Predictors of Violent Behavior by Patient or Caregiver of Patient in the Emergency Department

Eun Young Park; Eun-Nam Lee

doi:10.7475/kjan.2014.26.5.500

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Predictors of Violent Behavior by Patient or Caregiver of Patient in the Emergency Department

Eun Young Park¹, Eun-Nam Lee²

Korean Journal of Adult Nursing 2014;26(5):500-511.
Published online: October 31, 2014

DOI: https://doi.org/10.7475/kjan.2014.26.5.500

¹Department of Nursing, Daedong College, Busan

²Department of Nursing, Dong-A University, Busan, Korea

Corresponding author: Lee, Eun-Nam Department of Nursing, Dong-A University, 1 Dongdaesin-dong 3-ga, Seo-gu, Busan 602-714, Korea. Tel: +82-51-240-2864, Fax: +82-51-240-2920, E-mail: enlee@dau.ac.kr

• Received: February 13, 2014 • Accepted: October 1, 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Abstract
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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.
Conclusion
Knowledge of personal and institutional factors may permit emergency staff to minimize or prevent potential violence in the emergency department.
Key Words: Emergency departments; Violence; Patient

Figure 1.

ROC curve of predictors of violent behavior by patient or caregiver in the emergency department.

Table 1.

The State of Affairs of Violent Behavior for Medical Staffs of Patient or Caregiver (N=447)

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)

ER=Emergency room;

^†Multiple response.

Table 2.

Differences of Personal Factors according to the Experience of Violent Behavior (N=447)

Variables	Characteristics	Categories	Yes (n=123)^†	No (n=324)^†	x²	p
Variables	Characteristics	Categories	n (%)	n (%)	x²	p
General	Gender	Male	59 (48.0)	126 (38.9)	3.03	.082
	Gender	Female	64 (52.0)	198 (61.1)	3.03	.082
	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
	Patient/caregiver	Caregiver	63 (51.2)	147 (45.4)	1.22	.268
	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)	32.86	＜.001
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
	Drinking alcohol	Non-drinking	105 (86.1)	305 (95.3)	11.25	.001
	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)

ER=emergency room;

^†No respondent excluded;

^‡Internal (Internal medicine, Neurology);

^§Surgical (General surgery, Neurosurgery, Orthopedic surgery, Plastic surgery);

^||Others (Ophthalmology, Obstetrics, etc.).

Table 3.

Difference of Interpersonal Factors and Institutional Factors according to the Experience of Violent Behavior (N=447)

Factors	Characteristics		Yes (n=123)	No (n=324)	t	p
Interpersonal factors	Attitudes perceived by subjects when medical workers responded to them		2.16±0.54	2.71±0.55	9.32	＜.001
	Attitudes perceived by subjects when medical workers gave explanations to them		2.28±0.72	2.86±0.65	7.80	＜.001
	Proficiency perceived by subjects when medical workers treated to them		2.45±0.55	2.91±0.63	7.08	＜.001
	Subtotal		2.30±0.49	2.83±0.51	9.81	＜.001
Institutional factors	Delay in medical treatment hour	Standby for medical treatment	3.34±0.79	2.61±0.86	-8.14	＜.001
		Admission or discharge	3.15±0.84	2.43±0.82	-8.22	＜.001
		Emergency care or surgery, or tests	2.93±0.95	2.34±0.90	-6.00	＜.001
		Subtotal	3.14±0.73	2.46±0.74	-8.72	＜.001
	Propriety of medical treatment condition	Medical expenses	1.87±0.79	2.07±0.78	2.45	.015
		Numbers of medical workers	2.02±0.74	2.48±0.68	6.09	＜.001
		Environment of ER	1.89±0.76	2.44±0.71	7.21	＜.001
		Subtotal	1.93±0.58	2.33±0.53	6.99	＜.001

ER=emergency room.

Table 4.

Predictors of Violent Behavior by Patient or Caregiver in the Emergency Department (N=447)

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

OR=odds ratio; CI=confidence interval; ER=emergency room;

^†Dummy variable;

^‡Reversed value. Model fit (H-L Statistics x²=1.99, df=8, p=.981); Model x²: 157.617 (df=14, p＜.001); Model contains constant only: -2LL=481.94; Model contains independent variable: -2LL=324.33, Nagelkerke R²=.46.

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Predictors of Violent Behavior by Patient or Caregiver of Patient in the Emergency Department

Korean J Adult Nurs. 2014;26(5):500-511. Published online October 31, 2014

DOI: https://doi.org/10.7475/kjan.2014.26.5.500

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Predictors of Violent Behavior by Patient or Caregiver of Patient in the Emergency Department

Korean J Adult Nurs. 2014;26(5):500-511. Published online October 31, 2014

DOI: https://doi.org/10.7475/kjan.2014.26.5.500

Figure

Predictors of Violent Behavior by Patient or Caregiver of Patient in the Emergency Department

Figure 1. ROC curve of predictors of violent behavior by patient or caregiver in the emergency department.

Figure 1.

Predictors of Violent Behavior by Patient or Caregiver of Patient in the Emergency Department

Table 1.

The State of Affairs of Violent Behavior for Medical Staffs of Patient or Caregiver (N=447)

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)

ER=Emergency room;

^†Multiple response.

Table 2.

Differences of Personal Factors according to the Experience of Violent Behavior (N=447)

Variables	Characteristics	Categories	Yes (n=123)^†	No (n=324)^†	x²	p
Variables	Characteristics	Categories	n (%)	n (%)	x²	p
General	Gender	Male	59 (48.0)	126 (38.9)	3.03	.082
	Gender	Female	64 (52.0)	198 (61.1)	3.03	.082
	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
	Patient/caregiver	Caregiver	63 (51.2)	147 (45.4)	1.22	.268
	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)	32.86	＜.001
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
	Drinking alcohol	Non-drinking	105 (86.1)	305 (95.3)	11.25	.001
	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)

ER=emergency room;

^†No respondent excluded;

^‡Internal (Internal medicine, Neurology);

^§Surgical (General surgery, Neurosurgery, Orthopedic surgery, Plastic surgery);

^||Others (Ophthalmology, Obstetrics, etc.).

Table 3.

Difference of Interpersonal Factors and Institutional Factors according to the Experience of Violent Behavior (N=447)

Factors	Characteristics		Yes (n=123)	No (n=324)	t	p
Interpersonal factors	Attitudes perceived by subjects when medical workers responded to them		2.16±0.54	2.71±0.55	9.32	＜.001
	Attitudes perceived by subjects when medical workers gave explanations to them		2.28±0.72	2.86±0.65	7.80	＜.001
	Proficiency perceived by subjects when medical workers treated to them		2.45±0.55	2.91±0.63	7.08	＜.001
	Subtotal		2.30±0.49	2.83±0.51	9.81	＜.001
Institutional factors	Delay in medical treatment hour	Standby for medical treatment	3.34±0.79	2.61±0.86	-8.14	＜.001
		Admission or discharge	3.15±0.84	2.43±0.82	-8.22	＜.001
		Emergency care or surgery, or tests	2.93±0.95	2.34±0.90	-6.00	＜.001
		Subtotal	3.14±0.73	2.46±0.74	-8.72	＜.001
	Propriety of medical treatment condition	Medical expenses	1.87±0.79	2.07±0.78	2.45	.015
		Numbers of medical workers	2.02±0.74	2.48±0.68	6.09	＜.001
		Environment of ER	1.89±0.76	2.44±0.71	7.21	＜.001
		Subtotal	1.93±0.58	2.33±0.53	6.99	＜.001

ER=emergency room.

Table 4.

Predictors of Violent Behavior by Patient or Caregiver in the Emergency Department (N=447)

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

OR=odds ratio; CI=confidence interval; ER=emergency room;

^†Dummy variable;

Table 1. The State of Affairs of Violent Behavior for Medical Staffs of Patient or Caregiver (N=447)

ER=Emergency room;

†

Multiple response.

Table 2. Differences of Personal Factors according to the Experience of Violent Behavior (N=447)

ER=emergency room;

†

No respondent excluded;

‡

Internal (Internal medicine, Neurology);

Surgical (General surgery, Neurosurgery, Orthopedic surgery, Plastic surgery);

Others (Ophthalmology, Obstetrics, etc.).

Table 3. Difference of Interpersonal Factors and Institutional Factors according to the Experience of Violent Behavior (N=447)

ER=emergency room.

Table 4. Predictors of Violent Behavior by Patient or Caregiver in the Emergency Department (N=447)

OR=odds ratio; CI=confidence interval; ER=emergency room;

†

Dummy variable;

‡

Reversed value. Model fit (H-L Statistics x²=1.99, df=8, p=.981); Model x²: 157.617 (df=14, p＜.001); Model contains constant only: -2LL=481.94; Model contains independent variable: -2LL=324.33, Nagelkerke R²=.46.

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