Violence against health workers rises during COVID-19

Violence against health-care staff has got “even worse” since the COVID-19 pandemic—but new strategies are tackling the problem. Jacqui Thornton reports.

A new joint study by the International Council of Nurses, the International Committee of the Red Cross, the International Hospital Federation, and the World Medical Association has found that violence against doctors is endemic regardless of a country’s security situation. Moreover, respondents to the survey thought that violence by patients or their families against health-care workers has worsened and has become more frequent since the start of the COVID-19 pandemic.

More than 120 responses were received to the 31-question poll from May to July, 2021. The resulting report, published on July 19, found that of those organisations that had received reports of violence, 58% of the respondents perceived an increase, 30% disagreed, and 12% were unsure. 9% of those who reported violence said it had not occurred before the pandemic. All reported verbal aggression; 82% mentioned threats and physical aggression while 27% reported staff being threatened by weapons. 21% reported the death or severe wounding of a health-care worker or patient.

International Council of Nurses Chief Executive Officer Howard Catton said concrete action was needed to end the impunity for those who are violent. “This report highlights that the threats, aggression and violence nurses and other health personnel face have got even worse during the pandemic. Employers and governments have a duty to care for their staff and to investigate and sanction when attacks on healthcare occur.”

The authors told The Lancet in an email that, for their organisations, “the added value of the report is that it has surfaced great coping mechanisms that might inspire others to also take action to prevent violence against healthcare and change the reality of violence they might be faced with”.

Dr Luisa Pettigrew, research fellow at the London School of Hygiene & Tropical Medicine and a general practitioner in the UK, said it was deeply concerning to see that this is a universal issue given the context of global shortages of health-care workers. She agreed that despite the very small sample size, the study still demonstrates that this issue is affecting different settings and should help focus the attention of health-care leaders in each country to better understand the issues they are facing.

The survey shows the importance of improving relations between health personnel and patients and family members, with the most participants suggesting training in communication skills as an effective measure for de-escalating potentially violent situations. Despite the persistent presence of violence, practical solutions do exist. The report highlighted successful strategies from Bulgaria, Columbia, Italy, Portugal, and Taiwan which could be implemented globally.

According to the report, the Portuguese Association for Hospital Development said the frequency of violent events has been reduced from 9 cases per 1000 workers to 4 cases per 1000 workers in the year since the beginning of the pandemic, using data from a 14-year online reporting system. This decrease was due to a series of measures including the creation of a remote video call hotline, available 24 h per day with trained specialist support, and the identification of a security focal point for staff to coordinate with security officers.

In Italy, in 2020, after lobbying by nurses, the country’s parliament approved a new law to address violence against health workers, which extended prison sentences from 4 to 16 years for individuals who cause serious or very serious personal injuries to health personnel and increased the administrative penalty from €500 to €5000 for an action that, short of a crime, involves violence, abuse, offence, or harassment towards health-care workers. A National Day of Education and Prevention of Violence against Health Personnel (March 12) was created to raise awareness of the subject.

In Taiwan, the nurses’ association established a reporting mechanism for violent incidents in hospitals, with regular reporting of incidents targeting health personnel in and out of the hospital. Once the incidents are reviewed, lessons are incorporated into safety-management practices and staff education and training.

Pettigrew said: “The report should be essential reading for governments, health-care employers and other stakeholders such as the media and health-care users. It is a wake-up call for all countries to better understand how violence is affecting their health-care workforce and quality of services, in order to take action to stop it.”