The Role of Individual, Situational and Interactional Factors in Violence: The Case of Personnel Victimization in Hospital Emergency Wards

Abstract

Victimization through violence against personnel in the emergency ward (EW) was studied in all 25 general hospitals in Israel, using a self-report questionnaire (N = 1,484). Informed by routine activity theory as well as stress (negative affect) theories, the study analyzed victim and offender related variables, as well as structural, situational and interactional variables. A Victimization Seriousness Score (VSS) was constructed, based on participants' reports about the most serious type of violence they had experienced from patients and/or their relatives during the preceding year. The multiple regression analysis to explain the VSS was comprised of 35 independent variables relating to the victim's professional and personal characteristics, the hospital's structural features, and the offenders' personal characteristics, as well as situational and interactional factors, jointly explaining 47.4% of the variance (R2 = 0.474). As predicted, victimization by more serious violence was related to being security or nursing staff, positions of authority, and having no access to an emergency button. Male gender and being of Israeli or European/American origin (mainly from the former Soviet Union) was also related to more severe victimization. Offenders behaving more violently were younger, of Asian/African origin, new immigrants, and initially unstable (alcoholics, drug addicts, homeless, or psychiatric disorders). More serious victimization took place during evening shifts, related to severe medical problems and was characterized by the victim's inability to verbally communicate with the offender, and by calling other staff for help. The study demonstrates the importance of situational and interactional variables, and that violence in the EW is best explained by a comprehensive theoretical model that combines a routine activity approach with stress (negative affect) models. Suggestions are put forward for further research in this area.