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Patient-initiated violence


Patient-initiated violence is a specific form of workplace violence that affects healthcare workers that is the result of verbal, physical, or emotional abuse from a patient or family members of whom they have assumed care. Nurses represent the highest percentage of affected workers however other roles include physicians, therapists, technicians, home care workers, and social workers. The Occupational Safety and Health Administration used 2013 Bureau of Labor Statistics and reported that healthcare workplace violence requiring days absent from work from patients represented 80% of cases. In 2014, a survey by the American Nurses Association of 3,765 21% of nurses and nursing students reported physical abuse and over 50% reported verbal abuse within a 12-month period. Causes for patient outbursts vary, including psychiatric diagnosis, under the influence of drugs or alcohol, or subject to a long wait time. Certain areas are more at risk for this kind of violence including healthcare workers in psychiatric settings, emergency or critical care, or long term care and dementia units.

The American College of Emergency Physicians found that greater than 75% of emergency physicians were the victim of one or more violent incidents in the workplace, noting that the majority was by patients or their families. Causes for the increased presence of violence, especially in urban settings, are related to gang activity, lengthened waiting periods to see a doctor, a failure of community medical resources, and unavailable acute psychiatric treatment. In 2011 the Emergency Nurses Association studies the occurrence of physical violence at 54.4% and verbal violence at 42.5% among emergency room nurses. Within this study, 55.7% perpetrators of physical violence were under the influence of alcohol. 46.8% were under the influence of illegal or prescription drugs, and 45.2% were being treated for psychiatric reasons. A majority of the violent behavior that occurred was during the triage process at 40.2%.

Workers in departments that specialize in mental health are particularly at risk for patient abuse due to the psychiatric disease states, high rates of substance abuse, and previous violent patient behavior. A study of Canadian psychiatric nurses noted that stigma of psychiatric disorders plays a significant role in how nurses perceive violence. Caregivers were uncomfortable with the notion that patient violence is part of the job but also that it is unfair to believe that those with mental illness should be seen as more violent in nature. Osha reported that violent injuries in psychiatric aids was 10 times higher than any other healthcare worker at 590 injuries per 10,000 full-time employees.


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