A survey of workplace violence against physicians in the hospitals, Myanmar

Medicolegal analysis of physical violence toward physicians in Egypt

This study analyzed physical violence against physicians in Egypt from a medicolegal perspective. 88%, 42%, and 13.2% of participants were exposed to verbal, physical, and sexual violence. Concerning the tools of violence, 75.2% of attackers used their bodies. Blunt objects (29.5%), sharp instruments (7.6%), and firearm weapons (1.9%) were used. The commonest manners of attacks were pushing/pulling (44.8%), throwing objects (38.1%), and fists (30.5%). Stabbing (4.8%) and slashing (2.9%) with sharp instruments were also reported. Traumas were mainly directed towards upper limbs (43.8%), trunks (40%), and heads (28.6%). Considering immediate effects, simple injuries were reported that included contusions (22.9%), abrasions (16.2%), and cut wounds (1.9%). Serious injuries included firearm injuries (4.8%), internal organs injuries (3.8%), fractures (2.9%), and burns (1.9%). Most (90.5%) of injuries healed completely, whereas 7.6% and 1.9% left scars and residual infirmities, respectively. Only 14.3% of physicians proceeded to legal action. The current study reflects high aggression, which is disproportionate to legal actions taken by physicians. This medicolegal analysis could guide protective measures for healthcare providers in Egypt. In addition, a narrative review of studies from 15 countries pointed to violence against physicians as a worldwide problem that deserves future medicolegal analyses.

Workplace Violence among Nurses at a Tertiary Hospital in Myanmar: A Cross-sectional Study

ABSTRACT

Among all types of health-care workers, nursing professionals are at the highest risk of violence since they have to deal with patients and their families directly and frequently. This study aimed to assess the magnitude of both physical and psychological workplace violence (WPV) among nurses at a public hospital in Myanmar and identify related factors. A cross-sectional study was carried out among 192 nurses with a minimum 1-year of working service at a large tertiary hospital using a standard self-administered questionnaire developed by the World Health Organization/International Labour Organization in 2003. The prevalence of overall WPV in the past 12 months was 29.2%. In particular, verbal abuse was the most frequent type (27.1%), followed by bullying/mobbing (7.8%) and physical violence (1.6%). Majority of perpetrators were patient's relatives (62.7%) for verbal abuse and staff members (64.3%) for bullying/mobbing. The reporting rate was very low for verbal abuse (13.5%) and bullying/mobbing were not reported. Logistic regression analysis showed that respondents who were older than 45 years' group (adjusted odds ratio [AOR]: 19.32; 95% confidence interval (CI): 1.99-186.95, P = 0.011), those who were staff nurses (AOR: 17.87; 95% CI: 1.05-33.20, P = 0.046), and those who 1-5 years and 5.1-10 years of working experiences (AOR: 18.68; 95% CI: 3.43-101.65, P = 0.001) (AOR: 15.74; 95% CI: 2.80-88.42, P = 0.002) were more likely to be exposed to WPV than their respective counterparts. Awareness generation about the importance of WPV, enforcing available legal instruments, and establishing management strategies for safe working environments should be emphasized.

Mediating role of coping styles on anxiety in healthcare workers victim of violence: a cross-sectional survey in China hospitals

OBJECTIVE

The purposes of this study were to evaluate the rate of workplace violence in county hospitals in China and its impact on healthcare workers and to explore the relationship between hospital violence, coping styles and anxiety to provide effective procedures for reducing anxiety among healthcare workers.

METHODS

The study used stratified sampling to select 1200 healthcare workers from 30 county hospitals in China to conduct a questionnaire survey. Of these, 1030 were valid questionnaires, and the effective response rate was 85.83%. We collected demographic characteristics of our participants and administered the following scales to them: Workplace Violence, Trait Coping Style, Self-rating Anxiety. Data were statistically analysed.

RESULTS

The results showed that 67.28% of healthcare workers in county hospitals in China had experienced workplace violence in the previous 12 months, with prevalent verbal violence (66.12%) followed by physical violence (15.24%). Workplace violence in hospitals was negatively related to positive coping (r=-0.091, p<0.01) but positively related to negative coping (r=0.114, p<0.001) and anxiety (r=0.298, p<0.001). Positive and negative coping was negatively (r=-0.085, p<0.01) and positively (r=0.254, p<0.001) associated with anxiety respectively. Positive and negative coping influenced both hospital workplace violence and anxiety in healthcare workers who were victims of violence. Compared with positive coping, the mediating effect of negative coping was stronger (95% CI -0.177 to -0.006).

CONCLUSIONS

The incidence of workplace violence among healthcare workers in county-level hospitals in China is relatively high, and there is a correlation between hospital violence, coping styles and anxiety. Positive and negative coping play a mediating role in the impact of hospital violence on healthcare workers' anxiety. Therefore, hospital administrators should actively promote healthcare workers' transition to positive coping strategies and minimise the negative impact of anxiety on them.

Workplace Violence in County Hospitals in Eastern China: Risk Factors and Hospital Attitudes

Workplace violence (WPV) against health workers is a public concern worldwide. Yet little is known about WPV in Chinese county level hospitals and its risk factors. The current study aimed to examine the prevalence of and the risk factors of WPV in county hospitals. A total of 1,388 health workers were interviewed in eight county hospitals in four counties of Zhejiang Province. Results indicated that 7.8% of participants suffered physical attacks and 21.2% suffered physical threats, 51.6% experienced or witnessed Yi Nao (medical disturbance created by gangs using extreme means to obtain compensation from a hospital) at least once in the past year. Physical attacks were seen significantly more in physicians (10.9%) than in nurses (5.9%). Physicians were threatened at 27.1%, followed by nurses at 20.2%. Compared with general medicine, health workers working in emergency were significantly more likely to suffer physical attacks (odds ratio [OR] = 2.7, 95% confidence interval [CI] = [1.4, 5.2], p < .01) and WPV (physical attacks or threats; OR =2.5, 95% CI = [1.6, 4.1], p < .001). Being encouraged to tolerate WPV was correlated with physical attacks (OR = 6.1, 95% CI = [3.5, 10.4], p < .001) and WPV (OR = 6.7, 95% CI = [4.6, 9.8], p < .001). Health workers in county hospitals were vulnerable to encounter WPV. This highlights the need for a focused systematic prevention concerning health workers' safety and governmental regulations and the need for hospitals to encourage their employees to report the WPV.

Violence against physicians in Jordan: An analytical cross-sectional study

Background

High numbers of violence incidents against physicians are reported annually in both developing and developed countries. In Jordan, studies conducted on healthcare workers involved small number of physicians and showed higher percentages of violence exposure when compared to other investigations from the Middle East. This is a large study aiming to comprehensively analyze the phenomenon in the physicians’ community to optimize future strategies countering it.

Methods

The study has a cross sectional, questionnaire-based design. It targeted 969 doctors from different types of healthcare Jordanian institutions in Amman, between May to July, 2019. The questionnaire was designed to evaluate properties of reported abuse cases in terms of abusers, timing, and type of abuse, in addition to the consequences of this abuse.

Results

Prevalence of exposure to violence in the last year among doctors was 63.1% (611 doctors). 423 (67.2%) of male doctors had an experience of being abused during the last 12 months, compared to 188 (55.3%) of females (p< 0.001). Governmental centers showed the highest prevalence. Among 356 doctors working in governmental medical centers, 268 (75.3%) reported being abused (p< 0.001), and they were more abused verbally (63.5%) and physically (10.4%) compared to other medical sectors (p <0.001). The mean score of how worried doctors are regarding violence at their workplace from 1 to 5 was 3.1 ± 1.3, and only 129 (13.3%) believed that they are protected by law.

Conclusions

The study emphasized on the higher rate of violence against physicians in the governmental sector, in addition to the negative effect of abuse on their performance. Moreover, male physicians had higher incidence of workplace abuse. Therefore, strategies that ease and promote the real application of anti-violence policies should become our future target.

Workplace Violence and Neurosurgery: Insights from a Nationwide Survey

OBJECTIVE

Workplace violence (WPV) against neurosurgeons is an understudied phenomenon, as previous research has focused on high-risk specialties like emergency medicine and psychiatry. We sought to fill in this gap in the literature by determining the frequency and type of WPV that neurosurgeons experience.

METHODS

We sent a 26-question online survey to members of the American Association of Neurological Surgery via SurveyMonkey. This survey contained questions about WPV experienced over the previous two years, as well as questions about security measures and workplace protocols for WPV.

RESULTS

We received 107 responses of 4757 surveys disseminated, a response rate of 2.25%. Although small, this response rate is representative of historical survey response rates. In total, 53.3% of our sample reported WPV, and 4.7% reported at least one physical assault. In total, 50.5% of respondents were afraid of becoming a victim of WPV, and 40.4% felt less secure today than when they began practicing. A total of 17.8% of respondents reported that they had obtained a weapon or a concealed weapon permit due to a perceived threat. Tests for association revealed that early career and female neurosurgeons were significantly more likely to receive verbal threats than other neurosurgeons (P = 0.049 and 0.01, respectively).

CONCLUSIONS

WPV is prevalent in neurosurgery at rates comparable with a range of other specialties. Many neurosurgeons feel unsafe in the workplace, with some taking significant actions such as weapon acquisition. An opportunity for education and resources regarding WPV exists, especially among early career and female neurosurgeons.

Experiences of Workplace Violence Among Healthcare Providers in Myanmar: A Cross-sectional Survey Study

Background Healthcare providers face enormous threats to personal safety from workplace violence (WPV). Prior investigations estimate a highly varied prevalence of WPV in the United States and around the world, including both verbal and physical assault. Little is known about WPV in Myanmar. Only a single prior study has evaluated WPV experiences among physicians in Myanmar, reporting an unusually low prevalence of verbal (8.7%) and physical (1.0%) assault. Given this much lower prevalence compared with similar studies in other low- and middle-income countries (LMICs), we embarked on a study to identify the prevalence of WPV in a separate cohort of healthcare providers in Myanmar. Methods This was a cross-sectional analysis of WPV prevalence among healthcare providers who attended a national emergency medicine conference in Myanmar in November 2018. The survey instrument was adapted from a validated survey from the Joint Program on Workplace Violence in the Healthcare Sector (International Labour Office, International Council of Nurses, World Health Organization, and Public Services International), which had been used in other global settings. Results Sixty-three participants completed the survey questionnaire, including 35 women (55.6%) and 26 men (41.3%). Among them, 25 (39.7%) were primary care providers. Overall, the combined prevalence of WPV in the previous 12 months was found to be 47.6% (n = 30; 95% CI: 34.9-60.6%). The prevalence of verbal assault was 47.6% (n = 30; 95% CI: 34.9-60.6%), and that of physical assault was 4.8% (n = 3; 95% CI: 1.0-13.3%). Twenty-four participants (42.4%) reported that they were encouraged to report violence in the workplace, and five (8.1%) reported they had received training on how to manage WPV. Respondents who were 30-34 years in age and those working in private facilities were significantly less likely to report WPV on univariate analysis. Conclusion Although our cohort comprised a limited sample of a select group of providers, we found a dramatically higher prevalence of WPV experiences among healthcare providers attending an emergency medicine conference in Myanmar when compared with a prior investigation. Very few participants had received training on WPV, and less than half reported a work culture where WPV reporting is encouraged. To combat healthcare provider shortages, more investigation is required into WPV to understand its impact and identify amelioration strategies.

Workplace violence and its aftermath in China's health sector: implications from a cross-sectional survey across three tiers of the health system

OBJECTIVES

To determine the prevalence of physical violence and threats against health workers and the aftermath in tertiary, secondary and primary care facilities in China.

DESIGN

A cross-sectional questionnaire study.

SETTING

5 tertiary hospitals, 8 secondary hospitals and 32 primary care facilities located in both urban and rural areas of Zhejiang Province, China, were chosen as the study sites.

PARTICIPANTS

A total of 4862 health workers who have contact with patients completed a survey from July 2016 to July 2017.

OUTCOME MEASURES

The prevalence of physical violence, threats and Yi Nao, specific forms of physical violence and their aftermath were measured by a self-designed and verified questionnaire. Multivariable logistic regression models were used to examine the association between perceived organisational encouragement of reporting workplace violence (WPV) and physical violence, threats and Yi Nao after controlling for age, sex, level of facility, professional ranking and type of health worker.

RESULTS

Among all respondents, 224 (4.6%) were physically attacked and 848 (17.4%) experienced threats in the past year. Respondents in secondary hospitals were more likely to experience physical violence (AOR=3.29, 95% CI 2.21 to 4.89), threats (AOR=1.61, 95% CI 1.32 to 1.98) and Yi Nao (AOR=2.47, 95% CI 2.10 to 2.91), compared with primary care providers. Lack of organisational policies to report WPV was associated with higher likelihood of physical violence (AOR=3.64, 95% CI 2.57 to 5.18) and threats (AOR=2.21, 95% CI 1.76 to 2.78). Among physical violence cases, only 29.1% reported the attack to police mainly because most felt it useless to do so (58.8%). Only 25.7% were investigated and 72.4% of attackers received no punishment. Of all those attacked or threatened, 59.4% wanted to quit current post and 76.0% were fearful of dealing with urgent or severe cases.

CONCLUSIONS

Proper management of the aftermath of violence against health workers is inadequate. Formal guidelines for reporting and managing WPV are urgently needed.

Burnout among house officers in Myanmar: A cross-sectional study

Background

Burnout can result in a serious negative impact on a doctor's life, the quality of patient care, and the healthcare organization. This study aims to determine the prevalence of burnout and factors affecting burnout among the house officers in Myanmar.

Materials and methods

An exploratory cross-sectional quantitative survey study was conducted using a self-administered, web-based survey. House officers working in any of the government hospitals in Myanmar were invited to participate in the study. The survey link was distributed online via Facebook. To measure burnout, we utilised a non-proprietary single-item measure, validated to serve as a reliable substitute for the Maslach Burnout Inventory Emotional Exhaustion (MBI:EE). To measure global life satisfaction, the validated Satisfaction with Life Scale (SWLS) was used. The questions for the scales regarding the psychosocial environment were extracted from the long version of the validated Copenhagen Psychosocial Questionnaire (COPSOQ II). The scales selected were "possibilities for the development", "meaning of work", "commitment to workplace", "recognition", "social support from colleagues" and "social support from supervisors". Multiple logistic regression method was applied to determine the factors associated with burnout.

Results

Regarding the prevalence of burnout, out of 159 participants, 42.8% (n = 68) of the participants had no symptoms of burnout. 57.2% (n = 91) had one or more symptoms of burnout. Multivariate analysis showed that the only significant factor associated with burnout was "recognition" (OR 0.96, 95% CI: 0.94-0.97, P < 0.001).

Conclusion

From this study, we have determined the relatively high burnout prevalence and that recognition is the only preventive factor; increase in recognition will decrease the odds of burnout. Hence, urgent interventions are recommended to prevent undesirable effects on both health professionals and patients. Recognition for work done should always be in the heart of the health authorities and medical community in Myanmar.