Abstract
Purpose
The purpose of this study was to investigate predictors of violent behavior by patient or caregiver of patient in the emergency department.
Methods
Subjects of the study were 447 residents who have visited the emergency department in community P Metropolitan City during the past year. The data collecting period was from June 1, 2012 to August 31, 2012. Data was collected using self-reported questionnaires.
Results
Predictors of violent behavior in the emergency department were divided into personal and institutional factors. Personal factors included relationship with patients, presence of alcohol, reports of discontent during and past treatment and responses to deterioration in patient's conditions, institution factors included perceived attitudes toward medical workers’ explanations and proficiency of medical workers, and delay in medical treatment hours.
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Table 1.
Characteristics | Categories | n(%) | |
---|---|---|---|
Experience of violent behavior (n=447) | Yes | 123 (27.5) | |
No | 324 (72.5) | ||
Time of violence | 00:00~08:00 | 63 (51.2) | |
08:00~16:00 | 14 (11.4) | ||
16:00~24:00 | 46 (37.4) | ||
Types of violent † | Verbal violence | Had yelled | 116 (94.3) |
Talked down | 75 (61.0) | ||
Had curse | 62 (50.4) | ||
Had threatened | 26 (21.1) | ||
Physical threat | Grim expression to medical workers | 56 (45.5) | |
Walk to and fro with rage in ER | 37 (30.1) | ||
Square off to medical worker | 19 (15.4) | ||
Posed throwing a stuff | 13 (10.5) | ||
Kick at stuff of hospital | 12 (9.8) | ||
Physical violence | Push medical worker | 12 (9.8) | |
Grab medical worker's throats | 10 (8.1) | ||
Hit or kick medical worker | 7 (5.7) | ||
Medical worker was hit by thrown objects | 6 (4.9) | ||
Spit in a medical worker's face | 6 (4.9) | ||
Bite medical worker | 3 (2.4) | ||
Scratch medical worker | 1 (0.8) |
Table 2.
Variables | Characteristics | Categories | Yes (n=123)† | No (n=324)† | x2 | p |
---|---|---|---|---|---|---|
n (%) | n (%) | |||||
General | Gender | Male | 59 (48.0) | 126 (38.9) | 3.03 | .082 |
Female | 64 (52.0) | 198 (61.1) | ||||
Age (year) | 20~29 | 27 (22.0) | 40 (12.3) | 9.19 | .057 | |
30~39 | 16 (13.0) | 62 (19.1) | ||||
40~49 | 25 (20.3) | 66 (20.4) | ||||
50~59 | 28 (22.8) | 64 (19.8) | ||||
≥60 | 27 (22.0) | 92 (28.4) | ||||
Patient/caregiver | Patient | 60 (48.8) | 177 (54.6) | 1.22 | .268 | |
Caregiver | 63 (51.2) | 147 (45.4) | ||||
Relationships with patients | Patient | 60 (48.8) | 177 (54.6) | 19.05 | .002 | |
Parents | 15 (12.2) | 69 (21.3) | ||||
Offspring | 15 (12.2) | 32 (9.9) | ||||
Spouse | 13 (10.6) | 16 (4.9) | ||||
Friend | 13 (10.6) | 10 (3.1) | ||||
Other | 7 (5.7) | 20 (6.2) | ||||
Experience of discontent expression during ER care in the past | Yes | 38 (30.9) | 30 (9.3) | 32.86 | <.001 | |
No | 84 (69.1) | 294 (90.7) | ||||
Situational | Hospital | Advanced general hospital | 20 (16.3) | 58 (17.9) | 0.54 | .762 |
General hospital | 100 (81.3) | 261 (80.6) | ||||
Hospital | 3 (2.4) | 5 (1.5) | ||||
Medical department | Internal‡ | 54 (44.6) | 160 (50.6) | 6.42 | .093 | |
Surgical§ | 31 (25.6) | 89 (28.2) | ||||
Pediatric | 7 (5.8) | 23 (7.3) | ||||
Others|| | 29 (24.0) | 44 (13.9) | ||||
Drinking alcohol | Drinking | 17 (13.9) | 15 (4.7) | 11.25 | .001 | |
Non-drinking | 105 (86.1) | 305 (95.3) | ||||
Critical condition level | Very critical | 60 (48.8) | 96 (29.8) | 15.97 | <.001 | |
Critical | 41 (33.3) | 168 (52.2) | ||||
Neutral/non | 21 (17.9) | 58 (18.0) | ||||
Pain level | Very severe | 67 (54.9) | 132 (41.0) | 7.36 | .025 | |
Severe | 41 (33.6) | 150 (46.6) | ||||
Neutral/non | 14 (11.5) | 40 (12.4) | ||||
Anxiety level of subject | Very anxious | 73 (59.8) | 136 (42.1) | 11.56 | .003 | |
Anxious | 36 (29.5) | 146 (45.2) | ||||
Neutral/non | 13 (10.7) | 41 (12.7) | ||||
Discontent level about the deteriorated condition, when treated or waited | Very discontent | 42 (34.4) | 26 (8.1) | 81.54 | <.001 | |
Discontent | 54 (44.3) | 85 (26.4) | ||||
Neutral/non | 26 (21.3) | 211 (65.5) |
Table 3.
Table 4.
Variables | B | SE | Wald | p | OR | 95% CI |
---|---|---|---|---|---|---|
Gender (1=male, 0=female†) | 0.30 | 0.29 | 1.09 | .297 | 1.35 | 0.77~2.38 |
Age | 0.02 | 0.10 | 0.02 | .882 | 1.02 | 0.83~1.24 |
Relationships with patients (1=friends, 0=others†) | 1.80 | 0.60 | 9.13 | .003 | 6.06 | 1.88~19.49 |
Drinking alcohol (1=drinking, 0=non-drinking) | 1.37 | 0.51 | 7.12 | .008 | 3.93 | 1.44~10.75 |
Experience of discontent expression during ER care in the past (1=yes, 0=no†) | 0.96 | 0.34 | 8.10 | .004 | 2.62 | 1.35~5.10 |
Critical condition level of patients | 0.28 | 0.26 | 1.10 | .293 | 1.32 | 0.79~2.20 |
Pain level of patients | -0.09 | 0.26 | 0.12 | .729 | 0.91 | 0.55~1.52 |
Anxiety level of subject | -0.11 | 0.27 | 0.16 | .688 | 0.90 | 0.53~1.51 |
Discontent level about the deteriorated condition, when | 0.61 | 0.20 | 9.41 | .002 | 1.84 | 1.25~2.72 |
treated or waited | ||||||
Attitudes perceived by subjects when medical workers responded to them‡ | 0.46 | 0.37 | 1.54 | .215 | 1.58 | 0.77~3.26 |
Attitudes perceived by subjects when medical workers gave explanations to them‡ | 0.77 | 0.27 | 8.14 | .004 | 2.15 | 1.27~3.65 |
Proficiency perceived by subjects when medical workers treated to them‡ | 0.56 | 0.27 | 4.44 | .035 | 1.75 | 1.04~2.96 |
Delay in medical treatment hour | 0.61 | 0.23 | 6.91 | .009 | 1.84 | 1.17~2.90 |
Propriety of medical treatment condition | -0.01 | 0.32 | 0.00 | .973 | 0.99 | 0.53~1.86 |