Psychological consequences of aggression in pre-hospital emergency care: Cross sectional survey

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Abstract

Background

Pre-hospital emergency care is a particularly vulnerable setting for workplace violence. However, there is no literature available to date on the psychological consequences of violence in pre-hospital emergency care.

Objectives

To evaluate the psychological consequences of exposure to workplace violence from patients and those accompanying them in pre-hospital emergency care.

Design

A retrospective cross-sectional study.

Setting

70 pre-hospital emergency care services located in Madrid region.

Participants

A randomized sample of 441 health care workers (135 physicians, 127 nurses and 179 emergency care assistants).

Methods

Data were collected from February to May 2012. The survey was divided into four sections: demographic/professional information, level of burnout determined by Maslach Burnout Inventory (MBI), mental health status using General Health Questionnaire (GHQ-28) and frequency and type of violent behaviour experienced by staff members.

Results

The health care professionals who had been exposed to physical and verbal violence presented a significantly higher percentage of anxiety, emotional exhaustion, depersonalization and burnout syndrome compared with those who had not been subjected to any aggression. Frequency of verbal violence (more than five times) was related to emotional exhaustion and depersonalization.

Conclusion

Type of violence (i.e. physical aggression) is especially related to high anxiety levels and frequency of verbal aggression is associated with burnout (emotional exhaustion and depersonalization). Psychological counselling should be made available to professional staff who have been subjected to physical aggression or frequent verbal violence.

Introduction

Violence in the health care system is a complex and dangerous occupational hazard for health care staff that has increased in recent years. While workplace violence affects practically all sectors and employees at all levels, in the health sector this is a major risk. Violence in this sector represents almost a quarter of all workplace violence and may affect more than 50% of health care workers overall (Cooper and Swanson, 2002, Di Martino, 2002). In particular, in recent years health care professionals have been found to be at a high risk of violence from patients or those accompanying them in industrialized and developing countries, and this is a source of growing concern for these professionals as shown in several studies (Atawneh et al., 2003, Di Martino, 2002, Farrell et al., 2006, Gacki-Smith et al., 2009, Hahn et al., 2013). Not only has the number of incidents increased but the severity of the impact has also had profound traumatic effects on the primary, secondary and tertiary victims (Rippon, 2000).

Pre-hospital emergency care is any clinical care or intervention that an acutely ill or injured person receives from trained personnel in the pre-hospital environment. While all health sector staff in a hospital or primary care centre may be subjected to violence, this is more likely for staff working in pre-hospital emergency care (Grange and Corbett, 2002). Pre-hospital care providers may be at a higher risk of workplace violence than those who work in a hospital or primary care centre because their close initial contact with patients, often during crisis situations, takes place without the security and support systems that exist in those workplaces. In these circumstances, they are exposed to unpredictable and difficult situations where they may be victims of violent attacks. However, only a handful of scientific studies have been carried out in this field (Boyle et al., 2007, Joa and Morken, 2012, Koritsas et al., 2009, Petzäll et al., 2011, Suserud et al., 2002).

Section snippets

Background

Although the consequences of physical aggressions are more widely reported, the non-physical effects also cause considerable suffering (Needham et al., 2005). Research has demonstrated that psychological and emotional damage may persist and interfere with normal working and leisure lifestyles for months or even years after the incident (Rippon, 2000). Nevertheless, very little information about the psychological consequences of aggression is available.

Aims

The aims of this study are to identify the psychological consequences of aggression (burnout and mental health status) and to analyze differences depending on type and frequency of aggression. Based on the literature reviewed, higher levels of burnout and psychological distress were predicted in professionals exposed to verbal aggression or physical violence, and these levels will be significantly higher in those staff more frequently victimized.

Design and setting

An ex post facto cross-sectional design was used

Participants

The demographic profile of the sample is presented in Table 1. The majority of the subjects in the sample (64.6%) were male, with mean age 45, married or living with a partner, with a mean working experience of 18 years and regular employment status (84.5%). The mean length of employment in the current service was 11 years. A mean of one sick leave period over the last year was obtained for one third of the subjects. Age was the only demographic where significant differences were observed, as

Discussion

Very little research to date has evaluated the aggression suffered by health care professionals working in pre-hospital emergency care, and the existing studies focus on evaluating emergency care assistants (or paramedics), probably because of the different ways emergency health systems are organized: in English-speaking countries the service transferring patients to the hospital system itself tends to predominate, whereas the model in continental Europe (e.g. France, Spain and Germany) focuses

Limitations

The limitations to be taken into account when drawing conclusions from these findings are: first, the cross-sectional and retrospective design of the study; secondly, that all violent incidents occurring during the whole professional career of the SUMMA 112 staff were taken into account, as we consider that any violent incident is serious enough to have a lasting effect on the member of staff and to affect their current professional behaviour. Most other studies, however, only consider

Conclusions

In conclusion, health care staff who have suffered physical and verbal violence presented greater anxiety, emotional exhaustion, depersonalization and higher levels of burnout than those who had not experienced any aggression. Type of violence (i.e. physical aggression) is especially related to high anxiety levels and frequency of aggression is associated with burnout syndrome (emotional exhaustion and depersonalization).

The existence of adverse psychological consequences of physical and verbal

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