A Biopsychosocial Approach to Violence: Implications for Supporting Frontline Healthcare Workers

Background and purpose:
The COVID-19 pandemic destabilized health systems worldwide, leading to increased reports of violence against healthcare workers in hospital settings. Global systematic reviews show that verbal abuse against healthcare workers is the most common form of violence, both before and after the pandemic —followed by physical assault and sexual harassment. Such incidents are more prevalent among nurses in psychiatric and emergency departments than in other hospital areas. According to the Bureau of Labor Statistics, this workforce faces the second-highest rate of reported events in the U.S. alone.

This paper presents an analysis of narratives: reports that employees file when violence at work happens. Our purpose is to generate policy recommendations that support frontline healthcare workers before, during, and after a violent incident. From a biopsychosocial perspective (interactions between bodies, identities, and social systems), we integrate epidemiological data with neuroscientific theories on aggression. The parent study is the Boston Hospital Workers Health Study (BHWHS), a longitudinal cohort study of hospital-based patient care workers that is a partnership between Mass General Brigham and the Harvard T.H. Chan School of Public Health. Our central research question is: what policy and intervention insights emerge from the narrative descriptions that frontline healthcare workers include in formal assault reports to their hospitals?

Methods

We will reflect on the narratives included in violent incident report data (n=2,919) from 2019 to 2023 in two Massachusetts hospitals. These documents are created when employees report an instance of workplace violence, often including paragraphs detailing their experience. We will use reflexive thematic analysis to analyze the meanings, presence, and relationships of specific themes —while also addressing how our intersectionality and biases may influence the interpretation. The codebook was created to identify different types of violence under changing environmental, biological, and cultural factors. Social work science embraces theoretical pluralism. Therefore, the creation of the codebook, the epidemiological data analysis, and the recommendations to practice are informed by a theory synthesis: integrating social work, neuroscience, and epidemiology.

Results
Preliminarily, the data trends show a notable increase in the proportion of injury reports from 2021 onwards. There are multiple types of assaults (e.g., discrimination, sexual, physical, verbal), conscious and unconscious mechanisms at play, and patients being the primary aggressors. Nurses, patient care associates, and security personnel are the most affected. Emerging themes include the need for support in the incident's aftermath and the requirement for multicomponent interventions that engage diverse stakeholders.

Conclusions and Implications
Maintaining a motivated workforce is crucial for supporting the population's health needs in times of crisis. Workplace violence can negatively impact workers' health and organizational outcomes. Therefore, we expect our qualitative study to be an example for managers and researchers on systematizing report data with a solution-focused orientation. Moreover, our approach can help social workers establish collaborations with neuroscientists and epidemiologists. Our findings confirm the importance of time: what happens before, during, and after violence. Research on how to sustain multi-component interventions to help workers thrive is imperative.