Healthcare Worker's Experiences of Patient‐Initiated Workplace Violence in Emergency Departments: Qualitative Research
Bibliographic record
Abstract
AIM: To examine (a) 'on-the-spot' experiences, (b) contributing factors and (c) warning signs of patient-initiated workplace violence (WPV) from the perspectives of healthcare worker (HCW) victims and witnesses in emergency departments. DESIGN: A qualitative interpretive description study. METHODS: Data from in-depth semi-structured virtual interviews conducted from June to September 2023 with purposefully selected HCW victims and witnesses (n = 19), and incident reports (n = 47) from the Workplace Health Indicator Tracking and Evaluation database of two emergency departments in British Columbia, Canada, were analysed using thematic analysis. RESULTS: Participants reported (1) physical assault, (2) threats of physical assault, (3) emotional/verbal violence and (4) threats of sexual assault. Contributing factors to patient-initiated WPV encompassed three main themes and their subthemes: (1) the context of the care environment (care provision and unit flow, staffing shortages and wait times, patient needs being beyond what can be delivered); (2) the context of the patient (patients' physiological and psychological states, patients not having the 'benefit of our perspectives' and patients' previous experiences of losing freedom and experiencing violence); and (3) the context of the healthcare provider (healthcare provider education and interactions with patients). While not all patients demonstrated warning signs before exhibiting aggression, those who did, most commonly showed signs such as being irritable and/or avoiding eye contact or answering questions. CONCLUSION: Findings emphasised an urgent need for patient-centred, trauma informed and team-based care approaches and training programmes. IMPACT: While there is extensive body of evidence on patient-initiated WPV in relation to its prevalence, antecedents and consequences, there remains a gap in our understandings of contributing factors, and early warning signs. Through understanding the experiences of HCW victims and/or witnesses of 'on-the-spot' experiences and experiences leading up to aggression and violence, this study revealed further understandings of contributing factors and early warnings sings of patient-initiated WPV. Patient-initiated WPV in emergency departments involve multifaceted risk factors at the system, environmental, patient and healthcare provider levels and their mitigation require the adoption of patient-centred care, trauma informed care and team based care. REPORTING METHOD: The COREQ guidelines for qualitative research were used. PATIENT/PUBLIC CONTRIBUTION: No patient or public contribution.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.003 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".