Investigating the Impact of the Physical Environment of Healthcare Settings on Staff Security: A Systematic Review

Soheyla Mohammadigorji University of Florida

Work related violence is defined as “any incident in which a person is abused, threatened or assaulted in circumstances relating to their work” (Knowles, Mason, & Moriarty, 2013, p.926). Statistics and government reports show an increasing trend of violence against healthcare workers specially in emergency departments (ED). It is reported that about 11,000 healthcare personnel experience verbal or physical assaults annually. A recent study showed that over 78% of physicians experienced some levels of workplace violence over a twelve-month period (Lenaghan, Cirrincione, & Henrich, 2018). Similarly, a survey of emergency department staff reported 75% verbal assaults and 21% physical assaults over a twelve-month period. In another survey, nurses reported 25% physical violence over a three-year span (Daniel et al., 2015). Physical violence against nurses is “an endemic problem affecting nurses in all settings” around the world (Lenaghan et al., 2018).

Poor environmental design has been identified as one of the risk factors for type II workplace violence i.e. violence toward employees committed by a client. The National Institute for Occupational Safety and Health (NIOSH) (1996) recommended environmental considerations for preventing or reducing the risk of violence against healthcare workers (McPhaul et al., 2008). How and to what extent can the physical environment impact violence prevention has remained underexplored. Existing guidelines mostly focus on minimizing violent incidents through operational risk management strategies, however, they do not address these concerns when designing facilities such as EDs.

A systematic search of PubMed and CIHNAL as well as hand-searched of relevant studies is performed to appraise primary literature regarding the impact of physical environmental design on violence toward healthcare workers. Results of this review will help a future research on investigating the impact of the physical environment of EDs on staff security. The projected outcome will be to develop ED design guidelines against violence.