Qualitative Research On Medical Staff’s Psychological Responses To Emergency Room Physical Violence

BackgroundEmergency Department is the first gateway to hospital management, a forwardposition of healing the wounded and rescuing the dying, which plays a crucial role inhospital development. Medical staff in Emergency Department is a shrewed troopworking against time. However, as seen in common reports from news, newspapers,television, and the Internet, medical staffs in Emergency Department are sufferingfrom hospital workplace violence. Hospital workplace violence is defined by theWHO a“sthe curses, threats and attacks to the medical staff in Emergency Department,which cause explicit or implicit challenges to their security, wellbeing and health.”Hospital workplace violence includes physical violence and psychological violence.Accidents of physical violence should deserve wide concern from all sectors ofsociety, because they have a severe and long-term impact on not only medical staff inEmergency Department, but also on medical institutions and social benefits.We searched95previous studies on emergency room violence, majority of whichused quantative research methods to investigate epidemiological features. The objectsof these studies were mostly nurses. Psychological violence accounted for a highproportion of the study results while there were only2studies related to hospitalphysical violence. But no study was relevant to emergency room physical violence.Patient-centered health services have always been prioritized while the needs of thefrontline medical staff are overlooked. As the health professonal-patient relationshipsbecome increasingly strained in China today, more and more medical staff inEmergency Department suffer from accidents of physical violence. To deeplyunderstand the real world of clinical context, a qualitative research method wasapplied to recruit the medical staff who suffered from emergency room violence to beresearch participants. The face-to-face interview was employed to collect the dataregarding the description of violence situation, the accidents occurrence, and theresponding actions etc. Through the thorough describing and understanding the true feelings of the participants, the study aims at exploring the management strategies ofminimizing the physical violence occurrence in Emergency Department in order tobuild up a harmonious and comfortable medical environment for offering betterservices to patients and making contributions to society.PurposeWe summarized the true experiences of participants, interpreted their physicaland mental feelings, and analyzed the risk factors created by physical violence inEmergency Department. The ultimate purposes of study are to improve the medicalstaff’s abilities to take effective measures to deal with physical violence, to catch theattentions of the management authorities and to provide evidence basis for theimplementation of relevant policies.MethodsWe applied traditional grounded theory in qualitative research methods whichstresses the retrieval of theory from material, and this theory is widely used in suchfields as health science, pedagogy, psychology and sociology. We had no theoreticalassumption before the research was initiated. Through direct observation, wegeneralized the experience from original materials, and then reached a systematictheory. It is a method which summarizes a theory constantly from bottom to top. Itreflects the core concepts of the nature of phenomena based on the systematiccollection of material. Then relevant theories are constructed on the link among theseconcepts.With this method, we recruit the eligible participants，conducted an in-depthinterview with a semi-structured interview outline at an appropriate time, did therecording and wrote down the transcripts. We obtained both oral and writtenagreement on the processes above from the objects of study. The data collection wasnot stopped until the information was saturated. Ten medical staff who used to sufferfrom emergency room violence were interviewed with a audio-tape. The time forinterview was from20minutes to35minutes. We listened to the audios repeatedly,transcribed the interview material, and checked the transcript data at the same time. We read the transcripts word by word, and analyzed by following Colaizzi seven’sstep record method and by using Nvivo8qualitative research software. Then we usedgrounded theory to code the transcripts one by one.ResultsThrough carrying out opening coding for transcripts of10personal interviews,we gained145first-level coding. Also through axial coding and clustering of conceptsand categories from opening coding, we gained11second-level coding. Through theprocess of coding selected second-level coding and making comparison betweendifferent concepts and category relationships, we chose three core categories. Theywere listed as follows:1. Occurrence of emergency department’s physical violence: Accidents ofemergency room violence peaked during night shifts, in particular from10:00p.m. to2:00a.m. The sites include pre-hospital dispatch of cars and Emergency Department,priority given to the latter. There was no uniform identity and obvious appearance ofthe perpetrators. Drunkards and their companions were more aggressive.2. Response and decision-making of emergency department’s physical violence:When confronting physical violence, medical staffs mostly chose to avoid furtherconflicts in the first place. Few of them would fight back. When noting the personprone to violence, some of female nurses would deal with it in male nurses’accompany. The police arrived at the scene after receiving a report. But most of themedical staffs were not satisfied with the police’s attitude and their ways to solve theproblem. Technical offices and hospital managers would strive to protect the interestof the staff involved as much as possible. All the patients, without exception, receivedthe treatments and care as usual by study participants or other medical staffs.3. True feelings of emergency department’s physical violence: In terms ofphysical injuries,2participants were not injured, which was the first level in Fottvell3-level classification.6had soft tissues injury, which was second level.2were injuredseriously and even left sequelae, which was the third level. In terms of psychologicalstress and emotional reaction, there were negative emotions, including grievance, anger, helplessness, fear, boredom. Meanwhile they also reflected and learned fromthe lessons. Regarding needs and support, medical staffs who suffered fromemergency room violence needed security, psychological guidance, respect,knowledge about rules, procedures and law.ConclusionsBased on personal experiences, this study reveals true feelings of hospital medicalstaff in10cases of emergency department violence by applying qualitative researchmethods. These true feelings are all subjective ones which have reflected hospitalmedical staff’s inner world. Meanwhile, this study is also the process of summarizingcommon character from emergency department medical personnel’s characteristicswho once suffered physical violence.1. Accidents of physical violence have their own features. Medical staff shouldraise their vigilance according to the peak period, sites and people subject to violence.In addition, Medical staff should follow the regulatory standard system when offeringthe health services to clients, and pay attention to humanistic caring and interpersonalcommunication skills.2. Medical institutions should provide effective solutions to improving hospitalworking environment, helping medical staff perfect management and makingcollaboration among different sectors. These solutions can lessen violent attacks inemergency room and enable medical staff to protect their own wellbeing by means ofpsychological intervention.3. Various kinds of negative emotions and needs existed among medical staffs whosuffered from physical violence and should arouse the attention of health careauthorities and the related social departments. Relevant policies should be made todecrease their negative emotions and meet different kinds of needs. Therefore, aharmonious and comfortable medical environment is built to better serve patients andmake contributions to society.