Workplace violence experienced by healthcare providers (HCPs) in Sudan has gone viral, driving many HCPs outside the country. Globally, HCPs have accepted workplace violence as a phenomenon integral to their clinical work, causing an underreporting of incidents. This study reviews the causes and explores solutions for the phenomenon. Search strategies were conducted using internet sources including PubMed, Embase, Google Scholar, and Cochrane. References to Sudan were limited to HCPs in public healthcare facilities. A descriptive analysis was conducted on the global status of workplace violence toward HCPs. Future interventions were examined and discussed considering Sudan\'s circumstances. Results showed the \"pandemic\" nature of the phenomenon. Workplace violence contributes to the deterioration of the quality and efficiency of the healthcare system with consequences for effective healthcare delivery. It is concluded that a multiapproach intervention needs to be integrated to circumvent the standing multifactorial situation. Statutory actions are needed towards the widespread violence and impunity. Workplace organizational procedures are needed to address the patient\'s needs that overwhelm scarce resources. Robust educational efforts are recommended by HCP training bodies, the media, and other stakeholders to improve the doctor/patient relationship.

BACKGROUND: Workplace violence against medical staff in China is a widespread problem that has negative impacts on medical service delivery. The study aimed to contribute to the prevention of workplace violence against medical staff in China by identifying patterns of workplace violence, key risk factors, and the interplay of risk factors that result in workplace violence.
METHODS: Ninety-seven publicly reported Chinese healthcare violent incidents from late 2013 to 2017 were retrospectively collected from the internet and analysed using content analysis. A modified socio-ecological model guided analysis of the violent incidents focusing on risk.
RESULTS: Physical violence, yinao, or a combination of physical and verbal violence were the typical forms of violence reported. The findings identified risk at all levels. Individual level risk factors included service users\' unreasonable expectations, limited health literacy, mistrust towards medical staff, and inadequacy of medical staff\'s communication during the medical encounter. Organisational level risk factors under the purview of hospital management included problems with job design and service provision system, inadequacies with environmental design, security measures, and violence response mechanisms within hospitals. Societal level risk factors included lack of established medical dispute-handling mechanisms, problems in legislation, lack of trust and basic health literacy among service users. Situational level risks were contingent on risk factors on the other levels: individual, organisational, and societal.
CONCLUSIONS: Interventions at individual, situational, organisational, and societal levels are needed to systematically address workplace violence against medical staff in China. Specifically, improving health literacy can empower patients, increase trust in medical staff and lead to more positive user experiences. Organizational-level interventions include improving human resource management and service delivery systems, as well as providing training on de-escalation and violence response for medical staff. Addressing risks at the societal level through legislative changes and health reforms is also necessary to ensure medical staff safety and improve medical care in China.

BACKGROUND: Violence against paramedics has been described as a serious public health problem with the potential for significant physical and psychological harm, but the organizational culture within the profession encourages paramedics to consider violence as just \"part of the job.\" Therefore, most incidents of violence are never formally documented. This limits the ability of researchers and policy makers to develop strategies that mitigate the risk and enhance paramedic safety.
OBJECTIVE: Following the development and implementation of a novel, point-of-event violence reporting process in February 2021, our objectives are to (1) estimate the prevalence of violence and generate a descriptive profile for incidents of reported violence; (2) identify potentially high-risk service calls based on characteristics of calls that are generally known to the responding paramedics at the point of dispatch; and (3) explore underpinning themes, including intolerance based on gender, race, and sexual orientation, that contribute to incidents of violence.
METHODS: Our work is situated in a single paramedic service in Ontario, Canada. Using a convergent parallel mixed methods approach, we will retrospectively review 2 years of quantitative and qualitative data gathered from the External Violence Incident Report (EVIR) system from February 1 2021 through February 28, 2023. The EVIR is a point-of-event reporting mechanism embedded in the electronic patient care record (ePCR) developed through an extensive stakeholder engagement process. When completing an ePCR, paramedics are prompted to file an EVIR if they experienced violence on the call. Our methods include using descriptive statistics to estimate the prevalence of violence and describe the characteristics of reported incidents (Objective 1), logistic regression modeling to identify high-risk service calls (Objective 2), and qualitative content analysis of incident report narratives to identify underpinning themes that contribute to violence (Objective 3).
RESULTS: As of January 1, 2023, 377 paramedics-approximately 1 in 5 active-duty paramedics in the service-have filed a total of 975 violence reports. Early analysis suggests 40% of reports involved a physical assault on the reporting paramedic. Our team is continuing to collect data with more fulsome analyses beginning in March 2023. Our findings will provide much-needed epidemiological data on the prevalence of violence against paramedics in a single paramedic service, its contributing themes, and potential risk factors.
CONCLUSIONS: Our findings will contribute to a growing body of literature demonstrating that violence against paramedics is a complex problem that requires a nuanced understanding of its scope, risk factors, and contributing circumstances. Collectively, our research will inform larger, multisite prospective studies already in the planning stage and inform organizational strategies to mitigate the risk of harm from violence.
UNASSIGNED: DERR1-10.2196/37636.

Violence in the emergency department (ED) remains underreported. Patient factors are often cited as a source of confusion in determining the culpability of perpetrators and whether to proceed with incident reporting. This study’s objective was to determine how ED staff at one academic medical center perceive certain clinical scenarios and how this compares to local law enforcement officers (LEO). An anonymous survey with 4 scenarios was sent to multidisciplinary ED staff at our academic medical center, as well as local LEO and inquired whether respondents considered any of the scenarios to be reportable as a crime. Chi-square analysis was used for comparison. The study was deemed exempt by the Institutional Review Board. A total of 261 ED staff and 77 LEO completed the survey. Both groups were equally likely to believe that a reportable crime occurred in Scenario 1, where a patient with dementia punches a nurse (LEO: 26.0% vs. ED: 31.4%, p = 0.44), and in Scenario 2, where an intoxicated patient spits at a phlebotomist (LEO: 97.4% vs. ED: 95.0%, p = 0.56). However, the two groups differed in Scenario 3, in which a patient with delirium makes verbal threats to a doctor (LEO: 20.8% vs. ED: 42.9%, p < 0.001), and Scenario 4, in which a patient’s parent throws a chair at a medical student (LEO: 66.2% vs. ED: 81.2%, p = 0.009). As health systems seek to improve workplace safety, it is important to consider the barriers to reporting violent incidents, including staff’s understanding of what acts may constitute reportable violence, as well as LEO understanding of the unique ED environment and patient responsibilities.

BACKGROUND: Workplace violence is frequent, especially in long-term care, but often unreported.
OBJECTIVE: The aim of this study is to identify workers experiences and coping strategies when they face physical aggression from residents and assess the value of incident reports for violence follow-up.
METHODS: This mixed method study is based on incident reports collected over 3 years from two different long-term care geriatric facilities in France and thematic analysis of 20 semi-structured interviews of nurses and nursing assistants.
RESULTS: The reported frequencies of physical aggression among respondents range from none to daily aggression. Only 76 incident reports were submitted. Aggressions were under-reported by caregivers who often felt guilty for not having avoided them. Coping strategies included banalization and seeking support from colleagues. Incident reports can constitute a warning signal for the management team but are not a reliable tool for workplace violence follow-up.
CONCLUSIONS: Our study emphasizes the complexity of workplace violence prevention in long-lerm care settings. Proposals can be formulated to train and support caregivers, but a shift from a task-oriented organisation to a patient-centred approach seems necessary to reduce violence.
CONCLUSIONS: Situations to be reported should be better defined, aggression reporting encouraged and judgmental attitudes toward reports discouraged.

Objective: Hospital violence remains a global public health problem. This study aims to analyze serious hospital violence causes in China and the characteristics of perpetrators. It likewise seeks to understand frontline personnel\'s needs and put forward targeted suggestions. Methods: Serious hospital violence cases from 2011 to 2020 in the China Judgment Online System (CJOS) were selected for descriptive statistical analysis. A total of 72 doctors, nurses, hospital managers, and security personnel from 20 secondary and tertiary hospitals in China were selected for semi-structured interviews. Results: Of the incidents, 62.17% were caused by patients\' deaths and dissatisfaction with their treatment results. Moreover, it was found that out-of-hospital disputes (11.14%) were also one of the main reasons for serious hospital violence. The perpetrators were mainly males (80.3%), and had attained junior high school education or lower (86.5%). Furthermore, most of them were family members of the patients (76.1%). Healthcare workers urgently hope that relevant parties will take new measures in terms of legislation, security, and dispute handling capacity. Conclusion: In the past 10 years, serious hospital violence\'s frequency in China has remained high. Furthermore, their harmful consequences are more serious. The causes of hospital violence are diverse, and the characteristics of perpetrators are obvious. Frontline healthcare workers urgently need relevant parties to take effective measures in terms of legislation, security, and dispute handling capacity, to prevent the occurrence of violence and protect medical personnel\'s safety.

A Code Black is the coordinated response by healthcare staff and security to an act or threat of verbal and physical aggression or violence perpetrated by a patient, family member or visitor towards healthcare staff within a hospital setting. Behavioural disturbance is often verbally de-escalated by staff. However, as a last resort physical and/or chemical restraint may be necessary. Reports show that there is an increasing number of violent incidents in Emergency Departments (ED), emphasising the importance of staff training for Code Black events. This research examines the response of healthcare staff to aggression and violence in the ED, the supporting structures that manage a Code Black event and potential avenues for restructuring the response.
We used a constructivist methodology to evaluate the training needs of healthcare staff. In 2019, we interviewed 20 staff and conducted a series of ethnographic observations in EDs across four hospitals in the Western Sydney Local Health District (WSLHD) in New South Wales (NSW), Australia. We focussed on staff experiences of Code Black events and the current departmental response. Staff recounted experiences of 45 Code Black events which were collated and thematically analysed.
Our findings show that there are no guidelines for: assessing the risk of an agitated patient, best practice de-escalation techniques, when exactly to call a Code Black and the pre-determined allocation of staff roles for patient restraint. Code Black response efforts lacked a systematic approach to coordinating resources and personnel, and there was confusion over the role of security. When poorly managed, this placed healthcare staff, security personnel and patients at serious risk and had a negative impact on staff wellbeing. We found training in Code Black interventions relies heavily on learning on the job from experienced staff members.
A systematic, coordinated and consistent organisational response to Code Black events is essential for the safety of ED staff. The roles and responsibilities of health workers and security require clear definition, and health workers across the WSLHD require easily accessible and repeatable experiential training in managing Code Black events.

Improper, unprofessional, or misleading media reports about violence against medical care providers (typically doctors and nurses) may provoke copycat incidents. To examine whether media reports about violence against medical care providers in China follow professional journalism recommendations, we identified 10 influential incidents of violence against medical care providers in China through a systematic strategy and used standardized internet-based search techniques to retrieve media reports about these events from 2007-2017. Reports were evaluated independently by trained coders to assess adherence to professional journalism recommendations using a 14-item checklist. In total, 788 eligible media reports were considered. Of those, 50.5% and 47.3%, respectively, failed to mention the real and complete names of the writer and editor. Reports improperly mentioned specific details about the time, place, methods, and perpetrators of violence in 42.1%, 36.4%, 45.4%, and 54.6% of cases, respectively. Over 80% of reports excluded a suggestion to seek help from professional agencies or mediation by a third party and only 3.8% of reports mentioned the perspectives of all three key informants about an event: medical care providers, patients, and hospital administrators. Of those that mentioned medical care providers, patient, and/or hospital administrator perspectives, less than 20% indicated they had obtained the interviewee\'s consent to include their perspective. We concluded that most reports about violence against medical care providers in the Chinese media failed to strictly follow reporting recommendations from authoritative media bodies. Efforts are recommended to improve adherence to professional guidelines in media reports about violence against medical care providers in China, as adherence to those guidelines is likely to reduce future violent events against medical care providers like doctors and nurses.

The study purpose was to identify associations between assault deterrent presence in kindergarten through 12th (K-12) grade schools and physical assaults (PAs) against educators. Data collected through a two-phase study identified physical and nonphysical violent events and utilized a nested case-control study to identify PA risk/protective factors. Analyses included multivariable modeling. Adjusted analyses demonstrated a significant decreased risk of PA with routine locker searches (odds ratio [OR] = 0.49, 95% confidence interval [CI] [0.29, 0.82]). Also important, although not statistically significant, were presence of video monitors (OR = 0.72, 95% CI [0.50, 1.03]), intercoms (OR = 0.77, 95% CI [0.55, 1.06]), and required school uniforms/dress codes (OR = 0.74, 95% CI [0.52, 1.07]). These findings are integral to school nursing practice in which there is opportunity to influence application of relevant pilot intervention efforts as a first step in determining the potential efficacy of broad-based interventions that can positively impact the problem of school-related violence.

To date, most of the interdisciplinary scholarly literature pertaining to care work and labor studies of marginalized groups, such as women, visible minorities, and immigrants, has focused on emotional labor as well as concerns about high stress and high turnover. However, few mention racism and racialization. Using a single-case study research design of a long term care (\"LTC\") home in Toronto, Ontario, Canada, this paper contributes to our understanding of racism and racialization by analyzing participants\' experiences of work. It documents how particular social determinants of health (\"SDoH\"), such as race and racialization, can manifest themselves in the lives of workers. Drawing on critical race theory and feminist political economy, this study examines the ways in which the participants discuss their experiences of care work, with closer attention to racism and racialization.