Violence Directed at Healthcare Staff by Children and Adolescents Treated in In-Patient Psychiatric Wards: Emotional Labor, PTSD Symptoms, and Physical and Mental Fatigue.

Psychiatric patient violence adversely affects healthcare workers' quality of life and patient quality of care. In contrast to the common adult patient emphasis, the present study was designed to examine the relationship between healthcare staff-directed verbal and physical violence exhibited by children and adolescent psychiatric inpatients and post-traumatic stress (PTSD) symptoms, emotional labour, and physical and mental fatigue of staff. Our cross- sectional study recruited 113 multidisciplinary staff members working in child and adolescent psychiatric wards: 33 (29.2%) educational staff, including special education schoolteachers and social guides; 53 (46.9%) nursing staff, including nurses and nurse aides; and 27 (23.9%) multidisciplinary clinical staff, including physicians, psychologists, social workers, and occupational therapists. Five questionnaires were used: Exposure to Violence Questionnaire, PCL-5 (PTSD), Emotional Labour Questionnaire, MFI-20 (physical and mental fatigue), and a sociodemographic survey. Findings indicated that nearly all personnel had experienced verbal violence, and most had experienced physical violence from hospitalised children and adolescents. Such violence caused staff a moderate level of emotional labour. Exposure to violence was significantly related to PTSD symptoms, which fully mediated the relationship between violence exposure and physical and mental fatigue. Regression analysis identified PTSD symptoms as the primary predictor of staff fatigue. The most intensely felt emotions towards patients were empathy, caring and compassion. We conclude that healthcare staff engage in emotional labour to suppress negative and promote positive emotions to maintain professional functioning and cope with challenging patient behaviours. PTSD symptoms among violence-exposed healthcare teams should be addressed with targeted interventions as emotional-support, emotion-regulation workshops, training in conflict management and violence de-escalation. Providing a safe and supportive work environment for both patients and staff is of paramount importance.