|Year : 2014 | Volume
| Issue : 1 | Page : 25-28
Prevalence and attitude of workplace violence among the post graduate students in a tertiary hospital in Manipur
Jego Ori1, Ningthoukhongjam Shugeta Devi2, Akoijam Brogen Singh2, Kalpana Thongam1, Jumge Padu3, R Abhilesh1
1 Department of Otorhinolarngology, Regional Institute of Medical Sciences, Imphal, India
2 Department of Community Medicine, Regional Institute of Medical Sciences, Imphal, India
3 Department of Chest Medicine, Regional Institute of Medical Sciences, Imphal, India
|Date of Web Publication||24-Jun-2014|
Dr. Ningthoukhongjam Shugeta Devi
Department of Community Medicine, Regional Institute of Medical Sciences, Imphal
Source of Support: None, Conflict of Interest: None
Background: Workplace violence is any physical assault, threatening behavior or verbal abuse in circumstances relating to work, involving an explicit or implicit challenge to the safety, well-being or health of the employee. Doctors are facing violence in increasing numbers and there are less data available. Hence the study was carried out in an attempt to identify the magnitude of these problems and to assess the attitudes of the doctors regarding this problem. Objectives: To determine the prevalence and attitude of workplace violence among the postgraduate students. Materials and Methods: A cross-sectional study was conducted from January to June, 2011, at the Regional Institute of Medical Sciences, Imphal, Manipur. A self-administered questionnaire was used among the postgraduate students and findings expressed in the form of percentages. Chi-square test was used. Data were analyzed using database software. Ethical approval was obtained from RIMS Institutional ethics committee. Results: Of the total 286 PG students, 230 responded. 78.26% had experienced at least one form of violence, with the escorts of the patients committing 68.33% of the violence. Verbal threats were the commonest form. Maximum violence was committed at the emergency services (48.88%). Male doctors faced more workplace violence than females (P < 0.001). 78.26% of the respondents wanted work place violence to be a non-bailable offence. Conclusion: Our study found a high prevalence of workplace violence. Doctors face the possibility of being victims of aggressive and violent incidents while caring for the patients. Hence doctor's view regarding the punishment for workplace violence as a non-bailable offence should be taken into consideration.
Keywords: Doctors, Non-bailable, Violence, Workplace
|How to cite this article:|
Ori J, Devi NS, Singh AB, Thongam K, Padu J, Abhilesh R. Prevalence and attitude of workplace violence among the post graduate students in a tertiary hospital in Manipur. J Med Soc 2014;28:25-8
|How to cite this URL:|
Ori J, Devi NS, Singh AB, Thongam K, Padu J, Abhilesh R. Prevalence and attitude of workplace violence among the post graduate students in a tertiary hospital in Manipur. J Med Soc [serial online] 2014 [cited 2021 Apr 20];28:25-8. Available from: https://www.jmedsoc.org/text.asp?2014/28/1/25/135222
| Introduction|| |
Workplace violence is any physical assault, threatening behavior or verbal abuse in circumstances relating to work, involving an explicit or implicit challenge to the safety, well-being or health of the employee. 
Broadly there are three forms of workplace violence:
- Verbal violence such as intimidation, abuse threats.
- Physical violence like punching, kicking, pushing etc.
- Aggravated physical violence like use of weapons, e.g., guns, knives, syringes, pieces of furniture, bottles, glasses etc. 
For employees, violence can cause pain, distress and even disability or death. Physical attacks are obviously dangerous but serious or persistent verbal abuse or threats also can damage employees' health through anxiety or stress. 
Violence affects workers from all discipline in the healthcare sector. Violence is the second leading cause of death in the workplace.  The rate of physical violence among doctors was 16.2 per 1000 workers.  Most acts of violence in the healthcare setting go unreported.  Violence and assault in the emergency department are recognized as significant occupational hazards for medical professionals.  Learning what assault means to emergency care personnel is a critical step in planning long-term solutions to workplace violence. It is vital that doctors take a realistic account of all the risks of assault and build a comprehensive and supportive approach to the problem so as to ensure the safety in workplaces.
Incidences of patient's party assaulting the treating doctor are a common scenario nowadays all over India. Many incidents of strikes, closing down of emergency service, sit in protest following alleged assault of duty doctor has been reported frequently in media from different parts of the country including Manipur and more so in Regional Institute of Medical Sciences, RIMS. Doctors, in a range of work environments, face the terrifying possibility of being victims of aggressive and violent incidents while caring for patients. The consequences of these events are far reaching and include an increased cost to the health care system. Violence costs the victim and the authorities. Although the government has attempted to address the problems in other parts of India, , doctors are still experiencing assault in ever increasing numbers. To ensure that doctors stop being the victims of these events, a sound research is important. Therefore the study was carried out in an attempt to identify the magnitude of these problems and to assess the attitudes of the doctors regarding this problem.
- To determine the magnitude and attitude of workplace violence among junior doctors of Regional Institute of Medical Sciences (RIMS).
- To discuss the preventive measures as suggested by the doctors.
| Materials and Methods|| |
A cross-sectional study was conducted at Regional Institute of Medical Sciences (RIMS), Imphal, Manipur. The study was conducted from January to June, 2011, among the postgraduate students studying in RIMS. Data was collected using self-administered questionnaire method. The questionnaires were distributed to the participants and the filled questionnaires are checked for consistency and completeness, which is collected back on the next day.
Data was processed using statistical software. Data was analyzed in the form of descriptive statistics and proportions. The statistical test of significance was done using Chi square test. P < 0.05 was taken as significant.
RIMS Institutional Ethics Committee approved the study. Verbal consent was taken before administering the questionnaire. Personal identifiers were removed and confidentiality was maintained in which the data was not linked to the respondents in any way.
| Results|| |
The response rate was 80.41% of which 62.60% were male. Of the respondents, 78.26% had faced workplace violence and of them, 38.89% had faced workplace violence more than three times. Most commonly males were the perpetrator of the workplace violence contributing 66.67% of the cases. Escorts of the patients contributed to the maximum number of workplace violence which came to as high as 68.33%. Verbal threats (56.11%) were the commonest form of workplace violence. Most of the violence was experienced in the emergency services.
As suggestions to reduce workplace violence by the doctors, they wanted increased security for the doctors along with posting of public relations officer. They commented on the language barrier and wanted to improve the communication and behavior skills along with the posting of interpreters. They also wanted to improve the facility with increased manpower. And they also wanted the availability of senior doctors. They also felt that doctors from Chest and Psychiatry departments should be available in the casualty. They also wanted one patient escort per patient.
Of the postgraduate trainees, 78.26% of them wanted the punishment for workplace violence to be made a non-bailable offence.
[Table 1] shows the socio-demographic characteristics of the respondents and patterns of workplace violence experienced.
|Table 1: Socio-demographic characteristics of the respondents patterns of workplace violence experienced (n=230)|
Click here to view
[Table 2] shows the types and place of workplace violence.
[Table 3] shows the views of the doctors regarding the reasons that are responsible for the violence.
|Table 3: Views of the doctors regarding the reasons which are responsible for the violence|
Click here to view
[Table 4] shows the association of workplace violence with some selected variables of interest.
| Discussion|| |
In our study, 78.26% had faced at least one form of workplace violence. In a study in South China,  57.93% of the hospital staff was subjected to workplace violence. Our study was conducted only among the postgraduate trainees, and the duration of exposure to workplace violence was for the postgraduate training period, which may explain the differences found between the studies. In Rwanda,  among the health workers in the community, 39% of the respondents had experienced at least one form of workplace violence.
Verbal threats (56.11%) were the most common type of violence experienced. Reem A Abbas  also found that verbal abuse was the most common type of violence (98.7%), followed by threatening behavior (46.7%) and physical assault (38.7%), while sexual harassment was rare (1.3%). In our study too sexual harassment contributed 0.55% of the cases. Chen et al. found that 56.76% were in the form of psychological violence, 15.06% of physical violence and 6.67% of sexual violence.
Our study found that escorts of the patients were the most common perpetrators of workplace violence. This may be due to the miscommunication between the doctors and the patient's escorts. Rao  expressed that it is the doctor's responsibility to explain to the escorts about the nature of the illness, investigations needed, line of management and probable course and outcome in such a way it is understood by them and periodic updates of the condition of the patient. Jaiswal  also expressed that patient's escorts should have realistic expectations of the course and outcome of illnesses of the patient, their behavior should not impede treatment and repeated incidents of violence by them would make the doctors overcautious and result in not taking up a case for treatment.
Chandrashekharan  has said that prolonged duty hours and excessive workload make the doctor exhausted leading to tiredness and mood changes. Duty roster and hours should be planned scientifically so that there is less scope for physical and psychological exhaustion in the treating doctors round the clock.  Here arises the need of a proper management system which keeps the working hours of the doctors as humane as possible. The current estimated doctor population ratio in India is 1:1700 as compared to a world average of 1.5:1000 while the targeted doctor population ratio would be 1:1000 and achievable by the year 2031. 
78.26% of them wanted to make workplace violence a non-bailable offence. The state of Manipur doesn't have an act of its own law for punishment of workplace violence for medical services in comparison to the states of Orissa and Maharashtra. , Considering the high prevalence of workplace violence in Manipur it is high time that we also have a law for punishment of the offenders.
There should be a written policy in the emergency services about the punishments which would be pasted over the walls and other visible areas. This may act as a deterrent to the people committing the violence. Some other authors has suggested for the posting of armed guards in the emergency services while some doctors are against it.
There should be appropriate authority to report the violence as soon as possible. Some healthcare staff also has the traditional view that violence is "part of the job" or that the managers would not take action.  Most of the workplace violence goes unreported, but it doesn't mean that the victim is not suffering from the after-effects of the incident. There should be appropriate counseling facilities for the victim. Taking the incidence of the one case of kidnapping which occurred and one case of sexual harassment, the psychological condition and the effects of the incident to the person should have been assessed.
There are training and counseling centers for a worker to realize about workplace violence - how to handle the cases, what to do and where to report the incidence of such cases. Ultimately violence costs the victim and the authorities. Hence it is high time that there should be appropriate regulating bodies and authorities for handling workplace violence.
| Conclusion|| |
Three-fourth of the doctors have faced workplace violence of which nearly half of them have faced it more than three times. Verbal threats were the most common form of violence with the escorts of the patients committing the maximum number of violence.
| Recommendations|| |
There should be proper management of workplace violence which is occurring in RIMS, and appropriate rules and regulations should be there considering the high prevalence of workplace violence in RIMS and to prevent the administrative failure as an aftermath of the incidents.
| References|| |
|1.||International Labour Organisation, International Council of Nurses, World Health Organisation and Public Services International. Joint programme on workplace violence in the health sector. Informal technical consultation documents. Geneva: ILO/ICN/WHO/PSI, April 2002. |
|2.||Workplace violence. Wikipedia. Available from: http://en.wikipedia.org/wiki/Workplace_violence. [Last accessed on 2011 Nov 29]. |
|3.||Keely BR. Recognition and prevention of hospital violence. Dimens Crit Care Nurs 2002;21:236-41. |
|4.||Duhart DT. Violence in the workplace, 1993-99 (NCJ Publication No. 190076. Washington, DC: Bureau of Justice Statistics. |
|5.||Presley D, Robinson G. Violence in the emergency department: Nurses contend with prevention in the healthcare arena. Nurs Clin North Am 2002;37:161-9, viii-ix. |
|6.||The Orissa medicare service persons and medicare service institutions (Prevention Of Violence And Damage To Property) Act, 2008. |
|7.||Maharashtra Medicare Service Persons and Medicare Service Institution (Prevention of Violence and Damage or Loss to Property) Act, 2009. |
|8.||Chen Z, Peek AC, Yang G. Prevalence of and risk factors associated with workplace violence: A cross-sectional study in 7026 health staff in South China. Inj Prev 2010;16:A4. |
|9.||Newman JC, Vries DH, Kanakuze JA, Ngendahimana G. Workplace violence and gender discrimination in Rwanda′s health workforce: Increasing safety and gender equality. Hum Resources Health 2011;9:19. |
|10.||Abbas RA, Selim FS. Workplace violence: A survey of diagnostic radiographers in Ismailia governorate hospitals, Egypt. J Am Sci 2011;7:1049-58. |
|11.||Rao NG. Textbook of Forensic Medicine and Toxicology 1 st ed. New Delhi: Jaypee Brothers and Medical Publishers; 2000. |
|12.||Jaiswal JV. Doctors in the dock. 1 st ed. New Delhi: Jaypee Brothers Medical Publishers; 2004. |
|13.||Chandrashekharan R. Textbook of postgraduate psychiatry. In: Vyas JN, Ahuja N, editors. 2 nd ed., Vol. 1, New Delhi: Jaypee Brothers and Medical Publishers; 2009. |
|14.||Professional conduct, etiquette and ethics. Indian Medical Council Regulations; 2002. |
|15.||Vision 2015. Medical Council of India, New Delhi: March 2011. |
|16.||Royal College of Nursing/NHS Executive, 1998. Safer working in the community, London. |
[Table 1], [Table 2], [Table 3], [Table 4]
|This article has been cited by|
||Workplace violence toward resident doctors in public hospitals of Syria: prevalence, psychological impact, and prevention strategies: a cross-sectional study
| ||Okbah Mohamad,Naseem AlKhoury,Mohammad-Nasan Abdul-Baki,Marah Alsalkini,Rafea Shaaban |
| ||Human Resources for Health. 2021; 19(1) |
|[Pubmed] | [DOI]|
||Pattern of workplace violence against doctors practising modern medicine and the subsequent impact on patient care, in India
| ||Amandeep Kaur,Farhad Ahamed,Paramita Sengupta,Jitendra Majhi,Tandra Ghosh,William Joe |
| ||PLOS ONE. 2020; 15(9): e0239193 |
|[Pubmed] | [DOI]|
||Violence against nurses in healthcare facilities in the Czech Republic and Slovakia
| ||Martina Tomagová,Renáta Zeleníková,Radka Kozáková,Katarína Žiaková,Beata Babiarczyk,Agnieszka Turbiarz |
| ||Central European Journal of Nursing and Midwifery. 2020; 11(2): 52 |
|[Pubmed] | [DOI]|
||Extent and risk factors of psychological violence towards physicians and Standardised Residency Training physicians: a Northern China experience
| ||Huiying Fang,Lifeng Wei,Jingfu Mao,Haonan Jia,Peng Li,Yuze Li,Yapeng Fu,Siqi Zhao,He Liu,Kexin Jiang,Mingli Jiao,Hong Qiao,Qunhong Wu |
| ||Health and Quality of Life Outcomes. 2020; 18(1) |
|[Pubmed] | [DOI]|
||Prevalence and policy of occupational violence against oral healthcare workers: systematic review and meta-analysis
| ||Nada O. Binmadi,Jazia A. Alblowi |
| ||BMC Oral Health. 2019; 19(1) |
|[Pubmed] | [DOI]|
||Workplace Violence Against Medical Students in Shiraz, Iran
| ||Ali Sahraian,Camellia Hemyari,Maryam Ayatollahi,Kamiar Zomorodian |
| ||Shiraz E-Medical Journal. 2016; Inpress(Inpress) |
|[Pubmed] | [DOI]|