In all, 6302 questionnaires were distributed (). The overall response rate was 31.3% (n=1973), with the highest response rate being from residential homes and workshops for people with disabilities (42%). The lowest response rate was found in hospitals (26%). The characteristic of the study population is described in . The majority of the participants worked as nurses (46%) and were aged 40–49 (36%). Nearly half of the participants (48%) had been working in nursing or healthcare for more than 15 years.
Flow chart ‘generation of the study population.’
Characteristics of the study population (n=1973)
Frequency of verbal and physical violence
Over the previous 12 months, 56% of respondents had experienced physical violence and 78% verbal aggression. In all, 44% of respondents said they experienced physical violence and 68% verbal aggression once or more per month. The highest frequency of physical violence was found in inpatient geriatric care (63%) and the lowest in outpatient care (40%). These differences were statistically significant (p=0.000). Staff at residential homes for people with disabilities most frequently noted having experienced verbal aggression (86%). The lowest frequency of verbal aggression was, in contrast, reported by workshops for people with disabilities ().
Frequency of verbal and physical violence by workplace.
Type of violence
In all sectors, employees most frequently experience verbal aggression. Threatening gestures are also reported mainly by employees in facilities for people with disabilities (residential homes, 50%; workshops, 42%). In contrast, staff at inpatient facilities for the elderly (52%) and in hospitals (42%) most frequently reported being at the receiving end of pinching and scratching. Employees at inpatient facilities for the elderly more frequently reported being hit (35%) than respondents employed in other areas ().
Types of violence in the preceding 12 months by workplace
Management of episodes of violence in the 12 months preceding data collection
In all sectors, the employees affected mainly responded verbally to verbal and physical assaults, calling on the people who assaulted them to change their behaviour. Both medication and requests for support were most frequent in hospitals (34% and 34%, respectively). The police were called 57 times (6%) by hospital staff and 18 times (10%) by employees in residential homes for people with disabilities.
Only 41% (n=816) of the episodes of violence were reported, 60% (n=789) to a supervisor and only 2% (n=38) registered as an occupational accident with the statutory accident insurers.
Emotional and physical consequences
In all work areas, the majority of employees reacted with anger and annoyance to the violence that they experienced in the 12 months preceding data collection. At facilities for people with disabilities, their second most frequent reaction was a feeling of disappointment (workshops, 46%; residential homes, 30%), and in other work areas a feeling of helplessness. Staff at inpatient facilities for the elderly most frequently claimed to have been subjected to physical violence (32%) and pain for less than 10 min (20%; ).
Consequences of verbal or physical violence for the study participants by workplace
Training and social support provided by the facility
In total, 27% of respondents (27%) said they felt that their facility had prepared them particularly well for situations involving aggressive or violent clients (). In contrast, 65% stated that the support given by colleagues was good. In hospitals and in residential homes for people with disabilities, 42% and 11%, respectively, of the respondents stated that they had received no instructions on how to deal with violence.
Risk factors for experiencing physical and verbal violence
Younger workers under 30 years run a higher risk of being affected by physical violence (OR 1.8, 95% CI 1.3 to 2.5) or verbal aggression (OR 1.9, 95% CI 1.3 to 2.9) than older colleagues.
Another risk factor for physical and verbal violence is the work sector. Compared with inpatient nursing staff, employees at inpatient geriatric care units also run a higher risk of experiencing verbal aggression (OR 1.7, 95% CI 1.0 to 2.9) and there is also an increased risk of experiencing physical violence (OR 2.2, 95% CI 1.6 to 2.9). Employees who have been trained by their facilities in how to deal with violence run a lesser risk of experiencing physical and verbal violence (OR 0.7, 95% CI 0.6 to 0.9; OR 0.5, 95% CI 0.4 to 0.7) than staff in facilities where no such training is provided ().
Frequency and ORs and 95% CIs for verbal and physical violence (n=1891)
Risk factors for the experience of stress
Out of 1891 employees who had experience of verbal and physical violence, 434 participants gave no further information about this experience in the preceding 12 months. Of 1457 participants, around a third of employees feel seriously stressed by the violence experienced. This feeling of stress is most marked among workers in workshops for people with disabilities and in outpatient care (38% and 37%, respectively). Women are more frequently stressed than their male colleagues by the violence they experience (OR 1.5, 95% CI 1.1 to 2.1). In contrast to hospital staff, employees in outpatient (OR 1.3, 95% CI 0.9 to 2) and inpatient healthcare for the elderly (OR 0.5, 95% CI 0.4 to 0.8) feel stressed more often. The frequency of violence experienced also relates to the sense of personal stress. Those who experience physical violence on a daily basis are affected by stress (OR 3.0, 95% CI 1.6 to 5.5; ).
Frequency and risk factors influencing stress in the employees affected by violence and aggression (n=1457)
The better the facility is at training employees for dealing with aggressive and violent clients, the less risk employees run of experiencing either verbal aggression (OR 0.5, 95% CI 0.4 to 0.7) or physical violence (OR 0.7, 95% CI 0.6 to 0.9). Good training by the facility in question has a positive effect on the stress that staff experience ().