Abstract
Background: Health workers (HCWs) working in psychiatric hospitals are faced with a potential safety risk daily, and some have experienced a form of assault/attack by Mental Health Care Users (MHCUs). An MHCU who presents with a particular form of mental illness may pose a danger towards self, people, or property. The violent and aggressive behaviour may be evident and increased when more than one MHCU with this condition are admitted in a controlled environment for care, treatment, and rehabilitation (CTR), thus increasing danger to self, fellow MHCUs and HCWs. Therefore (MHCU) patients pose a danger not only to themselves, but physical and psychological danger to the HCWs. The assaults/attacks commonly experienced in psychiatric hospitals include swearing, racial abuse, threats, hitting, pushing, physical, verbal assaults, and sexual assaults.
Objective: The aim of this study was to identify the types of assaults/attacks on HCWs by psychiatric patients, quantify the frequency in the last 12 months and examine the factors related to assaults/attacks on HCWs as well as the health, physical, emotional, and psychological effects these incidents have on HCWs, in a selected psychiatric hospital in Gauteng Province, South Africa.
Methods: A quantitative cross-sectional survey was conducted at Sterkfontein Psychiatric Hospital in Gauteng Province. This hospital is one of the three main referral hospitals that offer specialised mental health services as guided by Mental Health Care Act No. 17 of 2002 (MHCA) as well as Criminal Procedure Act No. 51 of 1977. A convenience sampling method was used to select 137 HCWs. Information was collected using a self-administered questionnaire adapted from previous studies. Information was collected on types of assaults/attacks, participants socio-demographic characteristics, factors that make HCWs susceptible to assaults/attacks, perceived trauma after assault/attack, health effects as they relate to daily living and employment, effects of post-assault/attack incident, effects of assault/attack on sleep patterns for HCWs, the physical, emotional and psychological wellbeing and fitness to carry out work, and the availability of work-related Procedures and Training on dealing with an Aggressive Psychiatric Patient. Data were analyzed using EPINFO 7.2 and IBS Statistical Package for Social Sciences (SPSS Version 29). Descriptive analyses and inferential analyses using logistic regression crude odds ratios (OR), adjusted odds ratios (AOR) and their 95 % confidence intervals (CI) and p-values were used as indicators of the strength of
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association and to explain significant associations. A p value of 0.05 was considered significant.
Results: A total of 246 questionnaires were distributed and 137 were received completed for capturing and analysis. The response rate was 55.7%. The overall prevalence of assaults/attacks was 58.4%. The most common type of assault experienced by the HCWs was verbal assault, reported by 84.7% (n=116) of participants. Physical assaults were reported by 43.1% (n=59), swearing by 48.9% (n=67), threats by 28.5% (n=39), sexual assaults by 16.8% (n=23) and being pushed by 13.9% (n=19). Both racial abuse and hitting were the least reported types of assaults/attacks experienced by 10.9% (n=15) of the participants. Among participants, most were females (51.8%). The age distribution showed that 29.9% were in the 31-40 year age-group, followed by 26.3% in the 51+ age group, 22.6% in the 41-50-year age-group, and 21.2% in the 21-30 year age-group. Regarding the highest level of education, the majority had a diploma (40.1%); 18.2% had other qualifications, 17.5% had a degree, 15.3% had a postgraduate degree, and the smallest group had completed matriculation (8.8%). The job titles of the participants varied, with 45.3% being professional nurses, 28.5% enrolled nurse assistants, 6.6% enrolled nurses/staff nurses, 6.6% social workers, 2.9% registrars, 2.9% psychologists, 2.9% occupational therapists, 1.5% occupational therapy technicians, 1.5% consultant/specialist doctors, and 0.7% medical officers and student nurses. In terms of years of service, 27.7% had served for 1-5 years, 21.9% for 6-10 years, 16.8% for less than 1 year and 11-15 years each, 8.8% for 21+ years, and 8.0% for 16-20 years.
The results show statistically significant differences between age and assault/attack (p=0.024). Among those who experienced assault/attack, 26.3% (n=21) were aged 21-30 years, 27.5% (n=22) were aged 31-40 years, 15% (n=12) were aged 41-50 years, and 31.3% (n=25) were 51 years or older. No significant differences were found between assault/attack and gender, highest level of education, job title, or years of service. However, among the healthcare workers who experienced assault/attack (n=80, 58.4%), there was an almost equal split between males (48.8%, n=39) and females (51.2%, n=41). The majority had either a diploma (40%, n=32) or were professional nurses (50%, n=40). Years of service were spread out, with the highest percentage having 1-5 years (27.5%, n=22).
Among socio-demographic factors, age between 41-50 years (OR 4.16, 95% CI 1.40-12.35) and having a job title in the "Others" category (OR 11.14, 95% CI 1.11-112.01) were significantly associated with higher odds of assault/attack on healthcare workers (HCWs).
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Gender, education level, and years of service were not significant risk factors. Regarding training factors, only lack of access to Employee Wellness Programmes (OR 3.52, 95% CI 1.09-11.39 for those with access) was significantly associated with assault/attack, while availability of Standard Operating Procedures, clarity of roles/reporting, training on managing aggression, and counselling availability were not significant. None of the management factors like knowledge, confidence, clinical management of aggression, or incident management showed significant associations.
Conclusion: The prevalence of assaults/attacks on HCWs by MHCUs was high. More studies need to be conducted with a larger sample size of HCWs, to understand the different factors associated with incidents of assault/attacks on HCWs by MHCUs, and the effects these incidents have on HCWs’ physical, emotional, and psychological well-being.
Keywords: assault/attack, swearing, racial abuse, threats, hitting, pushing, physical assaults, verbal assaults, sexual assault, health effects of assault/attack.