Violence and aggression at work

Violence and aggression at work

M. N. Pemberton,1 G. J. Atherton2 and M. H. Thornhill31Consultant in Oral Medicine, University Dental Hospital of Manchester, Higher Cambridge Street, Manchester M15 6FH; 2Honorary Dental Surgeon, University Dental Hospital of Manchester, Higher Cambridge Street, Manchester M15 6FH; 3Professor of Clinical Oral Sciences, Oral Diseases Research Centre, St Bartholomew's and the Royal London Hospital School of Medicine and Dentistry, 2 Newark Street, London, E1 2AT
Correspondence to: Dr M. N. Pemberton.
The issue of violence and aggression towards healthcare personnel has received increasing attention over recent years. Surveys indicate that such behaviour does occur in both hospital and community dental settings, although in comparison, many other healthcare workers appear to be at greater risk. Information and advice to prevent and manage such situations, should they occur, are available.
Imagine the scene. It is a hot Friday afternoon, you are running late, and the extra 'toothache' that you agreed to see is in the chair. The patient has clearly had a few to drink and demands the offending tooth out now. Infection, however, makes local anaesthesia impossible and you offer to drain the abscess and prescribe antibiotics as an initial treatment instead. The patient is clearly unhappy. He repeats his demand for an immediate extraction more aggressively. As you try to explain, he gets up from the chair and comes towards you threateningly...
Unfortunately, aggressive behaviour and violence towards healthcare workers is an increasingly recognised problem. Earlier this year, it was widely reported that a general medical practitioner was stabbed in his surgery by a patient, and a healthcare assistant was severely beaten whilst on hospital grounds, all within the period of a single day. Not surprisingly, such events have led to renewed calls for steps to protect healthcare staff from aggression and violence at work. So are healthcare staff at significant risk of violent behaviour and assault whilst carrying out their professional duties?
Assessing the risk
The actual prevalence of aggression and violence in healthcare settings is difficult to determine from the literature, as much of the data is anecdotal with differing definitions used of what constitutes aggression and violence. Surveys however, suggest a wide variation in rates in different areas and amongst different groups of patients and staff. For doctors, the literature has been reviewed by Hobbs and Keane1, who concluded that the risk of suffering violent injury as a doctor remains low.
Experience of aggressive behaviour and abuse however was more common. One survey of general medical practitioners found that over 60 per cent of them had experienced abuse or violence by patients or their relatives over a 12 month period, with almost 20 per cent reporting some sort of abuse at least once a month, the problem appearing to be worse in inner cities.
Hospital cases
Violent events are also reported in hospitals. One survey of hospital doctors found that over half had been victims of, or threatened with, violence at work, while 41 per cent of junior doctors in high-risk areas such as accident and emergency (A&E) departments and psychiatry, reported experience of physical violence.
This issue has also generated much discussion in the nursing literature where, in A&E departments, nurses were the most common victims amongst all the staff present.2 Indeed, aggressive behaviour and violence towards nurses led to the Nursing Times and Royal College of Nursing launching the 'Stamp out Violence' campaign in 1998.3