Violence in the Emergency Department a Literature Review
Arch Trauma Res. 2016 Mar; 5(i): e28734.
A Systematic Literature Review: Workplace Violence Against Emergency Medical Services Personnel
Majid Pourshaikhian
1Section of Health Services Management, Iran University of Medical Sciences, Tehran, IR Iran
Hassan Abolghasem Gorji
oneSection of Health Services Management, Iran University of Medical Sciences, Tehran, IR Iran
Aidin Aryankhesal
aneSection of Health Services Direction, Iran Academy of Medical Sciences, Tehran, IR Iran
2Health Management and Economics Research Heart, Iran Academy of Medical Sciences, Tehran, IR Islamic republic of iran
Davood Khorasani-Zavareh
3Section of Health in Disaster and Emergency, School of HSE, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
fourClinical Sciences and Teaching Department, Karolinska Institute, Stockholm, Sweden
Ahmad Barati
1Department of Health Services Management, Iran University of Medical Sciences, Tehran, IR Islamic republic of iran
Received 2015 Mar 18; Revised 2015 Jun 22; Accepted 2015 Jun 24.
Abstruse
Context
In spite of the loftier prevalence and consequences of much workplace violence against emergency medical services personnel, this phenomenon has been given insufficient attention. A systematic review can aid the development of guidelines to reduce violence.
Objectives
The enquiry question addressed by this paper is, "What are the characteristics and findings of studies on workplace violence against emergency medical services personnel"?
Information Sources
A systematic literature review was conducted using online databases (PubMed, Scopus, Google Scholar, and Magiran) with the help of experienced librarians.
Report Choice
Inclusion criteria comprised studies in the English or Persian linguistic communication and researcher'southward access to the full text. At that place was no limit to the entry of the written report design. Exclusion criteria included lack of access to the total text of the commodity, studies published in unreliable journals or conferences, and studies in which the results were shared with other medical or relief groups and at that place was no possibility of breaking downward the results.
Information Extraction
A "Data extraction form" was designed by the researchers based on the goals of the study that included the title and author(due south), study method (type, identify of study, sample size, sampling method, and data drove/analysis tool), press location, data related to the frequency of types of violence, characteristics of victims /perpetrators, and related factors.
Results
The papers reviewed utilized a variety of locations and environments, methods, and instrument samplings. The majority of the studies were performed using the quantitative method. No intervention study was found. Almost studies focused on the prevalence of violence, and their results indicated that exposure to violence was loftier. The results are presented in 6 major themes.
Conclusions
Workplace violence and injuries incurred from it are extensive throughout the earth. The of import causes of violence include the shortage of training programs dealing with violence, lack of violence management protocols, and delays in response times. Therefore, afterthought and resolve are more than crucial than ever. Workplace violence reduction strategies and suggestions for future studies are besides discussed.
Keywords: Literature Review, Workplace Violence, Emergency Medical Services
1. Context
Workplace violence (WPV) is defined as any incident or state of affairs in which a person is threatened or attacked at work or under related conditions (1). Today, it is more often than not accustomed that WPV is a mutual occurrence amid medical jobs (2-7), and statistics show that 70-80% of doctors, nurses, emergency medical personnel, and public service workers will encounter ane or more than instances of violence annually (8). Violence against the prehospital emergency setting is less considered (9). Therefore, every bit of yet, there is no complete understanding of the incidence factors or recommendations for specific professional person communities on how to solve the problem of violence. WPV is an aggressive act that includes concrete or verbal assault, insult, or verbally intimidating behavior that occurs at work. Physical violence is divers as pushing, punching, kicking, grabbing, or any type of physical aggression. Verbal violence refers to annoying behavior, emotional abuse, and aggression (ten). Emergency medical services (EMS) personnel are trained to provide medical care or intervention services to injured or ill persons (4). They are the first ones who respond to the emergency needs of people (11). They work in diverse critical situations and need to react appropriately to safely transport patients to medical centers. Sometimes, they may see threats and violent reactions (7) in these unstructured environments (12). The loftier prevalence of WPV has been reported in a few studies (13), indicating the extent of the problem (11, 14).
The WPV may pb to complications for staff, organizations, and society. Even the fear of encountering it creates occupational stress (12), thereby negatively affecting the health of employees, organizational performance, and efficiency (five, 11). I study stated that 25% of WPV cases were injury-related incidences, of which 37% required medical care (9). Various factors are involved in the incidence of WPV (9), and some studies accept shown that trigger-happy incidents are non reported by employees (4). Other studies have offered recommendations for the control of violence, including staff training and the development of protocol for exposure to violence (5, 15), simply at that place are officially still no policies or procedures for the control of violence-causing situations (6). Even with the loftier prevalence of WPV and its consequences, a serious consensus has not yet been established about violence management.
2. Objectives
A systematic review of the existing literature has been proposed as a primal method of integrating the evidence (16). This study purposes to answer the question, "What are the characteristics and findings of studies conducted over 25 years on WPV against EMS personnel?"
2.1. Add in Value
This is the first systematic literature review of WPV against EMS personnel.
3. Information Sources
This study is a systematic review of the bones research carried out in the field of WPV against European monetary system staff from around the globe that has been published in English or Persian in the past 25 years (1990 - 2014). The present study was conducted according to a predesigned protocol.
3.1. Search Strategy
Searches were performed through electronic databases, including: PubMed, Scopus, Google Scholar, and Magiran, with the help of experienced librarians and using the post-obit keywords: violence, assailment, attack, workplace, ambulance, paramedic, emergency medical technician, prehospital, emergency medical services, and European monetary system. Transmission searches were conducted past tracking commodity references. The searches were carried out in September of 2014.
iv. Study Option
four.1. Inclusion and Exclusion Criteria
Inclusion criteria comprised the following: one) original research published in credible sources, 2) research related to WPV confronting European monetary system personnel, three) studies published within the past 25 years, and 4) English or Persian studies. Exclusion criteria included the lack of access to the full text of an article, studies published in unreliable journals or conferences, and studies in which the results were shared with other medical or relief groups and at that place was no possibility of breaking downward the results. No restrictions were placed on study design or methodology.
5. Information Extraction
To review the data, a "Data extraction grade" was designed past the researchers based on the goals of the report that included the title and author(s), report method (type, place of study, sample size, sampling method, and data drove/assay tool), press location, information related to the frequency of types of violence, characteristics of victims/perpetrators, and related factors.
5.one. Evaluation of Studies
The search results are based on keywords in study titles and abstracts. Thirty-three papers and one dissertation were accessed, and later reading the title and abstracts, 28 cases were selected. Five papers were excluded for the following reasons: ane report was published in 3 journals, and the near complete article was selected; ane newspaper had mutual indivisible results with medical and relief groups; one article was published at two different times, and the full text of 1 commodity was non accessible. Thus, at this point, 23 papers were included in the study, and ii researchers evaluated the full text of each of them. To assess the quality of the articles, the "Guide to evaluation of prevalence studies checklist" introduced past Vameghi et al. (17) was used. For the qualitative evaluation of studies, the design, proportion of the target population, description of inclusion/exclusion criteria, sampling, and sample size were considered. Each commodity was evaluated and classified by two researchers, and the papers of medium to high quality were included. In evaluating the quality of the articles with an emphasis on the approach used, more than weight was given to papers with a stronger summary of results. The qualitative assessment excluded 5 more than papers, and ultimately, 18 articles were selected (Figure 1).
Flowchart of Systematic Review
half-dozen. Results
The results of the reviewed studies can be presented in six major themes: "Frequency of violence," "Characteristics of perpetrators/victims," "Response to violence and reporting," "Consequences of violence," "Predisposing factors," and "Prevention factors of violence." Tables one - 9 summarize the characteristics of WPV and the major findings.
Table one. [Part 1]
Design and Key Findings of Selected Studies for Systematic Review About Workplace Violence Against Emergency Medical Services Staff
| No | Title | Author | Purpose | Setting/Country | Measures/Assay | Quality | Major Findings | Reference |
|---|---|---|---|---|---|---|---|---|
| 1 | Violent patient and prehospital providers | Tintinalli et al. 1993 | Estimate the frequency of violence directed toward prehospital providers. Identify the methods used to manage violent patients. Identify the medical, educational, and legal issues related to the management of tearing patients. | A convenient sample survey and a descriptive review of ambulance telephone call reports. Registrants (4200) at national association of EMS physicians in USA. | Review of ambulance telephone call reports for documentation of terms, violent or combative and verbal threats or physical violence, and too review of policies and procedures for direction of violent patients. | Moderate | There was a 0.8% incidence of vehement episodes in ambulance call report review. Only about 50% of survey respondents reported having a protocol for the management of violent patients. Injury to the prehospital providers in the past years was reported at 67% of respondents, and 67% had some training in management of vehement patients, and 25%: had trained in assessing the scene of potential violence. | (xv) |
| ii | Exposure of prehospital care providers to violence | Corbett et al. 1998 | Evaluate the experience of prehospital care providers with violence. | Emergency medical services (EMS) providers (522) in California, USA. | The questionnaire. Descriptive statistics. Chi square analysis. Correlation analysis. P < 0.05 significant | Relatively skilful | A total of 61% recounted attack on the job, and 25% had injury from assaults; 37% required medical attention; 35% said their company had a specific protocol for managing trigger-happy situations, and 28% stated e'er having received formal training in the direction of violence; 73% used protective gear. | (three) |
Tabular array nine. [Part nine]
Design and Key Findings of Selected Studies for Systematic Review Almost Workplace Violence Against Emergency Medical Services Staff
| No | Title | Author | Purpose | Setting/State | Measures/Analysis | Quality | Major Findings | Reference |
|---|---|---|---|---|---|---|---|---|
| 17 | The psychological consequences of aggression in prehospital emergency care | Bernaldo-De-Quiros et al. 2014 | Evaluate the psychological consequences of exposure to WPV from patients and accompanying them in prehospital emergency care. | Prehospital emergency care services personnel (441) in Madrid, Spain. | Questionnaire: demographic, level of exhaustion by Maslach burnout inventory, mental health status using (GHQ). Assay: SPSS, descriptive chi-square, Kolmogorov, Kruskal-Wallis. P < 0.05 was significant. CIs were 95%. | Good | Expose to physical and exact violence presented a significantly higher pct of feet, emotional exhaustion, depersonalization and burnout syndrome. Frequency of verbal violence (> v times) was related to emotional exhaustion and depersonalization | (12) |
| 18 | Paramedic self-reported exposure to violence in the EMS workplace, a mixed-method cross-exclusive survey | Bigham et al. 2014 | Describe and explore violence experienced by paramedics, types of violence, perpetrator, actions, and furnishings of these episodes. | Mix method survey on ambulance paramedics (1676) in Canada. qualitative questions about the impact of experiences. | Questionnaire: types of violence and the perpetrators. Open up-ended questions to study event details, mail service-consequence actions, and the personal impacts. Analysis: descriptive statistics and regression, and qualitative data were analyzed using content assay. | Good | 75%: experiencing violence. 67%: verbal, 41%: intimidation, 26%: physical, 14% and three%: sexual harassment and assault. Patients were identified every bit the most common perpetrators of violence. In the qualitative assay: Serious sequellae were reported, and participants stated that such events were "Part of the job." Paramedics may experience fearful for their safety when responding to calls of similar circumstance. | (13) |
Table 2. [Function 2]
Pattern and Cardinal Findings of Selected Studies for Systematic Review About Workplace Violence Against Emergency Medical Services Staff
| No | Title | Author | Purpose | Setting/Country | Measures/Assay | Quality | Major Findings | Reference |
|---|---|---|---|---|---|---|---|---|
| 3 | Prospective Field Study of Violence. | Mock et al. 1998 | Investigate the nature and frequency of violence encountered by European monetary system personnel. | European monetary system providers (297) were members of a countywide study in Tennessee, USA. | The questionnaire, prospective observations. Overt aggression calibration (OAS). Information assay: descriptive statistics, Fisher and t exam, CI: 95%, Bonferroni correction. P < 0.05: significant. | Good | There were 5% violent runs with 1 tearing episode for every xix runs. The violent behaviors were verbal aggression solely, fifty% (n = 8); physical assailment solely, 13% (n = two); both exact and concrete aggression, 38% (northward = 6). Exposure to violence is underreported in EMS documentation. | (18) |
| 4 | Exposure of prehospital providers to violence and abuse. | Pozzi et al. 1998 | Quantify the current existence of violence toward EMS personnel. Violence-related policies and appropriate training at European monetary system agencies. | EMS personnel (331) in fire department in Albuquerque, New Mexico, United states of america. | The questionnaire. Validity was measured per question response. Descriptive statistics analyzed question responses. | Relatively skillful | A full of ninety% said an assault or fierce action had been directed during their piece of work. Abusive and violent situations were the number i stressors; 71% had no clear protocols to handle abusive situations; 71% said abusive situations were considered a "Part of the job," and there was a lack training to learn how to protect them; fourscore%, felt aroused and 69% felt irritable after experiencing attack. | (6) |
Tabular array iii. [Role 3]
Design and Central Findings of Selected Studies for Systematic Review Almost Workplace Violence Confronting Emergency Medical Services Staff
| No | Championship | Writer | Purpose | Setting/Country | Measures/Assay | Quality | Major Findings | Reference |
|---|---|---|---|---|---|---|---|---|
| 5 | Exposure of French Ems personnel to violence | Duchateau et al. 2002 | Evaluate the problem of violence in French EMS organisation and characterize assaults. | The prehospital care providers (276) in Paris surface area, French republic. | The questionnaire about assaults during their careers, typology of the assaults and consequences. Descriptive assay: Results are presented in percentage and means | Proficient | 23%: one or more assaults. twoscore%: injured, wounds in ix% and fractures in ii%. 4% of assaults were followed past ill get out, 15% by a complaint. iv%: reported having received therapy against PTSD. 88% and 41% verbal and physical threat, consequently. 13%: threatened with a knife, 12% with a gun. | (19) |
| vi | Violence confronting EMS Personnel | Grange et al. 2002 | Determine the prevalence of violence against European monetary system providers in the prehospital setting. Make up one's mind associated factors. | Consecutive medical calls (4102) for EMS agencies in California, USA. | Demographic and situational information from the standard ambulance run sheets. Analysis: Prospective analysis descriptive, chi-foursquare, regression with 95% CIs, P < 0.05 was meaning. | Relatively good | 53%: prevalence of violence confronting prehospital care personnel. At that place were 4.5% fierce runs. Patients accounted for 89.7% of this trigger-happy beliefs. twenty.7% verbal, 48.9% physical, and thirty.iv% both verbal and physical attacks. Male, patient historic period, hour, police presence, psychiatric disorder, alcohol or drug utilize was associated with episodes of violence. | (four) |
Table 4. [Part iv]
Design and Primal Findings of Selected Studies for Systematic Review Almost Workplace Violence Against Emergency Medical Services Staff
| No | Championship | Author | Purpose | Setting/Country | Measures/Analysis | Quality | Major Findings | Reference |
|---|---|---|---|---|---|---|---|---|
| 7 | Injuries from assaults on paramedics and firewoman in an urban EMS | Mechem et al. 2002 | To determine the nature and frequency of injuries resulting from assaults on paramedics and in a big burn down section-based EMS system. | The retrospective descriptive study involved assaults and occupational injuries on EMS personnel (170000), U.s.a.. | Review of injury reports involving assaults. Variables: historic period, sex, work assignment, activity after assaulted, fourth dimension (day/week), nature of injury, medical care. Assay and information written report: means (SD), 95% (CIs). SAS statistic software viii. | Relatively skilful | 79.5%: paramedics were assaulted and 4.0%, injury reports due to assault during iii year. 81.8%: medical attention was sought and in 31.8%, the employee lost time from work. | (5) |
| eight | Experiences of threats and violence in Swedish ambulance service | Suserud et al. 2002 | Draw how ambulance personnel perceive. How they are subjected to and are influenced by, threats and violence in their twenty-four hour period-to-mean solar day piece of work. | Empirical descriptive study consisted of a questionnaire in three ambulance station (sample size: 66) in Sweden. | Questionnaire includes 13 structured and open-ended questions. Descriptive analysis for the prevalence. | Moderate | fourscore.3%: subjected to threats and/or violence. The majority: the relationship between paramedic and patient was about affected when threat or violence is a part of the state of affairs. The virtually common form of threats and violence was the use of threatening invectives (78%). 67%: subjected to some form of physical violence. 17%: treated with weapons. | (7) |
Tabular array five. [Function 5]
Pattern and Fundamental Findings of Selected Studies for Systematic Review Near Workplace Violence Against Emergency Medical Services Staff
| No | Championship | Author | Purpose | Setting/Land | Measures/Analysis | Quality | Major Findings | Reference |
|---|---|---|---|---|---|---|---|---|
| ix | WPV experienced by paramedic relationships with social support, job satisfaction and psychological strain | Brough et al. 2005 | Identify the extent and the characteristics of vehement incidents. Evaluation of perceived social support, job satisfaction, and psychological strain. | Paramedics (sample: 119) from Australian ambulance service from all of the geographic regions of Australia | Experiences of violence: a six-detail measure later test for face validity. Social support: Caplan, 1975 social support scale. Job satisfaction: Warr 1979 instrument. Psychological strain: GHQ-12, 1972. | Moderate | Exact violence was a meaning predictor of both chore satisfaction and psychological strain. Both supervisor and colleague support were significantly associated with job satisfaction. Job satisfaction and psychological strain produced a significant negative association as expected. The consequences of exposure to verbal violence are actually more than serious compared to the exposure to concrete violence. | (20) |
| 10 | A pilot report of workplace violence towards paramedics | Boyle et al. 2005 | Identify the percentage of paramedics who had experienced six different forms of workplace violence. | Paramedics (119) from the rural (Victoria) and metropolitan the South Australian, Commonwealth of australia | Questionnaire: types of WPV-paramedic'southward clarification paramedic'southward response-impact of event and demographic. Analysis: SPSS, descriptive, proportional differences, CLs 95%, χ2 examination, Fisher's and t-examination. | Good | 87.v%: exposed to workplace violence. Verbal corruption (82%), intimidation (55%), physical abuse (38%), sexual harassment (17%), and sexual assault (4%). Female more than male person experienced sexual harassment and assault. Half the paramedics experienced verbal abuse a few times in last year. | (2) |
Table half dozen. [Role 6]
Design and Central Findings of Selected Studies for Systematic Review About Workplace Violence Against Emergency Medical Services Staff
| No | Title | Author | Purpose | Setting/Country | Measures/Analysis | Quality | Major Findings | Reference |
|---|---|---|---|---|---|---|---|---|
| 11 | Hostile Workplace: Violence directed toward rural EMS Personnel | Carlson, 2007 | Place the types of violence. Evaluate EMS personnel's training experiences with regard to WPV. Identify the extent that work-related injuries. | A rural Ems in USA. The sample (96) was chosen from a conference that historically been Ems. | A "Self-designed survey of violence in workplace" questionnaire with a personal opinion and boosted comments section. Descriptive statistics. Personal opinion and additional comments were listed. | Good | 25%: sustained physical assault, 35%: harassed and 33% threatened by the patient and/or another person (family, bystander, etc.). 37.5%: had received some form of training on how to deal with potentially tearing situations. Of particular business organization are the reported forms of assault that possess a pregnant potential for moderate to serious injury (slap, push, striking, kicked, etc.). | (xiv) |
| 12 | Factors associated with Workplace Violence in paramedics | Koritsas et al. 2009 | Make up one's mind predictors of violence in paramedics | Paramedics (251), the rural Victoria and metropolitan South Australia, Commonwealth of australia | Cocky-designed questionnaire: half dozen forms of violence: assay: SPSS xiv.0 and discriminate function assay. | Good | Paramedics who experienced intimidation, sexual harassment and assault were more likely to be female who spent more time in directly patient contact/week were more likely to experience violence. Too, fully qualified paramedics were more than likely to experience violence than student paramedics. | (9) |
Tabular array seven. [Function seven]
Design and Key Findings of Selected Studies for Systematic Review Almost Workplace Violence Against Emergency Medical Services Staff
| No | Title | Author | Purpose | Setting/State | Measures/Assay | Quality | Major Findings | Reference |
|---|---|---|---|---|---|---|---|---|
| 13 | Threats and violence in Swedish prehospital emergency care | Petzall et al. 2011 | Investigate the incidents of threats and violence and to describe these situations. | Swedish ambulance services personnel (134) located in four counties in Sweden | Self- designed questionnaire. Analysis: SPSS 16.0, descriptive and inferential statistics, Inferential statistics, chi-square test. P < 0.05 were considered significant. | Good | 66%: experienced threats and/or violence during their work; 26%: experienced threats, and 16% faced physical violence. The most common kinds were threats of physical violence, with 27% of the respondents experiencing threats involving weapons. Ordinarily occurring physical violence was in the form of pushes, punches, kicks, and bites. In nearly cases, the perpetrator was under the influence of alcohol or drugs. Sexual activity, professional group, and piece of work feel hadn't whatever importance on the gamble of threats; 27%: threatened with some kind of weapon. | (11) |
| 14 | Exposure of Iranian EMTs to workplace violence: a cross-sectional analysis | Rahmani et al. 2012 | Describe the exposure of Iranian EMTs to workplace violence and to identify the importance of related factors. | Descriptive exploratory report in ambulance personnel (138) in Republic of azerbaijan Province, Islamic republic of iran. | Cocky-designed questionnaire: demographic information-exposure to 5 forms of WPV-related factors. Validity and reliability: face and content validity past experts and the test–retest. Analysis: SPSS, descriptive statistics. The results are reported with 95% CI. | Good | 75%: experienced at to the lowest degree one form of WPV; 71%: exact abuse, 38%: concrete assault, 9%: cultural harassment, 4%: serious injuries due to violence, eight%: workplace violence that included the use of weapons. Majority: response to WPV was to 'Invite the offender to at-home down'. xxx%: WPV as a common upshot in their job. | (21) |
Table 8. [Part 8]
Design and Key Findings of Selected Studies for Systematic Review About Workplace Violence Against Emergency Medical Services Staff
| No | Title | Writer | Purpose | Setting/Country | Measures/Analysis | Quality | Major Findings | Reference |
|---|---|---|---|---|---|---|---|---|
| fifteen | Risk factors for workplace violence in EMT student | Koohestani et al. 2012 | To decide the prevalence and chance factors for workplace | Descriptive study on emergency medical students (48) in Iran. | Self-designed questionnaire: demographic data, exposure to WPV, response to violence and related factors. Content validity and reliability: examination- retest. | Moderate | 47.91% and twenty.08% of participants had been verbally abused and physically assaulted, respectively. Most concrete and verbal violence happened to patients' families. The most common causes of WPV were delay in reaching the scene and lack of noesis about the role of the EMT | (22) |
| sixteen | The frequency of violence in workplace against emergency care personnel and the factors affecting the occurrence. | Sheikh-Bardsiri et al. 2013 | Decide the frequency of violence in workplace against emergency care personnel and the factors affecting the occurrence. | A descriptive report, on prehospital emergency care personnel (155) of KUMS, Islamic republic of iran. | A researcher-fabricated questionnaire- the frequency of violence in workplace and the affecting factors were assessed. The data were analyzed via descriptive statistics. | Good | 83.eight%: have experienced violence at least in one case a year. 67.7%: exact violence, 22.five%: physical violence and 9.6%: cultural violence. One of important affecting factors of violence occurrence is lack of cognition about the part of the EMS. | (23) |
6.1. Frequency of Workplace Violence
In nine studies (l%), information technology was reported that about 53 - 90% of personnel have experienced WPV. In iv studies (22%), trigger-happy incidence was about 0.viii - 8.5% according to ambulance missions. Exposure to types of physical or exact violence in 12 studies (67%) and threats or intimidation, sexual violence or assault, or harassment in 5 studies (28%) were reported. The frequency of exact violence was about 21 - 82% and occurred mostly as insults and humiliation. Physical violence, such as pushing, punching, scratching, kicking, slapping, biting, or the use of weapons, was reported to occur in about 13 - 79% of cases. Intimidation and/or threats were experienced by 10 - 55% of personnel. Victims were threatened past a variety of weapons, including knives, sticks, and firearms. Threats fabricated with firearms were reported in two studies as 17% and 27%, respectively (7, xi). Furthermore, incidents of cultural assaults, sexual assaults, and harassment were reported to exist ix.v%, xv.5%, and 3.5%, respectively.
half dozen.2. Characteristics of Perpetrators and Victims
Perpetrators of workplace violence were mentioned in eight articles (44%), and in 29 - 87% of the cases, patients and their relatives/assembly and less ofttimes others/bystanders were perpetrators of the violence. The results of the review differ on the characteristics of the victims of violence. Some studies showed that men (4) and those with extensive work experience (9) were exposed to more violence; others showed that the less experienced were exposed more to violence (7, 12), and most frequently, women encountered sexual assault (ix). Some other study showed that in recent years, gender, work feel, and professional person group practise non differ significantly in the face up of threats and/or violence (11).
6.3. Response and Reporting
In the literature reviewed, 5 articles (28%) reported the personnel reactions to exposure to threats and/or violence. On average, half the employees considered information technology normal, unimportant, and "Function of the job." 7 articles (39%) reported that victims of WPV underreported the frequency of violent episodes. The fearfulness of being negatively judged by managers, considering the report useless, and fear of revenge were the important causes of underreported violence. Some studies noted the absence of reporting mechanisms for ambulance missions (six, 15).
6.4. Workplace Violence Complications
Bodily injury from concrete violence was reported in viii papers (44%), ranging from 4% to 67% (average 44%). In most cases, injuries were minor, but there were cases of serious injuries. In 2 studies, the demand for medical care was 27% and 37%, respectively. Psychological injuries in the form of stress or PTSD1, feet, nervousness, sensitization, increased psychological strain, demoralization, mental exhaustion, and depersonalization were reported in 9 studies (45%). The review of viii articles (44%) showed the prevalence of organizational amercement in the grade of threatened job rubber, increased sick leave, decreased job satisfaction, mental energy, work effectiveness, participation in the piece of work procedure and decision making, occupational leave, burnout, and decreased well-existence every bit well every bit theft or harm to the property of the system. These furnishings increase the costs of both the emergency organization and society. Ane written report reported that in 80% of cases, incidence of WPV and its effects had a negative impact on the human relationship between patient and European monetary system personnel and acquired a driblet in quality of intendance (seven).
6.v. Predisposing or Predicting Factors
A shortage or lack of formal didactics in terms of exposure to violent situations was studied equally a predisposing cistron in 13 articles (72%), and it was reported that 9 - 97% of employees didn't have adequate formal pedagogy. Six studies showed that 52% of personnel believe at that place is no specific protocol for the handling of WPV. In five articles (28%), delayed response to the emergency situation was reported every bit a predisposing factor (three, 12, 21-23). In four studies (22%), drug abuse and alcohol (4, seven, 11, eighteen) and, in ii studies, (11%) psychological disorders were reported as factors leading to the escalation of violence (4, 11, eighteen). Other important predicting factors reported in some of the studies include unexpected illness, injury or death (21, 22), insufficient safety and lack of police presence at the scene (4, eleven, 13, xviii), inadequate skills and incompetency of personnel (23), and lack of awareness of Ems duties of (21-23).
half-dozen.6. Prevention Factors
In addition to predisposing factors, other factors were considered to prevent violence or injury. In four studies (22%), the use of special protective, bulletproof vesture and helmets (iii-5, 15) were mentioned. Two studies showed that these apparel are bachelor on average 63% for personnel (3, fifteen). Other of import preventing factors included proper behavior with a patient or relative (15, 23), control of crowds and aggressors (3), management of unsafe scenes (4, v, vii), the use of self-protection or self-defence (5, vii, 9, 15), a responsible and supportive approach of club (9) and the organization (10-thirteen, twenty), and attention to the energy loss of staff due to a long and stressful shift (13).
Table x.
Summary of Data About Included Studies and Searching Databases
| No | Writer | Study Place | Written report Design | Database | Sample Size | Quality Appraisal | References |
|---|---|---|---|---|---|---|---|
| 1 | Tintinalli et al. 1993 | USA | Descriptive | Gs | 4200 | Moderate | (15) |
| 2 | Corbett et al. 1998 | Us | Descriptive | Gsa. Pm | 490 | Relatively expert | (three) |
| three | Mock et al. 1998 | USA | Observational | Gsa. Pm. Sc | 297 | Good | (18) |
| 4 | Pozzi et al. 1998 | United states of america | Descriptive | Gs. Pm. | 331 | Relatively good | (6) |
| five | Duchateau et al. 2002 | France | Descriptive | Pm. Sc | 276 | Good | (19) |
| 6 | Grange et al. 2002 | USA | Descriptive | Gs. Pm. | 410 | Relatively good | (4) |
| 7 | Mechem et al. 2002 | Usa | Descriptive | Gs. Pm. Sc | 110 | Relatively good | (5) |
| eight | Suserud et al. 2002 | Sweden | experimental | Gs. Pm. Sc | 66 | Moderate | (vii) |
| nine | Brough et al. 2005 | Republic of austria | C.S. | Gs. Sc | 119 | Moderate | (20) |
| 10 | Boyle et al. 2005 | Austria | C.S. | Gs. Pm. Sc | 160 | Skillful | (2) |
| eleven | Carlson, 2007 | USA | Descriptive | Gs. | 96 | Expert | (14) |
| 12 | Koritsas et al. 2009 | Austria | Descriptive | Gs. Pm. | 253 | Good | (9) |
| thirteen | Petzall et al. 2011 | Sweden | Descriptive | Gs. Pm. Sc | 134 | Good | (11) |
| 14 | Rahmani et al. 2012 | Iran | exploratory | Gs. Pm. | 138 | Good | (21) |
| fifteen | Koohestani et al. 2012 | Iran | Descriptive | Magiran | 48 | Moderate | (22) |
| 16 | Sheikh-Bardsiri et al. 2013 | Iran | C.S. | Magiran | 155 | Good | (23) |
| 17 | Bernaldo-De-Quiros et al. 2014 | Spain | C.S. | Pm. | 441 | Practiced | (12) |
| xviii | Bigham et al. 2014 | Canada | Mix method | Gs. Pm. | 1676 | Good | (xiii) |
7. Conclusions
The literature review indicated that WPV against EMS personnel is a common and increasingly prevalent event in the world. Most studies were descriptive and prevalence studies that focused on a variety of verbal and physical violence and reported the extensive and prevalence of violence every bit verbal, concrete, and threatening, respectively. Sexual violence had a very depression incidence rate (2, 9, thirteen, 21, 23). The high consequence of violence against EMS personnel, organizations, and ultimately order indicates a demand for more serious consideration of a remedy and resolution at present more than than e'er. In 2 systematic reviews of violence in hospital emergency departments, similar results were obtained, suggesting that it is considerable (24, 25).
Psychological illnesses and the use of drugs, booze, and opiates by perpetrators of violence were introduced as predisposing factors (4, vii, 11, xviii).
Virtually studies indicated that the high prevalence of violence in the EMS caused physical and psychological damage to personnel, which in many cases required medical care, in improver to the imposition of loftier costs to the EMS staff. A report by Suserud showed that exposure to violence also harmed patient intendance (7). Therefore, compensation for injuries and the consequences of exposure to violence, legal and financial support of staff, specialized counseling, and psychological treatment to analyze situations and reactions will aid reduce the higher up-discussed complications.
The literature review showed that exposure to WPV is underreported due to the mental attitude of personnel, the belief that violence is "Part of the job," the fear of beingness negatively judged, the fear of a vendetta, and the lack of the necessary infrastructure to provide reporting on official ambulance forms (4-6, 9, 13-fifteen, 21). To understand the breadth of the problem and its predisposing factors, there should be a clear picture of the miracle that can simply be possible with bodily reporting. Correcting the attitude of staff and managers, creating a recording system (26), and encouraging reporting would be useful in this expanse. Pozzi (6) suggested that violence be reported according to OSHA's guidelines for the prevention of violence (10).
The deficiency or absence of formal sufficient preparation programs, the absence of a specific protocol on how to manage vehement situations (three-6, fourteen, 15), and delays in response time (3, 21-23, 27) are the three major factors in the predisposition to WPV. It seems that qualitative research that can offering deeper investigations of the predisposing factors of WPV is essential. Similar findings were obtained in Taylor and Rew's report, and the authors emphasized the need for further strong studies to explore these concepts (24).
The high prevalence and increasing rate of WPV advise that current controls of violence are not sufficiently developed. The review of literature indicated that the chief focus of the existing studies lay on the prevalence rates. It is essential that research studies with a stronger design and a focus on the correlations and predictors be performed. Since the purpose of a systematic review is to evaluate and integrate prove for the use of results in policy making, planning, and implementation, the findings of this written report suggest that strategies to reduce WPV at the individual, organizational, and policy levels are essential to bring emergency personnel, researchers, managers, and policy makers together to find appropriate solutions.
7.1. Suggested Strategies to Reduce Workplace Violence
Found guidelines and formal training/retraining programs to reduce and control WPV in the EMS setting and review periodically. Enact legislation and implement the necessary laws to emergency scene safety and the protection of on- duty personnel.
Public education regarding EMS personnel duties and social back up of Ems personnel should be made available. Response time and arrival times of ambulances on the scene should be improved.
7.two. Suggestions for Hereafter Studies
Design stronger studies (qualitative, interventional, and correlational) to explore the process of WPV and present prevention models. Introduce standard instruments for assessing and measuring of WPV in the EMS setting. Develop predicting tools for assessing risks of WPV in the European monetary system. Review the causes of WPV against Ems personnel from the viewpoint of violence perpetrators.
7.3. Study Limitations
The researchers tried to utilise all-encompassing search strategies to ensure the review of a maximum number of eligible studies; however, some studies may accept been missed. The apply of only two languages can crusade publication bias. The inability to use the results of unpublished studies can besides be a limitation. The methods of some of the studies were non clearly stated. Thus, it is recommended that the results of the current report exist used with caution.
Acknowledgments
Thank you to Mrs. Alibeyk, the manager of the university library. Her guidance in literature searching was greatly appreciated.
Footnotes
Authors' Contribution:Hassan Abolghasem Gorji was involved in the report conception and pattern, data drove, and assay. Majid Pourshaikhian participated in the study conception, pattern, data collection, and writing of the manuscript. Aidin Aryankhesal and Davood Khorasani-Zavareh were involved in the formulation and design of the study, data collection, and interpretation of the data. Ahmad Barati and other authors read and approved the final manuscript.
Funding/Support:This study was partially funded by Islamic republic of iran University of Medical Sciences. This article is part of a thesis of PhD approved by the section of health care management, school of health direction and data sciences, Iran University of Medical Sciences.
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Articles from Athenaeum of Trauma Research are provided here courtesy of Kowsar Medical Institute
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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4860284/
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