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      Pattern of Violence Among Healthcare Workers in a Tertiary Care Government Hospital and a Multi-Specialty Private Hospital in Sagar, India: A Cross-Sectional Study

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          Abstract

          Background

          Workplace violence in hospitals is an occupational hazard that affects healthcare workers (HCWs) negatively in many aspects and causes deterioration of the doctor-patient relationship, resulting in providence of substandard healthcare. This study was conducted to compare the pattern of violence in a tertiary care government teaching hospital and a multi-specialty private trust hospital in Sagar district, Madhya Pradesh, India.

          Methodology

          After ethical clearance of this cross-sectional, observational study, participants (frontline healthcare workers, including doctors and nurses) were asked about the type, frequency, department, and place of violence, etc., along with its perceived causes, solutions, and arrangements made by hospitals for dealing with it using a pretested, semi-structured questionnaire. Data analysis was performed using IBM SPSS Version 26.0 (IBM Corp., Armonk, NY). Categorical variables were described using frequency and percentages, and inferential analysis was conducted using the chi-square/Fisher's exact test. A P-value of <0.05 was considered statistically significant.

          Results

          Among the 113 participants, 67 (59.3%) were female, 53 (46.9%) were doctors, and 60 (53.1%) were nurses. The mean age of participants was 30.9±7.3 years. Predominantly verbal, emotional, and physical violence were present in 96.5%, 43.4%, and 6.2% of participants, respectively. Violent incidents against healthcare workers were more frequent in government hospitals as compared to private hospitals. Most healthcare workers (87.6%) tried to resolve violent incidents peacefully, and 1.8% tried to fight back. The most perceived cause of violence in both setups was a lack of morality and literacy among patients and their relatives (i.e., 83.2%), followed by a lack of proper facilities and a lack of trust in healthcare workers.

          Conclusion

          Both setups faced a substantial amount of violence. The loopholes in both setups, considering resources, security, and other facilities, are clearly visible, and specific steps must be adopted to protect both systems from violence.

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          Most cited references22

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          The health of the healthcare workers

          A healthcare worker is one who delivers care and services to the sick and ailing either directly as doctors and nurses or indirectly as aides, helpers, laboratory technicians, or even medical waste handlers. There are approximately 59 million healthcare workers worldwide. Recognizing the vital role played by health care workers as “the most valuable resource for health” the World Health Organization (WHO) had declared the years 2006 to 2015 as the “The decade of the human resources for health.” Do these millions of workers who toil every day to provide healthcare to the ailing population enjoy good health themselves? In other words, are the healthcare workers healthier than their patients? As those who care daily for the sick and injured, healthcare workers are often viewed to be immune to injury or illness. Ideally, the very fact that the health facility is within their reach would make one believe so. However, the picture is not as rosy as it seems. Healthcare industry is one of the most hazardous environments to work in. Employees in this industry are constantly exposed to a complex variety of health and safety hazards in the course of their work. Hazards range from biological exposure to disease causing organisms such as tuberculosis and human immunodeficiency virus (HIV) or exposure to chemicals such as glutaraldehyde and ethylene dioxide. Apart from physical hazards such as exposure to radiation and noise, there are also ergonomic issues such as heavy lifting and standing for long periods. Long working hours and shift work add to the stress of work. A healthcare worker is in need of protection from these workplace hazards just as much as any other category of workers such as miners or construction workers. The World Health Report 2006 – Working Together for Health – reported a severe healthcare workforce shortage especially in 57 countries, mostly in Africa and Asia. Fear of contracting infectious diseases is primarily responsible for high attrition rates among health care workers. In a report published by the WHO, the disease burden caused by percutaneous sharps injuries among healthcare workers was found to be three million per year. Moreover, 40% of hepatitis B, 40% of hepatitis C, and 4.4% of HIV among healthcare workers were due to needle stick injuries. It is very unfortunate that approximately 1000 healthcare workers die annually from occupational HIV, which can and should have been prevented. Despite this, almost 80% of healthcare workers remain unimmunized (against Hepatitis B) in many parts of the world. Another example of a serious occupational hazard would be that of tuberculosis among healthcare professionals. In the pre-antibiotic era, there were a number of health professionals who fell prey to the disease, however, with the advent of antibiotics, these numbers have substantially reduced. Now, however, we find a resurgence in the number of cases of tuberculosis infection and disease, especially among technicians, pathologists, and physicians. Reasons for this are varied ranging from heavy exposure to the pathogen at the workplace to poor infection control measures implemented at the hospitals and laboratories. This trend is not restricted to infectious diseases alone. Several studies have found that healthcare workers fare no better than the general population when it comes to non-communicable diseases such as diabetes and hypertension, as well as cardiovascular diseases. We continue to smoke, consume alcohol, eat junk food, sleep erratically, and remain obese with little physical exercise despite knowing the health risks that they pose. This shows that we do not always “practise what we preach.” Several action points come to mind. It is important that we devote adequate time to education – not only of ourselves but of those who work at different levels of the healthcare industry. Our approach to preventive programs, such as vaccinations, requires special attention and may need to be undertaken on a warfooting. There is a paucity of research into the hazards faced by healthcare workers in our country and we need to expand the scope of this research from single centre studies to the analysis of data from multiple centres. This alone will provoke interventions that are designed for large scale implementation. The need of the hour is to prioritize occupational health of health workers and ensure that the workforce is adequately trained and healthy. As humanitarians, it is our duty to help the most vulnerable sections but we should not end up paying the price of our lives for it. The way forward is no longer “Physician heal thyself” but “Physician protect thyself.” Medicus custodiat te!
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            A Study of Workplace Violence Experienced by Doctors and Associated Risk Factors in a Tertiary Care Hospital of South Delhi, India.

            The increasing incidences of violence against doctors in their workplaces are an important reason for stress among these healthcare workers. Many incidences of workplace violence against doctors have been reported in the past and are also being continuously reported from different parts of the country as well as the world.
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              Workplace violence against medical staff of Chinese children's hospitals: A cross-sectional study

              Background In China, medical staff of children’s hospitals are commonly exposed to violence. However, few studies on medical violence are conducted in the settings of children’s hospitals. The aim of this study is to assess the incidence, magnitude, consequences, and potential risk factors of workplace violence (WPV) against medical staff of children’s hospitals. Methods A retrospective cross-sectional design was used. A self-administered questionnaire was utilized to collect data on 12 children’s hospitals. The questionnaires were distributed to a stratified proportional random sample of 2,400 medical staff; 1,932 valid questionnaires were collected. A chi-square test and multiple logistic regression analysis were conducted. Results A total of 68.6% of respondents had experienced at least one WPV incident involving non-physical and/or physical violence in the past year. The perpetrators were mainly family members of patients (94.9%). Most of the WPV occurred during the day shift (70.7%) and in wards (41.8%). Males were 1.979 times (95% CI, 1.378 to 2.841) more likely than females to experience physical violence. Emergency departments were more exposed to physical violence than other departments. Oncology was 2.733 times (95% CI, 1.126 to 6.633) more exposed to non-physical violence than the emergency department. As a result of WPV, victims felt aggrieved and angry, work enthusiasm declined, and work efficiency was reduced. However, only 5.6% of the victims received psychological counseling. Conclusion Medical staff are at high risk of violence in China’s children’s hospitals. Hospital administrators and related departments should pay attention to the consequences of these incidents. There is a need for preventive measures to protect medical staff and provide a safer workplace environment. Our results can provide reference information for intervention strategies and safety measures.
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                Author and article information

                Journal
                Cureus
                Cureus
                2168-8184
                Cureus
                Cureus (Palo Alto (CA) )
                2168-8184
                3 November 2023
                November 2023
                : 15
                : 11
                : e48231
                Affiliations
                [1 ] Community Medicine, Government Bundelkhand Medical College, Sagar, IND
                [2 ] Community Medicine, Government Chhindwara Institute of Medical Sciences, Chhindwara, IND
                [3 ] Community Medicine, Tripura Medical College and Dr. B.R. Ambedkar Memorial (BRAM) Teaching Hospital, Agartala, IND
                [4 ] Pediatrics, Mahatma Gandhi Memorial Medical College, Indore, IND
                Author notes
                Article
                10.7759/cureus.48231
                10693911
                38050497
                753f8f35-43a7-48c9-8bfc-0132141087e1
                Copyright © 2023, Khiyani et al.

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 3 November 2023
                Funding
                This study was done with the financial support and sponsorship of the Indian Council of Medical Research under the ICMR Short-Term Studentship (STS) Programme 2020 (Ref no. 2020-03258).
                Categories
                Epidemiology/Public Health
                Quality Improvement
                Health Policy

                violence against doctors,verbal violence,multi-specialty hospital,tertiary care hospital,medical workplace violence,healthcare worker (hcw)

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