|Year : 2015 | Volume
| Issue : 3 | Page : 169-176
Strategies for reducing violence in hospital from the viewpoint of support-administrative staff: A qualitative study
Najmeh Bahman Ziari1, Mahmoud Keyvanara2, Mohammad Reza Maracy3, Azad Shokri1
1 Department of Management and Health Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
2 Department of Health Services Management, School of Management and Medical Information, Isfahan, Iran
3 Department of Epidemiology and Biostatistics, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
|Date of Web Publication||20-May-2015|
Najmeh Bahman Ziari
PhD Student in Health Policy, Department of Management and Health Economics, School of Public Health, Tehran University of Medical Sciences, Tehran
Source of Support: This paper was extracted from a M.S dissertation
that had been supported by Isfahan University of Medical Sciences, Conflict of Interest: None
Introduction: Today violence is considered as one of the issues relating to health and occupational safety of the people and is also one of the existing occupational hazards in hospital. Therefore, the present study was conducted to investigate strategies of reducing violence in hospital from the viewpoint of support-administrative staff to take necessary actions for removing and reducing it using the obtained information. Materials and Methods: The study was conducted qualitatively with semi-structured interview and opinions of 10 authorities and employees of support-administrative units in Alzahra Hospital about violence reducing strategies were collected. Thus, the contents were transcribed after interview and then the interview data was reduced and structured using thematic analysis. Results: Views of the people about necessary strategies and actions for reducing violence in hospital were studied and classified as 46 subthemes and 11 themes in three groups: Necessary action for preventing violence, necessary actions at time of violence and necessary actions after violence. Conclusion: Considering high prevalence of violence in hospitals and although it is not possible to remove violence completely, this issue should be considered by the policymakers in the country, suitable reporting system and a proper instruction for preventing and confronting with violence should be prepared in the hospitals and necessary actions particularly necessary actions after violence which have been neglected so far should be taken to reduce probability of stress and violence in hospital considerably.
Keywords: Hospital, qualitative study, staff, violence
|How to cite this article:|
Ziari NB, Keyvanara M, Maracy MR, Shokri A. Strategies for reducing violence in hospital from the viewpoint of support-administrative staff: A qualitative study. Int J Health Syst Disaster Manage 2015;3:169-76
|How to cite this URL:|
Ziari NB, Keyvanara M, Maracy MR, Shokri A. Strategies for reducing violence in hospital from the viewpoint of support-administrative staff: A qualitative study. Int J Health Syst Disaster Manage [serial online] 2015 [cited 2021 Feb 27];3:169-76. Available from: https://www.ijhsdm.org/text.asp?2015/3/3/169/157407
| Introduction|| |
It seems that violence and contention are of the common aspects of routine life  which today are considered as one of the issues relating to health and occupational safety of the people.  World Health Organization (WHO) has defined violence as deliberate use of physical power threateningly or really against self, others or the group or society which causes injury, death, mental damage or deprivation or increases probability of these events.  Workplace violence is defined in different ways as events such as abuse, threat or attack of the person or persons to the staff in positions such as time of performance at workplace, traffic and also working missions.  Workplace violence is also one of the existing occupational hazards in hospital.  Studies show that violence is increasing in many workplaces. Health caregivers are more exposed to violence than others in the world so that more than 50% of the health staff experienced violence while working and this problem in health systems is regarded serious  because some events such as violence have important long-term effects on healthcare staff, some cases such as low morale, anger, loss of confidence, job burnout, inability and change of job condition, intermittent headaches, gastrointestinal problems, anxiety, depression, hopelessness and loss of self-confidence  and since this problem causes heavy costs on healthcare systems, it should not be neglected. 
Unfortunately, violence against staff of healthcare centres in the world has increased more than ever  and the staffs employed in different wards of hospitals face all types of violence for reasons such as dissatisfaction with treatment, long waiting time, drug abuse and alcohol use. ,,, The studies conducted on prevalence of violence in hospitals of Iran have investigated violence against clinical team of hospitals particularly nurses and results indicate that prevalence of violence in these centers is high, many personnel have experienced violence and verbal violence was the most common one in hospitals ,,,,,,,,, and racial and sexual violence was the least common ones. ,,,, In most of studies the main attackers were companions and relatives of patients, ,,,,,,,,, and more violence was done by men. ,,,
Recent studies indicate that current face of workplace violence is just like the peak of a huge icy mountain.  Therefore, it is necessary to collect information on determination of all kinds of violence, its occurrence and recognition of successful strategies for confrontation with violence.  Although it is not possible to prevent all of the violent events in hospital, many cases can be prevented such as reduction of injuries, losses and destruction of properties. Management of violence has three stages: Violence prevention, activities at time of violence and what is done after violence.  In Iran, importance of this issue has been less known and no comprehensive studies have been conducted on the risk factors and necessary actions for prevention and reduction of violence in hospital. Therefore, the present study was conducted to investigate strategies of reducing violence in hospital from the viewpoint of support-administrative staff who face violence of patients and the companions to take necessary actions for removing and reducing it using the obtained information.
| Materials and Methods|| |
This study was a qualitative study with thematic analysis method. In thematic analysis researchers analyse the classification and categorisation of data to mine concepts and fundamental patterns of meaning.  The sampling was purposefully done and it was tried to interview with a variety of authorities and support-administrative unit's personnel in Alzahra Hospital, who had a history of violence by patients and companions, so a sample of employees were selected for the study who had higher exposure to violence according to a previous research. Finally, because of the lack of cooperation of some people and since in the last interviews, the researcher concluded that the new information does not come and collecting data is complete (repetition of experiences and prior knowledge), the number of respondents was limited to 10 people working in security and police unit, social work, admission and medical records, administrative management and professional services, income and complaints handling units. Semi- structured interviews lasted for 30-70 minutes. Interview questions were reviewed and controlled by experts in the field of research. Before doing any interviews by expressing purpose of studying, how to cooperate, methods of collecting and recording data, the researcher and the research participants and confidentiality of information and the characteristics of the respondents (such as name, voice recordings, text) and the application code instead of a name and also informed consent were obtained from interviewees.  After recording interview on paper, to analyse the data, each interview transcript was studied several times and the codes of each study was extracted and summarised and using thematic analysis to reduce the data and the structure and a total of 46 sub-themes and 11 themes were obtained. To ensure the validity and reliability of data during the study, participants reviewed data and the extracted codes to confirm the validity and codes were modified which did not reflect the views of the participants. Finally, to revise, text of some interviews, codes and themes extracted were examined by several faculty members.
| Results|| |
Of 10 people participated in the study, the majority were male (N = 8) that four people were working in security and police unit. Views of the people about necessary strategies and actions for reducing violence in hospital were studied and classified as 46 subthemes and 11 themes in three groups: Necessary action for preventing violence, necessary actions at time of violence and necessary actions after violence [Table 1],[Table 2],[Table 3],[Table 4],[Table 5] and [Table 6].
|Table 2: Themes and subthemes of necessary actions for preventing violence|
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| Discussion|| |
The study was conducted to investigate strategies of reducing violence in hospital from the viewpoint of support-administrative staff and as mentioned above, views of the people about strategies and actions required for reducing violence in hospital were studied and classified as 46 subthemes and 11 themes in three groups: Necessary action for preventing violence, necessary actions at time of violence and necessary actions after violence. Education, security actions, improvement of human resources planning, improvement of interactions, improvement of structure and performance of the centre, actions relating to clients and structural changes were included in the groups of necessary actions for preventing violence. To review the literature in this field in the country, few studies referred to some limited cases according to the cases determined in the questionnaire and anti-violence actions included some cases such as training methods for confrontation with violence, the presence of security facilities such as fence and mobile phones, increasing the number of personnel particularly security personnel, change in shift and working time, increasing break hours of the personnel, reduction of individual working time, investment for developing human resources, limitation of public access, promotion of workplace quality, instruction for public information, increasing welfare facilities of the wards and emergency department, the presence of psychiatric and psychological consultant in wards, shortening hospitalization time, rest room for companion of the patient, reducing the number of patients visited by each physician and the clients of clinic, expanding the environment of clinic and screening patients with history of violence. , In the study by Ghodsbin, 59% of the people believed that selection of suitable people for different affaires was a good way for controlling violence. Some also believed that a competent person can predict type of violence.  In many foreign studies, issue of personnel training has been emphasized. ,,, In the research in emergency departments of Turkey, most nurses declared that some of their on-the-job training should include some issues which help them prevent and control violence.  Other cases mentioned in the studies for prevention included suitable physical structure, security actions and facilities, suitable number of personnel, suitable reporting system and development of policies and laws for controlling violence ,, which was consistent with present study results.
Necessary actions at time of violence also included compatible actions and counteractions. In internal conducted studies, such cases have been mentioned as reactions and actions performed by the personnel against violence. In Kazemi study, these cases included reaction of physicians against violence, trying to explain to patient, silence, informing security and authorities and leaving the place.  Also in other studies, some cases were mentioned such as asking the aggressor to calm down, getting far from the place and not taking any action, informing security forces, self defense, crying mutually, reporting to the higher authorities and communicating to the family and colleagues. ,, In study by Talas, the most common ways of controlling violence were silence and not taking action and reporting the higher authority;  according to Fernandes et al., the best action at time of stress is to prevent from eye and physical contact with the person who is anxious and stressful too  that this study findings support these results. Occupational Safety and Health Administration (OSHA) also mentions that the necessary trainings such as ways of tranquilizing and removing stress using tranquilising techniques and expressing awareness with feeling of the opposing side and its effect on him/her can tranquilise the person because the opposite side will be sure that he/she is seen and considered important. 
Regarding necessary actions after violence, some actions related to personnel and some related to centre which were not discussed in local studies. In foreign studies, some issues such as report of the personnel as victim of violence, consultation for handling mental effects of violence and support of the victims were the actions after occurrence of the event ,, which improved quality of job services and reduced job violence in long term.
| Conclusion|| |
The study was faced with some limitations such as no cooperation of some authorities and personnel due to shortage of time and fatigue; also recording to this fact that of 10 people participated in this study, the majority were male (N = 8) and four of them were working in security and police unit, this shortcoming could be reflected on the viewpoint of staff, which limits the generalisation of the research results. Considering high prevalence of violence in hospital and viewpoints of staff about the actions for preventing and reducing violence; although it is not possible to remove violence completely, this issue should be considered by the policymakers in the country, suitable reporting system and a proper instruction for preventing and confronting with violence should be prepared in the hospitals and necessary actions particularly necessary actions after violence which have been neglected so far should be taken to reduce probability of stress and violence in hospital considerably.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]