The purpose of this study is to get a deeper understanding of staff who are exposed to threat and violence in the work with people with mental disabilities. Focus is aimed at the staff´s experience of that in their daily work can be exposed to threat and violence. The first question for the study is what definition the staff gives to threat and violence in the daily work with people with mental disabilities and the second one is what determines the decision in making/or not making a report in threat and violence in the daily work with people with mental disorders. To collect empirical data the study is based on seven individual semistructured interviews with staff working with people with mental disabilities. The theory used to analyse is the normalisationprocess. The analyse is based on the interview-participants views on how they define threat and violence, their view on the client and themselves and also reporting threat and violence. The result is that the staff is affected by different aspects and a conflict is made between context and individual. This conflict contributes to the decision in reporting and definition of threat and violence.

Hot och våld mot sjuksköterskor förekommer inom sluten vården och det är ett växande problem. Detta ses både inom somatisk och psykiatrisk vård. Hot och våld är underrapporterat, vilket är problematiskt ur synpunkten att det minskar möjligheterna att motverka, förhindra och hantera fenomenet. Olika strategier kan användas för att hantera konsekvenserna hos den enskilda sjuksköterskan efter att denne utsatts för hot och våld. Att drabbas av detta leder inte sällan till psykisk ohälsa och/eller fysisk skada som kan resultera i sjukskrivning. Arbetsmiljön är betydelsefull inom vården och patient/sjuksköterskerelationen bygger på en ömsesidig respekt samt empati. Denna vårdrelation kan vara svår att upprätthålla då hot och våld förekommer. En litteraturbaserad studie valdes till examensarbetet för att beskriva sjuksköterskors upplevelse av hot och våld inom sluten vården. Tio artiklar ur vetenskapliga tidskrifter granskades. Ett resultat sammanställdes utefter vad dessa studier kommit fram till. Utefter resultaten bildades tre teman och tio underteman som svarade till syftet i denna litteraturstudie.  Temana som framkom var, att känna sig utsatt, att inte känna stöd och att behöva hitta en lösning för att hantera hot och våld. Sjuksköterskorna önskade mer stöd från verksamheten de arbetade i för att kunna hantera fenomenet. Stödet de önskade låg i omgivningen i form av säkerhetsaspekter i arbetsmiljön. Även känslomässigt stöd upplevde sig sjuksköterskorna vara i behov av efter att de konfronterats med hot och våld. Detta för att kunna hantera sina känslor samt utveckla strategier att hantera liknande situationer i framtiden. Arbetsplatsen kan förbättra sin arbetsmiljö genom att erbjuda sjuksköterskor stöd samt hjälp att skapa personliga strategier att hantera hot och våld. Arbetsplatsen kan lära sig om utlösande faktorer och skapa ett aktivt förebyggande arbete för att förhindra hot och våld mot sjuksköterskor i framtiden. / Background: Within inpatient care violence and threats are a growing problem, which nurses are particularly exposed to in their workplace, especially by patients. It makes an impact on the relationship between them and it also creates consequences in the care of the patient and the ability of the nurse to provide it.  Aim: The aim of this study was to describe nurse experiences of threats and violence within inpatient care. Method: A literature study based on qualitative articles. Ten qualitative articles were used and analysed. Results: The results are grounded in three themes and ten sub-themes. Nurses experiences of violence and threats resulted in feelings of fear and concern when they were exposed to it. They felt difficulties to handle the problems and they asked for more strategies, both personally and in the working environment to deal with the issue.   Conclusion: The results showed that nurse's feelings in this subject were fear and concern in their profession were they need more strategies to handle situations in violence and threat. In the articles nurse's asked for more support programs and reflections from their managers.

Threats and violence, or the risk of being subjected to threats and violence in the workplace, is a major health and safety problems that exists in many professions. To be exposed to threats and violence can have serious consequences for the employee's health but also for the organization in question. The aims of this study was to investigate the prevalence of threats and violence at the Swedish Migration Board detention, and to examine whether there were health problems among employees who may be exposed to threats and violence. A web-based questionnaire was answered by 29 employees (response rate = 51 percent). The results showed that more employees had been exposed to verbal threats (66 percent), compared to physical violence (10 percent), and they showed a greater tendency to report physical violence, as opposed to verbal threats. The participants indicated that factors such as working alone, convey rejection decisions and escape attempts increased the risk of threats and violence. However, the majority of the participants reported that the preventive work, including, alarms, training and available equipment, worked fine. Further everyone reported that they received good support from colleagues when they were subjected to a threat or violent situation. Generally the employees reported that their health was good, which might partly be related to an experience that the preventions worked well at this workplace. Future research should investigate such a relationship.

Titel: Att vårda under rädsla- en litteraturstudie om vårdpersonals upplevelser av hot och våld inom psykiatrisk vård. Bakgrund: Rapporter visar att hot och våld är vanligt förekommande inom vård och omsorg. Våld förekommer i alla delar av vården, men det finns vissa avdelningar som är mer utsatta för våld än andra, exempelvis psykiatrin. Det verbala och fysiska våldet skapar en otrygg miljö och kan ge allvarliga konsekvenser för både för personal och patienter. Syfte: Att beskriva vårdpersonals upplevelser av hot och våld inom psykiatrisk vård. Metod: En litteraturstudie baserad på åtta artiklar med kvalitativ ansats. Dessa artiklarna granskades, analyserades och sammanställdes. Resultat: Hot och våld orsakade starka känslor som rädsla och ilska hos vårdpersonal som påverkade arbetet och privatlivet negativt. Den otrygga arbetsmiljön utgjorde ett hot mot vårdpersonalens yrkesroll och självbild. Våld på en psykiatrisk avdelning ansågs oundvikligt, och vårdpersonals förmodades acceptera det som en del av arbetet. Våldet hanterades och förebyggdes med olika strategier, samtidigt som stöd från chefer var bristfälligt. Konklusion: Våld mot vårdpersonal inom psykiatri är ett relativt outforskat ämne som är i behov av mer forskning. vårdpersonalen blir lidande av fysiska och psykiska konsekvenser, som påverkar vårdandet av patienterna och vårdpersonalens hälsa. För att förbättra arbetssituationen krävs mer utbildning för vårdpersonal i hantering av våld. Nyckelord: Vårdpersonal, Psykiatri, Hot och våld, Arbetsrelaterat våld / Title: Working under fear- a literature review about nursing staff’s experiences of threat and violence in psychiatric care. Background: Reports show that threat and violence is a common phenomenon in healthcare. It appears in every part of healthcare, but some units are at more risk than others, for example psychiatric care. The verbal and physical violence creates an insecure work environment and can cause serious consequences for both personnel and patients. Aim: To describe psychiatric nursing staff’s perceptions of threat and violence in psychiatric care. Methods: A literature review based on eight qualitative articles. These articles were examined, analyzed and compiled. Results: Threat and violence caused strong emotional reactions, like fear and anger, among nursing staff that influenced the work and their private life. The unsafe work environment composed a threat to the nursing staff’s professional role and self image. It was percieved that violence were unavoidable, and that nursing staff were expected to accept violence as a part of the job. Violence were handled and prevented with different strategies, while manegement support were lacking. Conclusion: Violence against nursing staff in psychiatric care are a relatively unexplored subject in need of more research. Nursing staff are suffering both physical and psychological damage due to violence in the workplace, which also effects the care given to patients and the nursing staff’s own health. To improve the work situation the nursing staff need more education in handling violence. Keywords: Nursing staff, Psychiatry, Threat and violence, Workrelated violence

This study aims to answer how social workers conceptualize the risk of violence in their workplace. The data consisted of seven interviews with social workers working in financial aid departments in or around the Stockholm area. Semi structured interviews were used to gather the data which then were processed with a fenomenographic method. The data was analyzed with Lazarus and Folkman theory on coping and Antonovsky’s generalized resistance resources. The findings in this study shows that all respondents have experienced threats or violence in some form in their work. They use strategies to cope with both the situation at hand and the emotions connected to the event. The respondents were affected in their spare time to some extent. It will be argued that there is a form of duality between to not accept violence and at the same time have understanding for client’s vulnerable situation and for the effect social workers decision-making have on the client’s lives.

Syfte: Syftet med denna studie var att beskriva ambulanssjuksköterskans upplevelser av hot och våld inom prehospital akutsjukvård, samt se vilka konsekvenser detta ledde till. Metod: 67 enkäter delades ut på ambulansstationer i Uppsala län. Av 67 tillfrågade var det 34 ambulanssjuksköterskor som svarade på enkäten. Insamlingen av data genomfördes med hjälp av enkäter som bestod av sex öppna frågor som sedan analyserades utifrån en kvalitativ innehållsanalys. Resultat: Resultatet som baseras på ambulanssjuksköterskornas svar visade att 97 % av respondenterna hade blivit utsatta för verbala hot och att mer än varannan utsatts för fysiskt våld på något arbetspass. Detta ledde till olika upplevelser hos ambulanssjuksköterskorna. Konsekvenserna upplevdes som större vid verbala hot än fysiskt våld. Genom analysen identifierades fyra kategorier; Omvårdnadssituationer med verbala hot och fysiskt våld, Privata- och yrkesrelaterade konsekvenser av fysiskt våld vid omvårdnadssituationer, Yrkesrelaterade konsekvenser av verbala hot vid omvårdnadssituationer samt Stöd för ambulanssjuksköterskor vid inträffade hot- och våldshändelser. Under dessa fyra kategorier tog ambulanssjuksköterskorna upp konsekvenser som både var yrkesrelaterade och privata. Slutsats: Studien visade att verbala hot och fysiskt våld mot ambulanssjuksköterskor är mycket vanligt förekommande. Detta resulterade i att majoriteten av ambulanssjuksköterskorna upplevde att omvårdnadssituationen blev obehaglig och de därför som en direkt konsekvens av detta reagerade med försiktighet, distanstagande från patienten eller direkt upphörde med patientvården. Studien visar att det uppstod större konsekvenser vid verbala hot än fysiskt våld. En fungerande handlingsplan fanns, men kunde bli bättre och tydligare. Detta tyder på att förbättringsåtgärder behöver göras när en hot- och/eller våldshändelse inträffar mot ambulanssjuksköterskor. Författarnas förhoppning är att studien ska fungera som underlag för förbättringar i prehospitala verksamheter. / Purpose: Aim of this study was to describe the experiences of threats and violence against ambulance nurses in prehospital emergency care, and see what consequences this entailed. Method: 67 questionnaires were distributed to ambulance stations in Uppsala County. Of the 67 asked ambulance nurses were there 34 that responded to the survey. The collected data was conducted using questionnaires that consisted six open-ended questions and then analyzed from a qualitative content analysis. Results: The results of the ambulance nurses responses revealed that 97% of respondents had been subjected to verbal threats and more than half experienced physical violence in any shift. This led to different experiences of ambulance nurse. The consequences were higher for verbal threats than physical violence. Through the analysis four categories were identified; Nursing Situations with verbal threats and physical violence, Private and occupational consequences of physical violence at nursing situations, Occupational consequences of verbal threats at nursing situations and Support for ambulance nurses to actual threats and incidents of violence. During these four categories, ambulance nurses brought up consequences that were both professional and private. Conclusion: The study showed that verbal threats and physical violence against ambulance nurses are very common. This resulted in that most ambulance nurses experienced that the nursing situation became uncomfortable and therefor, as a direct consequence they reacted with caution, distance itself from the patient or direct cessation of patient care. The study's findings showed that there were more consequences of verbal threats than of physical violence. A workable plan of action existed, but could be better and clearer. This suggests that improvements need to be made when a threat and/or violent incident occurs against ambulance nurse. The authors hope is that the study can become a basis for improvements in the pre-hospital operations.

Bakgrund: Hot och våld förekommer i alla delar av vården och det speglar ett hårdare klimat i samhället och framförallt inom akutsjukvården. Ambulanspersonalen arbetar patientnära och är extra utsatta i både ensamarbete och i komplexa situationer. Att uppleva hot och våld i arbetet kan få negativa konsekvenser för ambulanspersonalens hälsa och även för patientsäkerheten. Författarna har valt personcentrerad vård som specifikt kompetensområde då det har en betydande del av omvårdnadsprocessen. Syftet: Syftet var att belysa erfarenheter av hot och våld i samband med omhändertaganden av patienter inom ambulanssjukvård. Metod: Litteraturöversikt med en systematisk metod. Artiklarna söktes i två olika databaser, PubMed och CINAHL och totalt inkluderades 16 artiklar till resultatet. Analysmetoden som användes var en integrerad analys. Resultatet: Analyserades till tre kategorier; variationer av hot och våld, bidragande faktorer till hot och våld, konsekvenser av hot och våld. Resultatet visade att vara ung ambulanspersonal och sakna arbetslivserfarenhet var en bidragande orsak för att utsättas för hot och våld. De som utsätter ambulanspersonal för hot och våld var patienten, anhöriga och andra personer på plats. Slutsats: Det finns faktorer som ambulanspersonalen inte kan påverka. En starkt bidragande orsak till hot och våld mot ambulanspersonal var alkohol- och drogpåverkade patienter. Det som genomsyrar nästintill alla artiklar är att yngre och oerfaren personal lättare hamnar i dessa situationer, då den kliniska erfarenheten och livserfarenheten saknades. Det är viktigt att ambulanspersonalen är situationsmedveten och kan förutse vilka situationer som kan urarta och förebygga dessa. Konsekvenserna kan bli påtagliga i form av ökad stress och empatinedsättning för patienterna om personalen inte får det stöd som efterfrågas. / Background: Threats and violence occur in every part of the healthcare system and this is a reflection of a harder climate in society, especially in emergency medical services. Ambulance staff work closely with the patients and are vulnerable in situations when they are alone and when the situation is complex. When experiencing threats and violence at work can have negative consequences for the ambulance staff´s health and for the patient safety. Person-centred care has an imported role in the nursing-process. Aim: To illustrate the experiences in situations where threats and violence occur towards ambulance staff meanwhile they took care of patients. Method: Was a literature overview with a systematic method. The articles were searched in two different databases, PubMed and CINAHL and a total of 16 articles were included to the result. The analysis method used was a integrated analysis. Results: Were analysed in to three categories; variations of threats and violence, contributing factors to threats and violence, consequences of threats and violence. The results showed that being young and work in the ambulance and if they had none work experience was a contributing factor for being exposed to threats and violence. It´s patients, relatives and people on site who expose´s the ambulance staff for threat and violence. Conclusion: There were factors that the ambulance staff couldn't affect and one major contributing factor which led too threat and violence were alcohol- and drug affected patient´s. In almost all the article showed that younger and unexperienced ambulance staff were end up easier in these situations. It´s important that ambulance staff are aware of the situation and can predict which situations can degenerate and prevent them. The consequences for ambulance staff that don´t receive the support that was requested could lead to increased stress and lack of empathy toward the patient.

Syftet med studien var att undersöka hur ambulanspersonal upplever sin utsatthet för brott vid utryckning. Den undersökningsmetod som användes var halvstrukturerade intervjuer. Huvudresultat i studien var att de som intervjuades uppgav att de blivit utsatta för brott i form av hot om våld samt fysiskt våld, men att de inte upplever eller pratar om sig själva som offer, men de uppfyller delvis kraven för att kunna ses som ett idealiskt offer samt att de normaliserar sin utsatthet. Ett annat resultat visar att ambulanspersonalen anser att personuppgiftslagen hämmar dem i deras arbete när det kommer till säkerhet. Under intervjuerna framkom det att personuppgiftslagen påverkar deras känsla av trygghet på ett negativt sätt då de inte har all viktig information om personen de åker till. Det framkommer också att ambulanspersonalen värdesätter samarbetet med polis och att de behöver mer resurser. Studiens viktigaste slutsats är att ambulanspersonalen blir utsatta för hot och våld och att det är ett problem, men att de normaliserar sina upplevelser och inte pratar om sig som offer. / The purpose of the study was to investigate how paramedics experience their exposure to crimes during work, but also their thoughts about victim. The method of investigation used was semi structured interviews. The main result of the study was that the paramedics was subjected to crimes in forms of threats of violence and physical harm, but they do not see themselves as victims and they also normalize their vulnerability. Another result is that the personal data act prevents the paramedics in their work regarding their safety. During the interviews, it emerged that it effects their sense of security in a negative way since they do not have all the information about the person that they are about to assist. They also value the cooperation that they have with the police. The main findings of the study were that paramedics gets exposed to threats and violence and that this is a problem, although they normalize their experience and do not talk about themselves in terms of victims.

Bakgrund: Hot och våld inom akutsjukvården är ett stort och pågående problem. För sjuksköterskor är den specifika kompetensen att ge omvårdnad vilket utmanas inom akutsjukvården. Sjuksköterskor är de som främst utsätts i patientnära vård och ibland med en oförutsägbar arbetsmiljö. De vanligaste formerna av hot och våld är verbalt, fysiskt eller i form av sexuella trakasserier där nyexaminerade är särskilt drabbade. Faktorer som kan ligga bakom uppkomsten av hot och våld är bland annat frustration, stress, känslan av hjälplöshet och brist i kommunikationen. Syfte: Syftet med denna litteraturöversikt är att utforska hot och våld mot sjuksköterskor inom akutsjukvården och dess konsekvenser för att ge omvårdnad.Metod: En litteraturöversikt har genomförts med 20 vetenskapliga artiklar som publicerats under tidsperioden 2011–2021. Databaser som CINAHL och PubMed har använts.Resultat: Hot och våld leder till psykiska konsekvenser som ångest, rädsla och stress. Resultatet visar att sjuksköterskor blir mer benägna att byta avdelning eller avsluta sin anställning. Sjuksköterskor upplever brist på stöd från ledningen efter att ha blivit utsatta för våld och arbetsbelastningen blir svårare att hantera. Bristande kommunikation med kollegor och patienter leder till rädsla över att patienter inte får den vård de behöver.Slutsats: Omvårdnaden till patienter påverkas om sjuksköterskor utsätts för hot och våld. Det medför ett behov av ökat stöd från såväl ledning som organisation. För att sjuksköterskor ska kunna känna sig säkra på sin arbetsplats behövs förebyggande och förberedande strategier. Hot och våld bör även belysas i sjuksköterskeutbildningen. / Background: Threat and violence in emergency care is a large and ongoing issue. Registered nurses specific competence is giving nursing care, which is challenged within emergency care. Registered nurses are primarily exposed because of their close patient care and sometimes with an unpredictable work environment. The most common types of threat and violence is verbal, physical or sexual harassement where newly registered nurses are particularly affected. Factors which may influence the occurence of threat and violence are frustration, stress, the feeling of helplessness and lack of communication.Objective: The aim of this literature review is to explore threat and violence towards nurses in emergency care and its consequences in giving nursing careMethod: A literature review has been conducted with 20 scientific articles, published over the period 2011-2021. Databases such as CINAHL and PubMed have been used.Results: Threat and violence lead to psychological consequences such as anxiety, fear, and stress. The results show that registered nurses become more inclined to change department or end their employment. Registered nurses experience a lack of support from the management after being exposed to violence and the workload becomes more difficult to handle. Inadequate communication with colleagues and patients leads to fearing that patients will not receive the care they require.Conclusion: Nursing care is affected if registered nurses are exposed to threat and violence. This entails a need of increased support from the management as well as from the organisation. For these nurses to feel safe at their workplace, preventive and preparative strategies are necessary. Threat and violence should also be highlighted in nursing education.

This PhD thesis compared incidents of violence in two Malaysian hospitals and two English hospitals. Using a model of workplace violence, the aims of the thesis were to explore and compare six constructs: extrinsic, intrinsic, triggers, experiences, moderators, and consequences of workplace violence as perceived by Malaysian and English hospital staff. This study used data on experiences of violence gathered in 2005 for incidences in hospitals that occurred up to one year before the survey. The 2004 data from the Incident Report database (IRD) of the English hospitals was also used. Two instruments were developed for this thesis. First was the General Violence Victimization Questionnaire (GVQ), an instrument to identify the types, prevalence, nature, consequences, post-incident support, and reporting trends of violence in hospitals. The second instrument was the Violence Victimization Semi-structured Interview (VicQ) which explored factors leading to the violent incident, the violent incident itself, and psycho-social issues relating to the violent incident. Both instruments were translated into the Malay language for use in Malaysia. 227 people participated in the quantitative survey: 162 people from the Malaysian Government Hospitals (MGH) and 115 people from the National Health Service (NHS). A total of 25 people volunteered to be interviewed as part of the qualitative aspect of the study: 15 from the MGH and 10 from the NHS. Six categories of violence were compared: verbal, nonverbal, threat, physical, sexual, and psychologically-based. A total of 4118 violent incidents (1402 in MGH and 2716 in NHS) were reported. The most common type of violence was psychologically-based violence in the MGH and verbal violence in the NHS. Both samples perceived that the major source of workplace violence was from patients and involved one male perpetrator. There were differences between the two samples indicative of cultural differences. Of those interviewed, the Malaysian participants perceived that offenders were intrinsically motivated to offend. The English participants perceived that offenders had either intrinsic or extrinsic motivation for perpetuating violence. Differences were noted for substance abuse and customer relations as triggers of organisational violence. Comparisons of moderators were different for the two country samples. Comparisons of consequences were not significantly different. Comparisons across several demographic variables (gender, age, and occupational groupings) were not significant between the two country samples with regards to workplace violence victimisation. However, a comparison of length of service was found to be significant. The final path model differed from the original model of workplace violence. Additional findings include a difference between the established definition and participants‘ definition of workplace violence, a lack of anti-violence policies in Malaysian hospitals, under reporting, and unforeseen direct and direct relationships among the six constructs.