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

Reactions and perspectives of medical students on workplace violence during clinical training in Ardabil, Iran, 2020

BACKGROUND

Workplace violence continues among medical students in training. This study aimed to determine the reactions and perspectives of medical students against workplace violence during clinical training in Ardabil University of Medical Sciences in Iran, 2020.

MATERIALS

This descriptive cross-sectional study was conducted on 300 medical students from April to March 2020, in the Ardabil university hospitals. Students with at least one year training in the university hospitals were eligible to participate. Data was collected via questionnaires administered in the health ward. Data was analyzed through SPSS 23 software.

RESULTS

Most respondents had experienced workplace violence in the form of verbal (63%), physical (25.7%), racial (23%) and sexual (3%) violence during clinical training. Men were the aggressors during violence of a physical (80.5%), verbal (69.8%), racial (76.8%) and sexual (100%) nature (p < 0.001). When encountered with violence, 36% of the respondents did not take any action and 82.7% of respondents failed to report the incident. For 67.8% of respondents that did not report of violence incident, this procedure was deemed pointless, while 27% of respondents considered the violent incident insignificant. The main reason for workplace violence was perceived to be a lack of awareness of people about staff duties (67.3% of respondents). According to 92.7% of respondents personnel training was the most important factor in preventing workplace violence.

CONCLUSIONS

The findings suggest that the majority of medical students during clinical training in Ardabil Iran (2020) have been exposed to workplace violence. However, most students did not take any action or report the incident. Targeted personnel training, increase awareness of workplace violence, and encouragement of reporting these incidents should be promoted to reduce violence to medical students.

Nurses' exposure to violence and their professional commitment during the COVID-19 pandemic

Aims and Objectives

This study aimed to determine the relationship between nurses' exposure to violence and their professional commitment during the COVID‐19 pandemic.

Background

Violence against nurses is a common problem that persists worldwide.

Design

This was a descriptive cross‐sectional study.

Methods

An online questionnaire form and the Nursing Professional Commitment Scale were used to collect the data. The study was carried out online during the COVID‐19 pandemic between October–December 2020. A total of 263 nurses agreed to participate in the study. The STROBE checklist was followed for observational studies.

Results

During the COVID‐19 pandemic, 8.4% of the nurses stated that they were exposed to physical violence, 57.8% to verbal violence, 0.8% to sexual violence and 61.6% to mobbing. 52.1% of the nurses stated that they thought of quitting the profession during the COVID‐19 pandemic. The mean total Nursing Professional Commitment Scale score was 71.33 ± 15.05.

Conclusions

This study revealed that nurses' exposure to physical, verbal and sexual violence during the COVID‐19 pandemic decreased compared to before the pandemic. Nurses' exposure to mobbing during the pandemic was found to increase. A statistically significant difference was found between the status of the nurses' exposure to physical violence, verbal violence, and mobbing, working hours, number of patients given care, and their thoughts of quitting the profession. It was found that the status of exposure to physical violence, thinking of quitting the profession and working hours decreased professional commitment.

Relevance to clinical practice

In the light of these results, it is recommended that measures to prevent violence should be addressed in a multifaceted way. In managing the pandemic process, the decisions and practices should not be left to the managers' initiative to prevent mobbing. Initiatives that will increase nurses' professional commitment during the pandemic process should be planned and implemented.

Extent and risk factors of psychological violence towards physicians and Standardised Residency Training physicians: a Northern China experience

Purpose

Physicians and Standardised Residency Training physicians (SRTPs) have relatively high exposure to psychological violence. Its adverse effects are far greater than those of physical violence. However, no previous research has paid attention to the problem of psychological violence among them. This study aims to evaluate the extent, characteristics, and risk factors of psychological violence among SRTPs in comparison to physicians, and also to highlight the psychological violence experienced by SRTPs and suggest preventive measures.

Methods

A cross-sectional survey was conducted in northern China. 884 physicians and 537 SRTPs completed a questionnaire which compiled by the ILO, ICN, WHO and PSI in 2003 to measure violence in the workplace. Descriptive statistics and logistic regression analysis were used to analyse results.

Results

The effective response rates of physicians and SRTPs were 63.1%(884/1400) and 86.3%(537/622) respectively. 73.0%(645/884) of physicians and 24.8%(133/537) of SRTPs suffered psychological violence in the past year. Compared to physicians (29/645, 4.5%), SRTPs (42/133, 31.6%) experience more internal violence. Further, after experiencing psychological violence, physicians are willing to talk to family and friends, but SRTPs generally take no action. Shift work was a risk factor for both physicians (OR 1.440, 95% CI 1.014–2.203) and SRTPs (OR 1.851, 95% CI 1.217–2.815) suffering from psychological violence. In contrast, no anxiety symptoms protected physicians (OR 0.406, 95% CI 0.209–0.789) and SRTPs (OR 0.404, 95% CI 0.170–0.959) against psychological violence.

Conclusions

SRTPs and physicians in northern China have a high risk of experiencing psychological violence, and physicians experience more. Meanwhile, there are obvious differences in responses to psychological violence and risk factors between them. Therefore, medical institutions should pay more attention to psychological violence, especially among SRTPs, such as supporting the reporting of psychological violence, strengthening team relationships, and providing psychological comfort and counselling.

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

A cross-sectional survey on workplace psychological violence among operating room nurses in Mainland China

AIM

To investigate the status of workplace psychological violence (WPV) from managers, coworkers, or subordinates against operating room (OR) nurses in mainland China and identify risk factors.

BACKGROUND

WPV is a serious problem for nurses. However, limited information is available regarding the prevalence and risk factors of WPV against OR nurses in mainland China.

METHODS

A multi-center, cross-sectional study was conducted. OR nurses (n = 1557) from 26 hospitals, located in 13 cities of China, participated in this study.

RESULTS

Of the participants, 92.1% experienced WPV (30.9% from surgeons and 18.1% from senior nurses). Only 30.1% of the sufferers would report WPV. A logistic regression analysis revealed that nurses who had been in service longer and with senior professional titles were more likely to experience WPV.

CONCLUSION

Nursing managers should identify and resolve issues in a timely manner. Measures that promote effective team communication and facilitate teamwork, as well as inter-disciplinary educational workshops may be effective.

Prevalence and Associated Factors of Violence against Hospital Staff at Amanuel Mental Specialized Hospital in Addis Ababa, Ethiopia

Background. Violence at the workplace has become an alarming phenomenon worldwide. The real size of the problem is largely unknown and recent information shows that the current knowledge is only the tip of the iceberg. The enormous cost of violence at the workplace for person and community at large is becoming more apparent. It could be physical, sexual, and verbal in nature and could be actual or threatened. Objectives. To access prevalence and associated factors of violence against hospital staff at Amanuel Mental Specialized Hospital Addis Ababa, Ethiopia. Methods. An institution based cross-sectional study was employed in 2017. The data were collected using Workplace Violence in the Health Sector Country Case Study Questionnaire from 496 participants. Participants had been selected using simple random sampling technique and data were collected using a self-administered structured questionnaire. The collected data were entered into Epi-data version 3.1, and SPSS version 21 was used for Analysis. Binary logistic regression was fitted to identify factors associated with the outcome variable. Result. From 496 staff intended to have participated in this study, complete data were obtained from 435, making a response rate of 87.7%. This research showed high prevalence of violence and we have got that staff had been exposed to physical violence 36.8%, verbal violence 62.1%, and sexual violence 21.8 % over the past year, respectively. Age, sex, and contact with the patient were statistically significant variables (p < 0.05). Conclusion and Recommendation. According to this study, majority of AMSH staff were violated by the patient they care.

Violence against Nurses: A Neglected and Health-threatening Epidemic in the University Affiliated Public Hospitals in Shiraz, Iran

Background:

Nurses are more likely to be exposed to violence at their workplace in comparison with other employees.

Objective:

To determine various aspects of violence against nurses in Shiraz public hospitals.

Methods:

This cross-sectional study was conducted from 2017 to 2018, using a multistage random sampling method. Violence including verbal threats, verbal abuse, physical and sexual abuse as well as ethnical types, violence from patients, patients' companions and coworkers, and causes of violence were investigated using a checklist.

Results:

405 nurses with a mean age of 30.2 (SD 7.1) years and female to male ratio of 4.2 were interviewed. 363 (89.6%) nurses had experienced at least one kind of violence; 68.4% suffered from more than one type of violence. Verbal abuse (83.9%), verbal threats (27.6%), physical violence (21.4%), sexual abuse (10.8%), and ethnical harassment (6.1%) were the most common types of violence experienced by the nurses. Patients' companions, patients, and physicians were reported as the sources of violence in 70.6%, 43.1%, and 4.1% of cases, respectively. Nurses with non-official employment status and non-Farsi ethnicity, having a disease, with non-evening shift work, and those with short or long employment period were more affected. Unrealistic expectations by patients' companions and long working hours were the most common attributing factors.

Conclusion:

Violence against nurses, as a strenuous and health-threatening crisis, has become epidemic in public hospitals in our region. Effective interventions are warranted to sort out these problems.

Workplace Violence Against Nurses in Psychiatric Hospital Settings: Perspectives from Saudi Arabia

Objectives

Workplace violence (WPV) has become a world-wide concern. This study aimed to measure the prevalence of WPV among nurses working in psychiatric hospitals in Saudi Arabia.

Methods

This cross-sectional study was conducted at three psychiatric hospitals in Saudi Arabia between March and May 2017. Participants completed a self-reported questionnaire which was used to measure the prevalence and explore the associated factors of WPV. A multivariate logistic regression analysis was also performed.

Results

A total of 310 nurses (response rate: 62%) were included in this study. The prevalence of WPV against nurses was 90.3%, of which 57.7% had been exposed to both physical and verbal abuse. More nurses were exposed to WPV during the morning shift than the evening shift (58.4% versus 42.3%). Violent behaviour was exhibited mostly by the patients themselves (81.3%). Over half of the nurses (57.4%) required medical intervention in such cases. The majority of nurses felt either stressed (64.2%) or anxious (53.5%) and 34.2% felt depressed after the incident. Multivariate logistic regression analysis revealed that time of violence, source of violence, patient dissatisfaction with medical care and lack of organisational support for nurses were significantly associated with the occurrence of WPV in psychiatric units.

Conclusion

WPV has reached an alarming rate among nurses in psychiatric hospitals in Saudi Arabia. It is crucial to invest in the prevention of WPV by constant training of workers and a mutual policy with the police and the civic prosecutor in Saudi Arabia on how to respond to violent psychiatric patients.

Workplace Violence Against Iranian Nurses: A Systematic Review and Meta-Analysis

Nurses are exposed to workplace violence more than other healthcare professionals. This study aims to examine the prevalence of different types of workplace violence against Iranian nurses. A systematic review and meta-analysis were designed according to the PRISMA statement. To avoid bias, all stages of the research were done independently by two researchers. Eligible studies were retrieved from comprehensive search of several electronic databases included Magiran, Barakat Knowledge Network System, IranDoc, Regional Information Center for Science and Technology (RICST), Scientific Information Database (SID), Iranian National Library, PubMed/Medline, Cochrane Library, Scopus, Science Direct, ISI Web of Knowledge, CINAHL, and Google Scholar until April 2017. A random effects model was applied to combine studies. Data were analyzed using Comprehensive Meta-Analysis software version 2. In 26 studies, 10,858 nurses entered the meta-analysis process. The mean age and work experience of the nurses were 33.5 ± 7.5 and 10.85 ± 10.1 years, respectively. The prevalence of workplace verbal, physical, sexist, and racist violence and threat against Iranian nurses was 80.8% (95% confidence interval [CI] [74.2, 86.0]), 24.8% (95% CI [17.4, 34.0]), 6.7% (95% CI [4.9, 9.2]), 14.6% (95% CI [10.1, 20.7]), and 44% (95% CI [30.1, 58.8]), respectively. The prevalence of verbal and physical violence against the emergency department nurses was 89.7% (95% CI [69.4, 97.1]) and 21.0% (95% CI [12.6, 32.9]), respectively. The highest prevalence of verbal, physical, sexist, and racist violence was from patient's relative (42.3%, 95% CI [30.7, 54.7]), patients (12.6%, 95% CI [5.9, 25.0]), healthcare workers (5.1%, 95% CI [2.4, 10.4]), and patients (2.3%, 95% CI [0.9, 5.4]), respectively. Given the high prevalence of violence against the nurses in Iran, it is highly necessary to take certain intervention measures and design new policies.

Perceived Distributive Injustice, the Key Factor in Nurse's Disruptive Behaviors: A Qualitative Study

Introduction: Disruptive behaviors are one of the most topics affecting the wellbeing of organizations, therefore, it has become a significant research area. The purpose of this study was to determine experiences and perceptions of nurses who were involved in disruptive behaviors. Methods: A qualitative study was conducted by using a conventional content analysis. The data was obtained through 15 unstructured and in-depth interviews with nurses in six hospitals of Tehran city, Iran. A purposive sampling method was used. All interviews were recorded, typed and analyzed simultaneously. Results: The main theme obtained from the nurses' views and experiences analysis about disruptive behaviors were injustice and discrimination in hospitals including injustice in payments, work division, interactions, and judgment and evaluations. Conclusion: It seems that the best way to prevent and correct the disruptive behaviors was to eliminate the perceived nurses' injustice feeling and establishment the justice and fairness in organizations.

Antecedents and consequences of workplace violence against nurses: A qualitative study

AIMS AND OBJECTIVES

To explore Iranian nurses' perceptions of and experiences with the antecedents and consequences of workplace violence perpetrated by patients, patients' relatives, colleagues and superiors.

BACKGROUND

Workplace violence against nurses is a common problem worldwide, including in Iran. Although many studies have reviewed the antecedents and consequences of workplace violence, limited information is available on this topic. An understanding of the predisposing factors for violence and the consequences of violence is essential to developing programs to prevent and manage workplace violence.

DESIGN

Qualitative descriptive design.

METHODS

In this qualitative study, 22 unstructured, in-depth interviews were conducted with registered nurses who had experienced workplace violence and who were selecting using purposive sampling in nine hospitals. Inductive content analysis was used to analyse the data.

RESULTS

Five categories emerged as predisposing factors: unmet expectations of patients/relatives, inefficient organisational management, inappropriate professional communication, factors related to nurses and factors related to patients, patients' relatives and colleagues. Individual, familial and professional consequences were identified as outcomes of workplace violence against nurses.

CONCLUSIONS

Workplace violence by patients/their relatives and colleagues/superiors is affected by various complicated factors at the individual and organisational levels. In addition to negatively affecting nurses' individual and family lives, workplace violence may lead to a lower quality of patient care and negative attitudes towards the nursing profession.

RELEVANCE TO CLINICAL PRACTICE

Identifying factors, which lead to workplace violence, could help facilitate documenting and reporting such incidents as well as developing the necessary interventions to reduce them. Furthermore, native instruments must be developed to predict and monitor violence.

Encouraging employees to report verbal violence in primary health care in Serbia: A cross-sectional study

Introduction

Workplace violence is a serious and multidimensional problem that adversely affects professional and personal lives of employees. The aim of this study was to assess the prevalence and characteristics of verbal violence as a part of psychological violence among employees in primary health care in Belgrade, and to identify contributing factors of verbal violence in the workplace.

Methods

In this cross-sectional study, the final analysis included 1526 employees, using multi-stage sampling. Data were collected using the questionnaire Workplace Violence in the Health Sector Country Case Studies Research, developed by ILO/ICN/WHO/PSI. Descriptive statistics and logistic regression analysis were used to analyse the data. The general response rate was 86.8% (1526/1757).

Results

It was found that 47.8% of the participants were subjected to verbal violence. The main source of verbal violence was patient/client, 55.6% of employees did not report the incident. Among those who did not report the incident, 74.9% believed that reporting violence was useless. The interaction with patients (OR, 1.45; 95% CI, 1.02-2.06) and work between 6pm and 7am (OR, 1.27; 95% CI, 1.01-1.60) were significant contributing factors of verbal violence.

Conclusion

The results are indicative of a high prevalence of verbal violence against employees in primary health centres, which could have undesirable consequences. Conducting a better organizational measure and encouraging employees to report workplace violence could reduce the prevalence of verbal violence.

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.

Psychometric Properties of a Screening Instrument for Domestic Violence in a Sample of Iranian Women

BACKGROUND

Domestic violence against women is regarded as an important health problem among women and a serious concern in issues related to human rights. To date, a few screening tools for domestic violence exist for Iranian married women, but they assess only some of the domestic violence components.

OBJECTIVES

The present study aimed to design and determine the validity and reliability of a screening instrument for domestic violence in a sample of Iranian women.

MATERIALS AND METHODS

The present study was a cross-sectional psychometric evaluation conducted on 350 married women in Ilam, Iran, in 2014. The samples were selected through multistage sampling and the main method was cluster sampling. A 20-item, self-administered questionnaire was validated by exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). An Eigen value > 1 and a loading factor > 0.3 for each component were considered as indices for extracting domestic violence components. Reliability was calculated by test-retest and Cronbach's alpha. Also, the content validity index (CVI) and content validity ratio (CVR) were used to measure content validity. The data were analyzed using SPSS-13 and LISREL 8.8 software programs.

RESULTS

The self-administered instrument was completed by 334 women. The CFA and EFA methods confirmed embedding items and the three-factor structure of the instrument including psychological, physical, and sexual violence, which explained 66% of the total variance of the domestic violence. The ICC and Cronbach's alpha coefficients were > 0.7 for the components of the questionnaire. The test-retest also revealed strong correlations for each of the domestic violence components (r > 0.6).

CONCLUSIONS

The used instrument for measuring domestic violence had desirable validity and reliability and can be used as a suitable instrument in health and social researches in the local population.

Nurses' perspectives on workplace mistreatment: A qualitative study

An accurate understanding of workplace mistreatment and its impacts on nurses is crucial to hospital managers. A qualitative approach using conventional content analysis was adopted in this study to describe the perspectives of a sample of Iranian nurses concerning workplace mistreatment. After analyzing the transcribed interviews, three main themes emerged: (i) Demand for a more humanistic and appreciative environment; this theme consisted of three categories: "incompetent management practice", "invisibility of nurses", and "unethical behaviors"; (ii) Unprofessional interpersonal encounters which included three categories: "poorly defined job characteristics", "nurses' poor performance", and "inefficient supportive means and structures"; and (iii) Inaction despite injury, consisting of two categories: "passive and ineffective ways of coping with mistreatment", and "personal and professional negative impacts". Findings from this study can guide further investigation within diverse populations of Iranian nurses, as well as worldwide, in order for firm conclusions to be drawn. Future research could compare the perspectives of other stakeholders - patients and relatives, physicians, and managers concerning workplace mistreatment.