Violence in caring : risk factors, outcomes and support

The overall aim of this dissertation is to promote knowledge of violence against personnel in municipal caring by studying its magnitude, the risk factors involved, its consequences, and the significance of social support and prevention. A subsidiary aim was to develop methods for surveying and analyzing workplace violence in a care setting.

The five papers in this dissertation are based upon three studies: a pilot study; a literature review based on database searches; and, a nationwide questionnaire survey of the seven largest occupations in municipal nursing and caring (administrators, nursing specialists, supervisors, direct carers, nursing auxiliaries, assistant nurses, and personal assistants). A total of 2,800 individuals were covered by the survey. Violence was defined broadly, encompassing both verbal and physical aggression aimed at personnel.

The pilot study consisted in the testing of a recording form (list) to be used in the workplace, which resulted in a large number of violent incidents being reported. The literature review highlighted five distinct focuses of research on violence in a work setting. With the review as a foundation, a model for the identification and analysis of risks of violence was developed. The model operates at three levels: individual (specific factors), workplace (situational factors), and organization (structural factors).

It was found in the questionnaire study that over half of respondents had been exposed to violence or threat of violence on one or several occasions over the previous year. Over nine percent reported that they had been exposed on a daily basis, but there were also cases of aggravated physical violence. All occupational groups were exposed, but degree of exposure varied between groups. Low age and short occupational tenure proved to act as risk factors, as too did certain types of workplaces, working full-time with patients/clients, reorganization (downsizing), and high workload.

The consequences of acts of violence were many and varied. Financial, healthrelated, emotional, work-related, and social impacts were all reported. One out of five victims of violence sustained physical injuries, and emotional reactions were common. Violent acts did not only affect work with care recipients but also impacted on personnel's leisure time. Scarcely four out of ten had received support or help following an act of violence, while six out of ten stated that some kind of preventive intervention had been made in their workplace.

The overall results indicate that violence is a work-environment problem within the healthand-care sector. Indeed, for many it is a daily recurring problem. Acts of violence have different consequences according to the individual and the workplace.

List of scientific papers

I. Menckel E, Carter N, Viitasara E (2000). "Violence towards caregivers of persons with developmental disabilities. Developing a system for recording challenging behavior." Work 15(1): 3-8
https://pubmed.ncbi.nlm.nih.gov/12441502

II. Viitasara E, Menckel E (2002). "Developing a framework for identifying individual and organizational risk factors for the prevention of violence in the health-care sector." Work 19(2): 117-23
https://pubmed.ncbi.nlm.nih.gov/12454444

III. Menckel E, Viitasara E (2002). "Threats and violence in Swedish care and welfare--magnitude of the problem and impact on municipal personnel." Scand J Caring Sci 16(4): 376-85
https://pubmed.ncbi.nlm.nih.gov/12445107

IV. Viitasara E, Sverke M, Menckel E (2003). "Multiple risk factors for violence to seven occupational groups in the Swedish caring sector." Relations industrielles/Industrial Relations 58: 202

V. Viitasara E, Sverke M, Menckel E (2003). "Consequences of violence in Swedish municipal health-and-care work - the importance of social support and prevention." (Submitted)