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Health care personnel and workplace violence in the emergency departments of a volatile metropolis: results from Karachi, Pakistan.

ABSTRACT: Workplace violence (WPV) is an important challenge faced by health care personnel in the emergency department (ED).To determine the prevalence and nature of WPV reported by physicians and nurses working in the EDs of four of the largest tertiary care hospitals in Karachi, Pakistan and to understand the mental health impact of experiencing WPV.This cross-sectional survey was conducted between September and November 2008 using a widely used questionnaire developed by the World Health Organization. Overall, 266 (86% response rate) questionnaires were included in this study.A total of 44 (16.5%) physicians and nurses said they had been physically attacked, and 193 (72.5%) said that they had experienced verbal abuse in the last 12 months. Among those who reported physical attack, 29.6% reported that the last incident involved a weapon, and in 64% of cases the attacker was a patient's relative. Eighty-six percent thought that the last attack could have been prevented, and 64% said that no action was taken against the attacker. After adjusting for covariates, physicians were less likely than nurses to report physical attack (odds ratio [OR] 0.46; 95% confidence interval [CI] 0.2-1.0), and personnel with greater work experience (OR 4.8; 95% CI 2.0-11.7) and those who said that there were procedures to report WPV in their workplace (OR 3.2; 95% CI 1.6-6.5) were more likely to report verbal abuse. WPV was associated with mental health effects in the form of bothersome memories, super-alertness, and feelings of avoidance and futility.WPV is an important challenge in the EDs of large hospitals in Karachi. A majority of respondents feel that WPV is preventable, but only a minority of attackers face consequences.

SUBMITTER: Zafar W

PROVIDER: S-EPMC4332856 | biostudies-literature | 2013 Nov

REPOSITORIES: biostudies-literature

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Health care personnel and workplace violence in the emergency departments of a volatile metropolis: results from Karachi, Pakistan.

Zafar Waleed W Siddiqui Emaduddin E Ejaz Kiran K Shehzad Muhammad Umer MU Khan Uzma Rahim UR Jamali Seemin S Razzak Junaid A JA

The Journal of emergency medicine 20130904 5

<h4>Background</h4>Workplace violence (WPV) is an important challenge faced by health care personnel in the emergency department (ED).<h4>Study objectives</h4>To determine the prevalence and nature of WPV reported by physicians and nurses working in the EDs of four of the largest tertiary care hospitals in Karachi, Pakistan and to understand the mental health impact of experiencing WPV.<h4>Methods</h4>This cross-sectional survey was conducted between September and November 2008 using a widely us ...[more]

PMID: 24011477

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Project description: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.

Project description:ObjectivesThe primary objective of this study was to evaluate the effectiveness of a half-day training on de-escalation of violence against healthcare personnel regarding prevention and management of violence incidents versus a similar tertiary-level hospital with no such training. Secondary objectives were to compare the overall satisfaction, burnout, fear of violence and confidence in coping with patients' aggression of the healthcare personnel in the two hospitals.DesignMixed method design, with a comparative cross-sectional (quantitative) and focus group discussions (qualitative) components.SettingEmergency departments of the two tertiary care hospitals in district Peshawar over 6 months starting from May 2018.ParticipantsHealthcare personnel in the emergency departments of the two hospitals (trained vs untrained).Outcome measuresViolence exposure (experienced/witnessed) assessed through a previously validated tool in the past 5 months. Burnout, confidence in coping with patient aggression and overall job satisfaction were also assessed through validated tools. The qualitative component explored the perceptions of healthcare personnel regarding the management of violence and the importance of training on de-escalation of violence through focus group discussions in the two hospitals.ResultsThe demographic characteristics of the healthcare personnel within the two hospitals were quite similar. The de-escalation training did not lead to a reduction in the incidences of violence; however, confidence in coping with patient aggression and the overall satisfaction were significantly improved in the intervention hospital. The de-escalation training was lauded by the respondents as led to an improvement in communication skills, and the healthcare personnel suggested for scale-up to all the cadres and hospitals.ConclusionThe study found significant improvements in the confidence of healthcare personnel in coping with patient aggression, along with better job satisfaction and less burnout in the intervention hospital following the de-escalation training.

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Health care personnel and workplace violence in the emergency departments of a volatile metropolis: results from Karachi, Pakistan.

Publications

Health care personnel and workplace violence in the emergency departments of a volatile metropolis: results from Karachi, Pakistan.

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