産業医学および健康問題

抽象的な

The Management of Workplace Violence against Healthcare Workers: A Multidisciplinary Approach in an Italian Hospital

Pinto Victoria

Objective: The risk of aggression against healthcare workers (HCWs) is a globally well-known topic. However, many HCWs consider workplace violence (WV) as part of their job and this misconception leads to a broad underreporting. This cross-sectional study aims at providing a descriptive analysis of aggressive acts against HCWs registered in a 34-month period in a paediatric general hospital. We also suggest a model for the assessment of contributing factors related to the development of overt aggression.

Methods: A specific protocol for the management of WV was designed in the hospital with the aim of minimizing the WV risk through combined individual and collective organizational and techno-structural measures. The signaling process of WV is led by multidisciplinary teams which include occupational physicians and a psychologist following the root-cause approach. According to the protocol, each aggressive act is analyzed by the team using the “Modified Overt Aggression Scale” (MOAS), the “General Health Questionnaire-12” (GHQ-12) and the “Short Form-36 health survey” (SF-36). A report is finally prepared to address improvement measures to be implemented in the hospital. In the study a three-domain model of WV is developed considering: 1) assaulted HCWs, 2) attacker-related issues, and 3) environmental context. Contributing factors related to each domain are outlined and univariate analyses are performed to investigate their role in determining overt aggression. Then a multiple linear regression was set using factors previously resulted statistically significant.

Results: A total of 82 aggressive acts were registered in the period. MOAS scores registered a mean value of 3.71 (SD: 4.09). Verbal abuse was the most common form of WV. HCWs professional category, minor psychiatric disorder, emotional role limitation, type of containment used and emotion intensity were significantly associated to overt aggression (p<0.05), as well as attacker’s role in the hospital (p<0.05). The multiple regression analysis confirmed these findings.

Conclusion: Raising awareness on the aggression risk and contributing factors may lead to a relevant improvement of workplace environment and individual workers’ health and organization well-being.