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So far, there are only few data that provide information on the frequency of violent incidents in inpatient geriatric care facilities in Germany. Violence in residential care includes emotional, physical and sexualised forms of violence or a combination of these, which can be initiated by persons in need of care, employees or relatives and can be directed against persons in need of care or employees, intentionally or unintentionally, situationally or across situations. The term "employees" refers to all persons in inpatient care who are in direct contact with the persons in need of care: Aides, nursing staff and social care workers.

Studies from the Anglo-American area and Europe come to the conclusion that between 61 % and 90 % of care workers in elderly care are verbally assaulted within twelve months and 36 % to 84 % are exposed to physical violence (Zeh et al. 2009; Boldt et al. 2007). In Germany, in a survey of 1,973 workers from 6 facilities for the disabled, 6 general hospitals and 27 outpatient and inpatient care facilities, 78 % of workers with direct contact with patients or clients reported verbal violence and 56 % reported physical violence in the last 12 months. Physical violence was most common in residential care for the elderly, with 63% reporting such experiences, and verbal abuse was reported by 71%. Sexual harassment was reported by 12.7% of eldercare workers (Schablon et al. 2012).

Castle et al. (2015) identified 11 studies published between 2003 and 2012 in the MEDLINE and CINAHL databases that surveyed relatives or employees of care recipients in residential care, each with rather smaller samples ranging from 49 to 816 participants. The results are not comparable. In the most recent study, 24.3% of 452 family members in a telephone survey in Michigan reported at least one incident of physical violence against their family member living in a facility (Schiamberg et al. 2012). In a written survey of 4,451 caregivers in Pennsylvania, 28% reported observing intimidating behaviour by colleagues towards care recipients in residential care in the past three months; 27% reported yelling at them and 4% reported intentional physical injury (Castle 2012a).

Data on violence by care recipients towards other care recipients is available internationally from a survey of caregivers in residential care. 94% of respondents reported observing residents physically attacking other residents through behaviours such as pushing or pinching within a three-month period, and 97% observed shouting at residents (Castle 2012b).

In an older written survey of 361 inpatient nursing staff in Hesse (response rate 36%), 23.5% reported at least one case of self-inflicted physical violence against residents in the last 12 months. Most of the cases involved rough handling during nursing activities, rarely typical forms of interpersonal violence such as hitting or pushing. Psychological abuse or verbal aggression was reported by 53.7% of the caregivers about themselves, as well as nursing neglect. At least one form of violence was reported by 71.5%. 71.2% of the nurses reported having observed such behaviour by colleagues, including 34.9% physical abuse, 61.8% psychological abuse, 59.6% nursing neglect and 1.1% sexual harassment (Görgen 2010).

The study follows on from Thomas Görgen's study, but also aims to capture the current situation and paint a more complete picture of the incidence of violence - from the perspective of care workers.

The Frankfurt Forum for Elderly Care, an association of currently 42 homes, is planning to develop a violence prevention concept that is designed to meet needs, also serve as an argumentation aid and possibly be evaluable at a later stage. The aim is therefore to record the current starting point.

We are interested in how many of the employees of the participating facilities who have been working in nursing and care for at least 12 months state that they have experienced violence within the last 12 months /14 days:

• experienced emotional, physical, sexualised violence or neglect by those in need of care or relatives
• have witnessed emotional, physical, sexualised violence or neglect by persons in need of care towards persons in need of care
• having been emotionally, physically or sexually abused or neglected by a person in need of care
• having witnessed emotional, physical, sexual violence or neglect by caregivers towards persons in need of care.

Studies on the frequency of violence in inpatient care have systematic sources of error due to the subject of the research: Self-reporting from the perpetrator's perspective tends not to capture intended forms of violence. People in need of care themselves often cannot be questioned directly due to cognitive limitations or exhaustion caused by their multimorbidity, or they are reluctant to report experiences of violence by the persons on whom they depend. Relatives or colleagues cannot observe all potentially violent situations. Therefore, we decided to consistently look at the experiences of workers, who are the ones most likely to have an impact on the situation.

A standardised written and anonymised full survey was conducted of all nursing and care workers in the participating facilities who fulfilled the inclusion criteria. An instrument was used that was developed based on the survey by Thomas Görgen and with his support, and then tested in a two-stage pretest.

Data entry and analysis was done in SPSS for the entire study population, as well as per occupational group and per institution. The latter is only received by the respective institutions, while the overall evaluation and the evaluation per occupational group are received by all institutions. Recommendations for action for needs-based prevention concepts are to be derived from the results.

The survey was additionally conducted in four facilities in Cologne and Aachen.

You can download the results in a PDF file here.

• Residents need better protection also from other residents, especially in group situations.
• Physical and sexual violence by residents towards caregivers often occurs during personal care and is more likely to be perpetrated by those who attempt it more frequently. In such cases, work should be done in pairs, and personal care should be performed by caregivers of the same gender.
• Training on solution-oriented communication strategies could be helpful to reduce psychological violence against caregivers.
• The main challenge for nurses and caregivers in preventing violence could be lack of staff and thus lack of time.