Patient-centered communication and emotional well-being in the era of medical violence in China

Summary The past decade has witnessed an increasing number of patient assaults on doctors in China. Patient-centered communication (PCC) may be one way to mitigate this problem. This study examined the effects of PCC and patient trust on emotional health outcome, especially how patients’ attitude toward medical violence affected this relationship. Data were drawn from the China Governance and Public Policy Survey administered in 2017 with a sample size of 3784. The results showed that PCC had no direct effect on emotional well-being. Instead, patient trust completely mediated this path. Also, patients’ attitude toward medical violence increased the indirect effect of PCC on emotional well-being, suggesting a moderated mediation model. We call for education programs to promote PCC for both providers and patients, mass media campaigns to condemn violence against doctors and stricter law enforcement to stop medical violence.

The Mediating Effect of Perceived Social Acknowledgment on the Relationship Between Patient Assaults and Posttraumatic Stress Reactions in Emergency Nurses

This study explored whether posttraumatic stress symptoms resulted from workplace assaults were mediated by the perception of social acknowledgment by the victim. A sample of 444 emergency room nurses in China completed questionnaires measuring the frequency and types of patient assaults, the severity of physical injury, the perception of social acknowledgment, and the posttraumatic stress symptoms. Cross-sectional design, multiregression, and bootstrapping mediation analyses were used to test the hypotheses. Results showed that general disapproval and family disapproval mediated the relationship between the frequency of patient assaults and the severity of posttraumatic stress symptoms. These two factors also mediated the links between the injury severity of patient assaults and the development of posttraumatic stress symptoms. Implications for clinical practice and future research were discussed.

A Systematic Review of the Prevalence of Patient Assaults Against Residents

Objectives The purpose of this study is to systematically review the literature on the prevalence of patient assaults against residents in all specialties, and to identify curricula that address this issue. Methods The authors searched published English-language literature using PubMed and Scopus databases using key terms including “patient,” “assaults,” “threats,” “violence,” “aggression,” and “residents.” A separate search to identify curricula used the same terms in combination with key words including “curriculum,” “didactics,” and “course.” Bibliographies of studies found by electronic searches were also searched manually. Results Fifteen studies met the inclusion criteria. Of these, 7 were conducted on psychiatry residents alone, 6 assessed assaults on residents in nonpsychiatric specialties, and 2 reported cross-specialty data. The prevalence of assaults was defined as the percentage of residents who have experienced at least one assault. The prevalence of physical assaults on residents was 38% in surgery, 26% in emergency medicine, 16% to 40% in internal medicine, 5% to 9% in pediatrics, and 25% to 64% in psychiatry. All studies were cross-sectional; none collected data prospectively. Definitions of assault were heterogeneous or not specified. Few of the assaults were reported to clinical supervisors or training directors, and no programs had a formal reporting process. Approximately 21% to 79% of psychiatry residents and 30% of residents in other specialties had received some training on how to manage violent patients. We found no descriptions of formal curricula for managing the possibility of patient violence against residents or for preparing for the aftermath. Conclusions Although the data are limited, assaults by patients are commonly experienced by residents in training. There is a paucity of information and curricula that pertain to reducing the prevalence of these incidents and to addressing potential psychologic consequences, especially in nonpsychiatric specialties.