Violence Against Healthcare Workers at Primary Care Centers in Dammam and Al Khobar, Eastern Province, Saudi Arabia, 2019

Prevalence, pattern, and predictors of WPV against medical interns in Southwest Nigeria: a cross-sectional study

BACKGROUND

Workplace violence (WPV) is a significant occupational hazard threatening the safety and well-being of medical interns in Nigeria. Despite its critical impact, there is a notable research gap regarding the prevalence, patterns, and influencing factors of WPV among medical interns in Southwest Nigeria. This study aims to fill this gap by investigating these aspects.

METHODS

This cross-sectional study utilized online questionnaires to collect data from 379 medical interns at ten hospitals in Southwest Nigeria. The data were analyzed using descriptive statistics and logistic regression.

RESULTS

The study found that 62.5% of medical interns had experienced WPV. Verbal abuse was the most common type of violence (63.3%), followed by threats (50.4%), physical assault (24.3%), verbal sexual harassment (13.2%), and physical sexual abuse (2.6%). The primary perpetrators were patients' relatives (81.9%) and patients (61.2%). WPV predominantly occurred in the afternoon (68.8%) and in emergency rooms (70.5%). The primary triggers were long waiting times (64.6%) and unmet patient needs (54.9%). Female interns had higher odds of experiencing WPV, with an adjusted odds ratio of 3.01 (95% CI: 0.82-11.03, p = 0.01) than their male counterparts.

CONCLUSION

WPV is prevalent among medical interns in Southwest Nigeria, with patients as the main perpetrators. Healthcare organizations must implement measures such as promoting a culture of respect, establishing zero-tolerance policies, training interns to recognize and address WPV, and providing support for victims.

'That's Enough' - Workplace Violence Against Physicians, Pharmacists, and Nurses in Saudi Arabia: A Systematic Review of Prevalence, Causes, and Consequences

Background

Workplace violence (WPV) threatens the safety and well-being of healthcare providers and leads to significant organizational consequences, including staff burnout, reduced productivity, and high turnover rates. At the societal level, it reduces the quality of care, increases medical errors, and imposes a substantial economic burden on healthcare systems and communities. Despite the global attention to WPV, systematic reviews specifically addressing WPV across all three professions-physicians, pharmacists, and nurses-and in various healthcare settings in Saudi Arabia are lacking. This review examines the prevalence, contributing factors, types, sources, potential causes, reactions, and impact of WPV against HCPs in Saudi Arabia.

Methods

We conducted a systematic search of electronic databases from January 2010 to November 2024 and reviewed reference lists of included studies focusing on WPV against physicians, pharmacists, and nurses in Saudi Arabia. Two researchers independently screened studies for inclusion, resolved discrepancies through discussion, and extracted data in duplicate. The quality of included studies was assessed using critical appraisal tools for cross-sectional studies.

Results

A total of 42 studies were reviewed using the AXIS tool for cross-sectional studies. The prevalence of WPV against HCPs ranged from 26% to 90.7%. This range reflects overall WPV prevalence across various studies, encompassing different healthcare settings and professional groups. Verbal violence was the most reported type (19.7-98.2%), followed by threats (12-74.4%), physical violence (3-79%), and sexual violence (1.9-76.5%). Perpetrators were predominantly male, with patients (7.1-99.3%) and their relatives or friends (6.6-91%) as the primary sources. Contributing factors of WPV included gender, age, profession, workload, shift patterns, nationality, experience, and inadequate training. Causes included staff shortages, overcrowding, long waiting times, miscommunication, unmet patient demands, insufficient penalties, and inadequate security measures. Responses to WPV varied, with some HCPs reporting incidents and others taking no action. The impact on HCPs included psychological distress, reduced work quality, and occasional job resignation.

Conclusion

The high prevalence of WPV against HCPs in Saudi Arabia highlights the urgent need for enhanced protective measures, increased awareness of WPV policies, and improved reporting systems. Understanding the factors contributing to WPV can inform targeted intervention programs to foster safer healthcare environments.

Staff Safety Alert Banner Program Against Workplace Violence at an Urban American Hospital

BACKGROUND

Workplace violence (WPV) in healthcare has become an issue worldwide, with increasing prevalence after the COVID-19 pandemic. Notably, WPV in any setting has individual and systemic repercussions. However, despite extensive literature reporting the prevalence of WPV in healthcare worldwide, effective, standardized prevention policies have not been established. We developed and piloted a WPV initiative at an urban hospital in the state of Maryland. Here, we aim to describe our program development methods and implementation.

METHODS

The 6-month program utilized a reporting tool developed within patients' electronic medical records (EMRs) to request the display of a Staff Safety Alert (SSA) banner to alert healthcare professionals of patients who engaged in violent behavior and are at increased risk of subsequent behavior. This tool was piloted on 21 patient care units. A review committee either approved or denied case requests filed by frontline workers, with holistic consideration involving patient status, potential biases, and communication flaws.

RESULTS

Twenty-one banner requests were filed during the course of the pilot. Of which, eight were approved, and 13 were denied. The multi-trauma intermediate care floor filed the most case requests for a safety banner.

CONCLUSIONS/APPLICATION TO PRACTICE

Our pilot program offers a patient-centered intervention program where extensive personnel training and patient-focused considerations were applied prior to the approval or denial of a banner display. The SSA program was the initial step in institutionally combatting WPV in healthcare as staff are encouraged to officially document unsafe events followed by careful action in response.

Work Reward Moderates the Association Between Work Effect and Workplace Violence Among Medical Staff in China

Purpose

Workplace violence (WPV) against healthcare workers is a significant public health issue in China and globally. Although the effort-reward imbalance theory claimed that work rewards may moderate the relationship between work effort and WPV, the quantitative evidence is limited. This study aimed to examine if work reward could moderate the associations between work effort and WPV against medical staff based on the effort-reward imbalance theory.

Methods

This is a cross-sectional study, which was conducted in 12 hospitals in Shandong, China. Data collected from 3426 medical staff were analyzed in this study. Work effort was evaluated by working hours and night shift work times per month (NSWM), and work reward was evaluated by monthly income and perceived social status. WPV, occupational characteristics, physical disease, and social-demographic variables were also evaluated in this study.

Results

There were 1788 (52.2%) medical staff, who reported the experience of workplace violence. Working hours, NSWM, and perceived social status were associated with WPV (all p<0.001). Monthly income could moderate the associations between monthly income and WPV or verbal violence (p<0.05), and perceived social status could moderate the associations between NSWM and WPV (p<0.001).

Conclusion

Monthly income could moderate the associations between monthly income and WPV (verbal violence), and perceived social status could moderate the associations between NSWM and WPV, which could be explained by the effort-reward imbalance model. These findings also can be translated into practices to control WPV against medical staff.

Workplace Violence Against Primary Care Clinicians: A Narrative Review

Workplace violence (WPV) is a commonly reported occupational hazard in healthcare and its prevalence is increasing. WPV occurs in all types of practice settings, but little is known about WPV in primary care settings in the United States (US). Because primary care practice settings differ from the inpatient settings, further examination of WPV in primary care is warranted. Our objective was to summarize the available literature highlight important gaps. We conducted a search using Pubmed and OVID for US studies of WPV in US-based adult primary care practices. Studies including only pediatric populations were excluded. Due to the lack of available literature conducted in US primary care settings, we expanded our search to include international studies. We identified 70 studies of which 5 were US based. Due to the lack of significant numbers of US-based studies, we opted to conduct a narrative review of all available studies. The evidence shows that WPV is a common occurrence in primary care settings in many countries and that the majority of primary care clinicians have experienced at least some form of non-physical violence in their careers. Most of the studies conducted were cross-sectional in design and reported on both non-physical and physical forms of WPV. There was not a consistent trend between genders in experiencing the major forms of WPV, but women were consistently more likely to be subjected to sexual harassment. Potential root causes for WPV could generally be categorized as patient-level, clinician-level, clinical encounter specific, and operational root causes. While most WPV was found to be non-physical, it still had significant emotional and job-related impacts on clinicians. These troubling results highlight the need for further studies to be conducted in the US.

Evaluating the impact of an information-based education and training platform on the incidence, severity, and coping resources status of workplace violence among nurses: a quasi-experimental study

BACKGROUND

Workplace violence among nurses has emerged as a critical issue, posing a significant threat to their occupational safety. Education and training are the primary measures employed to prevent and respond to workplace violence. However, the current approaches have proven ineffective, possibly due to a lack of consideration for the specific needs of clinical nurses. Therefore, it is essential to explore the effectiveness of an informational education and training platform tailored to nurses' requirements. This study aimed to investigate the impact of such a platform on the incidence, severity, and coping resources of WPV in nurses.

METHODS

This research was a quasi-experimental study. An information-based education and training platform focused on nurse workplace violence was developed through literature reviews, expert meetings, consultations with software development companies, and a trial run. A tertiary general hospital in Suzhou was selected, in which hospital district A was the intervention group and hospital district B was the control group. A total of 276 nurses were recruited, 140 in the intervention group and 136 in the control group. The nurses' incidence, severity, coping resources status, and evaluation of the application were measured before the intervention and at 1, 3, and 6 months after the intervention.

RESULTS

The overall incidence of workplace violence, verbal aggression, and verbal threat among nurses showed statistically significant differences (P < 0.05) for the time effect, while the incidence of physical aggression demonstrated statistically significant differences (P < 0.05) for the between-group effect and the time effect. The severity of physical violence among nurses exhibited statistically significant differences (P < 0.05) for the between-group effect and time effect, and the severity of psychological violence showed statistically significant differences (P < 0.05) for the time effect. Nurses' total coping resources score and dimensions also showed statistically significant differences in terms of group, time, and interaction effects (P < 0.001). The evaluation questionnaire for the mobile application indicated usefulness scores of 2 (1, 2); ease of learning scores of 2 (1, 2); ease of use scores of 2 (1, 2); trust scores of 2 (1, 2.75); acceptance score of 1 (1, 2); and satisfaction scores of 2 (1, 2).

CONCLUSIONS

Implementing the nurse workplace violence information-based education and training platform proved beneficial in reducing the incidence and severity of workplace violence among nurses and enhancing their coping resources. This outcome suggested the platform's potential for further application and promotion in clinical settings.

Contemporary evidence of workplace violence against the primary healthcare workforce worldwide: a systematic review

Violence against healthcare workers recently became a growing public health concern and has been intensively investigated, particularly in the tertiary setting. Nevertheless, little is known of workplace violence against healthcare workers in the primary setting. Given the nature of primary healthcare, which delivers essential healthcare services to the community, many primary healthcare workers are vulnerable to violent events. Since the Alma-Ata Declaration of 1978, the number of epidemiological studies on workplace violence against primary healthcare workers has increased globally. Nevertheless, a comprehensive review summarising the significant results from previous studies has not been published. Thus, this systematic review was conducted to collect and analyse recent evidence from previous workplace violence studies in primary healthcare settings. Eligible articles published in 2013-2023 were searched from the Web of Science, Scopus, and PubMed literature databases. Of 23 included studies, 16 were quantitative, four were qualitative, and three were mixed method. The extracted information was analysed and grouped into four main themes: prevalence and typology, predisposing factors, implications, and coping mechanisms or preventive measures. The prevalence of violence ranged from 45.6% to 90%. The most commonly reported form of violence was verbal abuse (46.9-90.3%), while the least commonly reported was sexual assault (2-17%). Most primary healthcare workers were at higher risk of patient- and family-perpetrated violence (Type II). Three sub-themes of predisposing factors were identified: individual factors (victims' and perpetrators' characteristics), community or geographical factors, and workplace factors. There were considerable negative consequences of violence on both the victims and organisations. Under-reporting remained the key issue, which was mainly due to the negative perception of the effectiveness of existing workplace policies for managing violence. Workplace violence is a complex issue that indicates a need for more serious consideration of a resolution on par with that in other healthcare settings. Several research gaps and limitations require additional rigorous analytical and interventional research. Information pertaining to violent events must be comprehensively collected to delineate the complete scope of the issue and formulate prevention strategies based on potentially modifiable risk factors to minimise the negative implications caused by workplace violence.

Violence against healthcare workers in the emergency departments of Al-Madinah hospitals, Saudi Arabia

BACKGROUND

Workplace violence (WPV) directed against healthcare workers (HCWs) in healthcare facilities has always been neglected. These occupational hazards have been investigated in recent times and received greater attention from decision-makers. This study aimed to assess the WPV committed against HCWs in the emergency departments (EDs).

MATERIALS AND METHODS

All the emergency department (ED) healthcare workers (HCW) in the hospitals of Al-Madinah Province, Saudi Arabia, were invited to participate in this cross-sectional study by completing an online questionnaire during May 15 to August 15, 2020. Information sought included characteristics of the participant and workplace, violence, the participants' responses and emotions, the consequences of the WPV incident, and the level of satisfaction with the management of the WPV incident. Data was analyzed using SPSS; Chi-square test was used to assess the association between WPV and various participant and workplace characteristics. Binary logistic regression analysis performed to identify independent predictors of work place violence.

RESULTS

A total of 250 HCW filled the questionnaire. One-third of the participants were victims of at least one violent event, mostly nonphysical. The perpetrators were primarily the patient's companions, and a heavy workload/understaffing or an overcrowded environment was the main cause of the violence. The most frequent reaction was to call the hospital security. The emotions the participants experienced were disappointment, low self-esteem, and sadness. Most victims did not report the WPV incident because they believed that reporting was useless, insignificant, or they were fearful of adverse consequences.

CONCLUSION

The rate of violence in EDs in Al-Madinah hospitals was lower than expected, and only 33.3% of HCWs had experienced a violent incident in the last year. However, there is a substantial margin for interventions to improve the situation and protect the HCWs in the EDs.

Violence in the Nursing Workplace in the Context of Primary Health Care: A Qualitative Study

Violence demands considerable attention due to its complexity and social consequences. The objective of this study was to analyze violence in the nursing professional workplace in the context of primary health care in Brazil. It is a qualitative study with theoretical and methodological reference to institutional analysis. It was carried out in basic health units in Brazil. Nursing professionals (N = 11) participated in semi-structured interviews and discussion groups, in addition to a research diary and participant observation. Data collection took place from October to December 2021. The results are presented in five categories: types of violence and aggressors from the perspective of nursing professionals; the causes of violence reported by professionals; strategies for the management of violence; professionals' proposals for preventing violence in health contexts; the consequences of violence in the workplace. Nursing professionals make up a large part of the workforce and have reported verbal, physical, moral, and psychological violence. The main causes are associated with user access to services. For the prevention of violence, professionals do not see themselves as protagonists of change. The consequences are the loss of quality of work and the health of professionals who requested sick leave and transfers. The study's findings can help in the development of public policies and educational and management actions.

Nurses' rationale for underreporting of patient and visitor perpetrated workplace violence: a systematic review

BACKGROUND

Patient and visitor perpetrated workplace violence (WPV) is a problem within healthcare and is known to be underreported by nurses and other healthcare workers. However, there are multiple and diverse reasons identified in the literature as to why nurses do not report. This systematic review aimed to investigate nurses' reasons and rationale related to underreporting of violence that occurs in the workplace.

METHODS

Following PRISMA guidelines for systematic review reporting, studies conducted between 2011 and early 2022 were identified from MEDLINE, CINAHL, APA PsychInfo, and Psychological and Behavioral Sciences Collection via EBSCOHost. Quantitative studies related to patient and visitor perpetrated violence containing explanations, reasons, or rationale related to underreporting were included.

RESULTS

After quality appraisals, 19 studies representing 16 countries were included. The resulting categories identified nursing, management, and organizational factors. The most prominent nursing factors included nurses' fear of consequences after reporting, nurses' perceptions, and their lack of knowledge about the reporting process. Common management factors which contributed to nursing underreporting included lack of visible changes after reporting, non-supportive culture in which to report, and the lack of penalties for perpetrators. Organizational factors included the lack of policies/procedures/training for WPV, as well as a lack of an efficient and user-friendly reporting system. Supportive interventions from management, organizations, and community sources were summarized to provide insight to improve nurse reporting of WPV events.

CONCLUSION

Underreporting of WPV is a complex and multi-faceted problem. An investigation into the rationale for underreporting a workplace violent event illustrates nurses, management, and organizations contribute to the problem. Clear and actionable interventions such as educational support for staff and the development of a clear and concise reporting processes are recommended to encourage staff reporting and to help address WPV in healthcare.

Reducing Violence in Riyadh’s Emergency Departments: The Critical Role of Healthcare Providers

Emergency department staff are at high risk of experiencing violence and aggression from patients and visitors, which can have negative impacts on healthcare providers in the ED. The aim of this study was to explore the role of healthcare providers in addressing local violence in Riyadh EDs and investigate their preparedness for managing violent incidents. We used a descriptive, correlational design with survey methodology to collect data from a convenience sample of nurses, ED technicians, physicians, and advanced practice providers in Riyadh city’s EDs. To examine the associations, we used an analysis of variance (ANOVA) for unadjusted relationships and an analysis of covariance (ANCOVA) for adjusted associations. Measures included a demographic survey, and clinicians responded to an online survey. A total of 206 ED staff participated in the questionnaire, and 59% reported experiencing physical violence during an ED shift, with 61% of incidents being caused by relatives. Additionally, 32% of the participants witnessed workplace violence. Our findings revealed that male healthcare workers, physicians, and those working in the governmental sector were at the highest risk of experiencing violence. We also found a statistically significant association between the rate of patients seen in the ED and the frequency of assault (physical or verbal) in the ED. Our results suggest that the rate of workplace violence in Riyadh EDs is high, and more efforts are needed to protect the health and well-being of healthcare providers. Senior management should take a position against ED domestic violence and reinforce managerial and healthcare provider resources by adopting policies and procedures that protect healthcare workers’ safety. This study provides valuable insights into the nature and prevalence of violence in Riyadh EDs and highlights the critical role of healthcare providers in reducing violence in EDs.

Frequency and Impacts of Verbal Abuse on Healthcare Workers in a Secondary Healthcare Structure in Greece

BACKGROUND

Threatening and aggressive behaviors in healthcare settings constitute a significant problem that can affect not only the physical and mental integrity of staff but also patient safety and the quality of healthcare. Literature highlights verbal abuse as the most common form of non-physical violence and is estimated from 51.8% to 63.4% worldwide.

PURPOSE

The purpose of the study was the investigation of verbal abuse incidence toward physicians and nurses and the differences noted between them in a regional hospital.

METHODS

The study took place in a public regional hospital in southern Greece. A number of 185 nurses and 60 physicians completed the verbal abuse scale (VAS) for assessing verbal violence in the work environment; selected socio-demographic and occupational characteristics were also recorded.

RESULTS

Physicians have undergone verbal abuse once a week at a percentage of 38.3%, while at the same frequency; nurses record a percentage of 12.4%. Regarding the relationship between the victim of verbal abuse and the abuser, 26.7% of the physicians answered that the abuser was another senior member of the staff, while the percentage for nurses is higher and reaches 31.9%. According to VAS items, accusing and blaming (mean±SD=3.00±0.96) is noted as the most common form of verbal abuse for physicians, judging and criticizing stands out as the most frequent (3.17±1.11) and the most stressful action (3.25±1.11) form for nurses. The most frequent behavior by the physicians is to put the verbal abuse situation in a humorous context (2.78±1.14). In contrast, nurses are trying to clarify any misunderstanding that may occur (3.10±1.00).

CONCLUSIONS

Verbal abuse incidents are experienced by both physicians and nurses. They are stressful for the victims and can significantly affect work relationships and job satisfaction.

Associations between work-related variables and workplace violence among Chinese medical staff: A comparison between physical and verbal violence

Background

Workplace violence (WPV) against medical staff has been an important public health and societal problem worldwide. Although numerous studies have implied the differences between physical violence (PV) and verbal violence (VV) against medical staff, few studies were conducted to analyze the different associations between work-related variables, PV, and VV, especially in China.

Methods

A cross-sectional study was conducted among Chinese medical staff in public hospitals, and 3,426 medical staff were interviewed and analyzed. WPV, including PV and VV, were evaluated by the self-report of the medical staff. Work-related variables, physical disease, depression, and social-demographic variables were also measured. The work-related variables included types of medical staff, professional titles, hospital levels, managers, working years, job changing, working hours/week, night duty times/week, monthly income, self-reported working environment, and social position. Logistic regressions were conducted to examine the factors associated with PV and VV.

Results

A total of 489 medical staff (23.0%) reported the experience of PV and 1,744 (50.9%) reported the experience of VV. Several work-related variables were associated with PV and VV, including nurse (OR = 0.56 for PV, p < 0.01; OR = 0.76 for VV, p < 0.05), manager (OR = 1.86 for PV, p < 0.01; OR = 1.56 for VV, p < 0.001), night duty frequency/week (OR = 1.06 for PV, p < 0.01; OR = 1.03 for VV, p < 0.01), bad working environment (OR = 2.73 for PV, p < 0.001; OR = 3.52 for VV, p < 0.001), averaged working environment (OR = 1.51 for PV, p < 0.05; OR = 1.55 for VV, p < 0.001), and bad social position (OR = 4.21 for PV, p < 0.001; OR = 3.32 for VV, p < 0.001). Working years (OR = 1.02, p < 0.05), job changing (OR = 1.33, p < 0.05), and L2 income level (OR = 1.33, p < 0.01) were positively associated with VV, but the associations were not supported for PV (all p>0.05). The other associated factors were male gender (OR = 1.97 for PV, p < 0.001; OR = 1.28 for VV, p < 0.05) and depression (OR = 1.05 for PV, p < 0.001; OR = 1.04 for VV, p < 0.001).

Conclusion

Both PV and VV were positively associated with work-related variables, such as doctor, manager, more night duty frequency, perceived bad working environment, or social position. Some variables were only associated with VV, such as working years, job changing, and monthly income. Some special strategies for the work-related variables should be applied for controlling PV and VV.

Violence and unsafety in Italian hospitals: Experience and perceptions of nursing students

BACKGROUND: Assessment of workplace violence towards healthcare workers represents a challenge for healthcare organizations worldwide. Workers’ experience and perceived risk of violence may have a serious impact on job satisfaction and retention of workers. To date, no studies have been conducted on nursing students. OBJECTIVES: To assess the prevalence of physical and non-physical violence among nursing students during their clinical experiences and to analyze the perceived risk of violence. METHODS: Multicentre, cross-sectional survey. We enrolled a convenience sample of nursing students of the bachelor’s degree in Nursing of the University of Milan (Italy). The students completed a structured questionnaire prepared in accordance with the available literature on violence in healthcare settings. RESULTS: Out of 1185 questionnaires sent, 603 were collected (50.89%). 35.1% had experience of verbal violence during the clinical internship training period, while 8.1% were victims of physical violence. 202 students (33.5%) reported unsafety, which was related to experience of physical or psychological violence, witnessed episodes of violence, gender, hospital structure and efficacy of the safety policies. CONCLUSIONS: Our findings highlight that nursing students are exposed to the risk of violence which influences their perception of risk.

"TRIPLE-A: ACQUAINT, ANALYZE, AND ACT": THE INSIGHTS OF NURSE EDUCATORS TOWARD A BETTER UNDERSTANDING OF WORKPLACE VIOLENCE IN SAUDI ARABIA

AIM

To investigate the experiences and insights of nurse educators in order to acquire a better understanding of the nature and various factors associated with workplace violence, which could lead to the establishment of future actions and recommendations to eliminate or reduce aggression, abuse, incivility, and any other forms of violence in the health sector.

BACKGROUND

Workplace violence is one of the social phenomena that has not been fully explored in various settings such as educational institutions and healthcare facilities. A worker who had experienced violence could provide valuable insights that could help to better understand and sustainably protect an individual, a group, or an organization from workplace violence and its unfavorable consequences.

METHODS

Qualitative descriptive phenomenological study. A total of 18 nurse educators who met the inclusion criteria were enrolled as the study participants in a government university located in the Eastern Region of Saudi Arabia. Purposive sampling method was used in the recruitment. In addition, a semi-structured interview guide was employed to explore the participants' experiences and insights from February to June 2021. Data were analyzed using Colaizzi methods, and a COREQ checklist was utilized to report the study's results.

RESULTS

The participants' narratives generated three major themes, namely the "Triple-A": (1) "acquaint"; (2) "analyze"; and (3) "act," to better understand workplace violence themes.

CONCLUSION

The "Triple-A: Acquaint, analyze, and act" workplace violence themes can serve as a simple guide to better understand the nature and different factors associated with workplace violence: "acquaint" illustrates self-awareness; "analyze" pertains to the recognition to possible indications and signals; and "act" depicts an individual's proactiveness and responsiveness to workplace violence and conceivably catalyzes the decrease of this social hazard's prevalence.

IMPLICATION FOR NURSING MANAGEMENT

Leaders and managers in the nursing field should prioritize their participation in developing creative strategies and their implementation of policies to manage and mitigate violence in the workplace, such as initiating ongoing education (acquaint), creating robust procedures for reporting and referral (analyze), and establishing support networks, listening to victims' experiences, and promoting respect to individual differences (act).

The nature and pre-disposing factors of workplace violence: A qualitative study of how violence is experienced by ED personnel

BACKGROUND

Workplace violence against emergency department (ED) personnel, especially nurses, is a growing global challenge, and it can have serious adverse impacts on the personnel's life and patient care. Investigating the experience of ED personnel can help healthcare authorities find the underlying factors causing violence and use proper strategies to prevent it.

METHODS

In this qualitative exploratory study, data were collected using in-depth, face to face and semi-structured interviews with 20 ED personnel working in five hospitals in west Azerbaijan of Iran. The interviews were transcribed and transferred to MaxQda10 software for coding. Then, six steps conventional content analysis process proposed by Graneheim and Lundman (2004) was used to analyze the data.

RESULTS

Two overarching categories of "perceived violence" and "predisposing factors of violence" were extracted from the data analysis. Perceived violence was supported by "verbal violence," "physical violence," "ethnic violence," and "sexual violence." The sub-categories of the "predisposing factors of violence included "inefficient management," "low professional competence of personnel," and " violent atmosphere."

CONCLUSION

Concerning the high perceived experiences of violence in the ED, health care systems should take fundamental measures such as supporting the ED personnel, improving management, developing and implementing standard guidelines for triaging patients, conducting continuous educational courses on clinical knowledge and skills, and how to interact and communicate with clients would help prevent violence.

Workplace violence toward emergency medicine physicians in the hospitals of Taif city, Saudi Arabia: a cross-sectional survey

BACKGROUND

Workplace violence against health care workers is an emerging concern in various global health settings and the documentation of physical and verbal attacks against physicians in tertiary hospitals in Saudi Arabia is uncommon. This study aimed to determine the incidence of workplace violence against physicians in the emergency department of selected tertiary hospitals in Taif City, Saudi Arabia from June to July 2021. Associations between the incidence of violence and interventions and type of physicians and years of experience were also investigated.

METHODOLOGY

Using a cross-sectional design, a total of 96 physicians were recruited to answer the World Health Organization Questionnaire on Violence against Health Care Workers last June to July 2021.

RESULTS

It was found out that 75 physicians (78.1%) experienced verbal violence while 14 physicians (14.6%) experienced physical violence. Most of the workplace violence happened within hospital premises (84.4%). Despite having an experience of verbal and physical violence, only 44.8% of the respondents reported the incidents. The most common instigators were patients (55.21%), their relatives (78.00%), external colleagues (9.37%) and staff members (6.25%). Most respondents took no action, or reported the incidence to the police or senior staff member. The incidence of workplace violence and type of physician showed significant association. The number of years of practice in emergency medicine also exhibited statistically significant association with the incidence of verbal attack, frequency of violence, and location of incident.

CONCLUSION

There is high incidence of workplace violence among physicians in tertiary hospitals, and younger physicians with less experience in emergency medicine were the most susceptible to both verbal and physical violence. There is a need to strengthen policies to protect physicians against workplace violence.

Patient and visitor aggression de-escalation training for nurses in a teaching hospital in Cairo, Egypt

BACKGROUND

Workplace violence (WPV) has been recognized as a major occupational hazard worldwide. Healthcare professions are particularly at a higher risk of WPV. Patients and their relatives are commonly the most common perpetrators for WPV against physicians. Trainings on the universal precautions of violence, how to effectively anticipate, recognize and manage potentially violent situation is recommended by OSHA as a part of a written, effective, comprehensive, and interactive WPV prevention program.

OBJECTIVE

To implement and evaluate the effectiveness of a training session delivered to nurses. The training session aimed to increase nurses' ability to identify potentially violent situations and to effectively manage these situations in a teaching hospital in Egypt.

METHODOLOGY

A total of 99 nurses attended the training sessions. Confidence in coping with aggressive patient scale, along with nurses' attitudes toward WPV, were used to assess the effectiveness of the training sessions.

RESULTS

Nurses' perceived confidence to deal with aggression increased after attending the training sessions. Nurses' attitudes toward WPV positively changed after attending the training session.

CONCLUSION AND RECOMMENDATIONS

Increasing awareness of the problem among healthcare professions as well as the public is warranted. Violence prevention program with a zero-tolerance policy is warranted.

Exploring Experiences of Workplace Violence and Attempts to Address Violence Among Mental Health Nurses in the Kingdom of Saudi Arabia

INTRODUCTION

Workplace violence has emerged as a global phenomenon requiring immediate attention. The nursing profession is primarily affected, and the unique vulnerability of nurses to workplace violence is particularly evident in the field of mental health nursing.

AIMS

This study explores the experiences of mental health nurses with work-related violence and attempts to combat this violence in the context of inpatient mental health facilities in Saudi Arabia.

METHODS

This research comprises a qualitative exploratory study consisting of semistructured interviews with 16 participants using open-ended questions. The participants are psychiatric/mental health nurses with experience in the field, so this methodological approach facilitates a detailed investigation of their encounters with workplace violence.

RESULTS

This study reveals that nurses experience violence in accordance with two main themes and subthemes: experiences of workplace violence, the influence of violence on work settings, and efforts required to combat violence. Data show that these participants consider of prime importance access to training to increase safety through knowledge, improved communication, and protective skills, along with adequate staffing and a safe built environment.

CONCLUSION

The research findings confirm the urgency of addressing the needs of mental health nurses in inpatient psychiatric hospitals. Policymakers in the healthcare field must be aware of the inpatient psychiatric care climate and the need for support from those who staff these areas of practice. Training in specialized knowledge and skills is required to ensure a safe work environment as well as appropriate staffing levels, and a safe built environment. These conditions may be required to recruit and retain mental health nurses capable of providing best-practice care.

Verbal Abuse in the Operating Room: A Survey of Three General Hospitals in the Peloponnese Region

Background

The operating room is a special place in a hospital structure, which has a very high psychological load and many moments of tension, often leading to difficulties in communication between the health professionals involved, as well as cases of verbal and physical violence.

Purpose

The purpose of the study was to investigate the existence of verbal violence in the operating rooms of three general hospitals in the Peloponnese region of Greece.

Methods

A cross-sectional survey was conducted of health professionals (physicians and nurses) employed in the operating rooms of three general hospitals in the Peloponnese region. For the data collection, the Verbal Abuse Scale questionnaire (VAS) was used. A total number of 80 questionnaires were self-completed and collected. The statistical analysis was performed with the SPSS Statistics software v.25 (IBM Corp., Armonk, NY).

Results

Regarding the frequency of verbal violence faced by health professionals, 36.8% of physicians stated that they experience verbal violence once a year whereas more than 20% of nurses reported that such incidents occur more than once a month (p=0.148). For the physicians, the abuser was usually their supervisor, while for the nurses, a physician. The majority of physicians stated that they felt mainly anger (2.94 ± 1.35), disgust (2.58 ± 1.54), and sadness/hurt (2.35 ± 1.37) after the verbal abuse, whereas most of the nurses felt anger (3.49 ± 1.39), disgust (3.05 ± 1.52) and frustration (2.95 ± 1.47).

Conclusion

Nurses are more often the victims of verbal abuse than physicians and are more likely to feel frustrated after experiencing verbal abuse. Gradual change to the organizational culture is an important measure to stop the occurrence of such incidents.

Workplace Violence Against Physicians Treating COVID-19 Patients in Peru: A Cross-Sectional Study

BACKGROUND

The COVID-19 pandemic is an unprecedented challenge to health systems that has revealed shortcomings and increased unmet demands. Such situations might exacerbate workplace violence (WPV) against physicians, as has been reported in several parts of the world.

METHODS

To identify the frequency and characteristics of WPV suffered by physicians attending COVID-19 patients in Peru, a descriptive, cross-sectional study was conducted with an online survey of 200 physicians.

RESULTS

Of the survey respondents, 84.5% had suffered some type of WPV; 97.6% of these suffered nonphysical violence. Suffering more than one incident of violence was reported by 75.7% of respondents. The primary aggressor was a patient's family member or caregiver. Violence occurred most frequently in critical areas inside the health service facility, such as COVID-19 triage, tents, and hospital units, although it also occurred during teleconsultations. Multiple shortcomings of the health services were perceived as the main trigger of violence. Being a female physician (odds ratio [OR] = 2.48, 95% confidence interval [CI] = 1.06-5.83) and working in a COVID-19 ICU (OR = 5.84, 95% CI = 1.60-21.28) were the main factors associated with WPV.

CONCLUSION

Violence against physicians attending COVID-19 patients in Peru is common. The perceived factors that contribute most to violence are linked to deficiencies in health services.