In Japan, a survey of university hospitals [1] reported that 44.3% of employees had experienced some form of violence in the hospital within the past year, including verbal abuse and violence. Experiences such as abuse and violence from patients and their families have a great impact on the staff’s work and may cause them to leave their jobs [2]. However, many experienced staff have adapted to such experiences, and although they feel anxious about their daily work, they continue to work with no one to consult [1] [3]. Conversely, in overseas pediatric medical settings (ward, outpatient department, and emergency department), violence from the patient’s family is high [4] [5], and most staff have experienced verbal abuse and physical assault [6] [7] [8].

With the transition from an extended family to a nuclear family in Japan and growing up amid a few siblings and friends due to the decreasing birthrate, the generation of new and upcoming parents lack the experience of interacting with people with diverse values, ways of thinking, behaviors, and cultures. They are unable to realize that society is made up of themselves and others, and lack the imagination to think about the natural distance between them and others, consideration for their surroundings, and how their comments will be perceived [9]. Therefore, there are many families who make unreasonable demands and parents who use abuse or violence as an outlet for accumulated stress [9].

We conducted a national survey on the actual conditions of verbal abuse, physical assault, and harassment from patients and families received by staff within the past year in the pediatric medical setting [10]. Upon analyzing data of 3605 respondents (nurses, clerical workers, physicians, nursery teachers, and nursing assistants) from 521 facilities (79.5% of which were pediatric clinics and recovery rate of 22.4%), the results revealed that 10.5% of respondents have experienced harm, with verbal abuse being the most common, followed by harassment and physical assault. In terms of measures to manage verbal abuse and violence within the facilities, 10.7% had manuals and guidelines, while 9.0% had training programs; however, only 7.3% of respondents reported that these measures were effective in managing these events, of those who had experienced harm (45.6%).

We created a training textbook consisting of four typical problems collated and extracted from a nationwide survey [10] on the actual conditions of verbal abuse, physical assault, and harassment from patients and their families experienced by staff in the pediatric medical setting. The goal was to improve the staff’s ability to respond to each case (problems, necessary measures for prevention, and countermeasures for the event) by examining the cases from the perspective of the “individual” and the “staff.” This study aimed to confirm the validity and usability of the contents of this training textbook.

Of the 51 facilities to which the SAGPJ delegates belong, 54 managers from 46 facilities and nine employees (2 doctors, 7 medical staff) from nine facilities who joined the SAGPJ online workshop participated in this survey. In response to Q1 and Q2 above, all 63 staff members from 55 facilities answered “3: Yes” (Table 1 and Table 2). Table 3 shows the comments, opinions, and impressions from the subjects regarding the validity and usability of the content of the training textbook (Document 1).

https://shouni-kazoku.jp/update/wp-content/uploads/2021/02/kensyu.pdf.

The results of the survey confirmed the validity and usability of the content of the training text we developed. The evaluation of the text was uniformly high, and many commended the content of the text even when referring to the comments written in the free comment text box. A participant even ordered 30

training textbooks (shipped free of charge) stating, “I want to share the contents of this textbook with all the staff at my hospital and have an opportunity for a discussion.”

Using this training textbook, we will continue to implement online intervention programs to strengthen 1) the ability of the individual staff to respond to such situations, 2) administrative measures, and 3) team measures against verbal abuse, physical assault, and harassment. Employees who are concerned about complaints from patients and their families will be informed of the viewpoint/awareness and actual measures necessary for safe response and prevention, while facility managers will be provided with knowledge of measures necessary to protect employees. Intervention effects by reporting tools [11], education [12] [13] [14], and projects [15] have also been reported in overseas studies. We believe that it is important to create a comfortable and safe working environment by strengthening employees’ ability to respond to patients and families while equipping them with a common perspective and awareness.

We examined the validity and usability of the content of the training textbook on the steps to take in case of abuse of healthcare workers by patients and caregivers in pediatric medical settings that developed based on a nationwide survey in Japan. We found that the content of the textbook was highly usable as a training textbook for employees working at pediatric medical institutions throughout Japan.

We would like to thank Editage (https://www.editage.com) for English language editing.

This research was funded by the Grant-in-Aid for Challenging Exploratory Research from the Ministry of Education, Culture, Sports, Science, and Technology; Japan (18K19664) (principal investigator: Rie Wakimizu).

The authors declare no conflicts of interest regarding the publication of this paper.

Wakimizu, R., Kuwahara, H., Saito, Y. and Saito, M. (2022) Development of a Training Textbook for Countermeasures to “Verbal Abuse, Physical Assault, and Harassment in Pediatric Medical Settings”. Health, 14, 63-69. https://doi.org/10.4236/health.2022.141006