A total of 716 pieces of literature were found via the search of two literature databases PubMed and CNKI. While 693 articles are excluded for not meet the criteria. 23 articles are being selected after matching the criteria. The frequency of the categorized topics ranges from high to low are: ‘Risk evaluation’, ‘Peer and management support’, ‘Incident rates’, ‘De-escalation training’, ‘Consequences’, ‘Technical emergency system’, ‘Follow-up care’.
22 papers are focused on ‘Risk evaluation’, 19 papers mentioned about ‘Peer and management support’, 16 papers calculated on ‘Incident rates’ in specific regions, both ‘De-escalation training’ and ‘Consequences’ are discussed by 11 papers, only 6 papers provide through ‘Technical emergency system’ after analyzing the risk factors of WPV in Healthcare, merely 5 papers stressed the importance of ‘Follow-up care’, and proposed effective measures and suggestions. Seventeen pieces of literature were addressed both on ‘risk evaluation’ and ‘incidents rate’. While four pieces of research discussed ‘Peer and management support’, ‘De-escalation training’ and ‘Technical emergency system’. Only four researches mentioned both on ‘Consequences’ and ‘Follow-up care’.
As it is mentioned before that different departments of the hospital have different types of assaults occurrence.(Chapman, Perry, Styles, & Combs, 2009) invented the STAMPERAR assessment tool based on the STAMP acronym developed by (Luck, Jackson, & Usher, 2007). The acronym STAMPERAR including staring, tone and volume of voice, assertiveness, mumbling, pacing, emotions, disease process, anxiety, and resources. Whether or not the STAMPERAR is effective enough, this approach can be implemented to the prevention program based on the structure of different healthcare facilities (e.g., disease process, anxiety, and mumbling can weigh more in the psychiatric wards where patients suffer from frequent mental disorders).
Peer and Management Support
Among the 19 articles, only 2 papers talked about the agencies that take responsibility for WPV. Mentioned by (Blando, Ridenour, Hartley, & Casteel, 2015), the authors named few agencies including the New Jersey Department of Health and Senior Services (NJDHSS), Occupational Safety and Health Administration (OSHA)and The Health Professionals and Allied Employees (HPAE). Comparing with Chinese WPV agencies, there are only a few little known agencies like China Occupational Safety and Health Association, National Institute for Occupational Safety and Health (NIOSH).
The guideline for the occupational safety, such as Occupational Safety and Health Act in the US, Workplace Hazardous Materials Information System (WHMIS) in Canada, the Health and Safety at Work Act in the UK, was implemented for decades before China drafted and promoted a brief law ‘Law of the People’s Republic of China on Basic Medical Hygiene and Health Promotion’ in 2019. For example, based on the OSHA, different states in the US have their regulations or bills, such as Senate Bill 351 and House Bill 1879 that to increase the penalty for aggressions in healthcare on existent legislation(Hoffman, 2019).
However, given that this Law only provided a basic direction of protecting the rights of healthcare workers in hospital and medical disputes, local medical institutions still need to further introduce even local regulations to fully improve the safe and orderly working environment of the hospital, to provide patients with a comfortable medical experience. (Hoffman, 2019) proposed legislation from House Bill 39, Senate Bill 842, and House Bill 1880 that allowing the HCWs to leave out the last name from hospital ID badges. This is a very wise choice for the Chinese hospital to learn from to protect the privacy of HCWs to save unnecessary issues.
Among 16 articles that analyzed the incident rates that happened in the healthcare workplaces, nurses and physicians in the emergency room are at high risk for violence assaults, inpatient wards, psychiatry wards, and emergency departments are the most frequent places for aggressive behaviors against HCWs. While (Ferri, Silvestri, Artoni, & Di Lorenzo, 2016) reports the high-risk exposure for physicians in the geriatric wards (57%), another report from Italy also shows 64% assaults occurs in the waiting room (D’Ettorre, Pellicani, Mazzotta, & Vullo, 2018). Most of the assault-type is non-physical assault like verbal assault or threats, following up with the physical abuses or property damage, disturbing public order. The studies showed that 9.5-37.2% of HCWs had been sexually harassed in acute psychiatric units.
Barriers to implementing effective prevention programs were also being stated in (Blando et al., 2015)’s article. After collecting several physician’s quotes, specific barriers are listed such as management lack of accountability or disregard after being reported about WPV from the HCWs. HCWs do not have a consistent definition of violence, resulting in report inactive. A study showed that violence being reported on takes up to 57% in physical violence and 40% in non-physical violence, among which approximately 86% are simple oral reports to managers.
In another article, a survey named the Personal and Organizational Quality Assessment Revised (POQA-R) was used to estimates physical stress symptoms, workplace climate, psychological condition, and work performance. There are standardized scores for evaluation. 24 categories of personal and organizational quality were included, for example, personal questions contain fatigue, anger management, distress, and vitality; job-related questions contain productivity, clarity, satisfaction, communication, and social support; physical stress symptoms questions contains body aches, inadequate sleep, and rapid heartbeats. Research from reveals 94% of nurses suffered from at least one Post-Traumatic Stress Disorder (PTSD) symptom after violent assaults, which become a significant stressor for nurses. (Gates, Gillespie, & Succop, 2011) pointed out that workers suffering PTSD symptoms result in distressing emotions, withdrawal from patients, absenteeism, and job changes.
Technical Emergency System
As a part of the prevention system, hospitals should make sure there is a security check in the entry of the hospital and prohibit flammable and explosive items or sharp items entering the hospital. (Claudius, Desai, Davis, & Henderson, 2017) studies listed several weapons used by aggressive patients, such as charts, pencils, tape, linen hampers, and boxes of gloves. Only 15.7% of hospitals surveyed in a German report contains the technical emergency system.
When the de-escalating training practices are not able to prevent every violence, the healthcare organizations should construct their specialized intervention strategies, after the situation is not preventable and secure, the emergency system needs to be effective. Physicians should be taught in advance about how to escape from the danger to the safe areas to avoid further injuries. At the same time, a fully equipped alarm system seeks for the protection of the security guard, to control and stabilize the aggressive patients.
After the violence occurrence, it is important to give adequate support to the victim of the WPV. The management of the healthcare organization should show their understanding of the influence caused on the assault victims by allowing them to go home for several days to adjust. It is important to track every violent event happened in the hospital, observing and recording victims’ status and provide counseling for mental relief if the victim is suffered from PTSD symptoms. The management should take every measure to avoid absenteeism, turnover, or loss of productivity of the organization (Samuels, Hunt, & Tezra, 2018).
This study has several limitations. First, this article used limited articles resources from only two literature research data. The origin of the studies selected are distributed worldwide disproportionally, papers from African areas are excluded, and different resources are not balanced enough. Second, even though the main topic is going to compare the healthcare deficiencies of Chinese hospital regulations for females, the resources from the Chinses hospitals are not strong enough. Meanwhile, the language of the papers is in English. Future studies are encouraged to carry out more specific HCWs protecting strategy for Chinses hospitals, especially considering female HCWs.
Chinese hospital has multiple structures, primary and secondary hospitals has higher risks of WPV, such phenomenon was contributed to different risk factors, but the efforts to manage the safety strategies in the hospital will benefit any hospitals. What Chinese hospitals lack most about is a consistent system in every hospital and the awareness for HCWs to protect themselves from the WPV. The Chinses government should establish a professional association to supervise and administrate on the WPV especially in healthcare and implement a standardized guideline for the hospitals to follow to deal with the WPV problems in the healthcare systems.
Hospitals should establish committees to discuss the WPV and meet regularly, meeting especially with those departments with high-risk exposure rates, collecting the data of incidents rates, and tracking every violent event to help very victims and preventing the violence from happening again.
Committees should fully take into account the differences in gender in the work environment in healthcare. Reduce the chance of long-working hours and shifting work at night for female HCWs, establishing counseling to encourage sexual harassment reports, ensuring the confidentiality of privacy, and give special courses for female HCWs. Legislation should also upgrade the penalty for sexual assault to protect female workers.
- Blando, J., Ridenour, M., Hartley, D., & Casteel, C. (2015). Barriers to effective implementation of programs for the prevention of workplace violence in hospitals. Online journal of issues in nursing, 20(1).
- Chapman, R., Perry, L., Styles, I., & Combs, S. (2009). Predicting patient aggression against nurses in all hospital areas. British Journal of Nursing, 18(8), 476-483.
- Claudius, I. A., Desai, S., Davis, E., & Henderson, S. (2017). Case-controlled Analysis of Patient-based Risk Factors for Assault in the Healthcare Workplace. West J Emerg Med, 18(6), 1153-1158. doi:10.5811/westjem.2017.7.34845
- D’Ettorre, G., Pellicani, V., Mazzotta, M., & Vullo, A. (2018). Preventing and managing workplace violence against healthcare workers in Emergency Departments. Acta Biomed, 89(4-S), 28-36. doi:10.23750/abm.v89i4-S.7113
- Ferri, P., Silvestri, M., Artoni, C., & Di Lorenzo, R. (2016). Workplace violence in different settings and among various health professionals in an Italian general hospital: a cross-sectional study. Psychol Res Behav Manag, 9, 263-275. doi:10.2147/PRBM.S114870
- Gates, D. M., Gillespie, G. L., & Succop, P. (2011). Violence against nurses and its impact on stress and productivity. Nurs Econ, 29(2), 59-66.
- Hoffman, R. (2019). Violence Against Healthcare Workers. Patient Safety, 1(2), 2-2.
- Luck, L., Jackson, D., & Usher, K. (2007). STAMP: components of observable behaviour that indicate potential for patient violence in emergency departments. Journal of advanced nursing, 59(1), 11-19.
- Samuels, S. K., Hunt, S., & Tezra, J. (2018). Patient Violence against Healthcare Workers. Journal of Business and Behavioral Sciences, 30(2), 127-138.