What type of study is this?

This is a Qualitative Study study.

December 1, 2025Open Access

Healthcare Worker's Experiences of Patient‐Initiated Workplace Violence in Emergency Departments: Qualitative Research

NANassim AdhamiProvidence Health Care FHFarinaz HavaeiUniversity of British Columbia MKMegan KauliusUniversity of British Columbia

Key Points

Patient-initiated workplace violence significantly impacts healthcare workers in emergency departments, showing the need for intervention.
Qualitative analysis from interviews with 19 healthcare workers identified key warning signs including irritability and avoiding eye contact.
Investigative interviews alongside incident reports from two emergency departments provided a comprehensive view of the violence.
Adopting trauma-informed and patient-centered care approaches may help mitigate workplace violence in healthcare settings.

Abstract

ABSTRACT Aim To examine (a) ‘on‐the‐spot’ experiences, (b) contributing factors and (c) warning signs of patient‐initiated workplace violence (WPV) from the perspectives of healthcare worker (HCW) victims and witnesses in emergency departments. Design A qualitative interpretive description study. Methods Data from in‐depth semi‐structured virtual interviews conducted from June to September 2023 with purposefully selected HCW victims and witnesses ( n = 19), and incident reports ( n = 47) from the Workplace Health Indicator Tracking and Evaluation database of two emergency departments in British Columbia, Canada, were analysed using thematic analysis. Results Participants reported (1) physical assault, (2) threats of physical assault, (3) emotional/verbal violence and (4) threats of sexual assault. Contributing factors to patient‐initiated WPV encompassed three main themes and their subthemes: (1) the context of the care environment (care provision and unit flow, staffing shortages and wait times, patient needs being beyond what can be delivered); (2) the context of the patient (patients' physiological and psychological states, patients not having the ‘benefit of our perspectives’ and patients' previous experiences of losing freedom and experiencing violence); and (3) the context of the healthcare provider (healthcare provider education and interactions with patients). While not all patients demonstrated warning signs before exhibiting aggression, those who did, most commonly showed signs such as being irritable and/or avoiding eye contact or answering questions. Conclusion Findings emphasised an urgent need for patient‐centred, trauma informed and team‐based care approaches and training programmes. Impact While there is extensive body of evidence on patient‐initiated WPV in relation to its prevalence, antecedents and consequences, there remains a gap in our understandings of contributing factors, and early warning signs. Through understanding the experiences of HCW victims and/or witnesses of ‘on‐the‐spot’ experiences and experiences leading up to aggression and violence, this study revealed further understandings of contributing factors and early warnings sings of patient‐initiated WPV. Patient‐initiated WPV in emergency departments involve multifaceted risk factors at the system, environmental, patient and healthcare provider levels and their mitigation require the adoption of patient‐centred care, trauma informed care and team based care. Reporting Method The COREQ guidelines for qualitative research were used. Patient/Public Contribution No patient or public contribution.

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