Violence against healthcare professionals in intensive care units: a systematic review and meta-analysis of frequency, risk factors, interventions, and preventive measures

BACKGROUND

To assess the frequency, risk factors, consequences, and prevention of violence against healthcare workers in intensive care units.

METHODS

PubMed, Scopus, Google Scholar, EMBASE, Cochrane, and Web of Science were searched for studies on violence against healthcare workers in adult intensive care units. Risk factors, patient characteristics, and implications for healthcare workers were collected. Study quality, bias, and level of evidence were assessed using established tools.

RESULTS

Seventy-five studies with 139,533 healthcare workers from 32 countries were included. The overall median frequency of violence was 51% (IQR 37-75%). Up to 97% of healthcare workers experienced verbal violence, and up to 82% were victims of physical violence. Meta-analysis of frequency revealed an average frequency of 31% (95% CI 22-41%) for physical violence, 57% for verbal violence (95% CI 48-66%), and 12% for sexual violence (95% CI 4-23%). Heterogeneity was high according to the I2 statistics. Patients were the most common perpetrators (median 56%), followed by visitors (median 22%). Twenty-two studies reported increased risk ratios of up to 2.3 or odds ratios of up to 22.9 for healthcare workers in the ICU compared to other healthcare workers. Risk factors for experiencing violence included young age, less work experience, and being a nurse. Patients who exhibited violent behavior were often male, older, and physically impaired by drugs. Violence was underreported in up to 80% of cases and associated with higher burnout rates, increased anxiety, and higher turnover intentions. Overall the level of evidence was low.

CONCLUSIONS

Workplace violence is frequent and underreported in intensive care units, with potential serious consequences for healthcare workers, calling for heightened awareness, screening, and preventive measures. The potential risk factors for violence should be further investigated.

SYSTEMATIC REVIEW REGISTRATION

The protocol for this review was registered with Prospero on January 15, 2023 (ID CRD42023388449).

Experience of verbal violence among Chinese nursing students in clinical practice: a qualitative study

BACKGROUND

Workplace violence is prevalent in the nursing profession, and as a relatively junior link of the professional hierarchy, nursing students are not immune to it. Among these, verbal violence may have more serious consequences for the victims than physical violence, but the literature on verbal violence among nursing students in Chinese clinical settings is limited.

AIMS

To explore the verbal violence experience among Chinese nursing students in clinical practice, and the strategies used by nursing students to cope with violence.

DESIGN

A descriptive qualitative study.

METHODS

From January 2022 to June 2022, semi-structured interviews were conducted with 21 nursing students in clinical practice by purposive snowball sampling. Nvivo12 software and inductive content analysis were used for data analysis. This paper followed the COREQ (Consolidated criteria for Reporting Qualitative Research) guidance.

RESULTS

Through data analysis, three themes were defined:(1) Multiform verbal violence; (2) Hurting and impacting and (3) Struggling or Coping. The findings indicated that nursing students were subjected to multiple forms of verbal violence in clinical practice, not only from patients and caregivers, but also from peers such as clinical tutors and doctors, which not only harmed students' personal health and well-being, but may also contribute to the nursing industry's future loss of human resources. Seeking emotional support from others and forcing themselves to grow up were the most commonly used coping strategies.

CONCLUSION

Nursing educators and nursing managers need to pay attention to verbal violence in the clinical environment, and actively develop the ability of nursing students to deal with uncivilized behavior. Establishing relevant courses and training such as communication, resilience, and violence prevention, establishing a stricter clinical mentor appointment system, and teaching assessment system may be strategies to help nursing students better perform clinical practice.

The prevalence of emotional abuse in children living in Sub-Saharan Africa - A systematic review

OBJECTIVES

This study is meant to put a focus on the prevalence of emotional abuse in low-income states like the Sub-Saharan region.

METHODOLOGY

Searching PubMed, Google scholar, and web of science during February and April 2021 a total of 2264 articles were identified, 27 met the inclusion criteria. We added the results of 13 VAC (Violence Against Children and Youth) studies, conducted by UNICEF capturing information about experienced sexual, physical, or emotional violence in 13-24-year-olds, as well as 56 MIC (Multiple Indicator Cluster) studies, conducted by the CDC to research the disciplinary methods used with children aged 1-14 years in the past month by older household members. Finally, in a meta-analytic approach, we aimed to calculate a pooled estimate of the prevalence.

RESULTS

The included studies depicted a wide range in prevalence rates across countries. For example, while the VAC study in Lesotho in 2018 showed low incidence rates of emotional violence (6.9 % Females, 3.8 % Males), the average prevalence recorded by the MIC study was as high as 57.8 % for females and 59.2 % for males. On average, the MIC studies displayed a higher incidence and the discrepancy of prevalence of emotional abuse between females and males was small. Calculating a pooled estimate of the prevalence was not possible, due to the heterogeneity of the data.

CONCLUSIONS

In general countries displayed a high prevalence. A standardized use of a uniform definition of emotional abuse might help to display a more homogenous data set in the future, giving the opportunity for pooled estimates of prevalence.

Prevalence of violent communication within Indian organisations- A systematic review and meta-analysis

Background

Considering the normalisation of moderate aggression within organisations and the concern of violent occurrences being under-reported in India, violence reflected through coercive language appears to be more frequent than explicit acts of organisational violence.

Aim

To bring-forth consolidated evidence on the prevalence of violent communication within Indian organisations.

Method

1433 articles obtained from four major databases (PubMed, Scopus, Science Direct, Web of Science and Google scholar), complemented by 4 records identified through manual searching, were screened according to the PRISMA guidelines. Thirty-four finalised cross-sectional studies (published since 2000) reporting significant findings on the prevalence of violent communication within Indian organisations, underwent a systematic review (by narrative synthesis) and meta-analysis (using the random-effects model in STATA version 17).

Results

The pooled prevalence of any type of violent communication was 41%. The prevalence of violent communication was higher among males than females (44% vs 28%). Verbal violence was more prevalent than non-verbal violence (36% vs 20%). Subgroup analysis proved prevalence estimate to remain consistent irrespective of the organisational sector, type of organisation, sample size and publication year. However, meta-regression analysis confirmed the sampling method and type of violent communication as potential variables influencing the prevalence rates reported across the studies. All the identified factors influencing the occurrence of violent communication and the corresponding detrimental consequences faced by victims within each organisational sector, endeavour scope for the development of more context-specific prevention strategies.

Conclusion

As evident from the results, the prevalence of any type of violent communication within Indian organisations is quite high. The present review informs Indian entrepreneurs about the necessity for advocating practices to protect their human resources from the experience of violent communication. Practical implications have been presented for healthcare and educational organisations.

Cross-sectional survey of underreported violence experienced by adolescents: a study from Indonesia

BACKGROUND

Global studies on adolescent victims of violence require serious attention due to the possibility that underreported cases may be higher than official records indicate. Since Indonesia expects to witness a demographic bonus, extensive research is needed to strengthen early detection, case handling, and prevention. Here, we report the outcomes of a survey on physical, verbal, and sexual violence experienced by adolescents in West Java, an Indonesian province inhabited by 18% of the country's total population.

METHODS

We conducted a cross-sectional survey in 2017 using the International Society for the Prevention of Child Abuse and Neglect (ISPCAN) Child Abuse Screening Tool for Children (ICAST-C) questionnaire for detecting child abuse; an expert panel translated, simplified, and validated it based on a theoretical framework that combines paediatrics, public health, and medicolegal perspectives. We aimed to cover a large sample size and explore three types of violence (physical, verbal, and sexual) that have high evidentiary value in the forensic context. The respondents were adolescents in the first and second grades of middle school (12 to 14 years old) and high school (15 to 17 years old) in seven cities/municipalities in the province, selected through several stages of simple random sampling (N = 3452). We analysed the samples through univariate (percentage), odds ratio (OR), comparison, correlation, and correspondence analyses.

RESULTS

The results showed that 78.7% of the adolescents experienced violence in 2017, comprising those who encountered at least one incidence of physical violence (43.1%), verbal violence (12.2%), and sexual violence (4.5%). Data overlap includes 14.3% who experienced one type of violence in 2017, 7.4% who experienced two forms of violence, and 1.4% who underwent all three kinds of violence. The offenders were mainly adolescents across all types of violence, except for being forced to engage in sexual intercourse. Several victims of sexual violence did not state who the offenders were. Further, several characteristics showed a higher chance of experiencing violence than other characteristics, especially for adolescents who were still in middle school and those who lived only with their mothers. Correspondence analysis suggested subtle differences between characteristics.

CONCLUSION

We expect this study to help identify risk and protective factors that are essential to strengthening early detection efforts, decisive medicolegal examinations, case handling, and policy-making.

Prevalence and determinants of violence against health care in the metropolitan city of Peshawar: a cross sectional study

Background

Violence against healthcare personnel is a major public health problem. Healthcare personnel are at the frontline dealing with people in stressful and unpredictable situations. Therefore, this study was conducted to determine the prevalence and associated factors of violence against health care personnel.

Methods

A cross sectional study was conducted in the district Peshawar. Healthcare personnel from public and private sectors working in both the primary and tertiary levels of healthcare were invited to participate. Violence was assessed through a structured questionnaire previously used in Pakistan and was defined as experiencing and/or witnessing any form of violence in the last 12 months. Mental health was assessed through the General Health Questionnaire. Logistic regression was used to estimate the association of violence against healthcare personnel with psychological distress and demographic characteristics. Data entry and analysis were conducted in STATA 14.

Results

A total of 842 healthcare personnel participated in the study. The prevalence of violence experienced and/or witnessed by healthcare personnel in Peshawar was 51%. Verbal violence remained the predominant form of violence and almost half of the healthcare personnel (45%) were exposed to it. A quarter of the respondents (24%) reported physical violence alone or in combination with other forms of violence. In almost two third of the incidents the perpetrators were either attendants, relatives or the patients. The emergency unit and wards within healthcare facilities were the most common places where violent events took place. The major factors responsible for the violent incidents were communication failure, unreasonable expectations and perceived substandard care. No uniform policy/procedure existed to manage the incidents and the healthcare personnel adopted different responses in the wake of violent events targeting health care. Working in public healthcare facilities and having a larger number of co-workers/colleagues significantly increased the risk of violence in the healthcare settings while being a paramedic significantly reduced the risk as compared to physicians.

Conclusions

Violence against healthcare personnel is a serious public health issue and the prevalence is quite high. A holistic effort is needed by all stakeholders including healthcare community, the administration, lawmakers, law enforcement, civil society, and international organizations.

A Survey on Workplace Violence Experienced by Critical Care Physicians

INTRODUCTION

Workplace violence (WPV) has been defined as, "violent acts including physical assault and threats of assault directed toward personnel at work or on duty". Healthcare staff are at highest risk of WPV among the professionals and it is more common among the critical care services. Prevalence of WPV among doctors all over the world is around 56-80% and in Indian scenario, it is around 40.8-75%. There is scarcity of studies on WPV among doctors from India. To our knowledge, this is the first of its kind survey conducted to know about the incidence of WPV amongst critical care physicians in India.

MATERIALS AND METHODS

This survey was conducted after taking due ethical committee clearance amongst critical care physicians attending a critical care conference. The purpose of the study was informed to the participants and a pretested, self-administered, semi-structured questionnaire was distributed among them for their voluntary and anonymous response.

RESULTS

Out of 160 delegates who were given the questionnaire, 118 responses were collected and their forms were analyzed. Maximum responses (84%) received were of age group 20-40 years. Seventy-two percent respondents experienced WPV during their work hours. Most common type of violence reported was verbal violence (67%). Sixty-five percent respondents reported that poor communication was the leading cause of WPV. Due to WPV, most of the respondents (60%) had to change their place and pattern of work. Proper communication (76%) was the most common measure among multiple measures suggested by respondents for avoiding WPV. Eighty-three (98%) respondents opined that conflict management should be part of regular curriculum in medical education.

CONCLUSION

Improving the communication skills amongst critical care physicians, teaching doctors about conflict management in their regular curriculum of medical education, spreading awareness in public about patient rights and taking initiatives in propagating an idea to "Fight against the diseases and not against the doctors" are the key measures to combat WPV.

HOW TO CITE THIS ARTICLE

Kumar NS, Munta K, Kumar JR, Rao SM, Dnyaneshwar M, Harde Y. A Survey on Workplace Violence Experienced by Critical Care Physicians. Indian J Crit Care Med 2019;23(7):295-301.

Incidence rate of physical and verbal violence inflicted by patient and their companions on the radiology department staff of educational hospitals of medical university, Kermanshah, 2017

INTRODUCTION

Regarding the increasing risk of violence toward employees in diagnostic and therapeutic centers, radiology staff members are often exposed to forms of violence through direct contact with patients and with many professional stresses. The aim of this study is to investigate the causes and incidence of violence against radiographers in radiology departments of educational centers and hospitals.

MATERIALS AND METHODS

In this descriptive-analytic study, violence incidence was investigated in all 121 radiographers working in radiology departments of educational centers of Kermanshah in 2016. Data were collected by a reliable and stable researcher-made questionnaire. Data analysis was also performed using descriptive statistics and T test and Chi-square tests by STATA 11 software.

RESULTS

The results showed that 72.7% of radiographers had experienced violence in their work environment. Verbal violence (77.3%) was the most prevalent type where patient accompaniments were the most frequent cause of violence (54.7%), most of the violence incidents were at night shift (43.6%) and over-crowdedness was the most common cause of violence in the radiology department (21.0%). The verbal violence against radiographers younger than 40 was significantly higher (P = 0.04) than the age group above 40 years.

CONCLUSION

The incidence of verbal violence against radiographers in radiology departments is high which can be reduced by providing adequate human resource and equipment in radiology departments, re-training courses on the prevention and management of violent behavior and the suing the violent events against radiologists.

A Study of Workplace Violence Experienced by Doctors and Associated Risk Factors in a Tertiary Care Hospital of South Delhi, India

INTRODUCTION

The increasing incidences of violence against doctors in their workplaces are an important reason for stress among these healthcare workers. Many incidences of workplace violence against doctors have been reported in the past and are also being continuously reported from different parts of the country as well as the world.

AIM

To determine the prevalence of workplace violence among doctors and to study the associated risk factors in a tertiary care hospital of Delhi, India.

MATERIAL AND METHODS

A cross-sectional study was conducted using a self-administered semi-structured questionnaire. The contents were: data related to the workplace, incidences at work, violence prevention policy of the institution, reporting of incidences and follow-up, education and training for violence management. A total of 151 doctors participated in the study.

RESULTS

Total participants in the study were 151. The mean age of study participants was 26.73±4.24 years. Almost half (47.02%; 44.56% of males and 50.84% of females) of the doctors reported having an experience of violence during work hours in past 12 months. Among the cases, 39.4% were reported from Department of Obstetrics and Gynaecology while Surgery, Medicine and other departments reported 29.6%, 26.8% and 4.2% respectively. Patients or their relatives were perpetrators in most of the cases. Maximum (87.3%) of the reported cases were of verbal violence while 8.6% of the cases were of physical violence. Younger doctors with less work experience were more prone to physical violence. Regarding the time of violence, 35.1% of such cases occurred during afternoon while 30.1% of them took place at night.

CONCLUSION

A large number of doctors had experienced violence in past 12 months in a tertiary care hospital of South Delhi, India. Verbal violence came out to be most common form of violence experienced by the doctors. Afternoon or night hours were the timings when majority of such cases were reported.

Sources of workplace violence against nurses

BACKGROUND

Health care employees, especially nurses, are often victims of workplace violence.

OBJECTIVE

The objective of this research is to study the frequency and degree of violence against nurses and to analyze correlations between various sources and types of violence.

METHODS

A survey was carried out using a representative sample of nurses in Slovenia. Data was collected using a questionnaire designed specifically for the purposes of the survey. The collected data was analyzed using descriptive, correlational and inferential statistics.

RESULTS

A total of 692 nurses participated in the survey. Verbal violence (n = 416) and physical violence (n = 180) were identified. The most frequent perpetrators of verbal violence were patients (listed as a source of violence by 39.3% of the respondents) and peers (39.6%), with the most forceful identified as physicians and patients. Physical violence against nurses was most often initiated by patients (20.8%) who were also the most forceful source in this category. Nurse leaders were found to be the most frequent and forceful sources of violence in terms of leadership level. A positive correlation between external (patient and relatives) and internal (physician and nurse) sources of violence was determined.

CONCLUSIONS

A better understanding of the association between different types and sources of violence may support the development of action-oriented violence management. Health care organisations should limit violence at its less severe levels and at its primary source.

Indirect and verbal victimization by peers among at-risk youth in residential care

Verbal and indirect violence among peers in residential care settings (RCSs) are understudied social problems. This study, based on a sample of 1,324 Jewish and Arab adolescents aged 11-19 in 32 RCSs, examines the prevalence and multilevel correlates of verbal (such as cursing) and indirect (such as social exclusion) forms of victimization by peers in RCSs. Adolescents completed a self-report anonymous questionnaire in their facility. Hierarchical Linear Modeling (HLM) is used to examine the links between adolescents' victimization, individual-level characteristics (gender, age, adjustment difficulties, self-efficacy, staff maltreatment experiences and perceived institutional social climate), and RCS-level characteristics (setting type of care, size, structure, and ethnic affiliation). Most adolescents reported having been verbally (73%) and indirectly (62%) victimized by their peers at least once in the month prior to filling out the questionnaire. Vulnerability to indirect violence is higher among girls and those with low perception of their social self-efficacy. Younger adolescents, adolescents with higher levels of overall adjustment difficulties, those experiencing high levels of physical maltreatment by RCS staff and those perceiving levels of child friendliness in their RCS as poor, were all more vulnerable to verbal and indirect victimization by peers. Verbal victimization is positively associated with residence in Jewish RCSs and indirect victimization is positively associated with residence in therapeutic settings which contain higher concentrations of vulnerable youth compared with rehabilitative settings. The findings can assist in designing anti-bullying intervention and prevention programs tailored for the at-risk children and institutions identified in the study.