Original Research: Empirical Research – Qualitative
Understanding patient-to-worker violence in hospitals: a qualitative analysis of documented incident reports
Article first published online: 4 AUG 2014
© 2014 John Wiley & Sons Ltd
Journal of Advanced Nursing
Volume 71, Issue 2, pages 338–348, February 2015
How to Cite
2015) Understanding patient-to-worker violence in hospitals: a qualitative analysis of documented incident reports. Journal of Advanced Nursing 71(2), 338–348. doi: 10.1111/jan.12494, , , , & (
- Issue published online: 12 JAN 2015
- Article first published online: 4 AUG 2014
- Manuscript Accepted: 5 JUL 2014
- The Centers for Disease Control-National Institute for Occupational Safety and Health. Grant Number: R01 OH009948
- content analysis;
- healthcare workers;
- occupational health;
- work safety;
- workplace violence
To explore catalysts to, and circumstances surrounding, patient-to-worker violent incidents recorded by employees in a hospital system database.
Violence by patients towards healthcare workers (Type II workplace violence) is a significant occupational hazard in hospitals worldwide. Studies to date have failed to investigate its root causes due to a lack of empirical research based on documented episodes of patient violence.
Qualitative content analysis.
Content analysis was conducted on the total sample of 214 Type II incidents documented in 2011 by employees of an American hospital system with a centralized reporting system.
The majority of incidents were reported by nurses (39·8%), security staff (15·9%) and nurse assistants (14·4%). Three distinct themes were identified from the analysis: Patient Behaviour, Patient Care and Situational Events. Specific causes of violence related to Patient Behaviour were cognitive impairment and demanding to leave. Catalysts related to patient care were the use of needles, patient pain/discomfort and physical transfers of patients. Situational factors included the use/presence of restraints; transitions in the care process; intervening to protect patients and/or staff; and redirecting patients.
Identifying catalysts and situations involved in patient violence in hospitals informs administrators about potential targets for intervention. Hospital staff can be trained to recognize these specific risk factors for patient violence and can be educated in how to best mitigate or prevent the most common forms of violent behaviour. A social–ecological model can be adapted to the hospital setting as a framework for prevention of patient violence towards staff.