Factors associated with workplace violence

This study shows that workplace violence is more common among the younger age group. Health workers’ age has not been a consistent associated factor with workplace violence. In a study by Abodunrin et al (176) on 242 health workers at Ladoke Akintola University Teaching Hospital, Osogbo and Osun State Hospital, Asubiaro, Osogbo, Nigeria, it was observed that exposure to violence increased as the age of the respondents increased. Steinman (9), in the cross-country assessment of workplace violence in health facilities across South Africa, also reported that health workers between 40-45 years are vulnerable to the experience of workplace violence while Anderson & Parish (107) did not identify any relationship between age of the respondents and

Field Code Changed

Commented [DM5]: You don’t report researchers name like this. It is better reported as Steinman

Field Code Changed

occurrence of workplace violence among Hispanic nurses. In spite of these inconsistent findings, it may be plausible to argue that younger workers may not have developed adequate skills to handle situations which may predispose them to violent incidents in the hospital compared to the older ones who may have developed these skills on account of age and experience. More studies are needed to establish the relationship between age of health workers and occurrence of workplace violence.

This study observed that female gender is associated with an increased risk of workplace violence and more specifically the verbal abuse form. With studies conducted by Ukpong et al (28), Abodurin et al (176) and Azodo et al (29) in Nigeria reporting that the gender of the health workers does not significantly affect his/her exposure to workplace violence, the present observation is not in conformity with previous reports. However, the levels of workplace violence is often reflective of the sociocultural milieu in which the workplace is situated (9). The social correlate of violence against women in Nigeria is related to the traditional African patriarchal society that defines the gender power structure and worldwide, violence is often generally used in an attempt to wield power over or influence others (177). Within this context, the common view in this environment that females can be dominated could have contributed to the present observation. However, more studies are needed to clarify this relationship.

Similar to a previous report (176) from this environment, the marital status of the health worker did not significantly account for exposure to workplace violence. This observation is not in agreement with some other studies (9, 102). However, the marital status of health workers in this study contributed significantly to their experience of sexual harassment. Single health workers experienced more sexual harassment than other marital categories. This may be because they also mostly belong to the young age group category who are often viewed as powerless targets by the harassers (178). Furthermore, sexual pursuit of single employees is likely to be considered more

Field Code Changed

Field Code Changed Field Code Changed

Commented [DM6]: You should state your findings first and discuss it in line with other studies and not the other way round Field Code Changed

Field Code Changed

Field Code Changed Field Code Changed

Field Code Changed

acceptable because sexual harassment may be considered by some as normal courtship behavior(179).

Although, the professional group of the workers did not have a statistically significant association with workplace violence, pharmacists were the most exposed to workplace violence. Health care financing in Nigeria is poor (180). Therefore, most of the prescribed medications in government hospitals are often not available. The few available ones are sometimes expensive constituting a huge financial burden on patients who rely on out-of-pocket payment for their medical bills because only about 5% of Nigerian citizens are covered under the health insurance package (181).

Frustration of patients and relatives arising from this burden may predispose pharmacists to violence. It may therefore be important to advocate for an insurance package that provides better coverage. An example of a government initiative is the recent National Health Act (182) which provides for improved government coverage of health insurance but government has lacked the political will for its implementation. Physicians and Nurses are other professional groups following the pharmacists on the experience of workplace violence. This may not be unexpected for the Nurses as they spend longer time with the patients. The long time for clinical discussion, examination and investigations before diagnosis and treatment is administered in tertiary health facilities or unsatisfactory medical treatment outcome are some of the factors that may account for violence against Physicians. However, these observed peculiarities of these three groups of health workers were not observed to be potent enough to result in significantly higher exposure to violence compared to other workers.

Psychiatric and Emergency units represented the work settings with the highest exposure to workplace violence. This same observation has been documented in previous studies (3, 9, 70, 88). The mental conditions of patients in psychiatric settings can induce behavioral disinhibition and irritability, as well as leading to agitation and aggressiveness (183) . Moreover, the perceived

Field Code Changed

Field Code Changed Field Code Changed Field Code Changed Field Code Changed Field Code Changed

threat of violence may result in greater use of coercive measures such as seclusion, restraint and enforced medication, which patients often describe as traumatic (184) and can, in turn, trigger aggressive responses from patients instead of engagement and cooperation with treatment (185).

Factors such as unmet expectations of patients and their relatives considering the often severe and sometimes acute nature of their illness, perceived long waiting time and use of psychoactive substances by patients or relatives may be responsible for violence at the emergency unit (186).

Also, small and overcrowded hospital emergency units (as observed in the facility studied) has been documented to trigger workplace violence (187). To deal with violence in the emergency unit, it is imperative for hospital managements to find ways to decrease waiting time through better utilization of resources and the introduction of a triage system in which patients are prioritized and those who cannot wait for long are seen promptly (188).

Although shift work was not significantly associated with workplace violence when all the forms of violence were considered together, it had a significant association with the physical form of violence. This finding is consistent with a previous study which reported that working night shifts was considered a high-risk factor, predicting exposure to violence (166).

The level of worry expressed due to workplace violence is also an important factor to consider.

This study shows that the higher level of worry is associated with experience of workplace violence in respondents. This is consistent with previous reports (76, 189). Although, a high level of worry can also be a consequence of exposure to workplace violence, Hurrell et al. (189) has reported that a high level of worry may predate workplace violence. Fear at work from this worry might affect the worker’s self-efficacy or confidence which can affect the quality of health services provided to patients and which can lead to violence when patients or their relatives consider their expectations unmet. It might also lead to co-workers viewing them as professionally incompetent, resulting in acrimony and possible violence. When the different forms of violence

Field Code Changed

Field Code Changed Field Code Changed Field Code Changed

were considered, worry about workplace violence was particularly associated with an increased report of physical violence and verbal abuse. However, since this study is cross-sectional in design, the cause-effect nature of this relationship is difficult to interpret. Further studies will be needed to clarify the direction of this relationship.

Previous workplace violence prevention training has a statistically significant association with workplace violence in this study. However, it has been reported that workplace violence training reduces the exposure to workplace violence (95). The variation in results could be because in this study, one out of every two (50%) health workers who had previous training had the training more than five years ago, and thus, the competence gained from the training may have been lost.

Regular and periodic scheduling of training has been found to be essential (34). Furthermore, workplace violence prevention training may increase awareness of the need to report violent events (113) or make victims of violence to be more likely to recall previous violent incidents (113). Workers who received violence-prevention training may also be more likely to intervene during violent events, whereas their untrained counterparts may be more likely to remain passive (112).

In document Physical Violence (Page 110-114)