Understanding the Experience of Workplace Violence in Hospitals as Documented by Nursing Staff: Using the READ Approach

Abstract

Background: Workplace violence has a significant impact on patients, families, and staff safety. Workplace violence can produce traumatic results for those involved; the importance of preventive measures needs to be paramount in health service policy and process. Health care staff are required to document their experiences of violent incidents after every occasion, usually via an incident reporting system, which allows for a free text description of the event. There is a lack of understanding of how health care staff document reports of violence and how they explain the events. Methods: This study aims to determine the circumstances surrounding workplace violent events as documented by health care staff. The four-step Review, Extract, Analyze, and Document (READ) approach to document analysis was used to examine workplace violence incident reports over 12 months (September 2021–September 2022) in a tertiary referral hospital. Findings: Six categories of workplace violence were found: (a) “Escalation Dynamics”—patterns and progression of how violence incidents intensify; (b) “Warning Behaviors”—verbal or non-verbal signals that may foreshadow physical violence if not addressed; (c) “Authoritative Institutional Interventions”—how aggression correlates to protocols involving security personnel or law enforcement; (d) “Care Delivery Methods”—how certain treatment procedures and approaches might inadvertently elicit violence; (e) “Situational Stressors”—external circumstances or changes that act as triggers for violence; and (f) “Unprovoked triggers”—sudden and seemingly unprovoked violent outbursts. Conclusions and application to practice: Workplace violence in health care is a multifaceted interplay of events with the nurse involved in all aspects of the process. These findings can be used by occupational health nurses in education and policy development. The findings can be used to focus education on how violent incidents may escalate and provide more opportunities for de-escalation by health care staff.