Violence against staff in the municipal healthcare sector

The problem of violence against staff in the municipal healthcare sector has been the focus of increasing attention in Sweden. A nationwide survey of workplace violence was conducted in the healthcare sector. The results indicated that as many as 51% of those surveyed had been affected by violence either verbally or physically. The most vulnerable groups were auxiliary nurses, assistant nurses and those caring for mentally disabled people.

The groups most vulnerable to violence and threats of violence are primarily in occupational sectors involving customer, client or patient contacts, such as workers in the retail trade, security personnel, transport staff, and employees operating in the healthcare sector.

According to the report Work Environment 2001 (pdf file) (in Swedish), 17.3% of women and 9.5% of men reported that they had been exposed to violence at least once during the last 12 months. The female occupational groups most at risk were auxiliary nurses, assistant nurses, those caring for mentally disabled people, nursing specialists and personal assistants.

The overall objective of the doctoral thesis Violence in care (pdf file), carried out by the National Institute for Working life in 2004, was to gain a better understanding of violence against staff in the public healthcare sector in Sweden, to identify the risk factors and consequences, and to highlight social support and preventive measures.

Survey approach

The survey participants all belonged to the seven largest occupational groups in the Swedish municipal healthcare sector, working mainly with the elderly or persons with developmental disability. The seven occupational groups comprised administrators, nursing specialists, job supervisors, those caring for mentally disabled people, auxiliary nurses, assistant nurses and personal assistants.

A postal questionnaire was sent to 2,800 randomly selected individuals throughout Sweden, 400 to each occupational group. The questionnaire covered 29 different items referring to the previous year.

Violence was defined as ‘challenging behaviour’ including verbal threats, screaming, scratching, pinching, hitting, etc. The risk factors considered were of two types: individual characteristics, i.e., age, job tenure; and work-related conditions, i.e. workplace characteristics and terms of employment.

Main findings

In all, 2,214 people (79%) responded to the questionnaire. About 51% of those stated that they had been frequently exposed to violence over the previous year. Those most vulnerable were auxiliary nurses (38%), assistant nurses (33%) followed by people caring for mentally disabled patients (21%). 67% reported that they experienced incidents of violence or threats of violence several times a month and over 9% reported that such incidents occurred on a daily basis.

More than three quarters (79%) of the respondents had been exposed at some stage to verbal threats, screaming or scratching. The next most common type of violence was scratching or pinching (65%), and various kinds of physical blows (49%). Auxiliary nurses, personal assistants and assistant nurses were most at risk (about 60%).

The results also indicated that aggression aimed at staff usually comes from patients or care recipients (87%), but to a small degree also from patients’ relatives (8%).

Being young and having a short job tenure were significant individual risk factors. This was most obvious in the group of personal assistants, with an average age of 35 years, 52% of whom had been working for just a short time.

Respondents reporting being exposed to violence also experienced common work-related risk factors, such as the type of workplace, e.g. in specialised residences, working full-time with patients/clients, and a heavy workload.

The most common reaction of being exposed to any kind of violence was anger (41%), irritation (38%) or feeling sad (36%). Just over a third felt either helpless or insulted. There was no difference between the various occupational groups.

Looking at support and preventive measures, about 39% of those exposed to violence had received help or support after an incident, and 64% had benefited from some kind of preventive intervention.

In summary, the results indicate that violence is common in public healthcare services. Many employees are exposed to violence on a daily basis. It is usually verbal, but more serious forms of violence also occur. Occupational groups in close physical contact with clients, such as auxiliary nurses, assistant nurses and those caring for mentally disabled people, are most at risk. The consequences of acts of violence vary, depending on the individual and on the workplace. Such acts need to be recorded and analysed to allow for stronger preventive measures.

Reference

Viitasara, E., Violence in care: risk factors, outcomes and support , Doctoral thesis, Arbete och Hälsa, National Institute for Working life, Stockholm, 2004.