Exposure to Workplace Violence and Related Factors among Nurses Working in Hospitals Affiliated with Golestan University of Medical Sciences

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Extended Abstract
Background
Violence is a state of behavior in which a violent person imposes one’s will on others by using physical or non-physical force. Workplace violence in the healthcare system has become an important policymaking issue in recent years and is considered one of the most complex issues for the governmental system. Healthcare workers experience workplace violence 16 times more than other workers. Among hospital employees, nurses are more at risk of encountering violence than other hospital employees due to their long work duration and more contact with patients and their families. Since the nurse interacts with the patient and the management of cases of violence must be done by the nurse, the type of attitude and performance of the nurse determines the type of intervention and management performed by her/ him to control these situations. This study was conducted to determine workplace violence against nurses and their performance in the face of it in hospitals affiliated with Golestan University of Medical Sciences.
Methods
This cross-sectional study was conducted among nurses working in Golestan University of Medical Sciences affiliated hospitals (3937 subjects) in 2021. To determine the sample size according to Cochran's formula and taking into account the probability of type 1 error equal to 0.05 and error 0.055, the sample size was calculated to be 293 subjects, who were randomly selected by stratified sampling method with allocation proportional to the volume, and participated in the study. Inclusion criteria were the willingness of nurses to participate in the study and at least one year of work experience. Also, the exclusion criterion was failure to complete the questionnaire correctly. The data collection tool in this study was a questionnaire that consisted of two parts: the personal-professional profile of nurses and the workplace violence questionnaire (Workplace Violence in the Health Sector). This questionnaire had 64 questions in five parts including physical violence (15 questions), psychological violence (12 questions), sexual violence (10 questions), racial violence (11 questions), and reaction to violence (15 questions) and at the end of the questionnaire, there was an open-ended question titled "views and opinions on workplace violence and suggested solutions". The data analysis was conducted using SPSS version 23 statistical software. To describe and analyze the data using descriptive statistics methods (frequency and percentage for qualitative variables and mean and standard deviation for quantitative variables) and due to non-confirmation of the normality of data distribution (with the Kolmogorov-Smirnov test), non-parametric Mann-Whitney tests, Spearman’s correlation coefficient, and Kruskal-Wallis test were used to examine the relationship between variables. The Chi-square test was also used to investigate the relationship between types of violence and nominal variables. The significance level in this study was 0.05.
Results
The average age of the nurses participating in this study was 33.93 ± 7.16 years and their average work experience was 9.82 ± 6.32 years. Among the participants, 82.6% were women and the rest were men. Most of the nurses had a bachelor's diploma (91.5%), were married (77.5%), were officially employed (51.9%), worked in the emergency department (22.5%), and had rotating shifts (56%). The prevalence of workplace violence in one year was 86%. Mental and physical violence with a frequency of 79.5% and 42.7%, respectively, had the highest occurrences, and racial and sexual violence with a frequency of 17.4% and 7.8%, respectively, were the lowest ones. The nurses stated that the most common type of physical attack was pushing, punching, and kicking with 23.2%, 8.2%, and 7.5%, respectively. The most common types of psychological violence were insult, obscenity, verbal threat, and humiliation with frequencies of 55.3%, 43.7%, 25.6%, and 24.9% respectively. Nurses stated that the majority of sexual violence occurred in the morning shift (38.1%), in the trauma department (25%), and in terms of the time of occurrence of sexual violence during hospitalization in the emergency room (52.4%). The cause of racial violence was race in 38.8%, ethnicity in 32.7%, religion in 12.2%, language in 10.2%, and birthplace in 6.1%. In front of these acts of violence, the most reactions of the researched units were inviting the attacker to calm down (42.3%), discussing the issue with colleagues (23.5%), and not taking any specific action (19.5%). Other results indicated that 57.7% of nurses did not report the act of violence, and the uselessness of reporting (27.3%) and the insignificance of the incident (20.1%) were the main reasons for not reporting in their view. However, there were reports of violence. A percentage of nurses believed that the existence of preventive laws and regulations is effective in preventing violence in the workplace. In addition, the presence of guards and law enforcement officers, and measures leading to safety in the departments were mentioned with a frequency of 56.7%, 49.1%, and 43%, respectively, as the most important factors preventing workplace violence. Also, issues like providing the necessary training through the media to the people, controlling the entry and exit of patients' companions, installing cameras in the wards, giving more powers to the guards, and deploying the police force in the emergency room were mentioned as preventive factors of workplace violence. A significant relationship was observed between physical violence and the gender variable of nurses (P-value = 0.024) and the service department (P-value = 0.003) which was more in women than in men and in the emergency department than in other departments. Sexual violence also had a significant relationship with the nurses' service department (P-value=0.046), which was more in the emergency department than in other departments. A significant relationship was observed between racial violence with gender (P-value = 0.001), service sector (P-value = 0.028), and work shift (P-value = 0.005) which was more in women than in men, more in the emergency department than in other departments, and more in the rotating shift than the fixed one.
Conclusion
The results of this study help to establish laws and regulations related to violence, create specific procedures to report cases of violence, encourage personnel to report cases of violence, and follow up on violent incidents. According to the results, the prevalence of workplace violence was generally high in one year, but most of the nurses did not report any act of violence. Therefore, medical policymakers and hospital managers should consider improving nurses' communication skills, and security measures, training staff on anger management, and reducing nurses' workload.