Journal of Medical Society

ORIGINAL ARTICLE
Year
: 2020  |  Volume : 34  |  Issue : 2  |  Page : 76--80

Workplace violence in a tertiary health-care institute in Manipur: A cross-sectional study


Bishwalata Rajkumari, Joymati Oinam, Tamphasana Thounaojam 
 Department of Community Medicine, Jawaharlal Nehru Institute of Medical Sciences, Imphal, Manipur, India

Correspondence Address:
Joymati Oinam
Department of Community Medicine, Jawaharlal Nehru Institute of Medical Sciences, Imphal, Manipur
India

Abstract

Background: Workplace violence is much prevalent across the globe in almost all institutions dealing directly with the general public and hospitals are no exception to it. Therefore, the objective of this study is to determine the prevalence of workplace violence among doctors and nurses in a tertiary health-care institute in Manipur and to discuss the contributing factors and preventive measures against workplace violence. Materials and Methods: A cross-sectional study was conducted from March to April 2019 among a sample of 438 among doctors and nurses of clinical departments of a tertiary health-care institute, Manipur. A predesigned self-administered questionnaire which was modified and adopted from the “Workplace Violence in the Health Sector Country Case Study-Questionnaire” was used for data collection. Data were analyzed using SPSS IBM Statistics version 21. Statistical analyses such as mean, standard deviation (SD), proportion, and Chi-squared (χ2) test were performed taking P < 0.05 as statistically significant. Results: The mean (±SD) age was 31.02 (±7.1) years. About 32.8% had experienced at least one form of violence. Verbal abuses were the most common form (72.8%). Staff nurses (45.7%) faced the maximum number of incidents. Significantly male staff faced more workplace violence than females. Conclusion: The prevalence of workplace violence was a little more than 1 out of 4. Verbal abuse was the most common workplace violence. The communication gap (123, 49.8%) was cited as the main cause of workplace violence. Increasing security measures and limiting numbers of patient's attendants are required to deal with workplace violence.



How to cite this article:
Rajkumari B, Oinam J, Thounaojam T. Workplace violence in a tertiary health-care institute in Manipur: A cross-sectional study.J Med Soc 2020;34:76-80


How to cite this URL:
Rajkumari B, Oinam J, Thounaojam T. Workplace violence in a tertiary health-care institute in Manipur: A cross-sectional study. J Med Soc [serial online] 2020 [cited 2021 Feb 28 ];34:76-80
Available from: https://www.jmedsoc.org/text.asp?2020/34/2/76/307899


Full Text



 Introduction



Workplace violence is increasing alarmingly throughout the world and is much prevalent across the globe in almost all institutions dealing directly with the general public and hospitals are no exception to it. Hospitals have high incidence because it caters a service which attaches the emotional aspect of the patient and their escorts.[1] Workplace violence is defined as “Any physical assault, threatening behaviour or verbal abuse in circumstances relating to work, involving an explicit or implicit challenge to the safety, well-being or health of the employee.”[2] The Indian Medical Association (IMA) has reported that 75% of doctors in India experienced violence at work and according to IMA Manipur State Branch reported that more than 50 incidents of violence toward health-care providers took place in the last 3–4 years in Manipur.[3],[4] Nurses also faced the same violence at work. An analysis of data for more than 1.5 lakh nurses drawn from 160 global samples has revealed that two-third have experienced nonphysical assault and have an incidence rate of 25/10,000 nurses for injuries from assaults and violence.[5],[6] Annual incidence of workplace violence is 4 times more in health care as compared to all other professions and constitutes the 2nd highest risk group for work violence.[7],[8] Many incidents of strikes, closing down of emergency service, and sit-in protest following the alleged assault of duty doctor have been reported frequently in media from different parts of the country including Manipur and more so in RIMS, Imphal.[9] In a statement given by IMA Manipur Branch, the end result of such incidents will be the increasing “Defensive Medicine” practice which will directly affect the health-care delivery system of the country and state.[4] However, such a study has not conducted in state government tertiary hospital before. Therefore, the objective of this study is to determine the prevalence of workplace violence among doctors and nurses in a tertiary health-care institute in Manipur and to discuss the contributing factors and preventive measures against workplace violence.

 Materials and Methods



The study was conducted from March to April 2019 in a tertiary health-care institute in Imphal East district of Manipur. In Manipur, there are two government tertiary health-care institutes. This is the only state government institute and it caters patients all over the state of Manipur and the other one is under the central government. In this institute, there are undergraduate students, postgraduate trainees, and dental college. The study was conducted among all the doctors and nurses currently posted in the clinical departments. A total of 15 departments were included in our study which was further divided into major and minor departments depending on the patient load. The major departments include medicine, surgery, dental, obstetrics and gynecology, pediatrics, orthopedics, casualty, forensic medicine, and minor departments which included chest medicine, radiodiagnosis, dermatology, ophthalmology, ear, nose, and throat, psychiatry, and community medicine. Sample size calculation and sampling were not done as we intended to cover all the health-care providers who were posted in those departments. A list of all the eligible health-care providers was obtained from the administrative department and was included in our study. A total of 438 participants which included 309 doctors (86 interns, 56 postgraduate trainees, 72 junior residents, and 95 senior residents) and 129 staff nurses were included. Those who were on leave, unable to contact in two consecutive visits, senior faculty members from clinical departments, health-care providers from preclinical and paraclinical departments, and not willing to participate were excluded. A predesigned questionnaire which was modified and adopted from a questionnaire named “Workplace Violence in the Health Sector Country Case Study-Questionnaire” compiled in 2003 by the International Labor Office, International Council of Nurses, WHO, and Public Services International was used.[2] Data were collected using a self-administered questionnaire. The questionnaire consisted of four sections namely A (personal and workplace data), B (physical workplace violence), C (verbal abuse, bullying/mobbing, sexual harassment, and racial harassment), and D (measures). The questionnaires were distributed to the participants and filled questionnaires are checked for completeness and consistency.

Operational definitions

Workplace violence

Incidents where staff are abused, threatened, or assaulted in circumstances related to their work, including commuting to and from work, involving an explicit or implicit challenge to their safety, well-being, or health.

Assault/attack

Intentional behavior that harms another person physically, including sexual assault (i.e., rape).

Psychological violence (emotional abuse)

Intentional use of power, including threat of physical force, against another person or group, that can result in harm to physical, mental, spiritual, moral, or social development which includes verbal abuse, bullying/mobbing, harassment, and threats.

Abuse

Behavior that humiliates, degrades, or otherwise indicates a lack of respect for the dignity and worth of an individual.

Bullying/mobbing

Repeated and overtime offensive behavior through vindictive, cruel, or malicious attempts to humiliate or undermine an individual or groups of employees.

Physical violence

The use of physical force against another person or group that results in physical, sexual, or psychological harm which includes beating, kicking, slapping, stabbing, shooting, pushing, biting, and pinching, among others.

Harassment

Any conduct based on age, disability, HIV status, domestic circumstances, sex, sexual orientation, gender reassignment, race, color, language, religion, political, trade union or other opinion or belief, national or social origin, association with a minority, property, birth, or other status that is unreciprocated or unwanted and which affects the dignity of men and women at work.

Sexual harassment

Any unwanted, unreciprocated, and unwelcome behavior of a sexual nature that is offensive to the person involved and causes that person to be threatened, humiliated, or embarrassed.

Racial harassment

Any threatening conduct that is based on race, color, language, national origin, religion, association with a minority, birth, or other status that is unreciprocated or unwanted and which affects the dignity of women and men at work.

Threat

Promised use of physical force or power (i.e., psychological force) resulting in fear of physical, sexual, psychological harm, or other negative consequences to the targeted individuals or groups.

Statistical analysis

Collected data were entered in Microsoft Excel software and data cleansing was performed. Data were analyzed using SPSS IBM Statistics version 21 (Chicago, IL, USA). The analysis was done using descriptive statistics such as mean, standard deviation, and proportions. Analytical statistic such as Chi-square test and Fisher's exact test was used for comparing the proportions. P < 0.05 was taken statistically significant.

Ethical issues

Institutional Ethics Committee JNIMS approved the study vide letter No. Ac/06/IEC/JNIMS/2019 dated March 30, 2019, and informed verbal consent was taken from all the participants before administering the questionnaire. Their participation was completely voluntary and the right to refuse to participate in the study was respected. Personal identifiers were removed and confidentiality was maintained.

 Results



A total of 247 doctors and nurses participated in the study. The mean age of the participants was 31.02 ± 7.1 years. Majority belonged to the age group between 25 and 35 years (158, 63.9%); majority of them were staff nurses (107, 43.4%). Most of the respondents were female (186, 75.3%); majority who responded were from major departments (206, 83.4%) and were from Manipur (241, 97.6%). About 92 (37.2%) of the participants had < 1 year of work experience. Majority (153, 61.9%) of the participants were worried about workplace violence. Only 81 participants (32.8%) have ever experienced some form of workplace violence in their lifetime, however only 10 (12.3%) of them ever reported to investigate the cause to authority. Patient's party was the main perpetrator of the violence (68, 83.9%), followed by senior staff (11, 13.6%) [Table 1]. Verbal abuse was the most common type of violence faced by most of the participants (59, 72.8%), followed by physical assault (8, 9.8%). Majority of this violence took place in the major departments. Around three-fifths of this violence happened at night time (48, 59.3%), followed by evening [Table 2]. Among those who ever faced workplace violence, staff nurses (37, 45.7%) were the majority, followed by junior residents (13, 16%), PGTs and internees (13, 16%), and senior residents (9, 11.1%). Physical workplace violence was significantly more in males and those belonging to other states [Table 3]. Communication gap/misunderstanding (123, 49.8%) was cited as the main cause of workplace violence, followed by lack of hospital infrastructures (39, 15.7%) [Table 4]. Majority of the participants gave increase security measures (187, 75.7%) and staff (150, 60.7%) as the most common measures to reduce workplace violence [Table 5].{Table 1}{Table 2}{Table 3}{Table 4}{Table 5}

 Discussion



In our study, the overall prevalence of workplace violence was 32.8%, which is comparatively lower as compared to the studies done by Vanlalduhsaki et al.,[9] Manipur 2017 (50.3%) Sureja and Bhambhani,[10] Gujarat 2018 (67%), and Kumar et al.,[11] South Delhi 2016 (71%). Most of the previously published literature reported verbal abuse as the most common form of workplace violence. Studies conducted in different parts of the country reported verbal abuse as the most prevalent form of workplace violence which ranges from 47.4% to 87.3%.[9],[10],[11],[12],[13] Similar findings were also observed in our study where verbal abuse (72.8%) was the most common type of workplace violence. Regarding physical violence, only 9.8% reported which was comparable to a study conducted by Kumar et al.[11] (8.4%). However, a study conducted in a medical college in 2017, Manipur, reported 2.9% physical violence, which was much lower than the present study.[9] From here, we can have an insight that workplace violence is on an increasing trend in the last few years. In our study, males were significantly at higher risk of workplace violence as compared to females, which was comparable to the study done by Vanlalduhsaki et al.[9] and Sureja and Bhambhani[10] In the present study, workplace violence was most frequently occurred at night time than any other period of the day. This finding is similar to the study done by Kumar et al.[11] The main reason may be less number of doctors and staffs on duty and managing serious patients in an overcrowded high-pressure area. Various causes that are responsible for instigating violent episodes have been revealed in different studies. Other studies[10],[11] reported that the main cause for violent episodes was long waiting periods. According to a study conducted in Manipur,[9] the aggressive nature of the patient party was identified as the most common reason for violent episodes. In our study, communication gap and misunderstanding, lack of infrastructure, and aggressiveness of patient party were found to be the common causes of workplace violence. Some of the common suggestions given by participants to prevent workplace violence include increase security measures, increase staff members, improve communication, and limiting the number of patient's attendants. A study done by Sureja and Bhambhani[10] also revealed similar suggestions by doctors for improving the security system, maintaining optimum staff strength, and establishing good rapport and communication with patients. This study was perhaps the first of its kind in JNIMS and it gives us an insight into the workplace violence of this medical institute and the participants also give various measures to reduce the workplace violence which will provide the authority an important guidance in framing appropriate rules and regulations to reduce workplace violence in JNIMS. The study limitation was the noninclusion of senior faculty members from the clinical department as they tended to busy and difficult to approach because of the limited study duration and as majority of the workplace violence happen during emergency duty time which was usually done by senior residents and below.

 Conclusion



The overall prevalence of workplace violence was 32.8%. Verbal abuse was the most prevalent form of workplace violence. Staff nurses faced the maximum number of incidents. Increasing security measures and limiting numbers of patient attendants with appropriate rules and regulations should be made to deal with workplace violence.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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