Violence against healthcare workers

The Permeating Effects of Violence on Health Services and Health in Mexico

Mexico's violence related to organized crime activity has grown to epidemic levels in the last 12 years. We interviewed 22 Mexican health care providers from five states to examine how violence impacts health care services and health. We transcribed and analyzed semi-structured interviews using framework analysis. Our findings describe the ways in which community violence in Mexico permeates health care services, impacting health care providers, and the health of patients. We developed a model to reflect our main themes that illustrate how violence permeates health care services over geographic space and time. We identified three thematic categories: (a) the impact of violence on health care facilities and service provision, (b) the impact of violence on providers, and (c) the impact of violence on the health of the community. Our model articulates a dynamic process of the spread and permeation of violence. Prior literature focuses on the impact of violence as an occupational hazard and the effect of war or civil conflict on health care services. We extend this literature by documenting the impacts of widespread violence on Mexican health care services and providers. We discuss how violence impacts services, providers, and health in a country that is not officially at war. We compare our findings to previous literature on occupational violence in health professions and the impacts on health services in official war zones. Finally, we highlight the implications for health care practice and policy. We suggest that violence should be considered throughout the care continuum in Mexico and make the case for violence as a structural contributor to health and health disparities in Mexico. We suggest additional research on this under-investigated topic.

Measuring workplace violence for clinical dental hygienists

OBJECTIVE

This study aimed to develop and assess a tool for measuring violence experienced by clinical dental hygienists in the workplace.

METHODS

The basic questionnaire used in this study was created by referring to previous studies, the Negative Acts Questionnaire-Revised (NAQ-R) and the Workplace Bullying in Nursing-Type Inventory (WPBN-TI). The content feasibility was verified by ten experts in the field, and irrelevant questions were deleted, based on a content validity index value of 0.8. This study surveyed 205 clinical dental hygienists to test the tool's validity and reliability. Frequency analysis was conducted on items related to general characteristics and workplace violence.

RESULTS

The questionnaire set was 31 questions, which, comprised five domains, were finalized through reliability verification. These domains were verbal attacks and alienation (9 questions), inappropriate work experiences (6 questions), physical threats (4 questions), workplace sexual harassment (6 questions) and verbal violence (6 questions) from patients and their family members. Among the study participants, 47.3% said they received rude signals from others, 17.9% said they were subjected to sexual evaluations regarding their appearance, and 29.4% said their abilities were ignored by patients and family members of patients.

CONCLUSIONS

Clinical dental hygienists have been exposed to various types of violence in their workplaces, such as sexual and verbal harassment, by patients and their family members. This tool can be used in the dental setting to conduct surveys on workplace violence and establish a monitoring and support system.

Work place violence (WPV) against healthcare workers in Africa: A systematic review

BACKGROUND

WPV amongst healthcare workers has been reported as a public health challenge across the countries of the world, with more in the developing countries where condition of care and service is very poor.

OBJECTIVES

We aimed to systematically produce empirical evidence on the WPV against health care workers in Africa through the review of relevant literature.

METHOD

We sourced for evidence through the following databases: PubMed, Science direct and Scopus from 30th November to 31st December 2019 as well as the reference list of the studies included. A total of 22 peer reviewed articles were included in the review (8065 respondents). Quality appraisal of the included studies was assessed using critical appraisal tools for cross-sectional studies.

RESULT

Across the studies, diverse but high prevalence of WPV ranging from 9% to 100% was reported with the highest in South Africa (54%-100%) and Egypt (59.7%-86.1%). The common types were verbal, physical, sexual harassment and psychological violence. The correlates of WPV reported were gender, age, shift duty, emergency unit, psychiatric unit, nursing, marital status and others. Various impacts were reported including psychological impacts and desire to quit nursing. Patients and their relatives, the coworkers and supervisors were the mostly reported perpetrators of violence. Doctors were mostly implicated in the sexual violence against nurses. Policy on violence and management strategies were non-existent across the studies.

CONCLUSION

High prevalence of WPV against healthcare workers exists in Africa but there is still paucity of research on the subject matter. However, urgent measures like policy formulation and others must be taken to address the WPV as to avert the impact on the healthcare system.

Health care workers in conflict and post-conflict settings: Systematic mapping of the evidence

BACKGROUND

Health care workers (HCWs) are essential for the delivery of health care services in conflict areas and in rebuilding health systems post-conflict.

OBJECTIVE

The aim of this study was to systematically identify and map the published evidence on HCWs in conflict and post-conflict settings. Our ultimate aim is to inform researchers and funders on research gap on this subject and support relevant stakeholders by providing them with a comprehensive resource of evidence about HCWs in conflict and post-conflict settings on a global scale.

METHODS

We conducted a systematic mapping of the literature. We included a wide range of study designs, addressing any type of personnel providing health services in either conflict or post-conflict settings. We conducted a descriptive analysis of the general characteristics of the included papers and built two interactive systematic maps organized by country, study design and theme.

RESULTS

Out of 13,863 identified citations, we included a total of 474 studies: 304 on conflict settings, 149 on post-conflict settings, and 21 on both conflict and post-conflict settings. For conflict settings, the most studied counties were Iraq (15%), Syria (15%), Israel (10%), and the State of Palestine (9%). The most common types of publication were opinion pieces in conflict settings (39%), and primary studies (33%) in post-conflict settings. In addition, most of the first and corresponding authors were affiliated with countries different from the country focus of the paper. Violence against health workers was the most tackled theme of papers reporting on conflict settings, while workforce performance was the most addressed theme by papers reporting on post-conflict settings. The majority of papers in both conflict and post-conflict settings did not report funding sources (81% and 53%) or conflicts of interest of authors (73% and 62%), and around half of primary studies did not report on ethical approvals (45% and 41%).

CONCLUSIONS

This systematic mapping provides a comprehensive database of evidence about HCWs in conflict and post-conflict settings on a global scale that is often needed to inform policies and strategies on effective workforce planning and management and in reducing emigration. It can also be used to identify evidence for policy-relevant questions, knowledge gaps to direct future primary research, and knowledge clusters.

Cross-sectional study on patient-physician aggression in Belgium: physician characteristics and aggression types

OBJECTIVES

The aim of this Belgian research study was to describe the characteristics of physicians who are at increased risk for patient-physician aggression. Second, aggression subtypes were described and data were provided on the prevalence of patient-physician aggression in Belgium.

DESIGN

Cross-sectional survey.

SETTING

Primary and secondary care inside and outside hospitals.

PARTICIPANTS

Any physician who had worked in Belgium for the preceding 12 months was eligible to participate (n=34 648).

MAIN OUTCOME MEASURES

An online, original questionnaire was used to obtain physician characteristics (eg, age, sex, native language), department, working conditions and contact with aggressive patients during their career and during the preceding 12 months.

RESULTS

The questionnaire was completed by 4930 participants and 3726 (76%) were valid to take into account for statistics. During the preceding 12 months, 37% had been victims of aggression: 33% experienced verbal aggression, 30% psychological, 14% physical and 10% sexual. Multiple answers were allowed. Women and younger physicians were more likely to experience aggression. Psychiatric departments and emergency departments were the settings most commonly associated with aggression. Physicians who provided primarily outpatient care were more subject to aggression.

CONCLUSION

Belgian physicians experience several forms of aggression. Those most at-risk of aggression are young and female physicians who work in outpatient, emergency or psychiatric settings.

Low reporting of violence against health-care workers in India in spite of high prevalence

BACKGROUND

Violence against health-care workers has become a great issue in health-care organizations. This study was conceptualized with the aim to know the prevalence of violence and to identify gap between rate of reporting of an incident of violence at a tertiary care hospital in India.

METHODS

The study was descriptive and cross-sectional; a validated questionnaire was used as a tool. Reported incidents of violence against workers were collected. P value <0.05 was considered statistically significant in the analysis. A Z test for proportion at 95% confidence interval was applied to analyze the level of difference between prevalence, rate of reporting, and their level of awareness.

RESULTS

Of 394 respondents, 136(34.5%) workers had experienced workplace violence in the last 12 months. It was found that total 32 incidents of workplace violence were reported to the concerned authority. The reporting rate of violence is significantly low (23.5%), in spite of high prevalence (34.5%). Level of awareness regarding the reporting mechanism and regulations for the safeguard of health-care workers against workplace violence is only 24.6 %.

CONCLUSION

This study concluded that the prevalence of violence among health-care workers is quite high, but the reporting rate is significantly low. The low rate of reporting is because of lack of awareness about the reporting mechanism of workplace violence. It is recommended that sensitizing workshops should be conducted to increase the level of awareness, which will result in reduction in the prevalence of violence and building a safe and secured workplace for health-care providers.

Violence against doctors, a serious concern for healthcare organizations to ponder about

Background

Aggression and Violence against primary care physicians is reportedly common in Pakistan but there is no any documented study to-date on this burning issue.

Methods

A formed written questionnaire was distributed among 769 primary care physicians aged 31 ± 7.68 years. Apart from the demographic data, the questionnaire included questions regarding the level of safety that primary care physicians felt during their work setups and on-call duties, along with the experience of aggression against them by the perpetrators & the support provided by the hospital management in such cases.

Result

Response rate was 68% i.e. 524 physicians agreed to participate in the study. It was found that majority (85%) of the physicians has faced mild events, 62% have faced moderate events and roughly 38% were subjected to severe violence. Some physicians revealed more than one form of aggression being faced by them in 12 months preceding months which makes the collective percentage greater than 100%. Verbal abuse is the most frequent type of mistreatment faced by the doctors from the patients or their attendants.

Conclusion

A considerable number of physicians participated have faced mild violence in which verbal abuse was commonest; followed by moderate and severe events.

•

Aggression and violence against doctors is reportedly high.

•

Quantification of the sense of safety felt by male and female primary care physicians.

•

Determining the proportion of doctors who experienced aggression and violence.

•

Determining the type of aggression or violence.

•

Needing the necessary subject be made a part of the medical education and (CME).

Intolerance and Violence Against Doctors

Intolerance and grouse against doctors is a global phenomenon but India seems to lead the world in violence against doctors. According to World Health Organization, about 8-38% healthcare workers suffer physical violence at some point in their careers. Many more are verbally abused or threatened. Public is almost behaving like health sector terrorists. The spate of increasing attacks on doctors by damaging their property and causing physical injury is not acceptable by any civilized society. The public is becoming increasingly intolerant to a large number of social issues because of poor governance and vote bank politics. There is a need to arrest the development of further distrust between doctors and their patients/relatives, otherwise it will compromise all achievements of medical science and adversely affect healing capabilities of doctors. Rude and aggressive behavior of the patients or their family members, and arrogant and lackadaisical approach of the doctor, adversely affects the doctor-patient relationship and the outcome of the patient. The doctors, hospital administration and government must exercise "zero tolerance" with respect to acts of violence against healthcare professionals. It is possible to reduce the incidence of intolerance against doctors but difficult to eliminate it completely. The healthcare providers should demonstrate greater compassion and empathy with improved communication skills. The hospitals must have adequate infrastructure, facilities and staff to handle emergencies without delay and with due confidence and skills. The security of healthcare providers, especially in sensitive areas, should be improved by having adequate number of security guards, frisking facilities, extensive CCTV network and availability of "Quick response team" to handle unruly mob. In case of any grievances for alleged mismanagement, the public should handle the situation in a civilized manner and seek redressal through Medical Protection Act and legal avenues. Laws to prevent violence against doctors do exist but they need to be made more stringent and implemented properly.

Concern about Workplace Violence and Its Risk Factors in Chinese Township Hospitals: A Cross-Sectional Study

Workplace violence in Chinese township hospitals is a major public health problem. We identified the risk factors of healthcare workers’ worry about experiencing workplace violence in 90 Chinese township hospitals and determined specific measures for differing stages of violence (based on crisis management theory). Participants were 440 general practitioners and 398 general nurses from Heilongjiang Province, China (response rate 84.6%). One hundred and six (12.6%) respondents reported being physically attacked in their workplace in the previous 12 months. Regarding psychological violence, the most common type reported was verbal abuse (46.0%). While most (85.2%) respondents had some degree of worry about suffering violence, 22.1% were worried or very worried. Ordinal regression analysis revealed that being ≤35 years of age, having a lower educational level, having less work experience, and working night shifts were all associated with worry about workplace violence. Furthermore, those without experience of such violence were more likely to worry about it. Respondents’ suggested measures for controlling violence included “widening channels on medical dispute solutions,” “improving doctor-patient communication,” and “advocating for respect for medical workers via the media.” Results suggest the target factors for reducing healthcare workers’ worry by according to the type of education and training and possible measures for limiting workplace violence in township hospitals.

Violence against health workers in Family Medicine Centers

BACKGROUND

Health care violence is a significant worldwide problem with negative consequences on both the safety and well-being of health care workers as well as workplace activities. Reports examining health care violence in Saudi Arabia are limited and the results are conflicting.

OBJECTIVE

To estimate the prevalence and determine the demographic and occupational characteristics associated with workplace violence in primary care centers in Riyadh, Saudi Arabia.

METHODS

A cross-sectional study included 270 health care workers in 12 family medicine centers in Riyadh during November and December 2014. A structured self-administered questionnaire was used to estimate the frequency, timing, causes, reactions, and consequences of workplace violence plus participants' demographic and occupational data.

RESULTS

A total 123 health care workers (45.6%) experienced some kind of violence over 12 months prior to the study. These included physical (6.5%) and nonphysical violence (99.2%), including verbal violence (94.3%) and intimidation (22.0%). Offenders were patients (71.5%) in the majority of cases, companions (20.3%), or both (3.3%). Almost half (48.0%) of health care workers who experienced violence did nothing, 38.2% actively reported the event, and 13.8% consulted a colleague. A significant association of workplace violence was found with working multiple shifts, evening or night shift, and lack of an encouraging environment to report violence.

CONCLUSION

Workplace violence is still a significant problem in primary care centers. The high frequency of violence together with underreporting may indicate the inefficiency of the current safety program. More safety programs and training activities for health care workers, efficient reporting system, and zero tolerance policies need to be implemented to minimize workplace violence against health workers.