Medical Staff Partly to Blame for Patients' Violence, Israeli Study Finds

Reasearch carried out at Haddasah University Hospital; Out of 4,047 statements collected on violence, 39 percent were linked to staff behavior, 29 percent to patients, 16 percent to organizational aspects.

Dan Even
Dan Even
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Dan Even
Dan Even

A new Israeli study indicates that medical personnel have a part to play in patient violence against doctors and nurses in hospitals.

The research was carried out at Hadassah University Hospital, Ein Karem, by Sigal Shafran-Tikva for her Ph.D. It scrutinized attackers and their victims in nine violent events documented at Hadassah within 72 hours of the incident.

Hadassah Medical Center, Ein Karem, before work sanctions began. Credit: Oliver Fittousi

"Violence in the health-care system is different from violence in the street or on the soccer field because it appears in a place that symbolizes compassion and saving lives like an emergency or trauma room, turning it into a battlefield," Shafran-Tikva said.

The research was funded by the Institute for the Study of Health Services and Health Policy, and will be presented tomorrow at a conference hosted by the institute. The study collated information in questionnaires filled out by 705 doctors and nurses.

Among participating personnel, 39 percent reported that their conduct contributed to the violent incident in question. In general, 48 percent of those questioned said the behavior of hospital staff contributed to violent incidents.

Out of 4,047 statements about violence collected, 39 percent were linked to staff behavior, 29 percent to patients and 16 percent to organizational aspects.

In addition, 10 percent of the statements connected violence by patients to prolonged waiting time.

The study found that a nurse in an emergency room is 5.5 times more likely to be violently attacked than a nurse in an internal medicine ward.

The study showed that most violent situations begin with a seemingly innocuous incident that escalates. For example, a relative sitting next to a patient on a clean bed angering the staff, or relatives who want to visit a patient outside of visiting hours.

"In every one of those situations, hurt feelings were prominent and went both ways between attacker and victim and each side blamed the other," Shafran-Tikva said.

However, the research notes, "medical personnel who are violently attacked are not to blame for it, and there is no justification for violence ... But the medical team can act responsibly and avoid contributing to escalation of violence, and they should be given the tools to do so."

Patient violence sometimes occured when patients were perceived as having a violent background, but could also happen when ordinary people become involved by chance in the incident.

In terms of the role the organization plays, a number of factors have an impact on violence, including the architectural structure of the department, a lack of personnel and overcrowding.

The study found that doctors can help prevent violence by creating a more confident environment for patients and families to ask questions and giving detailed explanations if asked.

Explanations, conversations, respect and empathy were found to delay the outbreak of violent incidents, Shafran-Tikva said.

In contrast, factors precipitating violence included lack of respect, lack of awareness of service and a disrespectful tone of voice on the part of medical personnel.

The research recommends that a national task force be established to inculcate standard procedures in medical institutions and to improve awareness of good service in order to counteract and prevent violence.

Physical violence in hospitals has declined in recent years, but verbal violence has increased. According to Health Ministry statistics, from 2005 to 2007, hospitals reported 1,600 violent incidents. In 2008, the number spiked to 4,000 and then in 2009 declined to 3,670 and to 2,528 in 2010. About one-fifth of the violent incidents were physical and the rest verbal.

Few police complaints are filed following violence in hospitals, but the number of such complaints is on the rise.

In 2010, only 22 percent of complaints were reported to the police and only a few reached the courts.

In January 2011, Health Ministry director general Dr. Roni Gamzu issued a directive to hospitals to take steps to prevent violence, including providing better service and conducting training to administrators and departments on violence prevention.



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