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Assessment of exposure to physical and non-physical violence in physical therapy.

Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, R03-OH-009493, 2013 Mar; :1-9
Healthcare professionals have long been considered as a population vulnerable to workplace violence. The purpose of this project was to assess the causes and effects of physical therapists' exposure to physical and nonphysical violence by understanding the exposure experiences, and identifying intervention needs from physical therapists. To this end, a specific incident approach was used to collect qualitative data as very little is known about the exposure experiences of physical therapists. Semi-structured interviews were conducted with 96 physical therapists from a variety of settings (acute care, out- and in-patient rehabilitation, pediatrics, geriatrics, and home health). The majority (95%) of the participants have experienced at least one incident of physical or non-physical violence committed against them in the past 12 months. The most common physical violence experienced by therapists was being pushed, grabbed, or shoved (47%), whereas the most common nonphysical violence was being yelled or sworn at (80%). Almost all of the physical violence incidents were committed by patients, whereas perpetrators of nonphysical violence incidents were distributed among patients, personnel affiliated (e.g., nurse) or not affiliated (e.g., patient family) with the facility. Patients were most likely to commit violence against therapists during treatment and the transfer tasks. Those with certain conditions (e.g., dementia) were also more likely to strike than others. Open and frequent communication with other healthcare providers (e.g., nurses, doctors, or psychologists) informed many therapists (ranging from 38% to 85%) about patients' tendency to strike, and assisted the development of strategies to prepare for the potential assaults. Some therapists cited clear organizational policies concerning workplace violence to be helpful. Finally, self-defense and de-escalation training were considered beneficial as therapists were able to prevent major injuries to themselves or the patients by applying the techniques. In terms of outcomes, although the majority of participants cited anxiety or anger as their primary emotional responses immediately after the incidents, some were not bothered by the incidents when they were committed by patients, as therapists perceived patients having little control over their behaviors. Interestingly, nonphysical violence from facility associated personnel tends to elicit strong negative reactions. Finally, therapists suggested that de-escalation and self-defense training should be included as part of the curriculum of physical therapy education. Realistic job previews could also be utilized to provide to students with information about the exposure risks. Organizations should have clear policies concerning workplace violence. A team-based or interdisciplinary approach to treatment would help therapists address the assaults from patients. In addition, employers and the professional organization of physical therapy should provide seminars focusing on issues about workplace violence. Finally, supervisor and co-worker support had been identified as important resources to help therapists cope with their exposure to violence. These results suggest that workplace violence is a threat to the health and safety of physical therapists. In addition, therapists may face assaults from a variety of perpetrators. Depending on the nature and context of the assaults, therapists assign different meanings to the same incident and have different reactions towards the incident. Finally, intervention strategies targeting curriculum, workplace, as well as the profession as a whole were identified.
Health-care-personnel; Health-services; Exposure-assessment; Workplace-studies; Workplace-monitoring; Work-organization; Work-analysis; Occupational-exposure; Occupational-health; Occupational-health-programs; Occupational-health-services; Statistical-analysis; Medical-personnel
Chu-Hsiang Chang, Department of Psychology, Michigan State University, Room 346, 316 Physics Road, East Lansing, MI 48824
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Final Grant Report
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National Institute for Occupational Safety and Health
Performing Organization
University of South Florida