Physical and psychological abuse in Canadian operating rooms
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To the Editor,
A range of operating room behaviours can be detrimental to both team members and patients.1 We recently developed a scale measuring exposure to behaviours that show disrespect toward another person and result in a perceived threat to victims and witnesses.2 We call these “negative intraoperative behaviours.” Alongside this scale, we surveyed clinicians regarding physical abuse and several types of psychological abuse in the operating room. The Canadian Department of Justice defines physical abuse as any form of assault, where “someone uses force or the threat of force on someone else without that person’s consent.”1 In contrast, they define psychological abuse as when “a person uses words or actions to control, frighten or isolate someone or take away their self-respect.”2 These actions may take place in either “a pattern of behaviour or…” as “a single incident.”A Although abusive behaviours were not part of the final negative intraoperative behaviours scale, they are important stand-alone outcomes. A contemporary examination of abusive behaviours in Canadian operating rooms is needed. Such behaviours are therefore the subject of this short communication.
Our study demonstrated that hundreds of clinicians observe abusive behaviours in Canadian operating rooms. Abusive behaviours, especially physical assault, should never occur in any workplace because of the potentially harmful effect on victims and witnesses. When such events occur in a medical context, however, they are especially concerning because of their potential to undermine patient care. Incidents of abuse are likely to disrupt professional relationships,1 communication,1 and the diagnostic and procedural performance of operating room teams.3 It places patients at an increased risk of morbidity and mortality.4 As caregivers and patient advocates, operating room team members have a duty to act in a manner that is conducive to good patient care.
Institutions must take further actions to prevent these behaviours and create a culture of respect and safety. These efforts should include raising awareness about abusive behaviours in the operating room and their detrimental effects; increasing “soft skills” training, especially regarding conflict resolution, communication, and de-escalation techniques; and finally, instituting and enforcing a respectful workplace policy.
Department of Justice Canada. What is abuse? Abuse is wrong. Ottawa, Ontario: Department of Justice; 2009. Available from URL: http://www.justice.gc.ca/eng/rp-pr/cj-jp/fv-vf/aiw-mei/pdf/Abuse_is_Wrong.pdf (accessed May 2016).
Department of Justice Canada. Forms and types of violence. About family violence. Ottawa, Ontario: Department of Justice; 2015. Available from URL: http://www.justice.gc.ca/eng/cj-jp/fv-vf/about-apropos.html (accessed May 2016).
Conflicts of interest
This submission was handled by Dr. Gregory L. Bryson, Deputy Editor-in-Chief, Canadian Journal of Anesthesia.
- 2.Villafranca A, Robinson S, Rodebaugh T, et al. Validation of a questionnaire measuring exposure to negative intraoperative behaviors: 17AP2-2. Eur J Anaesthesiol 2014; 31: 251-2 (abstract).Google Scholar
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