Aggression and violence towards health care providers--a problem in Turkey?

Caring Knowledge as a Strategy to Mitigate Violence against Nurses: A Discussion Paper

Violence against nurses is a disturbing trend in healthcare that has reached epidemic proportions globally. These violent incidents can result in physical and psychological injury, exacerbating already elevated levels of stress and burnout among nurses, further contributing to absenteeism, turnover, and intent to leave the profession. To ensure the physical and mental well-being of nurses and patients, attention to the development of strategies to reduce violence against nurses must be a priority. Caring knowledge-rooted in the philosophy of care-is a potential strategy for mitigating violence against nurses in healthcare settings. We present what caring knowledge is, analyze its barriers to implementation at the health system and education levels and explore potential solutions to navigate those barriers. We conclude how the application of models of caring knowledge to the nurse-patient relationship has the potential to generate improved patient safety and increased satisfaction for both nurses and patients.

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.

Perceptions, challenges and experiences of frontline healthcare providers in Emergency Departments regarding Workplace Violence during the COVID-19 pandemic: A protocol for an exploratory qualitative study from an LMIC

INTRODUCTION

Workplace violence (WPV) against Healthcare Workers (HCWs) has emerged as a global issue. Emergency Department (ED) HCWs as front liners are more vulnerable to it due to the nature of their work and exposure to unique medical and social situations. COVID-19 pandemic has led to a surge in the number of cases of WPV against HCWs, especially against ED HCWs. In most cases, the perpetrators of these acts of violence are the patients and their attendants as families. The causes of this rise are multifactorial; these include the inaccurate spread of information and rumours through social media, certain religious perspectives, propaganda and increasing anger and frustration among the general public,ED overcrowding, staff shortages etc. We aim to conduct a qualitative exploratory study among the ED frontline care providers at the two major EDs of Karachi city. The purpose of this study is to determine the perceptions, challenges and experiences regarding WPV faced by ED healthcare providers during the COVID-19 pandemic.

METHODS AND ANALYSIS

For this research study, a qualitative exploratory research design will be employed using in-depth interviews and a purposive sampling approach. Data will be collected using in-depth interviews from study participants working at the EDs of Jinnah Postgraduate Medical Centre (JPMC) and the Aga Khan University Hospital(AKUH) Karachi, Pakistan. Thestudy data will be analysed thematically using NVivo V.12 Plus software.

ETHICS AND DISSEMINATION

The ethical approval for this study was obtained from the Aga Khan University Ethical Review Committee and from Jinnah postgraduate Medical Center (JPMC). The results of the study will be disseminated to the scientific community and to the research subjects participating in the study.The findings of this study will help to explore the perceptions of ED healthcare providers regarding WPV during the COVID-19 pandemic and provide a better understanding of study participant's' challenges concerning WPV during the COVID-19 pandemic.

Workplace violence among healthcare workers during COVID-19 pandemic in a Jordanian governmental hospital: the tip of the iceberg

During the COVID-19 pandemic, significant cases of violence, intimidation, or stigmatization were targeted at healthcare workers (HCWs), patients, and medical infrastructure. These occurrences were most likely just the "tip of the iceberg," with much more remaining unnoticed. The present study's purpose was to assess the frequency, characteristics, effects, and contributing factors of workplace violence (WPV) committed against HCWs in AlKarak Governmental Hospital (KGH), South Jordan, during the COVID-19 pandemic. A cross-sectional study was conducted among 382 HCWs (170 physicians and 212 nurses) working in the KGH, Jordan, during January and February 2021, using a semi-structured questionnaire. The current study showed that most participants (65.5%) reported exposure to WPV, mainly verbal violence (52.0%), and patients' relatives were the principal perpetrators in most incidents. The regular reporting of these incidents is deficient. The victims suffered psychological and physical effects. These assaults on healthcare facilities highlight the importance of effective risk communication at all levels of society to minimize anxiety, stigma, and, eventually, WPV. The way we communicate about COVID-19 is vital in motivating people to take proactive steps to fight the disease and safeguard healthcare.

Workplace Violence in Emergency Departments in Turkey

Background Studies on workplace violence against physicians in emergency departments (EDs) in Turkey are lacking.

Methods To describe the frequency and types of workplace violence, a 34-question online survey of the past 12 months was sent to physicians working in EDs in Turkey. Types of violence were categorized as verbal threats, physical assaults, confrontation, stalking, and sexual harassment.

Results A total of 366 physicians completed the survey; 4 were excluded (minimum 20 hours/week). Sixty-two percent of respondents were men. Ninety-nine percent reported verbal abuse and 54% reported physical violence. Family members, not patients, were the most common perpetrators of every form of workplace violence. Hospitals limiting the number of visitors and loitering had 14% reduction in physical threats. Only 23% of respondents indicated that their hospital offered information about preventing and managing workplace violence even though 86% noted interest. Only 1% never had fear, even though 89% indicated they had security staff. Over 89% felt that hospital security was lacking in number and ability to protect. For 82%, workplace violence affected their ability to provide patient care. Ninety percent indicated that current laws do not adequately protect them. There was also no statistically significant difference in any type of workplace violence based on the timing or length of shifts, type of hospital, or number of hours worked. Of all types of violence reported, only stalking demonstrated a statistically significant difference between men and women.

Conclusion Workplace violence is a real danger for physicians working in EDs in Turkey, similar to other countries, demonstrating that this problem transcends borders. Further studies should assess root causes of violent behaviors of patients and their visitors, as well as possible (administrative, social, and legal) mechanisms to minimize such violence. Hospitals that limited the number of visitors and empowered security officers were associated with decreased violence.

Six things to know about the homicides of doctors: a review of 30 years from Italy

Background

Healthcare workers have a 16 times greater risk of suffering workplace violence than workers in other sectors and around 50% experience workplace violence in the course of their career. The objective of this study is to explore the characteristics and circumstances of work-related killings of doctors.

Methods

Work-related homicides of doctors over the period 1988–2019 were identified retrospectively through the Italian national statistical agencies. Variables such as perpetrator, motive and location of the crime were obtained through forensic psychiatric work. After classification, the absolute and percent values of the main characteristics of the homicides were calculated.

Results

Over the period considered, 21 doctors were killed in Italy in connection with their professional activity. In 52% (n = 11) of cases, the killer was one of the doctor’s patients, in 29% (n = 6) of cases it was a patient’s relative, in 19% (n = 4) an occasional patient (first consultation). The location of the homicide was a community clinic in 48% (n = 10) of cases, the street in 19% (n = 4) of cases, the doctor’s home in 14% (n = 3), the hospital in 14% (n = 3) and the patient’s home in 5% (n = 1). In 57% (n = 12) of cases the perpetrator was not affected by any mental disorders. The motive for the homicide was revenge in 66.7% (n = 14) of cases; in 28.6% (n = 6) the revenge was preceded by stalking.

Conclusions

Doctors should be aware that the risk of being killed is not limited to hospital settings and that their patients’ family members might also pose a threat to them.

Early Report on the Impact of COVID-19 Outbreak in Neurosurgical Practice Among Members of the Latin American Federation of Neurosurgical Societies

BACKGROUND

The COVID-19 pandemic has caused severe economic consequences by local governmental measures to contain the outbreak. We provide insight on the impact that health care restriction has made on neurosurgical activity in Latin Iberoamerica.

METHODS

We performed an internet-based survey among presidents and members of the societies of the Latin American Federation of Neurosurgical Societies (FLANC). We blindly analyzed information regarding local conditions and their impact on neurosurgical praxis using SPSS software.

RESULTS

Information came from 21 countries. Sixteen society presidents reported having suspended regular activities and deferring local scheduled congresses, 14 reported mandatory isolation by government, and 4 instituted a telemedicine project. Four-hundred eighty-six colleagues, mean age 49 years, reported a mean 79% reduction in their neurosurgical praxis. Seventy-six percent of neurosurgeons have savings to self-support for 3-6 months if restrictions are long lasting.

CONCLUSIONS

Stopping activities among societies of the FLANC, together with a drop of 79% of neurosurgical praxis, adds to deficits in provider's protection equipment and increasing demand for attention in the health care systems, representing a huge financial risk to their sustainability. Neurosurgeons should be involved in local policies to protect health and economy. Telemedicine represents an excellent solution, avoiding another pandemic of severe diseases across all-specialties as nonessential care can turn essential if left untreated. Financial support and ethics code review is needed to battle this new disease, designated the occupational disease of the decade, that continues to scrag the health care system. Times of crisis are times of great opportunities for humanity to evolve.

Design of a tailored and integrated violence prevention program in psychiatric wards and prisons

BACKGROUND

Violence and threats of violence against personnel at psychiatric wards as well as in the prison service is a major work environment problem. To date results from interventions to prevent violence and threats in these sectors have been inconclusive or of small effect. One of the reasons may be that violence and threats of violence occur as a consequence of a complex interaction between employee-level and management-level factors.

OBJECTIVE

To design a tailored and theory-based intervention program directed at violence prevention in psychiatric wards and prisons that integrates the employee-level and management-level, and development of an evaluation design building on the Context, Process, and Outcome Evaluation Model.

METHODS

The study follows a stepped-wedged design with 16 work units entering the intervention in four groups with differing start dates from September 2017 to January 2019. The context and process evaluation includes: calculating the implementation degree; mapping of contextual factors; interviews with unit-leaders and employees before and after the intervention. The outcome evaluation includes performing multi-level statistical analysis on data from a three-monthly questionnaire to employees at the participating workplaces.

RESULTS

The first results will be available in 2020.

CONCLUSIONS

The comprehensive evaluation of the intervention will give insight into the processes and effects of the intervention.

Psychological violence against general practitioners and nurses in Chinese township hospitals: incidence and implications

Background

International reports indicating that around 10–50% of health care staff are exposed to violence every year; in certain settings, this rate might reach over 85%. Evidence has shown that people who experience psychological violence are seven times as likely to be victims of physical violence. Although there have been numerous studies on WPV in general hospitals, there is no consensus regarding the current status of psychological violence directed at health care workers in township hospitals in China. The purpose of this study was to estimate the prevalence and the risk factors of psychological violence in Chinese township hospitals.

Methods

A retrospective cross-sectional survey of township hospitals general practitioners and general nurses was conducted in Heilongjiang Province, China.Descriptive analyses and binary logistic regression analysis were used to estimated the prevalence and the risk factors of psychological violence.

Results

Regardless of whether the assessment period was the past 12 months, past 36 months, or during their entire career,GPs and nurses reported that verbal abuse was the most common type of psychological violence (28.05, 30.28, 38.69 and 40.45%, 43.86, 54.02%).The main perpetrator was patients’ relatives. Most participants responded to violence with “pretend nothing happened”, 55.63% of GPs and 62.64% of nurses reported that the perpetrator received no punishment. Around 47.62% of respondents reported that their workplace had no procedures for reporting violence. When workplaces did have a reporting system, 57.73% knew how to use them. Only 36.98% had training in managing aggression and violence. General nurses, individuals 35 years or younger, those with higher professional titles and who work in shifts are at greater risk of psychological violence.

Conclusions

Our results indicate a high prevalence of psychological violence in Chinese township hospitals, which can no longer be ignored. Effective measures should be taken to prevent and respond to workplace violence(WPV), especially psychological violence.

Trial registration

(Project Identification Code: HMUIRB20160014), Registered May 10, 2016.

Aggression and violence in healthcare and its impact on nursing students: A narrative review of the literature

Aggression and violence is a significant social problem in many countries and an increasing problem in healthcare settings in which nurses are particularly vulnerable. The literature suggests that aggression and violence has a significant negative impact upon nurses and potentially upon nursing students and can result in these staff members experiencing stress as a direct result of these adverse events. The literature suggests that there is confusion over what constitutes aggression and violence in the workplace and therefore a true lack of understanding of the scale of the problem relating to nursing students. This review proposes that nursing students are indeed at significant risk of aggression and violence in the clinical setting which has the potential to significantly impact their role as a novice carer. Furthermore, aggression and violence can manifest negative stress responses in individuals, therefore, the potential for nursing students to cope with stressful situations shall be presented.

Physical violence against health care workers: A nationwide study from Iran

Background:

Workplace violence is a serious and problematic phenomenon in health care settings. Research shows that health care workers are at the highest risk of such violence. The aim of this study was to address the frequency of physical violence against Iranian health personnel, their response to such violence, as well as the contributing factors to physical violence.

Materials and Methods:

A cross-sectional study was conducted in 2011, in which 6500 out of 57,000 health personnel working in some teaching hospitals were selected using multi-stage random sampling. Data were collected using the questionnaire of “Workplace Violence in the Health Sector” developed by the International Labor Organization, the International Council of Nurses, the World Health Organization, and the Public Services International.

Results:

The findings revealed that 23.5% of the participants were exposed to physical violence in the 12 months prior to the study. Nurses were the main victims of physical violence (78%) and patients' families were the main perpetrators of violence (56%). The most common reaction of victims to physical violence was asking the aggressor to stop violence (45%). Lack of people's knowledge of employees' tasks was the most common contributing factor to physical violence (49.2%).

Conclusions:

Based on the results, legislating appropriate laws in order to prevent and control violence in the workplace is necessary. Moreover, developing educational programs to manage the incidence of physical violence should be on health centers' agenda.

The impact of training program on nurses' attitudes toward workplace violence in Jordan

BACKGROUND

Nurses' attitudes toward workplace violence are still inadequately explored, and possess an impact in preventing, and managing the violent incidents and the quality of nursing care. Creating a demand for an effective intervention program to improve nurses' knowledge of and attitudes toward workplace violence.

OBJECTIVE

To study the impact of the training program on nurses' attitudes toward workplace violence in a military hospital in Jordan.

METHODS

One group before-after design was employed. A stratified random sample of 100 nurses working in three shifts was recruited. Data were collected earlier and after the preparation program using the Attitudes Toward Patient Physical Assault Questionnaire. "The Framework Guidelines for addressing workplace violence in the health sector", was adopted in this work. The preparation sessions were for one day each week over five weeks. The post-test assessment was over five weeks using the same questionnaire.

RESULTS

A total of 97 nurses completed the survey. The outcomes demonstrated the significant impact of the training program on nurses' attitudes towards workplace violence (t=6. 62, df=96, p=0.000). The prevalence of verbal abuse by patients and visitors was 63.9% and for physical abuse, 7.2% were from patients and 3.1% of visitors. Most violent incidents occurred during day duty and during delivering nursing care (40.2% and 32%, respectively). Major source of emotional support for abused nurses was from the nursing team (88.7%), while the legal support was from nursing management (48.5%).

CONCLUSION

The study highlights a general concern among nursing staff about workplace violence. Confirming that violence prevention education for staff is a necessary step forward to deescalate the problem. A significant effect of the training program was evident in this study.

Predictive validity of the HCR-20 for inpatient aggression: the effect of intellectual disability on accuracy

BACKGROUND

People with intellectual disability (ID) account for a large proportion of aggressive incidents in secure and forensic psychiatric services. Although the Historical, Clinical, Risk Management 20 (HCR-20) has good predictive validity in inpatient settings, it does not perform equally in all groups and there is little evidence for its efficacy in those with ID.

METHOD

A pseudo-prospective cohort study of the predictive efficacy of the HCR-20 for those with ID (n = 109) was conducted in a UK secure mental health setting using routinely collected risk data. Performance of the HCR-20 in the ID group was compared with a comparison group of adult inpatients without an ID (n = 504). Analysis controlled for potential covariates including security level, length of stay, gender and diagnosis.

RESULTS

The HCR-20 total score was a significant predictor of any aggression and of physical aggression for both groups, although the area under the curve values did not reach the threshold for a large effect size. The clinical subscale performed significantly better in those without an ID compared with those with. The ID group had a greater number of relevant historical and risk management items. The clinicians' summary judgment significantly predicted both types of aggressive outcomes in the ID group, but did not predict either in those without an ID.

CONCLUSIONS

This study demonstrates that, after controlling for a range of potential covariates, the HCR-20 is a significant predictor of inpatient aggression in people with an ID and performs as well as for a comparison group of mentally disordered individuals without ID. The potency of HCR-20 subscales and items varied between the ID and comparison groups suggesting important target areas for improved prediction and risk management interventions in those with ID.

Workplace violence towards workers in the emergency departments of Palestinian hospitals: a cross-sectional study

BACKGROUND

Workplace violence (WPV) in hospital emergency departments (EDs) is a common problem. The objective of this study was to assess the characteristics (level and type), associated risk factors, causes, and consequences of WPV against workers in Palestinian EDs.

METHODS

A cross-sectional study was conducted in 14 out of the available 39 EDs in Palestine: 8 from the West Bank and 6 from the Gaza Strip. Data were collected using a self-administered questionnaire between July-September 2013. Multivariate logistic regression models were used to examine risk factors associated with exposure to WPV.

RESULTS

A total of 444 participants (response rate 74.5%): 161 (32.0%) nurses, 142 (32%) physicians, and 141 (31.7%) administrative personnel. The majority (76.1%) experienced a type of WPV in the past 12 months: 35.6% exposed to physical and 71.2% to non-physical assaults (69.8% verbal abuses, 48.4% threats, and 8.6% sexual harassments). Perpetrators of physical and non-physical violence were mainly patients' families/visitors (85.4% and 79.5%, respectively). Waiting time, lack of prevention measures, and unmet expectations of patients and their families are the main reasons for WPV. The multivariate regression analysis showed that younger personnel (OR = 2.29 CI 95% 1.309-4.036), clinicians (nurses and physicians) (OR = 1.65 CI 95% 0.979-2.797) comparing with administrative, and less experienced ED personnel (OR = 2.39 CI 95% 1.141-5.006) are significantly at higher risk of exposure to WPV (P < 0.05). Low level (40%) of violence reporting is evident, largely attributed to not enough actions being taken and fear of consequences. Violence has been shown to have considerable consequences for workers' well-being, patient care, and job retention.

CONCLUSIONS

Violence against workers in Palestinian EDs is highly common. The effects of violence are considerable. Multiple factors cause violence; however, EDs' internal-system-related factors are the most amenable to change. Attention should be given to strengthening violence prevention policy and measures and improving incident-reporting system.

Psychological Violence in the Health Care Settings in Iran: A Cross-Sectional Study

Background:

Psychological violence is the most common form of workplace violence that can affect professional performance and job satisfaction of health care workers. Although several studies have been conducted in Iran, but there is no consensus regarding current status of such violence.

Objectives:

This study aimed to investigate the prevalence of psychological violence among healthcare workers employed at teaching hospitals in Iran.

Patients and Methods:

In this cross-sectional study, 5874 health professionals were selected using multistage random sampling. Data were collected using a self-administered questionnaire developed by the International Labor Organization, International Council of Nurses, World Health Organization, and Public Services International. Descriptive statistics were used to analyze the data.

Results:

It was found that 74.7% of the participants were subjected to psychological violence during the past 12 months. Totally, 64.5% of psychological violence was committed by patients’ families, but 50.9% of participants had not reported the violence, and 69.9% of them believed that reporting was useless.

Conclusions:

The results are indicative of high prevalence of psychological violence against healthcare workers. Considering non-reporting of violence in more than half of participants, use of an appropriate reporting system and providing training programs for health professionals in order to prevent and manage workplace violence are essential.

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.

Working experiences of Iranian retired nurses: a content analysis study

Understanding the experiences of retired nurses can be useful in increasing self-confidence, motivation to work and work enthusiasm among nurses. The purpose of this study was to explore the work experiences of Iranian retired nurses. A qualitative design was conducted using a content analysis approach. Purposive sampling was used to choose the study participants. Semi-structured interviews were held to collect the perspectives of 20 retired nurses (10 female and 10 male). Two main themes emerged in the data analysis: 'work problems and unpleasant experiences in a sense' with subthemes 'exhausting work', 'insufficient salary', 'inappropriate relation' and 'unsuitable social position'; and 'job satisfaction and pleasant experiences in a sense' with subthemes 'divine satisfaction and religious belief', 'satisfaction of patients and their companions' and 'love of nursing profession and relaxation experience'. The findings indicate the challenges that nurses face after retirement. These experiences will help nurse managers to adopt appropriate measures to support nurses after retirement.

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.

Breakaway technique training as a means of increasing confidence in managing aggression in neuroscience nursing

OBJECTIVE

The objective of this paper was to evaluate breakaway technique training with neuroscience nursing staff as a measure of increased confidence and safety in managing aggression.

METHODS

A quasi experimental design was used in a sample of neuroscience nursing staff (n=31), participating in 2×1h breakaway technique workshops. The workshops consisted of supervised skills training in safe breakaway techniques. A pre- and postintervention-matched questionnaire measuring confidence and safety around managing aggressive patients, and exposure to and confidence in dealing with breakaways, was self administered.

RESULTS

Statistically significant increases in confidence and safety in working with aggressive patients, and confidence levels for safe breakaways were reported. Qualitative comments demonstrated a desire for ongoing skills workshops.

CONCLUSIONS

This study provides early evidence of the importance of incorporating breakaway training into existing training programs which aim to minimise and manage aggression and violence in generalist settings.

Assessment of Turkish junior male physicians' exposure to mobbing behavior

AIM

To determine the extent of Turkish junior male physicians' exposure to mobbing behavior and its correlation with physicians' characteristics.

METHODS

The study included physicians recruited for compulsory military service in April 2009. No sampling method was used, questionnaires were delivered to all physicians, and 278 of 292 (95%) questionnaires were returned. We used Leymann Inventory of Psychological Terror including 45 items for data collection and structural equation model for data analysis.

RESULTS

A total of 87.7% of physicians experienced mobbing behavior. Physicians who worked more than 40 hours a week, single physicians, physicians working in university hospitals and private hospitals, and physicians who did not have occupational commitment were more exposed to mobbing (P<0.05). Mobbing was not associated with specialty status, service period, age, and personality variables (P>0.05). All goodness-of- fit indices of the model were acceptable (χ(2)=1.449, normed fit index=0.955, Tucker Lewis index=0.980, comparative fit index=0.985, and root mean square error of approximation=0.040).

CONCLUSIONS

Workplace mobbing is a critical problem for junior male physicians in Turkey. We suggest an introduction of a reporting system and education activities for physicians in high-risk groups.

Occupational risk due to violence in a psychiatric ward

OBJECTIVES

This study aimed to elucidate causes of aggression from clinical records of a psychiatric ward of a major urban public hospital where aggression towards Health Care Workers [HCWs] was the second leading cause of hospital work-related injuries after needlesticks.

METHODS

Psychiatric patients'clinical records for the period 2002-2005 were examined and coded. Data were analysed with the case-control approach to identify the determinants of the aggressive behavior towards HCWs, after adjustment for age, gender, nationality and diagnosis of the patients.

RESULTS

We examined 2.196 records and identified 321 individuals who had become violent at least once towards nurses, pshysicians or other patients or relatives during their hospitalization. The victims of the aggressive behavior were mainly nurses. A history of involuntary admission was strongly associated with aggression [OR 4.5, 95% CI 3.4-5.9]. Diagnosis, gender and nationality of the patients were not predictive of aggressive behavior towards HCWs.

CONCLUSIONS

Involuntary admission to a psychiatric ward might be a cause of violent behavior towards health care workers, mainly nurses.