Patient-initiated violence

Emergency departments The American College of Emergency Physicians found that greater than 75% of emergency physicians were the victim of one or more violent incidents in the workplace, noting that the majority was by patients or their families. Causes for the increased presence of violence, especially in urban settings, are related to gang activity, lengthened waiting periods to see a doctor, a failure of community medical resources, and unavailable acute psychiatric treatment. Within this study, 55.7% perpetrators of physical violence were under the influence of alcohol. 46.8% were under the influence of illegal or prescription drugs, and 45.2% were being treated for psychiatric reasons. A majority of the violent behavior that occurred was during the triage process at 40.2%. Psychiatric and dementia units Workers in departments that specialize in mental health are particularly at risk for patient abuse due to the psychiatric disease states, high rates of substance abuse, and previous violent patient behavior. A study of Canadian psychiatric nurses noted that social stigma of psychiatric disorders plays a significant role in how nurses perceive violence. Caregivers were uncomfortable with the notion that patient violence is part of the job but also that it is unfair to believe that those with mental illness should be seen as more violent in nature. OSHA reported that violent injuries in psychiatric aides was 10 times higher than any other healthcare worker at 590 injuries per 10,000 full-time employees. ==Factors==

Emergency departments have been identified as a key factor by patients crowding the ER, which contributes to patients being violent towards nurses. High levels of stress, nurses are being burnt out, and the turnover rate is increasing which creates a hostile work/environment. ==Underreporting==

Underreporting of patient-initiated violence is common with professionals claiming that assault is a part of the job. A report from the National Center for the Analysis of Violent Crime dedicates underreporting is likely due to a fear of retaliation, or belief that it will not lead to any change. There is also a commonly held belief that violence is a part of the job. The Massachusetts Nurses Association followed up on this common belief through a survey of three New England hospitals, finding that only 39% of participants reported all incidents of violence. The same report found that 70% of those who reported an incident found that management was supportive, however a majority noted that nothing was done to solve the problem. A study of Canadian psychiatric nurses reported that not only was violence a part of the job, but its occurrence no longer warranted reporting. The same report noted that underreporting drastically affects the ability of the Occupational Safety and Health Administration to track these occurrences. Many qualitative studies done on nurses suggest that there is frequent discouragement by hospital officials and legal officers to not press charges against abusive patients or their families related to an understanding that violence is a part of the job. ==Lasting effects of violence==

The effects of patient-initiated violence has been found correlate to lasting symptoms of post traumatic stress disorder, acute stress disorder, and high rates of burnout. ==Prevention==

Solutions to this issues range dependent on facility and location. A common suggestions from nursing staff is for additional trainings specifically on the de-escalation of high risk situations and health professional legal rights ==See also==