Workplace violence perpetrated by clients of health care: A need for safety and trauma‐informed care [2018]

To examine the relationship between workplace violence perpetrated by clients, their innate neurophysiological response to dis‐ease and the resulting interactions with healthcare providers.

Client‐on‐worker violence remains a problem globally. Workplace violence risk factors have been documented. A gap remains in understanding what has happened to clients that perpetrate violence, and the link between adverse childhood experiences (ACE), the neuroscience of threat and trauma‐informed care.

This explanatory study was part of a larger descriptive study.

Managers, directors, health/safety staff, nurses and educators (n = 99) from Australian rural and metropolitan health services participated in individual and group interviews. Following inductive thematic analysis, a secondary analysis, informed by understandings of ACE, polyvagal theory and trauma‐informed care, was conducted. Analysis was guided by the question: What happens to clients that causes them to instigate violence against healthcare workers? Reporting of this research adheres to the COREQ guidelines.

Clients can react aggressively when under perceived threat. Themes included are as follows: client stress and trauma, previous client trauma, impact of care provision on client and trauma‐informed care.

Healthcare services can be experienced as stressful environments. Coupled with high incidences of past trauma, clients’ assessment of risk and safety can be compromised resulting in inappropriate reactivity when staff are trying to provide care. Care provision can be perceived as a threat to clients’ physical and psychological safety, activating the fight protective response resulting in aggression. Understanding and applying neuroscience and implementing a cultural change of trauma‐informed care have the potential to reduce workplace violence. Even with these understandings, it is imperative that healthcare staff are protected and feel safe at work.

Relevance to clinical practice
Understanding trauma and the neuroscience of threat and safety can assist staff to understand what happens to clients that causes them to instigate violence against healthcare providers and implement systems and strategies to respond to such threat.

Jill Beattie Debra Griffiths Kelli Innes Julia Morphet

Journal of Clinical Nursing, 09 October 2018