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1.  Frequency and consequences of violence and aggression towards employees in the German healthcare and welfare system: a cross-sectional study 
BMJ Open  2012;2(5):e001420.
Objectives
In this study, the frequency and consequences of aggressive assaults on employees in the German healthcare and welfare system were investigated.
Design
A retrospective cross-sectional study.
Setting
Employees in the German healthcare system and their experiences of violence and aggression were examined in this study.
Participants
The sample consisted of 1973 employees from 39 facilities (6 facilities for the disabled, 6 hospitals and 27 outpatient and inpatient geriatric care facilities) who have regular contact with patients or clients.
Main outcome measures
The frequency of physical and verbal violence towards employees and the consequences of aggressive assaults were analysed.
Results
56% of respondents had experienced physical violence and 78% verbal aggression. The highest frequency of physical violence was in inpatient geriatric care (63%) (p=0.000). Younger workers run a higher risk of being affected by physical violence than older colleagues (OR 1.8, 95% CI 1.3 to 2.4). There is also an increased risk of experiencing physical violence in inpatient geriatric care (OR 1.6, 95% CI 1.2 to 2.0). Around a third of workers feel seriously stressed by the violence experienced. The better the facility trained employees for dealing with aggressive and violent clients, the less risk employees ran 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). Training by the facility has a positive effect on experienced stress (OR 0.6, 95% CI 0.4 to 0.8).
Conclusions
Violence towards nursing and healthcare personnel occurs frequently. Every third respondent feels severely stressed by violence and aggression. Occupational support provisions to prevent and provide aftercare for cases of violence and aggression reduce the risk of incidents and of perceived stress. Research is needed on occupational support provisions that reduce the risk of staff experiencing verbal and physical violence and the stress that is associated with it.
doi:10.1136/bmjopen-2012-001420
PMCID: PMC3488706  PMID: 23087013
Epidemiology; Public Health

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