|Year : 2013 | Volume
| Issue : 4 | Page : 204-207
Prevalence of violence and its perpetrators in support-administrative departments of Alzahra Hospital: 2013
Mahmoud Keyvanara1, Mohammad Reza Maracy2, Najmeh Bahman Ziari3, Azad Shokri4, Ayan Kordi3
1 Associate Professor, Department of Health Services Management, School of Management and Medical Information, Isfahan University of Medical Sciences, Isfahan, Iran
2 Associate Professor, Department of Epidemiology and Biostatistics, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
3 M.Sc. Student in Health Services Management, Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
4 PhD Candidate in Health Services Management, Hospital Management Research Center, Iran University of Medical Sciences, Tehran, Iran
|Date of Web Publication||16-Apr-2014|
Najmeh Bahman Ziari
Student of Health Services Management, Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan
Source of Support: This paper was extracted from a thesis that has been supported by Isfahan University of Medical Sciences, Conflict of Interest: None
Introduction: Violence is increasing in many workplaces among health care system. Hence, several studies have been performed in this field in Iran hospitals, but there is no study on the prevalence of violence among hospital support-administration staff; therefore, the present study aimed to investigate the prevalence of violence, its types, and perpetrators in support-administrative departments of Alzahra University Hospital. Materials and Methods: This descriptive-analytical study was performed in Alzahra University Hospital of Isfahan in 2013. The study population was all the support-administrative staff of the hospital, which was interacting with patients and their companions. Sampling was done by census. The research tool was a researcher-made questionnaire including five domains: personal information, workplace information, verbal violence, physical violence, and other violent acts. Validity of the questionnaire was evaluated by the views of experts and its reliability was confirmed by test-retest (r = 0.9). Finally, data were analyzed by using descriptive statistical indicators and statistical tests such as the Chi-square by SPSS 20. Results: According to the results, the overall prevalence of violence among support-administrative staff was about 81% and the most reported violence was verbal violence (78.4%). In all types of violence, the majority of attackers were patient companions and men had shown more aggression compared with women. Although emergency condition caused more violence, there was no significant correlation between violence and patient's condition. Conclusion: Based on results, the most reported violence was verbal violence and main perpetrators of that were men and patient companions. According to high incidence of violence and staff willingness to train in this field, it is suggested to hold workshops on coping with violence and appropriate and respectful communication with patients and families, using experienced and patient staff to interact with clients and administrative procedures of admission and discharge should become specified and shorter.
Keywords: Administrative-support departments, hospital, support-administrative departments, violence
|How to cite this article:|
Keyvanara M, Maracy MR, Ziari NB, Shokri A, Kordi A. Prevalence of violence and its perpetrators in support-administrative departments of Alzahra Hospital: 2013. Int J Health Syst Disaster Manage 2013;1:204-7
|How to cite this URL:|
Keyvanara M, Maracy MR, Ziari NB, Shokri A, Kordi A. Prevalence of violence and its perpetrators in support-administrative departments of Alzahra Hospital: 2013. Int J Health Syst Disaster Manage [serial online] 2013 [cited 2021 Feb 27];1:204-7. Available from: https://www.ijhsdm.org/text.asp?2013/1/4/204/130732
| Introduction|| |
Violence is common in any area of social life and in all cultures and races, and today is considered as one of the issues relating to health and occupational safety of the people.  World Health Organization has defined violence as the intentional use of physical force or power, threateningly or really against self, others or the group or society that causes injury, death, mental harm or deprivation, or increases probability of these events  and has classified it into four categories: Physical violence (knuckling, kicking, slapping, pushing, biting, pinch, and wounding with sharp objects), verbal violence (behaviors such as insult, humiliation, intimidation, ridicule, and insults), racial violence (threatening conduct because of race, color, language, nationality, religion, work with a minority, birth place or financial facilities, or any other status), and sexual violence (any unwanted conduct related to the sex of the person to be attacked and caused threat and insult or be embarrassed).  Workplace violence is defined as any event or situation in which the person is mistreated, threatened, or attacked in his workplace or related conditions.  Studies show that violence is increasing in many workplaces, health care system is one of those workplaces  and employees in various departments of hospitals had exposure to different types of violence for reasons such as dissatisfaction with treatment, log waiting time, drug use and alcohol, ,,,, and today this is considered as a serious problem in health care systems. 
Unfortunately, violence has multiple physical and psychological effects, briefly include physical injuries, migraine and tension headaches, anger, fear, depression, anxiety, guilt, loss of self-confidence, and belief in their abilities and adverse effects on the quality of patient care; aside the different effects of individual that is followed by disorders such as loss of workdays, restricted activity, termination of employment, change jobs, and even death.  Thus, workplace violence is a management issue that can have negative effects on the performance of employees and professional relationships by affecting the performance of the institution and change it into the unsafe and hostile workplace and also decreases the quality of care given to the patient.  Because the effects of violence against staff impose enormous cost to the health care systems, it cannot be negligible.  Hence, in order to gain more understanding about violence, several studies have been performed in this field in hospitals of different provinces of Iran that most studies examined violence against clinical staff, especially nurses and results indicate that the prevalence of violence in these centers is high, many staff have experienced violence and most reported violence is verbal type ,,,,,,,,,, and physical, ,,,,,,,,, respectively. However, there is no study on the prevalence of violence among support-administration staff of hospitals in the country and this group has been neglected; therefore, the present study aimed to investigate the prevalence of violence, its types, and perpetrators in support-administrative departments of Alzahra University Hospital.
| Materials and Methods|| |
This is a descriptive-analytical study carried out in 2013 in Alzahra University Hospital. The study population was all the support-administrative staff working in administrative affairs and secretariat, department of revenue development and insurance, reception and medical records, nutrition and distribution of food, hygiene, security guards, and social work who was interacting with patients and their companions. Sampling was done by census and exclusion criteria were unwillingness of employees to cooperate, at the end, 125 people participated in the study. The research tool was a researcher-made questionnaire including 26 objective questions in five domains: Personal information (six questions), information related to workplace (five questions), verbal violence (five questions), physical violence (five questions), and other violent acts (five questions) that physical violence included violence through physical contact, such as knuckling, kicking, slapping and; verbal violence, cases such as yelling, expression of terms that apply to insult, humiliation, intimidation, ridicule and insults, and also other violent acts meant offensive look, banging on the table, tearing up the sheet, and so on. Fist question in any area of violence was about exposure to violence in the past 12 months, if the response was positive, the participant responded to questions about exposure times, attacker person, attacker gender, and severity of disease. Face and content validity of questionnaire was evaluated by receiving the comments of five experts and professors and doings some changes, including the removal of some questions and changing the content of some other questions and its reliability was confirmed using test-retest method and McNemar test (r = 0.9). Thus, the questionnaires were distributed and collected among 20 employees, after a week, the questionnaires were distributed among the same people and the reliability of the questionnaire was confirmed by investigating the correlation between the responses. Questionnaires, after coordination with the hospital authorities, were distributed and collected anonymously and collectively. Finally, data were presented using descriptive statistics and analyzed by tests such as Chi-square test by statistical software SPSS20.
| Results|| |
The findings show that respondents, 66.4% (83 people) were male and 33.6% (42 people) were female. The majority had 10-15 years work experience and age range of 35-45 years. A total of 43.2% were diploma and associate degree, 32.8% with bachelor or higher, and 22.4% were under diploma. Of those, 91.2% were married and the rest were single.
As can be seen, 81% of support-administrative staff were exposed to violence at least once in 2012, and many people (36%) experienced all three types of violence [Table 1] and the verbal violence had the highest rate [Table 2] and [Table 3].
|Table 1: Frequency distribution of exposure to violence among hospital support‑administrative staff|
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|Table 2: Frequency distribution of violence types among hospital support‑administrative staff|
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|Table 3: Frequency distribution of violence types attackers in separation of person, attacker gender, severity of disease and the correlation between them|
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Above Table shows frequency distribution of violence types attackers in separation of person, attacker gender, severity of disease, and the correlation between them and based on results, there is no significant correlation between violence and person attacker and severity of disease (P < 0.50), but in relation to gender, the correlation was significant (P > 0.50) and men were more aggressive than women.
It is noted that 32% of the people stated that they are very concerned about the violence in their workplace. Of this number 67.2% stated that there is no instruction to report violence in workplace. A total of 40.8% were trained about violence and in general 85% were interested in training in this field.
| Conclusion|| |
According to survey results, 81% of support-administrative staff have experienced violence that the most reported violence was verbal violence (78.4%), other violent acts (52%), and physical violence (41.6%), respectively. Also, in other conducted studies in country's hospitals, the prevalence of violence was so high among clinical staff ,,,, and the most reported violence in hospitals ,,,,,,,,,,, and medical emergency centers, , was verbal abuse and other forms of violence, including physical violence, sexual, and racial have been followed. Studies in emergency departments of Turkish hospitals  and among nurses in a hospital in Hong Kong  and Southern Thailand  have also shown that most cases occurred were verbal violence (79.6%, 73%, and 38.9%, respectively) which this study is consistent with them.
In all types of violence, the majority of attackers were patient companions; however, there was not found any significant correlation between attacker and violence. Findings of the present study are in agreement with studies by Rahimzadeh et al., Sahebi and Nikkjoo, Kazemi, and Koohestani et al., Hassani et al., Rahmani et al., Shoghi et al., Zamanzadeh et al., and Ghasemi et al., and in all of these studies, the attackers were also companions and patient relatives, ,,,,,,,,, but in Aghajanlou et al.,  the most physically attacks were equally by patients (33.3%) and the companions (33.3%) and most of verbal abuse were done by patients' companions. Specific regulations of hospitals, such as limiting visiting hours, long waiting time to get the services, relatives worried about the condition of patients, unavailability of administrative personnel such as admission and discharge authorities and sometimes psychological disorders are among factors that cause workers exposed to violence by patients relatives. 
About gender of attackers, a significant correlation obtained and in all types of violence, especially physical violence, men were more aggressive than women. Other examined studies about the incidence of violence in hospitals, also indicated the relationship between violence and attacker gender and according to the surveys more violence was carried out by men ,,, In a study, physical violence and other types of nonverbal violence against male staff were done by men, but about female staff there was violence from both genders  A research on violence in America against surgical residents showed that most assailants were men.  Also in a survey conducted in China, violence was more prevalent in men's department.  A review study on violence in the emergency department was also reported that the majority of aggressive patients were young men.  The overall findings of studies show that aggression among women is less common than men and it has biological causes,  and given that most people exposed to violence in the study were male employees, this issue has increased conflicts.
No significant relationship was found between violence and patients condition in the study, although emergency situation of patients caused more violence and only about verbal violence, emergency and elective patients did not differ much. Salimi et al.,  survey also showed that in all types of violence, trauma patients companions comprised more attackers. Since the patient is in critical condition, hence, relatives experience various mental and physical pressures, such as worry about loved ones, fear, and sometimes anger  and this may cause more aggression.
Study was faced restrictions due to problems such as recall bias, lack of cooperation of some authorities to conduct research, lack of time and staff fatigue, and despite the employees bill of rights has been prepared and installed in the hospital to reduce the violence, the prevalence of violence is still high. According to the results about staff willingness for training in this field, in order to prevent violence especially conflicts with male patient's companions, it is suggested to hold training workshops on coping with violence, anger management, and also appropriate and respectful communication with patients and families, using experienced and patient staff to interact with clients and administrative procedures of admission and discharge should become specified and shorter. Finally, conducting other research qualitatively for a careful examination of violence causes and other aspects of the subject would be helpful.
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[Table 1], [Table 2], [Table 3]