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Service designSep 21, 2022

Physios felt less distress if the person who assaulted them did not mean to harm them: US study

Some physiotherapists in the USA view the bruises on their bodies resulting from being struck by a patient as ‘war wounds’ to be worn with pride. That is one of the sobering findings contained in an article by psychologists Jenna Van Fossen and Chu-Hsiang Chang – both of whom are based at Michigan State University – that appeared in the journal Physiotherapy last month.

Dr Chang interviewed 82 volunteer practising physiotherapists from 17 US states by phone in 2010 for up to an hour (four recordings were not included in the subsequent analysis as the interviewees had not experienced violence at work).

The participants had, on average, racked up 15 years in the physiotherapy profession and most were male (80 per cent) and most were white (91 per cent).

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Employer stratgies can help to prevent feelings of demotivation after a violent incident

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Filling a gap in the research

While violence against physiotherapists is fairly common in healthcare settings, the topic has received little attention from researchers who have focused on nurses’ and physicians’ experiences, the authors note.

‘Physiotherapists provide care to increase patient mobility and reduce pain and often engage in hands-on techniques that may be uncomfortable or even painful, causing patients to lash out. Between 50-70 per cent of physiotherapists report having been physically assaulted in their work,’ the authors note.

The physiotherapists in the study reported being

‘yelled at’ (N=53)

‘insulted’ (N=40)

subjected to ‘sexist remarks’ (N=31)

‘pushed, grabbed, or shoved’ (N=30)

'hit or slapped' (N=25) and/or 'kicked or punched' (N=21)

Physiotherapists working in acute care settings were more likely to have been abused verbally and physically, with patients being the most prevalent perpetrators. A ‘marked range’ in reactions was found among the interviewees: some reported feelings of ‘anger and sadness’, but others were apparently ‘not affected’.

Those working in acute care settings were also more likely to report feeling psychological distress as a consequence, the authors note. ‘After experiencing violence, physiotherapists are similarly likely to experience reduced well-being and job satisfaction.’

 Expectation of violence

One of the themes that emerged was that some physiotherapists accept – and even expect – to be subjected to violence at work. Almost half (45 per cent) of the participants indicated that some degree of violence from patients was ‘part of the job’.

‘Mild harm’ from patients ‘could even be seen as an indicator of proper work, making it something to exult in’, the researchers note. Indeed, one participant described her workplace injuries as: ‘Just bruises, but nothing of real consequence. But if we didn’t have bruises, we wouldn’t think we worked that week … We wear our war wounds proudly.’

The physiotherapists who saw violent encounters as ‘a part of the job’ tended to express ‘fewer negative emotions’ than those with a fundamentally different outlook. ‘Along with the evaluation that violence may be expected from patients who are cognitively impaired, they often did not associate outbursts from these patients with the intention to cause them harm.’

Physiotherapists who did not think the perpetrator intended to harm them tended to experience less distress. For example, one participant said: ‘If the person is cognitively intact it makes me feel outraged, but in this instance the patient had no idea, he had a severe brain injury. I would obviously not let it happen, but I would not take it to heart at all …’

Another participant described being injured as a ‘realistic part of the challenge of working with kids and families and middle and old adults too that have disabilities or challenges’.

The authors state: ‘Physiotherapists may alternately expect relatively more innocuous violence from cognitively impaired patients. This may represent a unique type of workplace violence in healthcare that can be tolerated.’

Workers may safeguard their well-being by attributing violence to external causes, and organizations should adopt thorough strategies to prevent violence and provide victims with support [Jenna Van Fossen and Chu-Hsiang Chang]

Implications for employers

Ms Van Fossen and Dr Chang urge healthcare providers to ensure that preventive policies are in place. ‘If organizations wish to avoid staff developing negative attitudes (which may lead to decreased performance and turnover), they should develop formal policies and implement procedures and practices to prevent violence.

‘This may take the form of adequate staffing, strategies for detecting warning signs in patients, and de-escalation training for workers.’

Organisations should ‘show they care’ by, for example, making follow-up phone calls or visits helping with paperwork and getting medical assistance, and implementing further safeguards, the authors suggest.

Providing extra support is especially vital when physiotherapists see an act of violence as ‘intentional’ and when the perpetrators are not cognitively impaired, the authors conclude.

'Workers may safeguard their well-being by attributing violence to external causes, and organizations should adopt thorough strategies to prevent violence and provide victims with support.' 

To see the full version of the article, titled, Aspects of Violence Leading to Distress and Changed Attitudes for Physiotherapists: A Qualitative Investigation, visit: https://doi.org/10.1016/j.physio.2022.08.005

Author: Ian A McMillan
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