Managing violence against healthcare personnel in the emergency settings of Pakistan: A mixed methods study

Objectives: The primary objective of this study was to evaluate the
effectiveness of a half day training on de-escalation of violence against
healthcare personnel regarding prevention and management of violence
incidents versus a similar tertiary level hospital with no such training.
Secondary objectives were to compare the overall satisfaction, burnout,
fear of violence, and confidence in coping with patients’ aggression of
the healthcare personnel in the two hospitals. Design: Mixed method
design, with a comparative cross sectional (quantitative) and Focus Group
Discussions (qualitative) components. Setting: Emergency departments of
the two tertiary care hospitals in district Peshawar over six months
starting in May 2018. Participants: Healthcare personnel in the emergency
departments of the two hospitals (trained vs untrained). Outcome measures:
Violence exposure (experienced/witnessed) assessed through a previously
validated tool in the past 5 months. Burnout, confidence in coping with
patient aggression and overall job satisfaction was also assessed through
validated tools. The qualitative component explored the perceptions of
healthcare personnel regarding the management of violence and the
importance of training on de-escalation of violence through Focus Group
Discussions (FGDs) in the two hospitals. Results: The demographic
characteristics of the healthcare personnel within the two hospitals were
quite similar. The de-escalation training did not lead to a reduction in
the incidences of violence, however confidence in coping with patient
aggression and the overall satisfaction was significantly improved in the
intervention hospital. The de-escalation training was lauded by the
respondents as led to an improvement in communication skills, and the
healthcare personnel suggested for scale-up to all the cadres and
hospitals. Conclusion: The study found significant improvements in the
confidence of healthcare personnel in coping with patient aggression,
along with better job satisfaction and less burnout in the intervention
hospital following the de-escalation training.