Facteurs lies aux episodes violents dans les soins

Madeleine Estryn-Behar, Nathalie Duville, Marie-Laurène Menini, Donatella Camerino, Serge Le Foll, Olivier le Nézet, Rachel Bocher, Beatrice van der Heijden, Paul Maurice Conway, Hans Martin Hasselhorn

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Introduction: The respective roles of medical specialties and work organization on violent events against healthcare workers (HCW) in different countries was examined. Methods: Using the results of the Presst-Next study, we analyzed data from 27 134 HCW in 7 European countries. Multivariate logistic analyses were conducted with SPSS 12 software. Results: After adjustment for age, gender and other occupational risk factors, the factors indicating insufficient team work were highly associated with an increased risk of violent events. Dissatisfaction with shift change (OR=1.35; 95%CI 1.23-1.47), uncertainty about treatment (OR=1.57; 95%CI 1 .44-1.71), and frequent interruptions (OR=2.04; 95%CI 1.81-2.31) were linked to violent events, up to twice the number among HCW reporting better team work. Contradictory orders, dissatisfaction with psychological support, and harassment by superiors were all significantly associated with increased reporting of frequent violent events. We observed a positive gradient between violent events and job demand (time pressure) (OR=1.25 for an intermediate score and OR=1.55 for a high score, compared with a low score). Loneliness at work, certain work schedules, and physical load increased the risk. Nurses' aides were exposed to violent events more often (OR=1.57; 95%CI 1.38-1.79) than head nurses. Older HCW and those with more experience were less exposed. The highest risks were associated with working in psychiatric (OR=4.89; 95%CI 3.82-6.25) and emergency (OR=2.68; 95%CI 2.10-3.44) departments, compared with home care and day care. The excess risk was an additional 30% in geriatrics and long-stay departments. Significantly less risk was observed in pediatrics, obstetrics and gynecology departments (OR=0.70; 95%CI 0.56-0.88). Conclusion: Team building requires time, and shift change is a key period. This time is far from nonproductive. Rather, its effective use reduces treatment errors, enhances quality of care, and reduces the frequency of violent events. It is crucial in every department.
Original languageUndefined
Pages (from-to)21-35
Number of pages15
JournalPresse medicale
Issue number1, Part 1
Publication statusPublished - 2006


  • METIS-238370
  • IR-78868

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