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 Table of Contents  
REVIEW ARTICLE
Year : 2014  |  Volume : 2  |  Issue : 1  |  Page : 1-5

A review on violence and related demographic factors in hospitals of Iran


1 Department of Health Services Management, School of Management and Medical Information,Isfahan University of Medical Sciences, Isfahan, Iran
2 Department of Epidemiology and Biostatistics, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
3 Health Services Management, Hospital Management Research Center, Iran University of Medical Sciences, Tehran, Iran
4 Health Services Management, Imam Khomeini Hospital, Golestan University of Medical Sciences, Golestan, Iran
5 Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

Date of Web Publication25-Jun-2014

Correspondence Address:
Najmeh Bahman Ziari
M.Sc in Health Services Management, Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2347-9019.135340

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  Abstract 

Today violence is considered as one of the issues relating to health and occupational safety of people, and healthcare workers are exposed to more violence than the others. This mater has not been well known in Iran too and limited actions have been done to evaluate the related risk factors of violence and thereby prevent and reduce its incidence in hospitals. Hence, this study aimed to investigate the research conducted at the country's hospitals on the incidence, and prevalence of violence and identify factors related to its incidence, among demographic factors. This narrative review study was carried out in 2013 by searching Google, Google Scholar, Scientific Information Database (SID), Irandoc, Magiran and PubMed sites using keywords combination of demographic factors, violence, aggression, hospital and Iran. The aim of study was to search for all studies about the prevalence of violence and related demographic factors in hospitals of Iran that finally 17 appropriate and consistent studies were selected. According to the results, violence in hospitals of Iran was more verbally and physically, and in general men were the main attackers and victims of violence. Age, work experience and low level of education can also be as effective factors to increase the violence. Considering this fact that some factors such as poor working conditions with lack of manpower to care for many patients and long waiting time has caused aggression, and therefore to reduce and prevent violence, better human resource planning using experienced and patient staff to interact with clients and increasing the number of employees for better care and staff training in coping with violence, anger management and appropriate and respectful communication with patients and families are suggested.

Keywords: Demographic factors, hospital, individual characteristics, Iran, review article, violence


How to cite this article:
Keyvanara M, Maracy MR, Shokri A, Kordi A, Ziari NB. A review on violence and related demographic factors in hospitals of Iran. Int J Health Syst Disaster Manage 2014;2:1-5

How to cite this URL:
Keyvanara M, Maracy MR, Shokri A, Kordi A, Ziari NB. A review on violence and related demographic factors in hospitals of Iran. Int J Health Syst Disaster Manage [serial online] 2014 [cited 2024 Mar 29];2:1-5. Available from: https://www.ijhsdm.org/text.asp?2014/2/1/1/135340


  Introduction Top


Today violence is considered as one of the issues relating to health and occupational safety of people [1] and is a concern to any person in any workplace [2] with its own physical, mental and financial consequences. But more important is the repetition of such events that could cause serious damage to people, environment and the process trend. Violence is defined in various ways in workplace that in specialized defining, it refers to events such as abuse, threaten or attack by a person or persons toward employees in situations including working time at workplace, commuting and also working missions. [3]

Researches show that occupational violence is more common among healthcare workers, police, drivers and guards [4] and healthcare workers are exposed to violence more than the others worldwide, so that more than 50% of health care workers have experienced violence at work and this problem is considered as a serious problem in health systems. [5] Because increased job stress and leaving the job, working morale reduction, trust to managers and colleagues and create an unfriendly work environment are of negative consequences of institutional violence and has great influence on the performance and success of the organization [6] and since this issue imposes large cost to healthcare systems, it is not negligible at all. [7] Studies also show that aggression or violent behavior towards staff of healthcare providers, worldwide, have increased dramatically than past [8] and researchers consider this increase in violence in hospitals as one of the major problems of health and believe that it is the result of increasing violence in society, in general. [9] Surveys indicate that employees were confronted with violence in different therapeutic and diagnostic departments of hospitals. [10],[11],[12] Ng and colleagues research on workplace violence against radiologists in public hospitals of Hong Kong showed that 61 percent of workers have been exposed to violence and the most violence was verbal abuse (97 percent). [10] A review study about violence in emergency department also states that nurses working in emergency department are exposed to violence between 60 to 90 percent. [13] The most important causes of violence refer to dissatisfaction with treatment, long waiting time, drugs and alcohol. [14],[15]

Generally, hospital is a place where people normally do not go to it and cannot expect normal behavior from the patient or his/her relatives by any cultural background. [16] Thus, according to the sensitivity of these centers, employees working in these centers including clinical staff, are more vulnerable to violence and threat than any other person. In developing countries, the issue of violence against healthcare personnel has recently been considered. On the other hand, due to lack of recording and reporting system in these countries for such events, research in this area is very limited [17] and the real size of the problem is not well identified. Recent studies indicate that the current figure of workplace violence is just the peak of a huge iceberg. So, gathering information on the extent and nature of violence in the workplace is an important component to prevent this problem. [18]

This matter has not been well known in Iran too and limited actions have been done about the evaluation of related and risk factors of violence, prevent and reduce its incidence in hospitals, and hence, this study aimed to investigate the research conducted at the country's hospitals on the incidence and prevalence of violence and identify factors related to its incidence among demographic factors.


  Materials and Methods Top


This narrative review study was carried out at the beginning of 2013 by searching sites like Google, Google Scholar, SID, Irandoc, Mgiran and PubMed using the keywords combination of demographic factors, violence, aggression, hospital, Iran and their Persian equivalence. The aim of this search was to find all of the studies that investigated prevalence, demographic factors and personal characteristics related to violence in hospitals of Iran. Studies were limited and in general, after the review of article titles and abstracts in the first stage and removing the irrelevant, duplicate, findings derived from conferences, seminars and articles that were not available, 33 studies and in the second stage, by reviewing content and aim, 17 appropriate and consistent studies with the study were extracted and evaluated. Then according to the study aim, demographic factors related to violence were selected, categorized in the description and interpreted in discussion.

Description

The World Health Organization (WHO) has classified violence in four categories: (1) Physical violence "knuckling, kicking, slapping, pushing, biting, pinch and wounding (with sharp objects)", (2) verbal violence,"behaviors such as insult, humiliation, intimidation, ridicule and insult", (3) racial violence, "threatening conduct due to race, color, language, nationality, religion, work with a minority, birth place or financial facilities or any other status" and (4) sexual violence, "any unwanted conducts related to sex, which is regarded as an attack to the person and would cause threat, insult and shaming". [5] Violence towards staff may result from a variety of sources including patients, family, friends or colleagues, [19] which has devastating effects on victims and observers and may even cause complications such as stress disorders after incident, [20] and therefore, it requires attention and follow-up.

From selected studies conducted on workplace violence in the health centers of Iran, all 17 cases were related to hospitals, which one of them was in English and others were Persian. Sample of 13 studies were nurses, 2 research physicians and in 2 studies included all clinical staff. Most studies data gathering was conducted through researcher-made questionnaires that placed standardized questionnaires like the questionnaire of World Health Organization, International Labor Organization, International Society of Nurses and the International Society of General Services about violence toward staff of health center the basis of their work [Figure 1].
Figure 1: The prevalence of different types of violence in hospitals of Iran

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The results showed that most of the staff, particularly clinical staff of hospitals have experienced violence and the most violence were verbal violence in Iran's hospitals [1],[7],[9],[17],[21],[22],[23],[24],[25],[26],[27] and the lowest were racial and sexual violence. [9],[16],[21],[23],[27]

Findings indicate in Iran, verbal violence against healthcare workers in accordance with 10 studies was 69.35 percent, [7],[9],[16],[17],[22],[23],[25],[26],[27],[28] physical violence [7],[9],[16],[17],[22],[23],[25],[26],[27],[29] the total 29.9 percent, sexual violence 22.6 percent in five studies [9],[16],[17],[23],[27] and also racial violence in two studies was 16.65 per cent. [9],[23]

Demographic factors related to violence

Studies were investigated on demographic factors, personal characteristics and their relation to violence in hospitals, which will be discussed as follows:

Attacker gender

Studies showed the significant correlation between violence and attacker gender in hospitals and according to them, more violence has been done by men. [16],[21],[24],[30] In a study, physical violence and other forms of non-verbal violence toward male employees were done by men but about female staff, there was violence by both genders. [17]

Victim gender

A review of the results of several studies showed that there are significant differences between sex and physical violence at work, in the way males are exposed to violence more than females. [7],[22],[25],[26],[29] Also in a study, all types of violence except sexual violence, against male doctors and medical students was more rather than their own population but sexual violence was more against women. [16]

In conjunction with verbal violence, a study showed that verbal violence is significantly more among male nurses, [31] but another research reported that the prevalence of violence was higher among women [7] and in a case female nurses had been more abused faced with bullying. [28] Unlike the above results, there have not found a significant correlation between gender and violence in some studies. [1],[17],[21],[24],[25],[26],[32]

Age

In some of the findings, a relation was obtained between age and aggression and increasing age reduces the prevalence of violence. [7],[32] Whereas, in other studies the opposite was true. [25],[29],[31] However, several studies have not confirmed the correlation between age and violence. [1],[7],[17],[24],[26]

Level of education

According to a study, most cases of violence were in people with diplomas and under degrees and the lowest level of verbal and physical violence has occurred among workers with a bachelor's degree and there is a significant correlation between education level and physical violence. [25] Although, in Sahebi and Gholamzadeh research, was not found a significant relationship between education level and violence. [7]

Work experience

In several studies, people with less work experience were abused more and with increasing work experience violence was reduced. [7],[17],[32] A study showed that highest level of verbal and physical violence were among employees with 1-4 years experience but no significant relationship was found between them. [25] However, in a study with increasing work experience, verbal aggression was increased [31] and in another study people with more than 10 years work experience have more exposure to physical violence [29] and in some studies have not also found a correlation between work experience and violence. [1],[17],[26]

Marital status

Few studies have examined the relationship between marital status and exposure to violence, in the meantime, in a study difference between married and single people was significant and married had higher aggression scores. [32] In another research, single people were attacked more than married people, physically and verbally [21] and in a study, there was no relationship between marital status and prevalence of violence. [31]


  Discussion Top


According to the results, there was more violence in hospitals of Iran: Verbally (69.35 percent) as well as physically (29.9 percent). In Malek Afzali study, [33] concerning domestic violence, verbal violence occurred 34 to 62 percent and in the study by Kazemian [34] physical violence occurred with 93 percent and verbal abuse 88 percent had the highest rates. These results were also obtained in Karimi [35] and Lavasani [36] studies among students and teachers and Jahanfar study [37] among football fans. Thus, it seems that this kind of violence is a serious cultural problem in our society, not only in the hospital but also in all society [35] that is learned through direct experience or observation of other behavior [38] and transmitted as an acquired behavior from a generation to other generation (social inheritance of violence). [39] Studies in Turkish hospital emergency departments [40] and among nurses in Queen Mary Hospital of Hong Kong [41] also showed that most cases occurred were verbal abuse (79.6 percent and 73 percent, respectively) that are in agreement with present study.

According to findings, demographic factors related to violence in hospitals of Iran were classified in five categories: (1) Gender, (2) age, (3) education level, (4) work experience and 5) marital status.

This study, in conjunction with attacker gender, concludes that men are more desired to aggression and violence that is consistent with a study conducted in China, where violence was more prevalent among male [41] and research on violence against surgical residents in America, which showed most attacker were male. [42] A review of research on violence in the emergency department also reported that the majority of aggressive patients were young men. [13] The overall findings of studies show that aggression among women is less common than men and the biological reasons can be noted to the level of chemicals such as testosterone, which is more in men than women and has an effect on aggression. [43]

Based on this, there is discrimination and violence against women and generally females are victims of crimes such as domestic violence, harassment and sexual violence; [44] and this violence is resulted from gender-oriented ideology and male power and inequality, discrimination and ultimately economic and financial dependence. [45] It was expected that women are more likely exposed to violence than men; in a study of violence in the emergency department, it was also expressed that people with smaller physical size and women are more vulnerable to violent attacks. [13] Although, there were different results in this case, but we can say that in general men had higher exposure to violence. This may be due to the reason that women are more emotional towards others compared to men and hence can have more empathy towards patients. [46]

Age may be a factor for the occurrence of violence. Results also revealed that age factor plays an important role on the incidence of violence as young and less experienced nurses had more exposure to violence. It was also pointed out in a review study that younger and less inexperienced people are more prone to violent behavior. [13] Kamchuchat, in a hospital in Thailand confirmed the results of the present study and showed that young nurses, because of less work experience, are not capable to handle and encounter difficult situations. [47] It sounds great mental excitements, inability to control emotions, certain problems affecting the younger age as job, mate selection and lack of adequate facilities could be possible factors influencing aggression. [32] It is thought that employees with more work experience have less exposure to violence. It was approved in some research that staffs with less work experience had more exposure to violence and by increased experience, violent behavior declined. Some researchers believe that with increasing work experience, one can anticipate and handle stressful situations. [31] It should be noted that in this study, some results also indicated that more work experience increases exposure to violence that are inconsistent with these findings and seems there are other reasons for this issue such as quality of work life.

In terms of education, workers with low education level were more exposed to violence. This could be due to the fact that education effects on people awareness on the proper manner to communicate and their ability to control their behavior and people with higher education do not involve physical violence. In Saberian study, men who were abused against their wives, had less education level [39] and Narimani indicated domestic violence decreases significantly with higher levels of women education. [48]

There are a variety of results in studies related to marital status in one research that single people were more attacked and in other study, married people had higher aggression scores. Thus, marital status plays a two-fold and important role in people mental health. Successful marital life by providing appropriate social, emotional and economical support for people contributes towards improving their mental health. On the other hand, there are several problems that arise from unsuccessful lives like its adverse effects on people and the incidence of violence and aggression.

Among the limitations of the study, performing a systematic review was not available according to topics dispersal, as different methods of data gathering and information reporting in research and data analyses were not comprehensive and integrated, and also results may not be indicative of problems in Iran due to variables such as demographic and cultural differences in different parts of the country. In general, studies on violence in hospitals of Iran are limited and in cases contradictory results were obtained. Therefore, a general conclusion cannot be made ​​based on this studies and further research is needed.


  Conclusion Top


According to the results, violence in hospitals of Iran was more verbally and physically and in general, men were the main attackers and victims of violence. Age, less work experience and low level of education can also be as effective factors in increasing violence. Given that poor working conditions with lack of manpower about care for many patients and the healthcare system overload caused long waiting time too and may cause violent outburst of disappointed patients and their families. However many hospital staff have not been trained to confront and prevent violence in workplace, as it shows that despite the high prevalence of violence and the its importance as a serious problem, there has not been a serious attempt to minimize this phenomenon so far. [14] Therefore, to reduce and prevent violence, better human resources planning, using experienced and patient staff to interact with clients are essential. If possible, increase in the number and capacity of staff, which is required for better services of clients; and staff training for appropriate and respectful communications with patients and families are important. Also, coping with violence and anger management training is needed and finally the measures should be taken to handle the victims of violence.

 
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