There has been a lot of attention in forensic mental health to the risk of aggression by patients against health care workers. This work suggests that the factors are similar to those for aggression more generally, including personality traits such as impulsivity and callousness, anger, and disinhibition as a result of substance use or cognitive impairment. There is more recent work but an excellent book by colleagues of mine is

Rice, M. E., Harris, G. T., Varney, G. W., & Quinsey, V. L. (1989). Violence in institutions: Understanding, prevention, and control. Hogrefe & Huber Publishers.

I would start by measuring health workers stress levels.  There is abundant literature on the burn-out effect of health workers

Thanks all. Do you guys think the problem exists in countries of all income levels? or is it more somewhere?

I know we have similar issues in Nigeria as violence against health workers is on the increase, this is one of the reasons UNICEF withdrew its aid to the country in July of this year. However, it is more about insurgency violence against health workers not from friends and families of the patients. The members of these groups are targeting health workers as they know this will create more national and international coverage than targeting citizens of the country. It is not very common in Nigeria and Africa generally for patients, friends or their family to attack health workers as we are still at the stage of getting full coverage by health workers. In addition, people seem to believe health workers and respect them in general. 

I think its more related to low and middle income countries. Most of the time it happens when the outcome of the illness is not favorable.  Many of the times due to overburden of work, healthcare providers in those countries do not get ample time to explain the health condition in detail to the patients or its relatives. If the patients or its relatives are made participants in the medical decision making, then such incidences can be minimized.

Prakash 

I agree with your explanation for this occurrence but i also think it might partly be due to the negligence practices by some health workers. Many friends and families in low and middle-income countries find this frustrating as one can see them begging for health workers to attend to their families in need of medical care. In this case if it results in an unfavorable outcome, these people see it as the fault of the health workers and take it to the extreme by resulting in violence. It also cannot be left unsaid that this might be due to the limited number of health workers in many low and middle-income countries making human resources inadequate for the healthcare demand. 

Thank you for your viewpoints so far colleagues. I started this question on research gate after a recent incident (ongoing) agitation between patient family and relatives along with the local community people against the Hospital staff of the only hospital in a hilly village of Nepal.

We have many issues like this in our country. Attached few links about tje most recent ongoing violence. Please feel free to give your opinions.

http://www.dailykos.com/story/2016/10/2/1576938/-Violence-Against-Health-Care-Workers-in-Nepal-Oct-2nd-edition-2016

http://kathmandupost.ekantipur.com/news/2016-09-28/charikot-hospital-staffers-halt-services-protesting-forceful-apology-video-of-doctor.html

http://www.myrepublica.com/news/6605

No one has commented about  the killings of polio immunization workers in Pakistan,  who were suspected of surreptitiously sterilizing young women..

The nature of their work puts many health care workers in precarious environments. They are called upon to respond to and treat patients experiencing acute mental health problems - while the vast majority are not violent, there is a small subset that do become physically violent. They treat patients in prisons and on battle fields. While health care workers are apolitical, groups involved in internecine conflicts may view their provision of health care services as aiding the enemy and therefore direct violence against them. While the trend has been a reduction in casualties due to warfare (see Steven Pinkers' book "The Better Angels of our Nature") the nature of warfare has evolved from army versus army of identified combatants operating under rules of war (that, by the way, protect medical workers) to "asymmetric warfare" involving non-state actors who operate in the shadows often targeting civilian targets and without regard to rules of war. Thus, for countries experiencing such internecine conflict, the battlefield is everywhere exposing health care workers to violence potentially whenever and wherever that treat patients.  

Violence against Health care workers seems an under researched, actually under reported issue in Low income countries. Scientific literatures from Low income countries are hardly found. I did find lancet articles (mostly US). We are hearing it almost everyday in news in Nepal. yet another news of violence and agreement today.

Violence, resistance and non-compliance were found to be connected to poor health care delivery and weak information flow in the Ebola outbreak, See:

Article Key experiences of community engagement and social mobilizat...

When I graduated from college around 1963 I was briefly a health field worker and discovered that migratory farm workers from Haiti thought we caused the disease by magic so we could get some sort of reward. I think this is the most common cause of violence against public health workers.

A check of news articles will reveal an instance a few years ago where white medical volunteers in Africa were arrested for spreading disease because they allegedly "hated black children". Sometimes the poorly educated take our endless and highly publicized self criticism very seriously. Its a great thing to point out our faults to ourselves, but we do not want to give the world the impression that we are all fiends.

However, I recently witnessed a very different cause. A victim of apparent manic depressive illness repeatedly failed to be there when the public health nurse came to her house by appointment. Then when the nurse did encounter her, the nurse was frustrated and raised her voice and therefore received a bloody nose.

Health care system constantly facing dissatisfaction from the consumer end  in relation to poor communication such as inappropriate explanations for treatment provided, reason for hospitalizations, poor update of health status of client, lack of soft skill among the healthy care workers etc. This could be solved to some level by integrating the family members as part of client care , informed decision making, liaison person, awareness creation on health care delivery system.  

This is an issue which is definitely under-searched. How frequent it is? what is the nature(verbal, physical or others), By whom and against whom?

The reasons In my view  belong to two three main aspects:

1. people who who come to health care institutions are generally not in a good mood. They are either ill or accompanying an ill relative. they therefore have lower threshold of tolerance. This means that they are easily agitated.

2. People have high expectation from medical care. Any failure of response to deal with illness, any delay in amelioration of pain may be attributed, by clients, to failure of care giver.

3.  Failure of communication between providers and consumers, some times due to lack in communication skills  and sometimes due towork conditions(overwork, tiredness etc)

Please could I ask why no one has mentioned the health care workers responsibility in these situations? I only have experience of situations in the UK, however a proportion of the aggressive behaviour i have seen was due to the health care workers attitude to the patient. Just wondering if there has been any research from this point of view?

Dear Julianne Crowley, 

If you read my comment, you will find that in point three I mentioned failure of communication which is mainly blamed on providers. We doctors are not good listeners in many occasions. We do not convey a clear message to the patient or his/her relatives. When unexpected events occur, people will blame doctors and may be angry. I totally agree with you that part of the defect is in health care providers. In one study, we found that almost half of the patients interviewed needed additional information on their conditions. These information as they specified related to nature of disease, treatment and prognosis. Things which are very logical that the providers explain to patients.