Branko Gabrovec, PhD
Types of Threats against Nursing Care 
Workers in Psychiatric Facilities
Scientific article
UDC 616.89+364.632
KEY WORDS: safety, quality, violence, psychiatric 
patient, nursing care
ABSTRACT - The purpose of this research was to 
define the type and frequency of violence towards 
the psychiatric nursing care workers across as wide 
sample as possible. For this research we decided to 
include workers that are most exposed to violence, 
i. e. the nursing staff, who work in secure and/or in-
tensive care psychiatric units. The research was con-
ducted in 5 psychiatric hospitals. For the purpose of 
this study, a non-experimental sampling method was 
employed using a structured questionnaire as the 
data collection instrument (n = 203). The prevalen-
ce of violence towards the psychiatric nursing care 
workers is high, particularly for those at intensive 
psychiatric care units and secure psychiatric units. 
Psychiatric nursing care workers must ensure safe 
and high-quality care even during aggressive beha-
viour of their patients; however, this is sometimes 
difficult, because they lack the functional knowledge. 
Representative results can serve as a basis for the de-
velopment of a comprehensive aggression prevention 
and employee education programme.
Znanstveni članek
UDK 616.89+364.632
KLJUČNE BESEDE: varnost, kakovost, nasilje, pa-
cienti z duševno motnjo, zdravstvena nega
POVZETEK - Namen te raziskave je bil na čim več-
jem vzorcu ugotoviti vrsto in pogostost nasilja, us-
merjenega proti zaposlenim v zdravstveni negi na 
področju psihiatrije. V to raziskavo smo vključili 
najbolj izpostavljene zaposlene v zdravstveni negi 
na področju psihiatrije, tj. zaposlene na intenzivnih 
oddelkih. Raziskava je bila opravljena v petih psihi-
atričnih bolnišnicah. Uporabili smo neeksperimen-
talno metodo raziskovanja s strukturiranim anketnim 
vprašalnikom (n = 203). Nasilje, usmerjeno proti 
zaposlenim v zdravstveni negi, je pogosto, posebno 
proti zaposlenim na intenzivnih oddelkih in oddelkih 
pod posebnim nadzorom. Zaposleni v zdravstveni 
negi na področju psihiatrije morajo tudi ob agresiji 
zagotoviti varno in kakovostno obravnavo, kar pa je 
velikokrat težko, saj jim primanjkuje funkcionalnega 
znanja. Dobljeni reprezentativni rezultati lahko služi-
jo za razvoj obsežnega programa preventive in uspo-
sabljanja zaposlenih.
1 Introduction
Patient security and high-quality psychiatric treatment are a priority on all levels 
of health care. With the development of the modern society and present trends, the in-
cidence of psychiatric diseases is on the rise. Despite the progress made by psychiatry 
specialists, the violence and aggressive outbursts are a key component when dealing 
with a psychiatric patient. In the future, more frequent cases of acute psychosis and 
various conditions involving aggression can be expected (Gabrovec, 2015a; Gabrovec 
and Lobnikar 2015; Gabrovec, Eržen and Lobnikar, 2014). 
Despite its human role, psychiatry, when in contact with the surroundings, cannot 
avoid occasional violent behaviour by their patients. Sometimes psychiatrists try to 
look away from potential and actual violent outbursts; however, it is always proven 
that no psychiatric aspect can be found, which, at some point would not involve vi-
Types of Threats against Nursing Care ...
38 Revija za zdravstvene vede (3, 2016)
olence. Violence expressed by individual patients is the link between the psychiat-
ry specialists, and security and criminal law (Kobal, 2009; Gabrovec and Lobnikar, 
2014). Because psychiatric healthcare workers perceive violence as a key component 
of their profession, they show a higher level of tolerance to violence compared to other 
professions (Kores Plesničar and Kodrič Lasič, 2004). At the same time, however, an 
increased level of concern has been detected across psychiatric health care faciliti-
es. Milčinski defined aggression as a behavioural characteristic, which is expressed 
through dominant, violent or assertive words or acts against other people; however, 
aggression can be concealed to the point that it expresses only through a psychosoma-
tic disorder; in the form of (auto)aggression, the violence can be targeted to the subject 
himself (self-injury, suicidal tendencies) (Milčinski, 1993).
Long before aggressive behaviour began to be studied within the course of 
studying violence and aggressive behaviour at workplace, it had already been addres-
sed by psychologists (e. g. Freud and Lorenz) and social psychologists (e. g. Berkowi-
tz, Zvonarevič, Mummendey et al.); whereas in the last decades, the researchers of or-
ganisational behaviour summarised these findings and adjusted them to organisational 
processes (Lobnikar, 2003).
Violence is divided into passive, physical and psychological violence (Živič, 
2000). A passive-aggressive patient refuses to cooperate and shows signs of alienati-
on. Verbal violence includes the use of aggressive and assertive words accompanied 
by gesticulations and facial expressions (Živič, 2000). A physically aggressive patient 
may attack others and harm them by beating, spitting, pushing, kicking, strangling, 
twisting hands, etc. This kind of behaviour can also be directed towards things (Kle-
menc and Pahor, 2000). Degradation, threatening and mocking are defined as psycho-
logical violence (Božič et al., 1999).
For the epidemiology of violent behaviour, Groleger (in: Pregelj and Kobentar, 
2009) states that individuals suffering from a mental illness are 3 to 4 times more 
prone to aggressive behaviour that individuals from the control group. Schizophrenia 
is observed among 1% of the general population, among 3.6% of criminal offenders, 
among 7–15% of murderers, and among 57–80% of murderers who were acquitted by 
reason of insanity (Groleger, 2009).
The risk for a violent act increases with the number of diagnosed psychiatric con-
ditions; whereas, associated diagnosis of a psychiatric illness and substance abuse is 
considered as a major risk factor (Groleger, 2009).
1.1 Violent behaviour of psychiatric patients and empirical data
Violent behaviour by psychiatric patients is most often directed towards health-
care workers (particularly the nursing staff), and towards other staff, such as police 
officers, security personnel, paramedics, and personnel in residential homes for older 
people, who deal with these types of patients. However, the psychiatric nursing staff is 
most often the target of violence due to the increased exposure at workplace. Dealing 
with patients suffering from acute illnesses represents a major risk for employees’ 
39Branko Gabrovec, PhD: Types of Threats against Nursing Care ...
health. The fact remains, however, that dangerous behaviour cannot be avoided, even 
though preventive measures are being implemented (Možgan, 2009).
Violent behaviour by hospitalised psychiatric patients, particularly in secure 
psychiatric units, was reported to range from 3.9% to 37% in different parts of the 
world (and in Slovenia between 6% and 7%). These data must not be overlooked. 
During violent outbursts by psychiatric patients, the personnel suffers most injuri-
es, which shows that knowledge used by the psychiatric personnel to timely identify 
and prevent violent behaviour among psychiatric patients is very important (Groleger, 
2009). Čebašek Travnik agrees that healthcare workers are not sufficiently protected 
against frequent violent behaviour (Čebašek Travnik, 2009).
Workplace violence includes (Canadian Centre for Occupational Health and 
Safety, 1999):
 □ threatening behaviour – such as pointing accusing fingers, arguing, destroying 
property, arsons, throwing objects on the floor or at people, and similar;
 □ verbal or written threats – all threats expressing intent to cause injury or damage;
 □ harassment – any behaviour used to degrade, embarrass, humiliate or upset a per-
son, or any known undesired behaviour; this includes the use of words, gestures, 
intimidation, oppression, gossiping and other unwanted acts; harassment also in-
cludes sexual harassment, particularly visual sexual harassment;
 □ verbal abuse – such as swearing, insulting, use of downgrading language, as well 
verbal sexual harassment;
 □ physical assaults – such as punching, pushing, kicking, use of weapons, rape, 
physical sexual harassment and murders. 
Violence is a common component of the psychiatric profession. 42% of the nur-
sing staff was exposed to physical violence and 73% of employees believe that additi-
onal measures should be taken to increase safety (Kolman, 2009).
As stated above, violent behaviour by psychiatric patients is most often directed to 
healthcare workers (particularly the nursing staff). Research shows that nurses more 
often experience violence at workplace compared to other healthcare professionals. 
The urgent care personnel, particularly in secure and intensive psychiatric care units, 
are most exposed to violence (Clerk, 1989; Kiran, 2003). Van Leeuwen and Harte 
also agree that the correlation between serious incidents and aggression is high (Van 
Leeuwen and Harte, 2011).
35–80% healthcare workers were subjected to physical violence at workplace at 
least once during their employment. Nurses are most exposed to this type of behaviour 
(Clements et al., 2005). In USA, up to 1.7 million employees suffered from workplace 
related injuries and 60% of these employees were employed in health care. The per-
centage of injuries among the healthcare workers is 6.1/10,000; whereas, the percen-
tage in other professions is 2.1/10,000 (Janocha and Smith, 2010). 
Despite the already high statistical percentage of injured health workers, the actual 
percentage is even higher, particularly because incidents frequently remain unreported 
40 Revija za zdravstvene vede (3, 2016)
(Gates et al., 2011). Up to 70% of incidents or abuse against nurses is never reported 
(Stokowski, 2010).
1.2 Aim of the research
The study sought to establish the type and frequency of violence towards the 
psychiatric healthcare workers across as wide sample as possible. We were interested 
in types and frequency of violence directed at employees in psychiatric nursing care 
and correlation between different types of violence. 
2 Methods and Sample
For this research, we decided to include workers that are most exposed to violen-
ce, i.e. the nursing staff, who work in secure and/or intensive care units. The research 
was conducted in 5 psychiatric hospitals. 
The study involved a non-experimental quantitative research coupled with a struc-
tured questionnaire which was designed by using literature sources on aggression and 
violence in healthcare setting (Astrom et al., 2002; Clements et al., 2005; Gates et al., 
2011; Hahn et al., 2010).
The questionnaire consisted of 80 questions, which were divided into 5 sets: work 
and violence at workplace, work organisation, influence of various factors on the 
safety and quality of patient care, education and demographic data. In our research we 
used data compiled from questions about work and violence at workplace and demo-
graphic data. A descriptive Likert scale was used (1 – strongly disagree; 2 – disagree; 
3 – partly agree; 4 – agree; 5 – strongly agree). While developing the questionnaire, a 
focus group of postgraduate nursing students (2nd cycle) was formed, whose remarks 
and suggestions were added into the questionnaire. 
We have supplied 249 questionnaires to employees. 203 (81.52%) employees 
completed and returned the questionnaire and 46 failed to return them. The questio-
nnaire survey took place in March and April 2013.
2.1 Statistical analysis
The data were analysed with descriptive statistics, correlation, the Kolmogorov-S-
mirnov test, Mann-Whitney U test and linear regression. The data were processed with 
the statistics program IBM SPSS v. 21.0 and IBM AMOS v. 21 with a p < 0.05 level of 
significance. The compiled data were processed by means of descriptive statistics, cor-
relation analysis, Kolmogorov-Smirnov test and Mann-Whitney U test and regression 
analysis. Non parametric tests were used as we have had a non-normal distribution of 
data. The contents of the questionnaire proved valid and reliable, with a high enough 
degree (Cencič, 2009) of internal consistency (Cronbach Alpha minimum 0.77). The 
external validity of the questionnaire was evaluated through a focus group, prior to the 
data acquisition.
41Branko Gabrovec, PhD: Types of Threats against Nursing Care ...
3 Results
203 respondents included 95 (46.8%) men and 108 (53.2%) women. The ratio 
between men and women was high, which can be contributed to the fact that more 
male employees work in secure and intensive psychiatric care facilities compared to 
other departments for somatic disorders. The oldest respondent was 58 years old, and 
the youngest was 20 years old. Educational structure was as follows: high-school: 136 
(67%), post-secondary school: 5 (2.5%), higher education: 54 (26.6%), university or 
higher: 8 (3.9%).
Table 1 shows the types of violence and prevalence of violence directed towards 
the staff working in psychiatric hospitals in Slovenia.
Table 1: Types of violence and prevalence of violence directed towards the staff wor-
king in psychiatric hospitals in Slovenia
Verbally abused by a patient 92.6%
Verbally abused by the patient’s family members 40.9%
Verbally abused by colleagues 13.3%
Verbally abused by superiors 13.8%
Sexually harassed by a patient 24.6%
Sexually harassed by the patient’s family members 0.5%
Sexually harassed by colleagues 0.5%
Sexually harassed by superiors 0.5%
Physically abused by a patient 84.2%
Physically abused by the patient’s family member 2.0%
Physically abused by colleagues 1.0%
Physically abused by superiors 0.5%
Physically harmed by a patient 63.5%
In the last year, verbal violence has been the most frequently reported form of vi-
olence. It has been reported by up to 92.6% of respondents. 84.2% of respondents re-
ported being physically abused by their patients in the last year. 63.5% of all employe-
es have suffered injuries inflicted by their patients. Up to 40.9% of employees have 
also frequently experienced verbal violence by the patient’s family members. Verbal 
violence by colleagues (13.3%) and superiors (13.8%) was also significant. Employe-
es have also been a target of sexual violence by their patients (24.6%) (Table 1).
On a Likert scale (1 – strongly disagree; 2 – disagree; 3 – partly agree; 4 – agree; 
5 – strongly agree), employees feel vulnerable at their work place (2.52 ± 0.62) fre-
quently experiencing fear and (2.49 ± 0.60) and insecurity (2.36 ± 0.69). Colleagues 
show a high level of understanding (1.34 ± 0.57), whereas the level of understanding 
among superiors is somewhat lower (1.74 ± 0,73).
A statistically significant correlation was established between the patients’ verbal 
and physical violence in the last year (r = 0.446; p < 0.01); between the patients’ verbal 
violence and employees’ physical injuries in the last year (r = 0.216; p < 0.01); betwe-
en the patients’ sexual harassment at workplace and the patients’ physical violence 
42 Revija za zdravstvene vede (3, 2016)
at the workplace (r = 0.216; p < 0.01); between the patients’ physical violence and 
injuries inflicted by the patients (r = 0.290; p < 0.01); and between the patients’ verbal 
violence and sexual harassment (r = 0.161; p < 0.01). 
A significant correlation was also established between workers’ emotions and fe-
elings during patients’ aggressive behaviour: fear and insecurity (r = 0.646; p < 0.01), 
devastation and ignorance (r = 0.612; p < 0.01), powerlessness and insecurity (r = 
0.598; p < 0.01), vulnerability and fear (r = 0.519; p < 0.01), vulnerability and devasta-
tion (r = 0.510; p < 0.01), powerlessness and fear (r = 0.503; p < 0.01), vulnerability 
and insecurity (r = 0.490; p < 0.01), devastation and vulnerability (r = 0.485; p < 0.01), 
lack of understanding by superiors and colleagues (r = 0.478; p < 0.01), ignorance and 
powerlessness (r = 0.356; p < 0.01), ignorance and fear (r = 0.325; p < 0.01), ignorance 
and anger (r = 0.267; p < 0.01), devastation and anger (r = 0.271; p < 0.01). 
Table 2: Regression analysis of variables, such as fear and powerlessness
Model R R2 ΔR2 Std. err.
1 .059a .269 .266 .534
a. Predictors: (Constant), Fear, 1 for Analysis 1
It was established that the “fear” variable can be used to explain the 26.6% varian-
ce of the “powerlessness” variable (Table 2).
We also checked if the lack of differences in experiencing violence between the 
two genders is statistically significant. The research shows that the correlation betwe-
en the two variables is not statistically significant. The same was carried out for “age”, 
“education level” and “work experience” variables.
We concluded that no statistically significant correlation can be established betwe-
en variables, such as “gender”, “education”, “length of service”, and “work and vio-
lence at the workplace”, which means that all employees are exposed to all types of 
violence regardless of gender, age and length of service.
Compared to other countries, our results (84.2%) can be compared only to a Swe-
dish research (Soares, 2000) with 85% level of physical violence by the patients and a 
Turkish research (Picakciefe, 2012) with 71.4% level of violence. Compared to other 
researches, our research shows a higher frequency of physical violence by the patients 
(Kolman, 2009 – 42%, Clements et al., 2005 – 35–80%, Privitera, 2005 – 25%, Han 
et al., 2010 – 42%). The research findings are supported by theory (Gabrovec and Er-
žen, 2016; Gabrovec, 2015b; Kobal, 2009; Davison, 2005; Klemenc and Pahor, 2004; 
Božič et al., 1999), as well as theories about violence within the organisation (Bowie, 
2002; Pagon et al., 2001).
Below we have identified some of the safety issues, which have arisen in connecti-
on with the work organisation. The respondents from the sample most agreed with 
the following statement: “Safety of our employees and patients is our organisation’s 
top priority” (2.36). A high level of agreement was also observed with the following 
statement: “The lack of experienced staff has a negative effect on my ability to provide 
high quality care to my patients” (2.26). The following statements were most critici-
43Branko Gabrovec, PhD: Types of Threats against Nursing Care ...
sed: “Work organisation supervises the management of patient aggression” (1.79), and 
“The management of the work organisation has a clear vision about the risks related 
to patient care and staff safety” (1.87). 
We have also analysed some factors that do not affect the safety of the patients and 
patient care quality. The respondents from the sample most agreed with the following 
statements: “Relationship with other team members affect the quality of my work” 
(2.73); “Only a sufficient number of employees can ensure a 24-hour monitoring and 
detection of potential risks” (2.68); and “Personal characteristics of team members 
affect the quality of my work” (2.67). The following two statements were most di-
sagreed with: “We receive sufficient motivation and incentives to perform our work in 
a quality and safe manner” (1.53); and “The number of employees working in a shift 
is sufficient” (1.76). 
Within the work organisation and within the scope of other factors employees 
mainly perceive their own role as positive, and the role of the work organisation as 
negative.
Under the education section, the respondents from the sample evaluated the listed 
statements as follows: “Practical workshops on safe patient management should be 
available” (2.88), “Training with multiple revision workshops on safe patient manage-
ment should be available” (2.88), “Written action guidelines on safe patient manage-
ment should be available” (2.79), “Theoretical workshops on safe patient management 
should be available” (2.52), “The staff receives sufficient training for safe patient ma-
nagement” (2.14), and “We feel confident about our level of knowledge on managing 
patients exhibiting aggressive behaviour” (2.01). 
A high need for continuous practical workshops has been observed, because the 
staff’s knowledge on dealing with aggressive psychiatric patients is insufficient and 
mostly limited to theoretical workshops. The respondents are very critical about their 
own knowledge and wish for a more comprehensive education.
4 Discussion
The prevalence of patient violence towards the medical staff, particularly employe-
es working in nursing, is high. 
Research shows a varied, but still high prevalence of all types of violence towards 
psychiatric nursing staff. Our research focused on establishing the actual prevalence 
of different types of violence towards psychiatric nursing staff in Slovenia. The focus 
was placed on different types of violence: verbal violence, sexual violence and physi-
cal violence. We divided the source of violence by patients, patient’s family members, 
colleagues and superiors. 
Based on the representative sample, the research established that a high level of 
violence is directed towards the nursing staff. In the last year, the verbal violence 
level has increased to 92.6%. 84.2% of respondents reported to have been physically 
44 Revija za zdravstvene vede (3, 2016)
abused by their patients in the last year. 63.5% of all employees have suffered injuries 
inflicted by their patients. Up to 40.9% of employees have also frequently experien-
ced verbal violence by the patient’s family members. Verbal violence by colleagues 
(13.3%) and superiors (13.8%) was also significant. Employees are also a target of 
sexual violence by their patients (24.6%). 
Compared to other research conducted in psychiatric nursing care, the percentage 
was higher than in research from Kolman (2009), but similar to Stokowski (2010) and 
Clements et al., (2005). There is less violence in residential homes for older people 
– verbal violence: 71,7%, physical violence – 63,8% (Gabrovec and Eržen, 2016), 
in paramedic services at homes – verbal violence: 78%, physical violence – 56,1% 
(Gabrovec, 2015a).
We have established an important positive correlation between verbal and physi-
cal violence, between verbal violence and injuries inflicted by patients, between ver-
bal violence and sexual harassment, and physical violence and sexual harassment. 
We have also tried to identify emotions and other feelings experienced by the staff 
when dealing with aggressive psychiatric patients. We have established that employe-
es most often feel vulnerability, fear, insecurity and powerlessness. Employees least 
often face lack of understanding by their colleagues and superiors, which shows a high 
level of trust among the colleagues, and the relationship between the employee and the 
work organisation. Important correlations have also been established between almost 
all of these variables. 
We have also established that no statistically significant correlation was found 
between variables, such as “gender”, “age” and “length of service”, and any type of 
aggression towards psychiatric nursing staff. Aggressive behaviour at workplace is 
not in any case related to employees’ gender, age or work experience. 
With this research we have discovered one of the highest levels of aggression, 
which is directed towards psychiatric nursing staff. The research results can serve as a 
basis for a systematic approach to handle violence towards employees in health care. 
Dr. Gabrovec Branko
Vrste groženj zaposlenim v zdravstveni negi na področju psihiatrije
Zagotavljanje varnosti in kakovosti obravnave pacienta s psihiatrično motnjo je 
prednostna naloga vseh ravni zdravstvenega varstva. Incidenca psihiatričnih bolezni 
z razvojem sodobne družbe in pričujočih trendov narašča. Navkljub napredku psihi-
atrične stroke je nasilje oz. izbruh agresije sestavni del obravnave pacienta s psihia-
trično motnjo. Tudi v prihodnje lahko pričakujemo pogoste pojave akutne psihoze in 
različnih stanj, kjer lahko pričakujemo agresijo (Gabrovec in Lobnikar, 2014). Kljub 
svoji humanistični vlogi se psihiatrija ne more izogniti občasnemu nasilnemu rav-
nanju svojih bolnikov v stiku z okoljem. Včasih si skušajo psihiatri zatisniti oči pred 
45Branko Gabrovec, PhD: Types of Threats against Nursing Care ...
možnim in dejanskim nasiljem, vendar se je vselej izkazalo, da psihiatrije, ki se ne bi 
srečevala z nasiljem, ni. Zaradi nasilja posameznih bolnikov povezujemo to stroko z 
varnostnim in kazenskopravnim področjem (Kobal, 2009). Nasilje zdravstveni delavci 
v psihiatriji sprejemajo kot sestavni del poklica in so do njega bolj tolerantni kot za-
posleni v drugih poklicih (Kores Pleseničar and Kodrič Lasič, 2004). Hkrati pa zazna-
vamo naraščujočo skrb zaradi nasilja v psihiatričnih zdravstvenih ustanovah. Milčin-
ski (1993) meni, da je agresivnost vedenjska značilnost, ki se kaže v gospodovalnih, 
nasilnih ali napadalnih besedah ali dejanjih proti drugim ljudem; je pa lahko prikrita, 
izrinjena tako daleč, da se razodeva le v kaki psihosomatski motnji; kot avtoagresiv-
nost se lahko obrne proti subjektu samemu (samopoškodbe, samomorilne tendence).
Agresivno vedenje so že veliko pred preučevanjem nasilja in agresivnega vede-
nja na delovnem mestu začeli preučevati psihologi (npr. Freud in Lorenz) in socialni 
psihologi (npr. Berkowitz, Zvonarevič, Mummendey et al.), v zadnjih desetletjih pa 
so raziskovalci s področja organizacijskega vedenja njihove ugotovitve povzeli in jih 
prilagodili organizacijskim procesom (Lobnikar, 2003).
Najpogosteje se z nasiljem bolnikov s psihiatrično motnjo soočajo zdravstveni de-
lavci (predvsem zaposleni v zdravstveni negi), pa tudi drugi deležniki v procesu obrav-
nave: policija, varnostne službe, reševalci, zaposleni v domovih za starejše občane. 
Najbolj izpostavljeni pa so kljub vsemu zaposleni v psihiatrični negi, ki so ves največ 
časa v stiku z bolniki. Delo z akutno bolnimi ljudmi predstavlja precejšnjo nevarnost 
za zdravje zaposlenih. Dejstvo je namreč, da tudi če so preventivni ukrepi implemen-
tirani, se nevarnemu vedenju vedno ne da izogniti (Možgan, 2009).
Pomembni so podatki o nasilnem vedenju v psihiatričnih bolnišnicah, zlasti na 
oddelkih pod posebnim nadzorom, ki se gibljejo od 3,9 % pa vse do 37 % v različnih 
delih sveta (v Sloveniji med 6 in 7 %). Ob nasilnem vedenju na psihiatričnih oddelkih 
je največ poškodovanih med osebjem, kar opozarja na potrebo po ustreznem znanju 
o delu z bolniki, ki imajo duševno motnjo, o pravočasnem prepoznavanju in prepre-
čevanju njihovega nasilnega vedenja (Groleger v Pregelj and Kobentar, 2009). Da je 
malo narejeno za varnost zdravstvenih delavcev pred pogostim nasiljem bolnikov nad 
osebjem, meni tudi Čebašek Travnik (2009).
Pojav nasilja je sestavni del psihiatrične stroke. Kar 42 % zaposlenih v zdravstve-
ni negi je bilo izpostavljenih fizičnemu nasilju in kar 73 % jih meni, da je na področju 
zagotavljanja varnosti treba narediti več (Kolman, 2009). Kljub velikemu statistične-
mu odstotku poškodovanih v zdravstveni dejavnosti je dejanski odstotek še večji, pred-
vsem zaradi pogostega neporočanja o incidentih (Gates et al., 2011). Kar 70 % inci-
dentov ali zlorab proti medicinskim sestram ostaja neprijavljenih (Stokowski, 2010). 
Za sodelovanje v tej raziskavi smo si izbrali najbolj izpostavljene osebe, in sicer 
zaposlene v zdravstveni negi na oddelkih pod posebnim nadzorom in/ali intenzivnih 
oddelkih. V raziskavi je sodelovalo 5 psihiatričnih bolnišnic. 
249 anketnih vprašalnikov smo razdelili med zaposlene. 203 (81,52 %) so vpra-
šalnik vrnili, 46 jih ga ni vrnilo. Anketiranje je potekalo v marcu in aprilu 2013. Not-
ranja konsistentnost vprašalnika je bila visoka. Zanesljivost merjenja je znašala 0.77 
Cronbach-ovega koeficienta Alpha. 
46 Revija za zdravstvene vede (3, 2016)
Ob oblikovanju anketnega vprašalnika smo s študenti magistrskega študija zdra-
vstvene nege pripravili fokusno skupino, katere pripombe in posebnosti smo vnesli v 
vprašalnik. Ta je vseboval 80 vprašanj, ki so bila razdeljena v 5 sklopov: delo in na-
silje na delovnem mestu, delovna organizacija, vpliv različnih dejavnikov na varnost 
in kakovost obravnave bolnika, izobraževanje in demografski podatki. Za to raziskavo 
smo uporabili podatke z vprašanji o delu in nasilju na delovnem mestu in demografske 
podatke. Podatki, ki so bili zbrani s pomočjo anketiranja, predstavljajo bazo, ki smo jo 
statistično obdelali s pomočjo statističnega programa SPSS v. 20. (SPSS In., Chicago, 
IL, USA). Tako zbrane podatke smo obdelali z uporabo opisne statistike, korelacijske 
analize, testa Hi-kvadrat, analize variance in regresijske analize. 
Od vseh 203 anketiranih jih je bilo 95 (46,8 %) moških in 108 (53,2 %) žensk. 
Razmerje moški/ženske je visoko, kar lahko pripišemo razlogu, da je na zaprtih in 
intenzivnih psihiatričnih oddelkih zaposlenih več moških kot na ostalih somatskih od-
delkih. Najstarejši anketirani je bil star 58, najmlajši 20 let. Izobrazbena struktura je 
bila naslednja: srednja: 136 (67 %), višja: 5 (2,5 %), visoka: 54 (26,6 %), univerzite-
tna in več: 8 (3.9 %).
Verbalno nasilje v zadnjem letu je najbolj pogosta oblika nasilja. Pojavlja se pri 
92,6 % anketiranih. Fizično nasilje je s strani bolnikov v zadnjem letu doživelo 84,2 
% anketiranih. 63,5 % zaposlenih je bilo v preteklosti poškodovanih s strani bolnika. 
Zelo pogosto je tudi verbalno nasilje svojcev, kar 40,9 %. Omembe vredno je tudi ver-
balno nasilje sodelavcev (13,3 %) in nadrejenih (13,8 %). Zaposleni se soočajo tudi s 
spolnim nasiljem s strani bolnikov (24,6 %).
Zaposleni se pri svojem delu počutijo ogrožene (2,52 ± 0,62), največkrat sta priso-
tna strah (2,49 ± 0,60) in negotovost (2,36 ± 0,69). Razumevanje sodelavcev je veliko 
(1,34 ± 0,57), nekoliko manjše je razumevanje nadrejenih (1,74 ± 0,73). Ugotovili smo 
pomembno statistično korelacijo med verbalnim nasiljem in fizičnim nasiljem bolnika 
v zadnjem letu (r = 0,446; p < 0.01), med verbalnim nasiljem s strani bolnika v zad-
njem letu in poškodbo na delovnem mestu (r = 0,216; p < 0.01), med spolnim nadlego-
vanjem bolnika na delovnem mestu in fizičnim nasiljem bolnika na delovnem mestu (r 
= 0,216; p < 0.01), med fizičnim nasiljem s strani bolnika in poškodbami, povzročeni-
mi s strani bolnikov (r = 0,290; p < 0.01) ter med verbalnim nasiljem bolnika in spol-
nim nadlegovanjem s strani bolnika (r = 0,161; p < 0.01). Ugotovimo tudi, da lahko s 
spremenljivko »strah« pojasnimo 26.6 % variance spremenljivke »ogroženost«.
Pomembne korelacije najdemo tudi med čustvi in čutenjem zaposlenih ob agresiv-
nosti bolnika: strah in negotovost (r = 0,646; p < 0.01), obupanost in neznanje (r = 
0,612; p < 0.01), nemoč in negotovost (r = 0,598; p < 0.01), ogroženost in strah (r = 
0,519; p < 0.01), ogroženost in obupanost (r = 0,510; p < 0.01), nemoč in strah (r = 
0,503; p < 0.01), ogroženost in negotovost (r = 0,490; p < 0.01), obupanost in ogro-
ženost (r = 0,485; p < 0.01), nerazumevanje nadrejenih in nerazumevanje sodelavcev 
(r = 0,478; p < 0.01), neznanje in nemoč (r = 0,356; p < 0.01), neznanje in strah (r = 
0,325; p < 0.01), neznanje in jeza (r = 0,267; p < 0.01), obupanost in jeza (r = 0,271; p 
< 0.01). Na področju izobraževanja so anketirani iz celotnega vzorca ocenili naslednje 
trditve: »Za varno oskrbo bolnikov so potrebne praktične delavnice« (2,88), »Za varno 
47Branko Gabrovec, PhD: Types of Threats against Nursing Care ...
oskrbo bolnikov je potrebno izobraževanje z večkratnimi obnovitvenimi delavnicami« 
(2,88), »Za varno oskrbo bolnikov so potrebne pisne smernice ukrepanja« (2,79), »Za 
varno oskrbo bolnikov so potrebne teoretične delavnice« (2,52), »Za varno oskrbo bol-
nikov so osebju na voljo ustrezna usposabljanja« (2,14) in »Znanje, s katerim razpola-
gam, je zadostno za obvladovanje agresivnega psihiatričnega bolnika« (2,01). 
Ugotovili smo, da med spremenljivkami: »spol«, »izobrazba«, »delovna doba« in 
spremenljivkami dela in nasilja na delovnem mestu ne najdemo statistično pomemb-
nih korelacij, kar pomeni, da so kateri koli obliki nasilja izspostavljeni vsi zaposleni, 
ne glede na spol, starost ali delovno dobo.
Izražena je večja potreba po kontinuiranih praktičnih delavnicah, saj njihovo 
znanje obvladovanja agresivnega psihiatričnega bolnika ni zadostno in se večinoma 
srečujejo le s teoretičnimi delavnicami. Anketirani so do svojega znanja kritični, želijo 
pa si celostne ureditve izobraževanja.
V nadaljevanju smo identificirali nekatere varnostne probleme, ki se pojavljajo 
v zvezi z delovno organizacijo. Anketirani v celotnem vzorcu so najbolje ocenili na-
slednjo trditev: »Varnost zaposlenih in pacientov je največjega pomena v naši orga-
nizaciji« (2,36). Visoko so ocenili tudi naslednjo trditev: »Pomanjkanje izkušenega 
osebja negativno vpliva na mojo zmožnost zagotavljanja kvalitetne oskrbe bolnikov« 
(2,26). Najbolj kritični so bili do naslednjih trditev: »Delovna organizacija poskrbi za 
supervizijo obvladovanja agresivnosti psihiatričnega bolnika« (1,79), in »Vodstvo de-
lovne organizacije ima jasno predstavo o tveganjih glede oskrbe bolnikov in varnosti 
osebja« (1,87). 
V primerjavi s tujino so naši rezultati primerljivi le z raziskavo, opravljeno na 
Švedskem (Soares, 2000), kjer je odstotek fizičnega nasilja s strani bolnika 85 %, 
pri nas 84,2 %, in s turško raziskavo (Picakciefe, 2012), kjer je odstotek 71,4 %. V 
primerjavi z drugimi raziskavami pa je pogostost fizičnega nasilja bolnika v naši raz-
iskavi večja (Kolman, 2009 - 42 %, Clements, 2005 - 35 do 80 %, Privitera, 2005 - 25 
%, Han, 2010 - 42 %). Ugotovitve iz raziskave so v skladu s teorijo (Kobal, 2009; 
Davison, 2005; Klemenc in Pahor, 2004; Božič, Uršič, Strojan, Ziherl in Bučar, 1999), 
in tudi s teorijami nasilja v organizaciji (Bowie, 2002; Pagon in sodelavci, 2001).
Raziskava, ki smo jo opravili, kaže na eno največjih stopenj agresije, usmerjene 
proti zaposlenim v zdravstveni negi na področju psihiatrije. Rezultati raziskave so 
lahko podlaga za sistematičen pristop k obvladovanju agresije, usmerjene proti zdra-
vstvenim delavcem. 
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Dr. Branko Gabrovec, docent, zaposlen pri Nacionalnem inštitutu za javno zdravje. 
E-mail: branko.gabrovec@nijz.si