The most common causes of employee abuse in healthcare, the role of communication and risk assessment in prevention

Abstract

The problem of abuse of health workers is not a new phenomenon, and there has been a significant upward trend in past decades. In a Hungarian survey, 7% of nurses surveyed said they were regularly abused during work. Only 13% of respondents have not been a victim of aggression thus far. 51% of nurses reported one or two occasions during their careers, and 29% reported more than two abuses. Workplace abuse has adverse effects on staff, which can significantly impair the quality of health care, pose a high risk to patient safety, and adversely affect patient satisfaction.

The aim of this publication is to summarize the most common general causes of abuse in healthcare institutions, to draw attention to the importance of risk assessment and the means of communication that can be used to prevent worker abuse.

The adverse event reporting system in Hungary is the NEVES reporting system, which provides institutions with the opportunity to collect data on 21 topics on a nationally available online interface. Events were voluntarily reported using a structured datasheet which protects anonymity. By the time the research began, 137 reports had been received on the issue of employee abuse. During the statistical analysis of the data on the reported abuses, we looked for the causes and factors contributing to the occurrence of the events, as well as the possibilities for their prevention. The scope of the information from the analyses was expanded on the basis of Hungarian and international publications, as well as the results of consultations and focus group discussions with experts with practical experience in the field.

According to the reports, 67.9% of abusers may have had a mental illness. The aggressive state of the abuser was influenced by medications in 22 cases, drugs in 13 cases, and alcohol in 17 cases. The majority of reported cases occurred in the active, non-surgical ward (41.6%) and in psychiatry (39.4%). According to reports, the onset of aggression was facilitated by three contributing factors in 39 cases, two in 36 cases, one in 18 cases, and four in 24 cases. The research shows that in a considerable proportion of cases (15.3%) communication played a role in the occurrence of aggression, so this should be given special attention during prevention measures. We were able to identify a number of risk factors in the background of the atrocities experienced by the employees, and the causal list, supplemented with literature sources and information from expert discussions. These risk factors were classified into 12 main categories, as follows: 1. shortcomings of regulations; 2. employees do not follow the rules; 3. patients and / or their relatives do not follow the house rule; 4. problems related to education; 5. workflow issues; 6. human resource issues; 7. problems with care staff; 8. problems with patients; 9. problems with relatives; 10. communication problems; 11. infrastructure problems; 12. previous knowledge and experience gained from similar events is not utilized.

By knowing the causes, targeted preventive measures can be taken. Much of the causes is related to communication. Improper communication on the part of employees can create tension in the patient or their relative, which can even lead to abuse. It is particularly important for workers to be able to recognize signs of impending violence in a timely manner and to avoid it through appropriate communication (using verbal techniques that can be learned through training). The introduction of surveys assessing the risk of aggressive behaviour and the preventive measures taken based on the results of these surveys could effectively contribute to the prevention of abuse. However, the practice of this is not widespread in Hungarian institutions.

The occurrence of events cannot be avoided in all cases, but their occurrence can be partially prevented and their number can be reduced by appropriate measures. Regular data collection and analysis provides an opportunity for institutions to identify areas for improvement and to prevent the occurrence of new cases. In most cases, complex processes play a role in the development of abuse, so the problem must always be examined in a complex way.