Unveiling the veil: Exploring experiences of patient-initiated workplace violence in long-term care and mental health and substance use settings.

Abstract

Background: This paper focuses on patient-initiated workplace violence (referred to WPV hereafter) towards healthcare workers in long-term care (LTC) and mental health and substance use (MHSU) care settings. While an extensive body of evidence has thoroughly examined WPV, our understanding of what takes place immediately before or during a violent incident, known as 'on-the-spot' experiences is limited.

Objective: This study examined (a) 'on-the-spot' experiences, (b) contributing factors, and (c) warning signs of impending WPV using the experiences of healthcare worker victims and witnesses and healthcare attendees in LTC and MHSU.

Methods: The study was conducted in one LTC home and two MHSU units in British Columbia, Canada. In-depth semi-structured virtual interviews were conducted with 17 participants from June to September 2023. Workplace Health Indicator Tracking and Evaluation (WHITE) data included 38 WPV incidents occurring between January 2022 to March 2023. Data were analyzed using thematic analysis.

Results: Six participants (35%) identified as both victims and witnesses of WPV, four participants (24%) as only victims, and five participants (29%) as only witnesses. Contributing factors to WPV encompassed two main themes and their subthemes: (1) patient/resident factors (cognitive impairment and neurodevelopmental conditions); (2) healthcare factors (lack of continuity of care across healthcare, community and family, care provision, approaches and skills in interactions with patients/residents, access to safety tools and security personnel, and unmet needs and workload and human resource challenges).

Conclusion: WPV may be reduced through access to specialized care, adoption of team-based care and person-centered care approaches, addressing resource constraints, and offering context-specific training.