Table 1.
Stakeholder-Identified Challenges and Recommendations for Addressing Patient-Perpetrated Harassment
| Challenge | Description | Example quote* | Stakeholder recommendations |
|---|---|---|---|
| External | |||
| Societal culture | Societal norms and values that enable harassment | “It is a societal concern and it is not just military, it’s not just Veterans Administration.” (no. 05) | N/A |
| Military culture | Military norms and values that enable harassment | “I always think of the VA as like pseudo military, it’s like one level down from the military culture. And the military culture, of course, is having a real problem with [harassment].” (no. 16) | N/A |
| Organization | |||
| Climate around harassment | Shared perceptions that VA tolerates patient-perpetrated harassment and fails to hold perpetrators accountable | “There becomes kind of like this learned helplessness for a lot of the employees...well this is just part of the culture...get used to it because it’s not going anywhere.” (no. 07) |
Norms campaigns Patient education Bystander intervention Staff training Policies/guidelines |
| Policies/guidelines | Lack of clear polices for addressing patient-perpetrated harassment | “There is not a really clear process or procedure in reporting things like this.” (no. 04) | Policies/guidelines |
| Leadership | Lack of leader awareness and/or support around the need for interventions to address harassment | “I’m not sure how much upper management is aware of it...it does not seem like there’s been any action taken on that.” (no. 12) | Leadership support |
| Staff | |||
| Cognitive appraisals | Ambiguity around labeling harassment and assessing whether/how to intervene | “[Staff think], ‘Oh... the [woman] Veteran did not even say that [the harassment] made them uncomfortable, so maybe we should not report that.’” (no. 04) |
Staff training Policies/guidelines |
| Patient-staff dynamics | Fear of damaging the therapeutic relationship or provoking patient retaliation | “If I were to have confronted that patient yesterday, that would have made my entire interaction with him more difficult.” (no. 18) | Staff training |
| Competing priorities | Lack of time or staff resources to address harassment given other priorities, needs, or duties | “Are you going to have the police officer taking the [harassment] report, or are they going to be up on this mental health unit dealing with an issue up there?” (no. 09) |
Leadership support Policies/guidelines |
| Patient | |||
| Awareness | Lack of awareness about definition and impact of harassment | “I know some of the men [patients] may not really even consider what they are doing harassment and they might think it’s just mild to call someone ‘Honey’ or ‘Baby’ or whatever...” (no. 15) |
Norms campaigns Patient education Bystander intervention |
| Clinical diagnoses | Psychiatric or other clinical diagnoses that complicate management of harassing behaviors | “The issue is that you have to discriminate, particularly on the mental health unit, whether someone is impaired in their reality testing and...they have no sense of boundaries.” (no. 05) |
Policies/guidelines Staff training |
*Themes are not mutually exclusive and multiple themes may apply to a single quote