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Growing trend of violence in hospitals

Occupational violence is a worldwide, multifaceted problem affecting all industries, including healthcare. Frequency of hospital violence exists beyond news headlines and television shows impacting significant number of care providers and patients. Hospitals at one time were much like mosques and schools and were considered somewhat sacred. Unfortunately, that’s not the case anymore. Previously, violence had only been addressed as a criminal, psychological, anthropological or sociological problem. The most frequent form of occupational violence was verbal abuse, followed by threatening behavior, physical violence, and obscene behavior.

Violence is increasing in hospitals because:

1. Doctors are no longer thought of as ‘miracle workers’ rather they have formed mafia or ‘cartels’. This means they are more easily blamed when a patient’s condition deteriorates.

2. Hospitals are now regarded as businesses. This perception has been aggravated by television as well as by the effects of the recession on jobs.

3. The greater the social distance (difference between peoples’ economic, political and class distinctions) between patients and health care staff at the time of the event, the greater the possibility of violence.

4. Patients’ psychiatric and drug/alcohol history and patients’ relatives’ dissatisfaction with care given, long waiting time, and staff shortages are the main precipitants of violence.


Occupational violence affects health services delivery. Violence as a public health issue has many negative manifestations such as low worker morale, heightened job stress, increased employee turnover, and reduced trust of management, coworkers, and hostility in the work environment.

Apart from allied health workers and general practitioners, nurses experience a higher risk of being exposed to the most distressing occupational violence in form of verbal abuse followed by threatening behavior from patients’ and their relatives. Nurses often have to get uncomfortably close with extremely stressed-out people, so an element of aggression is perhaps inevitable. Some assaults come from people experiencing psychosis or other mental crises. Dementia and in-home-care patients are also frequent sources. Plenty of people attack nurses out of simple frustration.

A patient or visitor may witness or participate in a violent event but is soon gone from the hospital. The care provider, however, remains, and may encounter violence day after day, leading to physical, mental, and emotional hardship. Violence against health staff is a complex and persistent occupational hazard facing the medical profession. This violence can take the form of intimidation, harassment, stalking, beatings, stabbings, shootings, and other forms of assault. Psychological consequences resulting from violence may include fear, anxiety, sadness, depression, frustration, mistrust, and nervousness. These consequences can have a negative impact on staff retention. Care providers exposed to abuse and violence early in their careers became disillusioned with the profession. Aggression, abuse, and violence experienced by care providers cause them to feel incompetent, guilty, powerless, worthless, and fearful of criticism.


Many incidents go underreported because they do not fall into the hospital’s definition of ‘violence’ but others are omitted because officials do not want them to reflect negatively on the hospital’s image. Many victims of violence today bring with them into hospitals all the mental complexities, physical pain, and emotional worries conducive to a continuation of violence.

The challenge hospitals are facing is how to develop a zero-tolerance policy through de-escalation and self-defense training in order to prevent, mitigate, control, and respond to such violence within the caring and compassionate nature of the hospital environment.

Methods must be found to meet the needs of arriving victims without claiming care providers as collaterally damaged victims themselves. Violence is harming patients, care providers and hospitals. Violence harms patients by changing or reducing care providers’ attitudes toward them. The attitude and behavior of a care provider dealing with violence on a care unit is different from one on a unit without violence. Violence takes away from care providers’ concentration and attention to patients. Care providers are leaving the profession, retiring early and not promoting patient care as a profession because of violence. Violence also harms the reputation of hospitals. The reputation of a hospital affects patient selection or non-selection for care. Reputation also influences the physician’s choice of where to practice and helps job seekers decide where to apply and work.

The most often used strategies by all health professionals to defend against violence from patients and patients’ relatives include staying calm, trying to negotiate, ignoring comments/actions, and terminating the consultation. Telephoning police and/or security is also used by allied health professionals and nurses as a major defense strategy to deal with violence by patients and patients’ relatives.

Since all classes, economic levels, races, and educational levels are mixed, as people become patients in a hospital therefore the care providers need to recognize individual patient’s social norms and attempt to make accommodations. Hence empathy is a key factor for de-escalating violence.

To reduce anger, aggression and violence on a care unit, a hospital should identify and develop methods to reduce the strains on patients, visitors and care givers. Listening to and observing a patient, family member or visitor is expounded as the best way to predict and avert tendencies of aggression and violence.

An effective strategy aimed at minimizing occupational violence needs to be all encompassing and comprehensive, sensitive to big-picture issues, and locality specific.

In its effort to minimize such violence, hospitals’ management needs to focus on cooperation and integration across public health, health care, mental health, criminal justice, social service, education and other relevant sectors.

The writer is a Karachi based freelance columnist and is a banker by profession. He could be reached on Twitter @ReluctantAhsan

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