Identification of violence in Turkish health care settings

Violence in the Emergency Department: What Can We Do?

BACKGROUND

 Violence in healthcare settings is a problem around the world, with hospital emergency departments (EDs) being the most common sites. The most important step in preventing violence is to determine the causes and characteristics of the problem. However, there is not enough information in the literature about the particular areas of EDs in which violence occurs.

OBJECTIVES

 We aim to produce results that can contribute to violence prevention activities by gathering detailed information about violent incidents in EDs and the intensity of this violence.

METHODS

 Our study was planned as a retrospective and descriptive study at a tertiary emergency medicine clinic. Our data include "code white" data between January 1, 2015, and December 31, 2019. The characteristics and types of violence were recorded and categorized.

RESULTS

 We evaluated 141 incidences of severe violence reported during the study period. We determined that 55.2% of the violence was directed at physicians and 21.3% at nurses. Verbal violence was by far the most common type of violence, comprising 98.6% of the cases. We found that the violence cases occurred in examination rooms, observation areas, and triage units of the ED (58.2%, 24.1%, and 11.3%, respectively).

CONCLUSION

 We determined that violence in the ED is most common after standard working hours, and the most frequent exposure to violence is in examination rooms, observation areas, and triage areas. These findings may be useful in determining preventive measures in EDs, where violence is most common.

The occurrence and consequences of violence against healthcare workers in Turkey: before and during the COVID-19 pandemic

BACKGROUND

Before and throughout the COVID-19 pandemic, healthcare workers (HCWs) were victims of workplace violence (WPV). There are no reliable statistics on the occurrence and consequences of WPV against HCWs in Turkey throughout the pandemic period.

OBJECTIVE

We investigated the rates of WPV against HCWs in Turkey in the pre-pandemic and pandemic periods, variables associated with WPV, and the relationship between these variables and job satisfaction and burnout.

METHODS

A structured online questionnaire was disseminated through social media channels to HCWs in various healthcare settings. All the respondents also completed the Maslach Burnout Inventory (MBI) and Job Satisfaction Scale. Based on the data obtained, we determined the frequency, causes, and consequences of WPV against HCWs before and during the pandemic.

RESULTS

There were 701 completed questionnaires. 68.2% of participants were female, and 65.6% of them were doctors. The rate of WPV was 54.1% and 24.3% before and during the pandemic, respectively. Verbal abuse was the most common kind of WPV. Female HCWs were more likely to be physically assaulted than their male counterparts, especially those working in COVID-19 units. The majority of HCWs who were exposed to the violence at least once did not report WPV. HCWs exposed to WPV during the pandemic reported more emotional exhaustion and depersonalization and a lower perceived level of personal achievement.

CONCLUSION

HCWs were exposed to significant levels of violence both before and during the pandemic. Preventing WPV against HCWs and removing barriers to reporting abuse is crucial.

Evaluation of violence against emergency physicians

Aim: To identify the causes of violence in the emergency department and suggest ways to reduce the violence experienced. Material and Method: The population of this cross-sectional survey study consisted of all emergency medicine physicians who participated in the symposium on frequent emergencies held in Cyprus on May 6, 2022. The survey consisted of a total of 20 items comprising 16 multiple-choice and four fill-in-the-blank questions related to demographic characteristics and violence. It was administered to 230 physicians who volunteered to participate in the study. Results: A total of 230 physicians, 65.2% (n=150) male and 34.8% (n=80) female, participated in the study. It was determined that 28.7% of the participants had been exposed to physical violence, 89.2% to verbal violence, and 1.3% to sexual violence within the last year. The factors causing violence were identified as the low educational level of patients’ and their family members, patient requests for unnecessary medical practices, aggressive nature of family members, and patients’ desire to be examined before their turn. As the number of shifts worked by the physicians and number of treated patients increased, the frequency of exposure to violence also increased. Women were exposed to more violence. As the title and age of the physicians increased, the frequency of exposure to violence decreased. Conclusion: We consider that violence against physicians can be reduced by informing patients and patient’s relatives and improving the working conditions of physicians.

Compassion Fatigue and Satisfaction in Nurses and Midwives during the COVID-19 Pandemic in Turkey

Objective: To examine the levels of compassion fatigue and compassion satisfaction of nurses and midwives during the COVID-19 pandemic and the influencing factors. Methods: This descriptive study was carried out with the participation of Turkish midwives and nurses. In the study using the convenience sampling method, data were collected online using an online questionnaire. The questionnaire, created through the Google form, was shared between May and June 2021 in the midwife and nurse groups (Facebook, Instagram, WhatsApp) on electronic platforms. Compassion fatigue (CF) and compassion satisfaction (CS) consisting of the burnout (BO) and secondary traumatic stress (STS) subcomponents were assessed by the Professional Quality of Life scale. The study was completed with 402 nurses and midwives from various units. Descriptive statistics, and the Mann-Whitney U and Kruskal-Wallis tests were used in the analysis of the data. Results: Among the participants, the rate of dissatisfaction with the clinic worked was 24.6% and the turnover intention rate was 70.6%. During the pandemic period, 75.6% of the participants reported that they were exposed to verbal violence, 7.7% to physical violence, and 74.4% to mobbing behaviors. Low CS was found in 24.9% of the participants, a high level of BO in 27.1%, and high STS in 32.8%. Conclusion: Violence and mobbing against nurses and midwives should be prevented in order to increase the professional quality of life.

Development and Validation of a Comprehensive Questionnaire to Assess Interpersonal Discord (Bullying, Harassment, and Discrimination) at the Workplace in a Healthcare Setting

Objective

This study was conducted to develop and validate a comprehensive questionnaire to assess bullying, discrimination, and harassment in healthcare settings.

Methodology

A mixed-method study design was used to develop and validate the questionnaire. In phase I, qualitative approaches were used for the development, which included literature search, focus group discussions (FGDs), following which the construct was developed. In phase II, face validity and construct validity were established using quantitative approaches.

Results

The final questionnaire consists of 25 items divided into five sections addressing the burden, impact, reasons for underreporting, risk factors, and mitigation strategies. The questionnaire has very good consistency with a Cronbach’s alpha score of 0.86.

Conclusion

This is a comprehensive tool with appropriate psychometric properties with potential use for evaluating the problem of interpersonal discord in the form of bullying, harassment, and discrimination in a healthcare setting.

The Relationship Between Violent Behavior in Healthcare Settings and Communication Skills: An Empirical Study on Provincial Hospitals in Ankara

OBJECTIVE

Violence in the health care is a multifaceted and complex social phenomenon that attracts the attention of researchers and policymakers in many countries around the world. Violence against healthcare workers has several factors, but there are limited data on the association between violence against healthcare workers and the communication skills of healthcare workers. In this study, we examine the relationship between healthcare professionals' communication skills and violent incidents experienced or witnessed by healthcare workers.

METHODS

The sociodemographic and professional data of 296 healthcare professionals were obtained. All participants were assessed using a communication skills inventory. The total and categorical scores of the communication skills inventories were compared between participants who had been exposed to violence and those who had not.

RESULTS

It was found that the emotional score of individuals who had suffered more than one physical attack was lower than that of others (P = .037). In addition, nurses were found to have more verbal violent behavior experience than their counterparts. Other comparisons were found to be insignificant.

DISCUSSION

Healthcare professionals should not only evaluate complex problems such as violence in the health care but also emphasize the role of patients and their relatives. Violence against healthcare professionals cannot be based on a simple factor. We believe that there are many factors that lead to violence. The causes of violence in the health care should be examined by future studies.

Workers' compensation claims among private skilled nursing facilities, Ohio, 2001-2012

INTRODUCTION

Skilled nursing facilities have one of the highest rates of occupational injury and illness among all industries. This study quantifies the burden of occupational injury and illness in this industry using data from a single state-based workers' compensation (WC) system.

METHODS

Ohio Bureau of Workers' Compensation claims from 2001 to 2012 were analyzed among privately owned, state-insured skilled nursing facilities and are presented as claim counts and rates per 100 full-time equivalents (FTE). Worker, employer, incident, and injury characteristics were examined among all claims and by medical-only (medical care expenses and/or less than eight days away from work) and lost-time (eight days or more away from work) claim types.

RESULTS

There were 56,442 claims in this population of Ohio skilled nursing facilities from 2001 to 2012. Overexertion and bodily reaction, slips, trips, and falls, and contact with objects and equipment accounted for the majority of all WC claims (89%). Overexertion and bodily reaction, and slips, trips, and falls comprised 85% of the 10,793 lost-time claims. The highest injury event/exposure rates for all claims were for overexertion and bodily reaction (3.7 per 100 FTE for all claims), followed by slip, trips, and falls (2.1), and contact with objects and equipment (1.9).

CONCLUSION

Understanding the details surrounding injury events and exposures resulting in WC claims can help better align prevention efforts, such as incorporation of safe patient handling policies and lifting aids, improvement in housekeeping practices, and employee training within skilled nursing facilities to prevent worker injury and mitigate related expenses.

Violence in healthcare at a glance: The example of the Turkish physician

BACKGROUND

Violence is an important public health problem that threatens the peace of mind in health institutions as well as in many other sectors. In recent studies, it was stated that violence occurs more frequently in healthcare centers compared to other establishments. In terms of being exposed to violence, healthcare personnel is at 16 times more risk. Violence against healthcare employees has increased gradually in Turkey and the world; it's a serious occupational hazard to consider.

AIMS

The aim of our study was to analyze the situation about violence against physicians, to emphasize its importance, to shed light on preventive measures and to create programs and to raise awareness of violence against physicians.

METHODS

This descriptive study was conducted between October-December 2017. A link was sent to the participants to participate voluntarily through the social media platforms mostly used by physicians and they were asked to fill out a questionnaire.

RESULTS

83.3% of the 948 physicians that participated have experienced at least one episode of violence so far. The most common type of violence was verbal. More than half of violent events occurred in hospitals. One-third of the physicians did nothing in the face of violence, more than half could not report this situation due to lack of time, only one-quarter of those who sought support received it. Only 23.7% of the perpetrators were punished, while physicians saw the lack of deterrent sanctions as the main cause of violence. While 90.2% of physicians feel occupational burnout, 81.6% thought that physicians can protect themselves through effective legislation against violence in healthcare.

CONCLUSION

The Law on Violence in Health should be enacted and put into practice as soon as possible.

Workplace Violence in Outpatient Physician Clinics: A Systematic Review

Workplace violence (WPV) has been extensively studied in hospitals, yet little is known about WPV in outpatient physician clinics. These settings and work tasks may present different risk factors for WPV compared to hospitals, including the handling/exchange of cash, and being remotely located without security presence. We conducted a systematic literature review to describe what is currently known about WPV in outpatient physician clinics. Six literature databases were searched and reference lists from included articles published from 2000-2019. Thirteen quantitative and five qualitative manuscripts were included which all focused on patient/family-perpetrated violence in outpatient physician clinics. No studies examined other violence types (e.g., worker-on-worker; burglary). The overall prevalence of Type II violence ranged from 9.5% to 74.6%, with the most common form being verbal abuse (42.1-94.3%), followed by threat of assault (14.0-57.4%), bullying (2.5-5.7%), physical assault, (0.5-15.9%) and sexual harassment/assault (0.2-9.3%). Worker consequences included reduced work performance, anger, and depression. Most workers did not receive training on how to manage a violent patient. More work is needed to examine the prevalence and risk factors of WPV in outpatient physician clinics for purposes of informing prevention efforts in these settings.

Workplace violence among municipal health care workers in Diamantina, Minas Gerais, Brazil, 2017

Background

Health care workers stand out in recent studies as a function of high rates of workplace violence.

Objective

To calculate the prevalence of workplace violence involving health care workers and associated factors.

Methods

Cross-sectional study with municipal health care workers in Diamantina, Minas Gerais, Brazil. Data were collected in interviews from December 2016 through March 2017. Variable workplace violence was considered as outcome on univariate and multivariate analysis. Descriptive and analytical statistical techniques were used (Poisson regression).

Results

The study population comprised 203 municipal health care workers (79% response rate). The prevalence of workplace violence was 40.4-47.9% for women and 22.0% for men. Occupational factors associated with violence were job satisfaction, support at work and psychological demands.

Conclusion

The prevalence rates we found and associated factors point to the relevance of health protection policies targeting this category of workers which may contribute to mitigate the negative effects of violence on the health of workers and consequently on the quality of care delivery.

Violence against health employees in a child health and diseases clinic: A tertiary-level hospital example

Aim:

Violence in health is an important public health problem that threatens community peace. In our study, it was aimed to examine the state of exposure to violence among employees in our clinic in the last one year and our employees’ opinions and attitudes about violence.

Material and Methods:

The study was performed cross-sectionally. In this study the Violent Incident Form developed by Arnetz (1998) was used as a data collection tool.

Results:

A total of 182 healthcare workers were included in the study. Of the participants, 14 (7.7%) were faculty members, 37 (20.3%) were physicians, 24 (13.2%) were interns, 70 (38.5%) were nurses, 10 (5.5%) were medical secretaries, and 27 (14.8%) were ancillary health personnel. The female/male ratio was 143/39. Seventy-nine (43.4%) of the employees had been exposed to violence at least once in the last year. Of those experiencing violence, 57 (72%) were female, 28 (35%) were nurses, 21 (27%) were residents, 16 (20%) were interns, five (6.5%) were faculty members, five (6.5%) were allied health personnel, and four (5%) were medical secretaries. Physicians were exposed to violence with a higher rate (p<0.05). Exposure to violence was observed most frequently in the pediatric emergency department. Of all the violent incidents, 58% occurred during night shifts and 46% occurred during examination/treatment/physical care. The perpetrator was a patient in only one incident, the other perpetrators were patients’ relatives, and 63% of the perpetrators were men. All violent incidents involved verbal violence, seven (8.8%) incidents contained elements of physical violence, such as spitting, pushing, kicking, biting, restraining or using an object. Only 29 (36.7%) of the 79 staff reported violence, and 50 (63.3%) did not take any action after the violence.

Conclusion:

Violence in health is a common and serious problem even in tertiary hospitals. In our study, only one-third of the affected staff reported violence after exposure to violence. The risk of violence should be reduced in order to ensure a safe work environment, which will be possible by raising awareness of healthcare workers and effective implementation of violence prevention programs.

Attitudes towards and experiences of ethical dilemmas in treatment decision-making process among medical oncologists

AIM

This study aimed to evaluate the attitudes towards and experiences of ethical dilemmas in the treatment decision-making process among medical oncologists who are the members of the Turkish Society of Medical Oncology.

MATERIALS AND METHODS

A questionnaire was developed based on related literature. Between April 1 and May 1, 2016, questionnaires were electronically sent to 412 medical oncologists who were the members of the Turkish Society of Medical Oncology. Overall, 125 of 412 medical oncologists (30.33%) filled the questionnaire.

RESULTS

Most medical oncologists encountered dilemmas, such as a lack of comprehension among the patients and family members regarding the information provided, a lack of clarity regarding the identity and role of individuals in the decision-making process, and demands for futile treatment. The most common problem (70.4%) was the lack of available clinical ethics consultancy services to guide medical oncologists when facing an ethical dilemma. Legal concerns regarding withholding or withdrawing futile treatments were high. More than half of the medical oncologists (56.8%) reported the preservation of the quality of life as their primary professional duty.

CONCLUSION

Our results demonstrate that medical oncologists tend to adopt an approach that respects patient autonomy and that adheres to the principle of proportionality rather than a paternalistic approach when facing ethical dilemmas. Within this context, we suggest an increased use of a multidisciplinary team approach, ethics consultancy services, and training programmes as well as the publication of ethical guidelines tailored to the oncology field.

Prevalence of Physical and Verbal Violence Against Health Care Workers in Turkey

Workplace violence has affected many individuals in recent years, irrespective of age, gender, race, educational level, and sector. We analyzed the responses to the Workplace Violence in the Health Sector Country Case Study Questionnaire, applied online to 447 health care workers who worked in public or private health care institutions in different cities of Turkey. Frequencies, percentages, and a chi-square independence test were used for data analysis through SPSS 18. Of the participants, 37.4% were doctors, 61.3% were midwives-nurses or emergency medical technicians (EMT), and 1.3% worked in units with no direct contact with patients and relatives (such as management and the hospital pharmacy). A total of 36.7% of participants reported exposure to physical violence, and 88.8% reported exposure to verbal abuse at least once during their working lives. Many participants who were victims of physical violence or verbal abuse did not report incidents because they thought it would provide no benefits. Regulations on effective communication training, changes in workplace conditions, and effective implementation of violence prevention procedures may help to reduce the rates of verbal abuse and physical violence in the health care sector. In addition, when managers show support for their employees in the prevention of workplace violence, it may help employees to feel more secure in their workplaces.

Risky sexual behaviour and human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) among healthcare workers

BACKGROUND

South Africa is known to have one of the highest prevalence rates of human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) globally, with one in seven healthcare workers being HIV-positive. An HIV-positive healthcare workforce is less equipped to respond to the increasing spread of the epidemic.

OBJECTIVES

Assessment of the factors contributing to high HIV prevalence rates among healthcare workers is important in planning the development of human resources. This review sought to identify and understand predominant risky sexual behaviours among healthcare workers in HIV and AIDS-affected countries.

METHODS

This study reviewed articles focusing on sexual behaviour among healthcare workers. Major health science databases (e.g. ProQuest, Cochrane, PubMed and CINAHL) were searched for combinations of keywords including 'healthcare workers', 'risky sexual behaviour' and 'HIV and AIDS'. Articles from a range of countries met inclusion and exclusion criteria.

RESULTS

Findings of the study revealed three main contributing factors: unprotected sex, multiple sex partners and sexual violence. Sexual violence emerged as the dominant risk factor in the majority of the studies. Most research was conducted in developed countries where the HIV infection rate is much lower than it is in developing countries.

CONCLUSION

More research needs to be conducted in developing countries and appropriate strategies should be implemented to reduce sexual violence among healthcare workers. Appropriate procedures on reporting sexual violence coupled with education on HIV and AIDS as well as influencing attitudes and belief systems could assist in reducing the spread of HIV and AIDS within the healthcare workforce while minimising the effect on patient care.

Workplace violence against physicians in Turkey's emergency departments: a cross-sectional survey

OBJECTIVE

We aimed to determine the prevalence of violence directed at emergency department (ED) physicians in Turkey and confirm the factors influencing such violence.

DESIGN

Cross-sectional survey study.

SETTING

Country of Turkey.

PARTICIPANTS

Physicians currently practising in EDs in Turkey.

MAIN OUTCOME MEASURES

The prevalence of violence directed at physicians and factors that may influence it, such as physicians' personal characteristics, ED characteristics and physicians' opinions regarding the causes of and suggested methods of preventing violence.

RESULTS

A total of 713 physicians participated. Of these, 78.1% reported being subjected to violence in the past year and 65.9% reported more than one such incident. Being subjected to violence was related to age (p=0.008), working in an ED with a high patient admission rate (p=0.018), current position (p<0.001), working outside regular work hours (p<0.001), working in a state hospital (p<0.001) and level of experience (p<0.001). Gender, type of patient typically seen, region and patient waiting period did not influence subjection to violence. The present safety precautions against violence do not appear to influence the prevalence of violence.

CONCLUSIONS

Our results indicated that ED physicians' experience of violence is related to personal characteristics such as age and level of expertise, and hospital and ED characteristics such as high patient admission rates. Presently, no measures taken to reduce this violence have been proven effective.

The Relationship Between Sociodemographic Characteristics, Work Conditions, and Level of "Mobbing" of Health Workers in Primary Health Care

Mobbing is a type of violence which occurs in workplaces and is classified under the community violence subgroup of interpersonal violence. The aim of this study is to examine health care workers who work in primary health care in the city of Mugla and to determine whether there is a relationship between sociodemographic characteristics, work conditions, and their level of mobbing. A cross-sectional analysis has been conducted in which 130 primary health care workers were selected. Of the 130, 119 health workers participated, yielding a response rate of 91.5%; 83.2% of health workers are female, 42.9% are midwives, 27.7% are nurses, and 14.3% are doctors. In all, 31.1% of health workers have faced with "mobbing" in the last 1 year, and the frequency of experiencing "mobbing" of those 48.6% of them is 1 to 3 times per year. A total of 70.3% of those who apply "mobbing" are senior health workers, and 91.9% are female. The frequency of encountering with "mobbing" was found significantly in married health workers, in those 16 years and above according to examined total working time, in those who have psychosocial reactions, and in those who have counterproductive behaviors. It has been discovered that primary health care workers have high prevalence of "mobbing" exposure. To avoid "mobbing" at workplace, authorities and responsibilities of all employees have to be clearly determined.

Levels of the Staff's Exposure to Violence at Locked Psychiatric Clinics: A Comparison by Occupational Groups

This study explored the rates of exposure to violence among physicians, nurses, and other health care staff members working at the locked psychiatric clinics, to examine the quantity and types of violence exposed, and to compare occupational groups by the level of exposure to violence. In parallel with the existing literature, the present study supports the proposition that physicians and nurses working at psychiatric units represent a risky group in terms of exposure to violence. The survey found that 87.6% of staff members viewed security measures insufficient. It is considered by the authors that preventive actions should be taken to reduce the risk of exposure to violence against the staff members working at the locked psychiatric clinics.

A test of safety, violence prevention, and civility climate domain-specific relationships with relevant workplace hazards

BACKGROUND

Safety climate, violence prevention climate, and civility climate were independently developed and linked to domain-specific workplace hazards, although all three were designed to promote the physical and psychological safety of workers.

PURPOSE

To test domain specificity between conceptually related workplace climates and relevant workplace hazards.

METHODS

Data were collected from 368 persons employed in various industries and descriptive statistics were calculated for all study variables. Correlational and relative weights analyses were used to test for domain specificity.

RESULTS

The three climate domains were similarly predictive of most workplace hazards, regardless of domain specificity.

DISCUSSION

This study suggests that the three climate domains share a common higher order construct that may predict relevant workplace hazards better than any of the scales alone.

Physician exposure to violence: a study performed in Turkey

Recently, in Turkey, there has been an increase in the number of violent acts against healthcare workers, towards doctors in particular. This study aimed to investigate the extent of violence, the causes of violence and to evaluate proposed solutions to violence. Out of 597 physicians, 86.4% indicated that they were exposed to at least one type of violence (physical, verbal, sexual) throughout their careers. Among the physicians participating in the study, 27.5% suffered physical threats and 68.6% suffered verbal violence in the past year. Only 40.4% reported the physical violence to their institution. Physicians indicated that the top three causes of violent behavior were excessive demands of patients, the expectation that the issue will be solved immediately and blaming physicians for their problems. To stop violence against themselves, physicians need to raise their voices, along with those of their personal or professional organizations, and should report and follow up incidents.

User Violence and Nursing Staff Burnout: The Modulating Role of Job Satisfaction

Exposure to patient violence in health staff can lead to the onset of burnout in these workers. The main goal of this investigation is to study how exposure to this kind of violence affects onset of burnout and to appraise the role of job satisfaction as a modulating variable. A descriptive, cross-sectional study was carried out using a self-administered anonymous questionnaire with the nursing staff of all the public hospitals of the Region of Murcia (Spain), obtaining a sample of 1,489 health professionals. From the results obtained, we underline the modulating role of extrinsic job satisfaction in the relationship between nonphysical violence and emotional exhaustion, and the protective effect of job satisfaction on the impact of nonphysical violence and the level of cynicism. No effects of job satisfaction in the relationship between physical violence and burnout were observed. We therefore conclude that experiencing nonphysical aggression has a lower impact on the psychological health of workers who are satisfied with their job, and interventions aimed at increasing these workers' extrinsic job satisfaction are highly recommended.

Physical assault, physical threat, and verbal abuse perpetrated against hospital workers by patients or visitors in six U.S. hospitals

BACKGROUND

An elevated risk of patient/visitor perpetrated violence (type II) against hospital nurses and physicians have been reported, while little is known about type II violence among other hospital workers, and circumstances surrounding these events.

METHODS

Hospital workers (n = 11,000) in different geographic areas were invited to participate in an anonymous survey.

RESULTS

Twelve-month prevalence of type II violence was 39%; 2,098 of 5,385 workers experienced 1,180 physical assaults, 2,260 physical threats, and 5,576 incidents of verbal abuse. Direct care providers were at significant risk, as well as some workers that do not provide direct care. Perpetrator circumstances attributed to violent events included altered mental status, behavioral issues, pain/medication withdrawal, dissatisfaction with care. Fear for safety was common among worker victims (38%). Only 19% of events were reported into official reporting systems.

CONCLUSIONS

This pervasive occupational safety issue is of great concern and likely extends to patients for whom these workers care for.

Occupational Risks of Health Professionals in Turkey as an Emerging Economy

BACKGROUND

Health services are one of the work areas that contain important risks in terms of the occupational health and safety of the laborer. Professionals in various areas of health services encounter biological, chemical, physical, ergonomic, and psychosocial risks, particularly in hospitals.

OBJECTIVES

This study has been performed to evaluate the impacts of the occupational risks on health of health professionals in Turkey.

FINDINGS

In Turkey, as an emerging economy, the history of studies on health professionals is not longstanding. There have been various regulations intended for the occupational health and safety of health professionals in line with the Regulation of the Provision on Patient and Staff Safety prepared in 2012. However, applications can differ from region to region, institution to institution, and person to person.

CONCLUSIONS

We believe that this review will lead health professionals to be aware of occupational risks and contribute to planning health services for health professionals.

Workplace violence against nurses in Chinese hospitals: a cross-sectional survey

OBJECTIVES

To determine the prevalence of workplace violence that Chinese nurses have encountered, identify risk factors and provide a basis for future targeted interventions.

SETTING

Heilongjiang, a province in northeast China.

METHODS

A cross-sectional survey.

PARTICIPANTS

A total of 588 nurses provided data. There were also in-depth interviews with 12 nurses, 7 hospital administrators and 6 health officials.

RESULTS

A total of 7.8% of the nurses reported physically violent experiences and 71.9% reported non-physically violent experiences in the preceding year. Perpetrators were patients or their relatives (93.5% and 82%, respectively), and 24% of nurses experienced non-physical violence that involved Yi Nao (gangs specifically targeting hospitals). Inexperienced nurses were more likely to report physical (13.2%) or non-physical (89.5%) violence compared with experienced nurses. Graduate-level nurses were more likely to perceive and report non-physical violence (84.6%). Nurses who worked rotating shifts were 3.668 times (95% CI 1.275 to 10.554) more likely to experience physical violence, and 1.771 times (95% CI 1.123 to 2.792) more likely to experience non-physical violence compared with nurses who worked fixed day shifts. Higher anxiety levels about workplace violence and work types were associated with violence. Interviewees perceived financial burdens, unsatisfactory treatment outcomes and miscommunications as influencing factors for workplace violence.

CONCLUSIONS

Preplacement education should focus on high-risk groups to reduce workplace violence. Increased awareness from the public and policymakers is necessary to develop effective control strategies at individual, hospital and national levels.

Workplace Violence: An Extensive Issue for Nurses in Pakistan-: A Qualitative Investigation

The objective of the present study was to examine the incidences of violence during nurses' careers and their impacts on their work life in the Islamic Republic of Pakistan. The current article highlights workplace violence toward nurses as a serious issue in Pakistan, which is almost an unexplored area as data are scarce. Individual interviews were conducted, applying a qualitative approach for getting the in-depth knowledge about the subject. Grounded theory method was used for data analysis and NVIVO-10 was used for information processing. Majority of the nurses experienced violence in the previous 6 months of their career. Nurses also confirmed that verbal abuse was witnessed and although experienced frequently, they did not report it, as they believed that reporting was useless and no action would be taken. Most nurses reported that due to violence, they experience stress, low work performance, low job satisfaction, high absenteeism, and high turnover intentions. The results illustrated a clear trend of an increasing number of violence incidents toward nurses. The findings of the present study possibly will assist hospital administration to manage and reduce violence at workplace.

Impact of hospital type II violent events: use of psychotropic drugs and mental health services

BACKGROUND

While violence can adversely affect mental health of victims, repercussions of violence against workers is not as well characterized.

MATERIALS AND METHODS

We explored relationships between workplace violent events perpetrated by patients or visitors (Type II) against hospital employees and the employee use of psychotropic medications or mental health services using a data system that linked violent events with health claims.

RESULTS

Significant associations were observed between reported Type II workplace violent events and employee prescription claims for anti-depressants and anxiolytics combined (RR = 1.45, 95% CI = 1.01-2.33) and anti-depressants alone (RR = 1.65, 95% CI = 1.10-2.48). No significant association between reported violent events and health claims for treatment of depression or anxiety was observed.

CONCLUSIONS

Type II violence experienced by hospital workers may lead to increased use of psychotropic drugs, particularly anti-depressants but also anxiolytics. Our results suggest an important role of employee assistance programs in mitigating the psychological consequences of workplace violent events.

Causes and management of aggression and violence in a forensic mental health service: perspectives of nurses and patients

Nurses' attitudes about the causes and management of aggression affects their choice of intervention. We aimed to compare the attitudes held by patients and staff in a forensic mental health service with the Management of Aggression and Violence Attitudes Scale, and examine the factor validity of the tool in this setting by conducting a prospective comparative questionnaire survey. Staff (n = 72) and patient (n = 98) attitudes differed to a limited extent. Confirmatory factor analysis refuted the previously reported structure of the tool. Exploratory factor analysis suggested three underlying factors related to modifiability of aggression, hands on management, and hands off management. Patients were more optimistic than nurses about the modifiability of aggressive behaviour. Male patients and those with diagnoses other than personality disorder were significantly more likely to agree about modifiability than controls. Forensic inpatients recognize the need for the use of a range of techniques to prevent and manage aggression and violence, but selected groups are most likely to believe that aggression is modifiable. Prevention and management of aggression training should emphasize the modifiability of aggressive behaviour. The development of measures of modifiability and management style would assist in the evaluation of training and would offer new avenues for research.

Violence experienced by nurses at six university hospitals in Turkey

This research was conducted to analyse the violence experienced by nurses employed at six university hospitals. A descriptive and cross-sectional study was conducted. The research sample consisted of 441 nurses who worked in the emergency, intensive care and psychiatry units of six university hospitals in Turkey between June 2008 and June 2009 and who voluntarily agreed to participate. It was found that 60.8% of the nurses were subjected to verbal violence and/or physical violence from patients, visitors or health staff. Of the nurses who were subjected to workplace violence, 42.9% stated that their experience of verbal and/or physical violence had a negative impact on their physical and/or psychological health, and 42.9% stated that their work performance was negatively affected. Of these nurses, 1.8% stated that they received professional help, 13.6% stated that a report was made and 9.5% stated that they contacted the hospital police in some way. According to the findings of this research, similar to the situation worldwide, nurses in Turkey are subjected to verbal and/or physical violence from patients, visitors and health staff.

Workplace bullying among healthcare workers

This paper aims to assess consistent predictors through the use of a sample that includes different actors from the healthcare work force to identify certain key elements in a set of job-related organizational contexts. The utilized data were obtained from the 5th European Working Conditions Survey, conducted in 2010 by the European Foundation for the Improvement of Living and Working Conditions. In light of these objectives, we collected a subsample of 284 health professionals, some of them from the International Standard Classification of Occupations--subgroup 22--(ISCO-08). The results indicated that the chance of a healthcare worker referring to him/herself as bullied increases among those who work on a shift schedule, perform monotonous and rotating tasks, suffer from work stress, enjoy little satisfaction from their working conditions, and do not perceive opportunities for promotions in their organizations. The present work summarizes an array of outcomes and proposes within the usual course of events that workplace bullying could be reduced if job demands were limited and job resources were increased. The implications of these findings could assist human resource managers in facilitating, to some extent, good social relationships among healthcare workers.

Perpetrator, worker and workplace characteristics associated with patient and visitor perpetrated violence (Type II) on hospital workers: a review of the literature and existing occupational injury data

PROBLEM

Non-fatal type II violence experienced by hospital workers (patient/visitor-on-worker violence) is not well described.

METHODS

Hospital administration data (2004-2009) were examined for purposes of calculating rates of type II violent events experienced by workers. We also conducted a review of the hospital-based literature (2000-2010) and summarized findings associated with type II violence.

RESULTS

484 physical assaults were identified in the data, with a rate of 1.75 events/100 full-time equivalents. Only few details about events were captured, while non-physical events were not captured. The literature yielded 17 studies, with a range proportion of verbal abuse (22%-90%), physical threats (12%-64%) and assaults (2%-32%) reported. The literature lacked rigorous methods for examining incidence and circumstances surrounding events or rates of events over time.

DISCUSSION

For purposes of examining the impact of type II violence on worker safety, satisfaction and retention, rigorous surveillance efforts by hospital employers and researchers are warranted.

Workplace violence against physicians and nurses in Palestinian public hospitals: a cross-sectional study

Background

Violence against healthcare workers in Palestinian hospitals is common. However, this issue is under researched and little evidence exists. The aim of this study was to assess the incidence, magnitude, consequences and possible risk factors for workplace violence against nurses and physicians working in public Palestinian hospitals.

Methods

A cross-sectional approach was employed. A self-administered questionnaire was used to collect data on different aspects of workplace violence against physicians and nurses in five public hospitals between June and July 2011. The questionnaires were distributed to a stratified proportional random sample of 271 physicians and nurses, of which 240 (88.7%) were adequately completed. Pearson’s chi-square analysis was used to test the differences in exposure to physical and non-physical violence according to respondents’ characteristics. Odds ratios and 95% confidence intervals were used to assess potential associations between exposure to violence (yes/no) and the respondents’ characteristics using logistic regression model.

Results

The majority of respondents (80.4%) reported exposure to violence in the previous 12 months; 20.8% physical and 59.6% non-physical. No statistical difference in exposure to violence between physicians and nurses was observed. Males’ significantly experienced higher exposure to physical violence in comparison with females. Logistic regression analysis indicated that less experienced (OR: 8.03; 95% CI 3.91-16.47), and a lower level of education (OR: 3; 95% CI 1.29-6.67) among respondents meant they were more likely to be victims of workplace violence than their counterparts. The assailants were mostly the patients' relatives or visitors, followed by the patients themselves, and co-workers. Consequences of both physical and non-physical violence were considerable. Only half of victims received any type of treatment. Non-reporting of violence was a concern, main reasons were lack of incident reporting policy/procedure and management support, previous experience of no action taken, and fear of the consequences.

Conclusions

Healthcare workers are at comparably high risk of violent incidents in Palestinian public hospitals. Decision makers need to be aware of the causes and potential consequences of such events. There is a need for intervention to protect health workers and provide safer hospital workplaces environment. The results can inform developing proper policy and safety measures.

Workplace violence in Hong Kong, China: nature, impact, and preparedness

This article reports a survey of workplace violence in Hong Kong. A sizable number of the 1,198 organizations that were questioned reported that they had experienced such violence over the 2 years preceding the study, but the problem was not prevalent. In both the private and government sectors, nonphysical violence happened more frequently than physical violence, and there was a reported lack of preparedness of many organizations to deal with the violence. Compared with private organizations, government organizations experienced more coworker and customer violence, but more private than government organizations believed that workplace violence caused the loss of key employees and clients. Correlation analysis found that a subculture of workplace violence appears to emerge over time, such that the more customer violence is experienced, the more is coworker violence, and the more the nonphysical violence, the more the physical violence. These findings are discussed with reference to international findings.

Patient and visitor violence in the general hospital, occurrence, staff interventions and consequences: a cross-sectional survey

AIM.: This study focuses on the experience of healthcare staff with regard to patient and visitor violence in a general hospital. The occurrence of patient and visitor violence, staffs' interventions and the consequences of violence for different professions are investigated.

BACKGROUND

There is a lack of studies describing the factors influencing the occurrence of patient and visitor violence, intervention strategies and consequences. Existing studies often focus on nurses' experiences and single interactive factors between staff and patients/visitors involved.

DESIGN

A cross-sectional survey.

METHOD

The survey was conducted in 2007 including 2495 staff working on different wards in a Swiss university general hospital. The questionnaire used was the Survey of Violence Experienced by Staff German Version-Revised.

FINDINGS

Half of the staff experienced patient and visitor violence in the past 12 months and 11% in the past week. The age of the staff and the length of experience in their present workplace influenced the exposure to patient and visitor violence. Violence occurred mainly when staff carried out tasks involving close personal contact. Only 16% of the staff was trained in aggression management. The feeling of confidence in managing patient and visitor violence depended significantly on the organizational attitude towards violence. The principal interventions used were calming and informative discussion.

CONCLUSION

To prevent patient and visitor violence and improve management strategies, training which focuses on communication skills, which is specific to the professional context and which emphasizes patient centeredness, need to be designed and implemented. A strong organizational commitment is imperative to reduce violence.

The incidence and risk factors of workplace violence towards female nurses reported via internet in an acute psychiatric hospital

The authors conducted a prospective follow-up study to explore incidence and risk factors related to workplace violence towards nurses. Seventy-seven volunteers were recruited to complete a baseline questionnaire. Participants then used a designated Web site to report violent incidents they encountered during a 6-month period. A generalized estimating equation was used for data analysis. A total of 74 members completed the study; 456 events were reported. The incidence rates of various types of violence are reported in this paper. Risk factors for violence included short duration of employment, marital status, and a high level of anxiety. Strategies to reduce future violence from psychiatric patients include preplacement education that targets this high-risk group of nurses and efforts to reduce the staff anxiety levels.

Workplace violence in healthcare settings: risk factors and protective strategies

This article describes the risk factors and protective strategies associated with workplace violence perpetrated by patients and visitors against healthcare workers. Perpetrator risk factors for patients and visitors in healthcare settings include mental health disorders, drug or alcohol use, inability to deal with situational crises, possession of weapons, and being a victim of violence. Worker risk factors are gender, age, years of experience, hours worked, marital status, and previous workplace violence training. Setting and environmental risk factors for experiencing workplace violence include time of day and presence of security cameras. Protective strategies for combating the negative consequences of workplace violence include carrying a telephone, practicing self-defense, instructing perpetrators to stop being violent, self- and social support, and limiting interactions with potential or known perpetrators of violence. Workplace violence is a serious and growing problem that affects all healthcare professionals. Strategies are needed to prevent workplace violence and manage the negative consequences experienced by healthcare workers following violent events.