace violence against healthcare professionals: a systematic review.
        Aggress Violent Behav. 2020; 51: 1-8
        • Pich J.
        • Roche M.
        Violence on the job: the experiences of nurses and midwives with violence from patients and their friends and relatives.
        Healthcare (Basel). 2020; 8: 522
        • Stranks J.
        The manager's guide to health & safety at work.
        8th ed. Kogan Page Ltd, London2006
        • Institute E.
        Violence in healthcare facilities.
        in: Healthcare risk control. 2017 May 24
        • Gillespie G.L.
        • Gates D.M.
        • Miller M.
        • Howard P.K.
        Workplace violence in healthcare settings: risk factors and protective strategies.
        Rehabil Nurs. 2010; 35: 177-184
        • Hodge A.N.
        • Marshall A.P.
        Violence and aggression in the emergency department: a critical care perspective.
        Aust Crit Care: Off J Confeder Austr Crit Care Nurses. 2007; 20: 61-67
        • Kaushik V.
        • Walsh C.A.
        Pragmatism as a research paradigm and its implications for social work research.
        Soc Sci. 2019; 8: 255
        • Saunders M.
        • Lewis P.
        • Thornhill A.
        Research methods for business students.
        6th ed. Pearson Education, Harlow2012
        • Tronstad O.
        • Flaws D.
        • Lye I.
        • Fraser J.F.
        • Patterson S.
        The intensive care unit environment from the perspective of medical, allied health and nursing clinicians: a qualitative study to inform design of the 'ideal' bedspace.
        Aust Crit Care. 2021; 34: 15-22
        • Smith J.
        • Firth J.
        Qualitative data analysis: the framework approach.
        Nurse Res. 2011; 18: 52-62
        • Gale N.K.
        • Heath G.
        • Cameron E.
        • Rashid S.
        • Redwood S.
        Using the framework method for the analysis of qualitative data in multi-disciplinary health research.
        BMC Med Res Methodol. 2013; 13: 117
        • Funk L.
        • Spencer D.
        • Herron R.
        Making sense of violence and victimization in health care work: the emotional labour of ‘not taking it personally.
        Int Rev Vict. 2021; 27: 94-110
        • Sundberg F.
        • Olausson S.
        • Fridh I.
        • Lindahl B.
        Nursing staff's experiences of working in an evidence-based designed ICU patient room-An interview study.
        Intensive Crit Care Nurs. 2017; 43: 75-80
        • Weare R.
        • Green C.
        • Olasoji M.
        • Plummer V.
        ICU nurses feel unprepared to care for patients with mental illness: a survey of nurses' attitudes, knowledge, and skills.
        Intensive Crit Care Nurs. 2019; 53: 37-42
        • Charlesworth M.
        • AF B.
        Qualitative research in critical care: has its time finally come?.
        J Intensive Care Soc. 2016; 17: 146-153
        • Yatchmenoff D.K.
        • Sundborg S.A.
        • Davis M.A.
        Implementing trauma-informed care: recommendations on the process.
        Adv Soc Work. 2017; 18: 167-185
        • Dimoff J.K.
        • Kelloway E.K.
        • Burnstein M.D.
        Mental health awareness training (MHAT): the development and evaluation of an intervention for workplace leaders.
        Int J Stress Manag. 2016; 23: 167-189
        • Morse J.M.
        "Cherry picking": writing from thin data.
        Qual Health Res. 2010; 20: 3