Pediatric healthcare workers' primary and secondary experiences of patient behavioral events: A cross-sectional study

AbstractBackground: Patient behavioral events, encompassing a variety of physically aggressive behaviors, are common yet under-reported occurrences that pose threats to healthcare workers. Although existing research addresses personal experiences of severe (or acute) patient behavioral events, not much is known about indirect experiences of high-frequency (or chronic) events of low and high severity. A conceptual framework, integrating chronic stressors and secondary traumatic stress, guides the delineation of primary acute, primary chronic, secondary acute, and secondary chronic patient behavioral events. Objective: This study focuses on pediatric healthcare workers’ experiences with patient behavioral events and associated stress-related outcomes, work attitudes, and work behavior. Patient behavioral events are explored as both primary experiences (i.e., those that are directly targeted) and secondary experiences (i.e., those that are witnessed or heard about). Design: This cross-sectional, survey-based design was co-created by researchers and healthcare practitioners to improve the robustness and relevance of the correlational findings. This study was not pre-registered. Setting(s): Six hospitals identified by the Solutions for Patient Safety- Employee Staff Safety leadership team were invited to participate in a study conducted by an external academic researcher and her team. Three children’s hospitals (academic medical centers and free-standing hospitals) in the Midwest and South in the United States participated in the study. Participants: Approximately 2,918 healthcare workers, 18 years or older, with bedside responsibilities from units identified by each participating hospital, were invited to participate; the 521 respondents were nurses, ancillary staff, providers, and technicians/assistants with an average age of 37.76 years and were predominantly female and white. Methods: Healthcare workers completed an anonymous survey asking about their primary and secondary experiences with patient behavioral events, stress-related outcomes (work pressure, emotional demands, burnout), work attitudes (job satisfaction, engagement, hospital attachment), and work behaviors (work withdrawal, turnover intentions) using established measures whenever possible. Measures were assessed on Likert scales, and responses were analyzed using descriptive and inferential statistics. Results: Findings reveal positive correlations between patient behavioral event frequency and stress-related outcomes, negative correlations with work attitudes, and positive correlations with most work behaviors. Furthermore, these correlations remain consistent whether patient behavioral events are directly targeted (primary) or heard about/witnessed (secondary). Exploratory analyses highlight variations based on healthcare workers' roles and units. Conclusions: These insights contribute to an expanded understanding of the potential for ripple effects of patient behavioral events on healthcare professionals' well-being and work-related outcomes.