Hospital Violence In Tertiary Hospitals And Associated Factors In China

ObjectivesHospital violence not only affects the physical and mental health of medical staff,but also brings losses to the hospital.The prevention and disposal of hospital violence is an important issue to be explored and solved in the current hospital management practice in China.The purpose of this study is to conduct a quantitative survey and qualitative interviews of medical staff in 136 tertiary hospitals to learn the current situation of hospital violence in China,to discuss associated factors,further compare the current situation and policies about preventing and handling in foreign countries.Then to provide advice about the disposition of hospital violence in China.MethodsTaking the medical staff in 136 tertiary hospitals in China as the research sample,self-administered questionnaires were used to investigate the overall situation experiencing hospital violence and the situation of physical assault,verbal assault and sexual assault.Chi-square test and logistic regression analysis were used to explore the relationship between hospital violence and demographic characteristics,occupational characteristics,doctor-patient relationship and professional environment of medical staff.The qualitative interviews were divided into two parts,one was to screen out the qualified medical staff who agreed to participate in the follow-up in the quantitative study to supplement the missing results;the other was to design an interview outline according to the literature research,in order to further survey the time and place of medical staff experiencing the hospital violence and put forward the associated factors and feelings.Through literature review to collect policies and laws published by government departments in domestic and foreign countries and to sorted out the policy experience of preventing and dealing with hospital violence.Results1.Current situation of hospital violence experienced by medical staff in sample hospitals1.1 The quantitative survey recovered effective samples about 48361,including 20786 doctors(43.0%)and 27575 nurses(57.0%).1.2 The results shows that 5580 doctors(26.8%)and 5556(20.1%)nurses thought they had experienced hospital violence in the past year.A higher proportion of doctors and nurses agreed to experience verbal violence at least once a month in the past year was 80.8%and 71.2%,a lower proportion agreed to experience physical violence and sexual assault at least once a month in the past year,the doctors were 4.7%and 1.6%,the nurses were 6.1%and 1.9%.2.Associated factors about hospital violenceGender,title,age,educational background,administrative position,region,hospital type,the hospital has adopted measures to prevent and mitigate doctor-patient conflicts,the security staff can be in place in time for violence,the staff have enough time to communicate with patients,the hospital has developed a medical error reporting and prevention mechanism and the hospital helpes purchase medical malpractice insurance are the factors influencing medical staff to experience hospital violence.3.The results of qualitative interviews3.1 The qualitative interviews recovered effective samples about 18,including 8 follow-up surveys and 10 interview outline results.3.2 The results show that medical staff think the most serious experience is verbal assault.And the hospital violence occurs mostly in the morning or after a long waiting time for patients.Hospital security measures still need to be improved.Medical staff have a low understanding of national policies and hope that the punishment needs to be strengthened.4.Domestic and foreign policy experiences in preventing and handling hospital violence4.1 Foreign policies are summarized from the United States,Britain,Russia and Australia.These countries have special legislation on hospital violence and vigorously advocate the concept of ’zero tolerance of medical violence’.4.2 Domestic policies summarize the major laws,regulations,policies and declarations related to hospital violence,medical violations,medical disputes and maintenance of hospital order promulgated in China from 1999 to 2018.Conclusions1.The level of hospital violence experienced by medical staff in sample hospitals is similar to the results of foreign researches.The level of verbal violence experienced by medical staff in sample hospitals is more serious and similar to that of foreign countries.The level of physical violence and sexual violence experienced by medical staff in sample hospitals is lower than that of foreign countries.2.The mid-level title,30-49 years old,the western region,the women’s and children’s hospital,emergency department,obstetrics and gynecology department and pediatrics are the medical staff who become the key crowd to be prevented hospital violence.3.It is recognized that low level of hospital measures,insufficient communication time between doctors and patients,low level of trust between doctors and patients,high expectation of patients,inadequate formulation and implementation of policies,and objectivity of media reports are important associated factors of hospital violence,which can be used as a measure to prevent hospital violence.4.The policy suggestions:pay attention to the system construction of supplier disputes prevention,strengthen the health literacy of the demander and patient education,implement the supervisory function and improve the supervisory system.