Understanding healthcare workers' responses to violence and aggression at work.

The primary objective of this study was to investigate whether there was evidence for the proposed mechanisms
within the Ehlers and Clark (2000) cognitive model of Post-Traumatic Stress Disorder( PTSD). Two principal relationships were to be investigated: firstly, whether
behavioural and cognitive strategies prevented change in the nature of the trauma memory and appraisals of the trauma and its sequelae over time; secondly, whether
aspects of trauma memory and subsequent appraisals of the trauma and its sequelae mediated the relationship between
peritraumatic cognitive processing and PTSD symptoms. The second research objective involved further validation of the Ehlers and Clark (2000) model. The study was conducted on a population of health service employees exposed to aggression and/or violence at work, using a prospective,
longitudinal design.A low response rate meant that there
was not sufficient power to test these relationships. The findings from Study I were a low response rate, low reporting of incidents of violenced rid aggression and low PTSD symptoms,particularly amongst ambulance workers.

Findings from Study I led to a qualitative study being carried out to investigate: the possible reasons for the low response and reporting rate; the lack of PTSD symptoms; and to explore responses of ambulance workers to workplace
violence and aggression. Twenty-four interviews were carried out with ambulance workers, and the data was analyzed using Thematic Analysis. PTSD symptoms were described by interviewees in themselves and their colleagues following incidents of violence and aggression Low response rates were discussed in the context of a general reluctance to report incidents and to show
that they had not been affected by violence and
aggression. The responses to violence and aggression took two forms, a macho or tough response and a reflective, sensitive approach. Colleague relationships were an important source of support for many of the ambulance
workers and management were portrayed as uncaring. These
findings were considered in the context of the literature
and the Ehlers and Clark (2000) model.