Violence and Aggression in the Health Care Sector

At this level, there are factors that very often are not influenced by our will.       

Our experiences and our perception of others behaviour is based on how we perceive others. The basis is to view others as we would our own relatives. This is taken as a professional foundation in the field of treatment of the wounded and sick. Patients expect from general nurses above all politeness, empathy, pain and symptom relief, solving their problems, respect, but they can very often consider healthcare professionals as their servants.  However, a healthcare professional has also certain connotations (expression of thanks, cooperation, observing the rules and a certain obedience) that – as well as the expectations of the patient – very often does not reflect the reality. There is no relevant detailed study about conceptions and feelings of nurses and other medical non-physician professions. Contemporary studies and research deals almost without exception with patient satisfaction but not the satisfaction of the medical staff. From this point of view, focus groups reflecting healthcare professionals’ feelings would be very highly valued.  Healthcare professionals come into a close contact with patients in situations that are very stressful for the patients. They have many problems, have a feeling of helplessness; they are in psychological and physical discomfort and very often have to wait for help an amount of time that seems disproportionately long to them. The following contact with them deepens the stress not only of the patient but also of the nurse (Grimaldi, 2013).  

 Literature advises one to calm down, think, control one´s emotions and seek in the other person one´s own relatives strategies on how to manage conflict situations .Healthcare professionals are not machines. They have the right to their emotions and if they have to face violence, they will be stressed. Moreover, the perception of the patient plays a role and if somebody behaves roughly; then he is no longer our relative who needs our help but a  stranger and an enemy. This reaction should not be viewed as unprofessional but as a normal defensive one – of a healthcare professional  as a human, who is stressed and decides between an attack (to stop the violence) or to search for an escape route.  

A sequence of various factors contributes to such situations when a healthcare professional is not able to solve the conflict with the patient in an effective way because it affects their ability to maintain self-control and following reactions (behaviour). These factors are very important but often subconscious and underestimated. The prevention of negative factors on the healthcare professional´s side or their elimination overlaps to a considerable extent with the prevention of professional stress (Nešpor, 2007). 

Factors decreasing the self-control ability of a healthcare professional  

• Sleep deprivation or subdeprivation

It causes disturbances of cognitive functions including the ability to make the right judgement and adversely affects decision-making skills. It has been shown that sleep deprivation disables the control of negative emotions and in surgery, sleep deprivation endangers above all persons with limited experience. Coffee during night shifts improves the feeling of being awake, but it doesn´t lead to less mistakes.

• Personality of a healthcare professional

E.g. inadequate ambition, upbringing, unsolved personal or family problems, demanding life situation and physical or mental illness. Another factor is when colleagues in the healthcare service solve conflicts by means of power and strength – this way of conflict solving is still rooted in the society. It is an ancient tool when a stronger person wants to achieve her/his goal by means of strength. 

• Negative life experience in the past

This factor is very important at a certain patient type (drunken patients and homeless people) and can lead to prejudices and excessive reactions from general nurses.

• Time factor

The necessity or tendency to perform more tasks at the same time (especially when a nurse has to take care of a lot of patients at one time) worsens the performance and leads to exhaustion.

• Relevant knowledge and competences

It is often spoken about professionalism of healthcare professionals and their maximal efforts underpinned by current nursing and medical knowledge and technology. These expert communities knows what is not possible but patient’s don´t know it.

• One-sided physical or mental strain

Very often sitting or standing in a fixed position can cause great strain. Consequently, pain symptoms and premature exhaustion arise.

• Factors dealing with the workplace and work organisation

These factors involve long waiting, administrative burden of both healthcare    professionals and patients, interpersonal conflicts in medical teams, insufficient consultation and communication opportunities, insufficient personal and technical equipment, poor workplace design and spatial arrangement.     

• Healthcare system

This factor involves healthcare fee collection, low accessibility of medical care, lobby of health insurance companies and all other problems with the healthcare concept in the Czech Republic that affect activities of individuals (nurses) who have influence on these factors.

• Factors dealing with other social interactions

These factors involve availability of alcohol and non-alcoholic drugs including their advertisement, media influence (violence in the TV and printed media), influence of the culture. At the same time, the prevailing opinion in society is that it is possible to achieve the success by means of power (Bennett, 2012; Nešpor, 2012).

Considering the above mentioned, it is obvious that there are many factors influencing conflict situations between a healthcare professional and a patient. Thus, the problem becomes more complicated that also reflects its conceptual solution.   It is evident that there is a close relationship between negative emotions and violence.  This includes the healthcare professionals as well. It is always important to evaluate the situation from both points of view of the patient and the healthcare professional and to perceive the situational behaviour and its reciprocity. Absence of these essential facts on the one side evokes humiliation feelings on the other side.  In addition, humiliation is one of the strongest emotions (Baumeister, 1996).