| Abstract: |
SUMMARYBackgroundViolence towards health care staff is an increasing problem. During the last decade, labor unions have contributed to efforts to increase awareness of the importance of workplace violence as an occupational hazard.Most people think of violence as a physical assault however, workplace violence is a mush broader problem; it is any act in which a person is abused, threatened, intimidated assaulted in his or her employment. Workplace violence is includes: threatening behavior, verbal or written threads, harassment, verbal abuse and physical attack.The possible effects of aggression on an individual are varied and likely depend on the severity and frequency of episodes and the perceived vulnerability to further episodes. The reported sequaelae of violent incidents towards doctors include varied psychological disturbances, and changes in behavior.OBJECTIVES:• To identify the magnitude of the problem.• To determine the underlying risk factors.• To identify the impact of workplace violence on the health care personnel and the work.• To propose recommendations for minimizing this problem.Subjects and MethodsThe present study was conducted among health care personnel in Zagazig university hospitals during the period from June 2004 to June 2005.The total sample size of health care personnel were 256, random sample selected from different departments. Data were collected vies field visit and personal interview with health care personnel in the selected departments using predesigned questionnaire.Each subject in the study was requested to answer the following models:(A) Questionnaire covers the following items.1- Demographic characteristics.2- Job Satisfaction.3- Violent incident.4- Risk Factors.5- Security Facilities at workplace.6- Training.(B) Eysenk personality InventoryRESULTSThe present work showed that the prevalence of workplace violence among the health care personnel were 73.8%. The prevalence of exposure to verbal, threat and physical violence were 73.8, 51.2 and 31.25 respectively.The prevalence of exposure to workplace violence was statistically significant higher among the workers compared with nurses and doctors (92.9, 75.8% and 62% respectively).There is statistically significant difference between doctors, nurses and workers as regard exposure to different types of violence , the prevalence of exposure to verbal, threat and physical among workers were significant higher (92.9%, 75% and 67.9% respectively), compared with doctors (62%, 45.1 and 23.9% respectively).The frequency of exposure to verbal violence is statistically significant difference between the studied groups, that 82.1% of workers exposed more than 10 times to verbal violence during the previous year, while 50.3% and 28.2% of doctors. About 50% of workers exposed more than 10 times of to threat and 50% of workers exposed more than 10 times of physical violence , while 7% of nurses and 2.8% of doctors exposed more than 10 times to physical violence. There is statistically significant difference between the studied groups as regard types and frequency of physical violence, workers and nurses nearly exposed to all types of physical violence but doctors exposed only to grabbing, pushing and hitting with object.The percentage of exposure to verbal violence differed among the health care personnel according to the department of work. The highest percentage of verbal violence was among health care personnel working in psychiatry department (100%) followed by emergency department (90.9%) and out patient clinics (87.5%).In the present study, exposure to threat and physical violence differed among the health care personnel according to the department of work. The prevalence of threat is statistically significant higher among health care personnel at out patient clinics and emergency departments (70.8% and 68.2% respectively). Also the health care personnel at emergency department the most exposed to physical violence (59.1%) followed by psychiatry department (50%).There is no statistically significant difference regarding the general characteristics of assailant in violence incidents among the studied groups, the assailant usually male, and middle age (20-40 years). The assailant of violent incident usually was relatives/visitors (93.7%) while patient represent (6.3%).Regarding smoking workplace violence is statistically significant higher among smokers (21%) while no smoker among none exposed to workplace violence. Regarding age and duration of work the longer the duration of work the less exposure to workplace violence and the older the age the less exposure to workplace violence.(77.7%) of the exposed health care personnel to workplace violence suffer from one or more of after effects (flashbacks, sleeplessness, fearfulness, depression and take time off work. 11.64% suffer from bruises and scratches, 3.7% suffer from superficial wounds. About the time loss 20% lose less than one hour, 10% lose from one to four hours, 6.3% lose a day work and 1.6% loses more than one day.Overcrowding represent the chief physical environmental risk factors leading to workplace violence accounts 76.6% .while other physical environmental risk factors as perceived noise, high temperature , inadequate light , bad housekeeping and work in isolated place represent weak risk factors .Showed that insufficient staff as a risk factor contributing to workplace violence among exposed health care personnel was 83.9%. Health care personnel reported that lack of training and experience is not one of risk factors leading to workplace violence. It was noticed that 76.7% of the exposed health care personnel reported that dissatisfaction with treatment by the patients and their relatives. 79.8% of exposed health care personnel to workplace violence reported that inadequate security is the most important risk factor.Majority of violent events occurred during the evening and night shifts 55.6%, 46.6 % respectively. There is no statistically significant difference between doctors, nurses and workers as regard reporting violent incidents to hospital management. About 37.6% of exposed health care personnel to workplace violence report violent incidents.Regarding, security facilities at the studied departments, there is no security alarm at any departments, only there is a security camera at emergency department. There is no training program on how to deal with a potentially violent situation.Job satisfaction score is statistically significant higher among non exposed (9.1791?2.6223) compared with exposed (8.111?2.9161).There is no statistically significant difference as regard Job satisfaction score among doctors, nurses and workers.There is no statistically significant difference as regard personality among exposed and none exposed.ConclusionFrom this, we can conclude that; the risk of violence directed at health care professionals in their working environment has aroused widespread concern. Clinical areas most associated with violence are accident and emergency departments, psychiatry. The prevalence of exposure to workplace violence was statistically significant higher among the workers compared with nurses and doctors.Overcrowding, insufficient staff, dissatisfaction with treatment by the patients and their relatives and inadequate security were the most important risk factors leading to workplace violence. Majority of violent events occurred during the evening and night shifts. There is no statistically significant difference between exposed and none exposed as regard personality.RecommendationsFinally , it was recommended that proper Environmental Designs (Develop emergency signaling, alarms, and monitoring systems, Design waiting areas to accommodate and assist visitors and patients who may have a delay in service) , Administrative Controls and Behavior Modifications(Provide all workers with training in recognizing and managing assaults, resolving conflicts, and maintaining hazard awareness).
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