JOURNAL OF INTERNATIONAL CRISIS AND RISK COMMUNICATION RESEARCH

ISSN: 2576-0017
2024, VOL 7, NO S11

Incidence of workplace violence against

Nursing in Eastern Province, KSA
Kholood Mohammad Mugharbel1, Suad Saif Aldossary2, Afaf Saeed
Alsadoun3, Raja Khamis Alshamsi4, Hussein Ali Alojayan5, Ameenah
Mohammed Alsawad6, Amani Fareed Almutlaq7, Arwa Mohammed
Aldosari8, Dana Bader Aloramy9, Horiya Abdulaziz Alzuwaiyed10, Meaad
Yaqub Alyousef11, Rana Ali Alkhumairi12

1. MD, Family Medicine Consultant, Director of Integrated Care Outcome Department, Directorate
of Health Affairs Eastern Province1, RN, BSN, MHA, Performance Improvement Supervisor,
Directorate of Health Affairs Eastern Province,
2. RN, BSN, MSN, Head of Nursing Department, Directorate of Health Affairs Eastern Province
3. RN, BSN, Performance Improvement Supervisor, Directorate of Health Affairs Eastern Province
4. RN, BSN, MSc, Head of Technical Affairs, Directorate of Health Affairs Eastern Province
5. RN, BSN, Quality and Safety Officer, Directorate of Health Affairs Eastern Province
6. RN, Quality Officer
7. EHC, MD, Pediatric Regestrar
8. EHC, RN, BSN, Nursing Operation Services
9. EHC, RN, BSN, Talent Acquisition Department
10. EHC, RN,BSN,Quality and Patents Safety Department, EHC
11. RN,BSN, Patients Education Department, EHC

Corresponding author: Suad Aldossary

Email: [email protected]

Abstract
Purpose: Workplace violence in emergency departments and outpatient clinics is a
significant problem worldwide. This study aimed to identify the percentage of nurses
Who were exposed to Violence, its sources, and factors influencing experiences of
Violence and reporting them.
Research methods: The study was conducted between September and December
2023
in the emergency departments and outpatient clinics of three hospitals in Dammam,
Eastern Province, Saudi Arabia. Data were collected from 130 nurses Working in
these departments.
A descriptive questionnaire was used; it consisted of 27 items about types of
Violence, their sources, and ways to confront it. Behaviors.
Results: 51.5% of the participants were exposed to Violence, 11.5% of them to
Physical assault, 31.6% of them to verbal abuse, and 40% of them to verbal threats.
Patient companions were responsible in 54% of Violence. The most common
reactions To Violence were sadness and lack of concentration. "Fear" was the most
common Coping method among nurses.
The study showed that 4.6% of Participants who were exposed to physical attacks
and
Verbal threats did not report the incidence of Violence to managers, as 40% did not
Have a reporting system.
Conclusion: Based on the study findings, it is suggested that each hospital establish
a
Reliable reporting system, as well as provide a comprehensive program of support
Services for nurses who have been assaulted.
Keywords: Hospital service, Violence, Workplace, aggregation

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Kholood Mohammad Mugharbel1, Suad Saif Aldossary2, Afaf Saeed Alsadoun3, Raja Khamis Alshamsi4,
Hussein Ali Alojayan5, Ameenah Mohammed Alsawad6, Amani Fareed Almutlaq7, Arwa Mohammed
Aldosari8, Dana Bader Aloramy9, Horiya Abdulaziz Alzuwaiyed10, Meaad Yaqub Alyousef11, Rana Ali
Alkhumairi12

1. Introduction
Workplace violence is any act or threat of physical Violence. Verbal,
Intimidation threats or other disruptive behavior occurs at the work site. It ranges
From threats and verbal abuse to physical assaults and even homicide. It can affect
And involve employees, clients, customers, and visitors. (Sleem, 2016) [1].
Violence against nurses is a complex and ongoing occupational hazard facing the
Nursing profession. This Violence can take the form of intimidation, harassment,
Stalking, hitting, stabbing, shooting, and other forms of assault. Nurses are among the
most frequently assaulted workers in the workforce. The psychological consequences
Violence may include fear, anxiety, sadness, depression, frustration, distrust, and
Nervousness. These results can hurt nurse retention.
The International Council of Nurses (ICN) recognized that Violence in the Workplace
Is an important issue that demands Attention and competence in dealing with it
Including reporting and ways of protection (R. Kumar, 2016) [2].
In this study, the researcher will illuminate the Problem of Violence against nurses
and Provide recommendations for addressing it.
2. Background
Nursing staff performance has a significant role and influence in the medical field.
Violence against nurses is a significant challenge for healthcare administration.
Attention is focused on it because it hurts the quality of healthcare provided and
health organizations.
Common types of Violence include physical assault, verbal abuse, aggression,
Mobbing, and bullying. Patients, relatives, and co-workers are the main perpetrators
(Sleem, 2016) [1]
Employers must arrange for a nonviolent, safe, and healthy workplace for all Nurses,
Take all precautions to reduce the risk of Violence in the Workplace, and allow for
Work-related safety duty laws. Any harmful act committed against nurses in the
Workplace by a patient or a visitor is called workplace violence against nurses.
Workplace violence is directly related to reduced job satisfaction, humiliation,
Emotional distress, intention to leave the job, and, in general, increased employee
Turnover. (P. Dnyaeshwar, J. Rajpoot, 2022) [3]
This study aims to explore workplace violence, its prevalence and consequences, its
Impact on nursing, and the strategies that have been developed to prevent such
Incidents.
3. Objectives
This study aims to explore the experience of nurses with work violence

and Aggression, its Impact, and their response. Identify any reporting barriers

Experienced by the victims and any contributing factors and consequences of the

Victimization incident with law enforcement after reporting by the victim. (Kim

Swanson, 2014) [4]

Literature Review
An in-depth literature review was conducted using the Search series (Violence or

Aggression), Using EBSCO and ProQuest Information Services from various

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 Incidence of workplace violence against Nursing in
Eastern Province, KSA

Countries. It showed that 336 articles conducted over the past 10 years were relevant

For health practitioners or nursing workplace violence. English studies were

examined, and 15 articles were selected. This helped identify various areas of the

Questionnaire.

Such as types/forms of Violence, reporting of Violence, risk factors for Violence, the

Impact of violence and mitigation strategies from which 15 items were created.

(Piyush Ranjan, drpiyushdost, 2021) [5].

Alkorashy, al Moalad (2016) [6].

The study indicated that nearly half of the participants had been exposed to

Violence in the professional environment during the 12 months before the survey. The

Majority of people perceived verbal abuse violence in the Workplace as. Most of the

Nursing professionals identified patients as the primary cause. Just over half cited

Staff shortages, misunderstandings, long waits for service, lack of staff training, and

Crisis prevention policies as contributing factors.

Fatima Sayed et al. (2022) [7]

They noted a high burden of Violence against nurses in healthcare settings. There

Has been underreporting of such violent acts against nurses. These events cause

Psychological trauma and bad memories for the victims. It also appears that there is a

Deficiency in dealing with these events. This led to the activation of the role of

Occupational Health in healthcare facilities, were occupational health practitioners.

Healthcare facilities can face the challenges of improving reporting of Violence

against nurses by Simplifying procedures and avoiding blaming the victim. They must

also Ensure the safety of workers and enhance procedures for dealing with incidents.

Violence against them and urged occupational health practitioners to participate in

Investigations of such incidents to discover factors that could help prevent Violence

1830
Kholood Mohammad Mugharbel1, Suad Saif Aldossary2, Afaf Saeed Alsadoun3, Raja Khamis Alshamsi4,
Hussein Ali Alojayan5, Ameenah Mohammed Alsawad6, Amani Fareed Almutlaq7, Arwa Mohammed
Aldosari8, Dana Bader Aloramy9, Horiya Abdulaziz Alzuwaiyed10, Meaad Yaqub Alyousef11, Rana Ali
Alkhumairi12

Against nurses in the future. Large-scale research is needed to characterize the

Problem further and develop effective interventions to prevent Violence against

healthcare workers.

Smita Kafle (2022) [8]

The study indicated that any act that causes physical, psychological, or sexual

harm to nurses in the Workplace is workplace violence (WPV). Unfortunately, this

has become so common that it is now considered an undesirable part of the job and is

ignored rather than reported. However, nurses must be properly educated about

hospital policies against Workplace Violence (WPV) and encouraged to report any

case.

Mahmoud Mustafa Al‐Qadi (2021) [9]

The study indicated that developing insights into the concept will assist in

designing new research scales that can effectively measure the underlying issues,

provide a framework that facilitates nursing interventions, and improve the validity of

future studies.

(Mobaraki et al, 2020) [10]

This review highlighted the Problem of different types of Work Place Violence

(WPV) that nurses experience daily in other regions of the world. According to the

results of the review, verbally violent behavior is the main form of Work Place

Violence (WPV) reported by nurses worldwide, followed by physically violent

behavior with severe consequences, such as injuries. Daily exposure to Workplace

Violence (WPV) can impact nurses' mental and physical health, which may influence

the Quality of care they provide to their patients. According to the findings of this

review, there is a lack of firm policies and legislation in most nursing settings,

causing a Higher and more frequent risk of such Violence. Therefore, more research

1831
 Incidence of workplace violence against Nursing in
Eastern Province, KSA

is needed to Identify solutions to address this Problem, such as reporting policies and

education. Courses and posters distributed around the health facility with appropriate

Interventions to confront this violent behavior in its various forms.

5.The study sample:

The study sample consisted of all male and female nurses in three government
Hospitals in Dammam in the Eastern Province of the Kingdom of Saudi Arabia to
Identify the causes of violence and forms of assault.
6.Study tool:
The researcher used a questionnaire to collect information to reach the study's
Objectives and answer its questions.
The questionnaire was developed in the English language, validated and used in a
Previous study conducted by the Massachusetts Nurses Association Congress on
Health and Safety and Workplace Violence and Abuse Prevention (MNA 2008). The
Questionnaire contains 27 structured multiple-choice questions related to the
Prevalence of Workplace Violence, forms and perpetrators as well as precipitating
Factors for Workplace Violence. The reliability of the tool was determined by
Cronbach's alpha (a = 0.7615)
7.Data collection
Self-administered questionnaires were distributed to participants after obtaining
Approval to conduct the study from the Research/Ethics Committee of the Specialized
Eye Hospital. Data were collected from January to May 2023.
8.Data Analysis
The data was analyzed using descriptive and inferential statistics. The goal was to
Compare variables across groups and investigate the relationship between selected
Demographic characteristics and perceptions of Workplace Violence.
9.Result
From the 300 questionnaires distributed, 130 were returned, all of whom had worked
in nursing for 5years and more (Table 1). Most of them were between 21 to 30 years
(19.2%).31-40 years (43.8%) 41-50 years (30.8%) and 51-60 years (6.2%) The majority
of participants were staff nurses (100%) and worked various 8-hour shifts Furthermore,
most participating nurses were female (73.3%) Nearly all of the nurses were Saudis
(86%), and the non-Saudis were from the Philippines and India. 79 participants (60%)
reported that they had not received any training in dealing with violence.
Table 1. Sociodemographic data on participants (n=130).
Factors Frequency Percent%
Age (Years)
20 years and under 0 (0%)
21-30 years 25 (19.2%)
31-40 years 57 (43.8%)
41-50 years 40 (30.8%)
51-60 years 8 (6.8%)
Over 60years 0 (0%)
Nationality
Saudi 113 (86.9%)
Non-Saudi 17 (13.1 %)
Work experience (years)
Less than one year 3 (2.3%)

1832
Kholood Mohammad Mugharbel1, Suad Saif Aldossary2, Afaf Saeed Alsadoun3, Raja Khamis Alshamsi4,
Hussein Ali Alojayan5, Ameenah Mohammed Alsawad6, Amani Fareed Almutlaq7, Arwa Mohammed
Aldosari8, Dana Bader Aloramy9, Horiya Abdulaziz Alzuwaiyed10, Meaad Yaqub Alyousef11, Rana Ali
Alkhumairi12

1-5 years 48 (36.9%)

6-10 years 45 (34.6%)
More than 10 years 34 (26.2%)
Gender
Male 36 (27.7%)
Female 94 (72.3%)
Shift
Day 78 (60%)
Evening 26 (20 %)
Night 22 (16.9 %)
Weekend 0 (0 %)
Others 4 (3.1%)
Specialty area
Emergency Department 32 (24.6 %)
Out-Patient Department 41 (31.5%)
Not Applicable 5 (3.5 %)
Other 52 (40%) (40%)

Types of violence are broadly categorized into physical and non-physical assault.
Physical assault was defined as the intentional use of force (hitting, kicking, slapping,
choking, biting, or pushing). Non-physical assault includes verbal harassment and
abuse (including threats and offensive comments), including any offensive comment.
Through the responses, the researcher found that 124 nurses were subjected to verbal
assault, 96 were subjected to physical assault such as beating, and 83 were subjected to
physical assault with a weapon.
Table2. Characteristics of Reported Violence Events of Study Participants.
Variables Frequency Percent %
Definition
Verbal abuse such as threats 124 (95.4)
Physical Violence such as kicking 96 (73.8)
Physical violence with a weapon 83 (63.8)
Others 3 (2.3)

Seriousness of violence problem

Very serious 37 (28.5)
Somewhat serious 32 (24.6)
Not too serious 21 (16.2)
Not at all serious 19 (14.6)
Not sure 21 (16.2)

Table 3. The number of times has experienced such acts of violence/abuse at work in
the past two years
Variables Never Occasionally Frequently Regularly
Spit on 123(94.6) 6(4.6) 1(0.8) 0
Objects were thrown at me 114(87.7) 15(11.5) 1(0.8) 0
Beaten 124(95.4) 5(3.8) 1(0.8) 0
Assaulted with weapon 128(98.5) 1(0.8) 1(0.8) 0
Verbally Abused 83(63.8) 41(31.5) 6(4.6) 0
Verbally threatened 78(60) 46(35.4) 6(4.6) 0
slapped 116(89.3) 12(9.2) 1(0.8) 1(0.8)

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 Incidence of workplace violence against Nursing in
Eastern Province, KSA

Table 4. Frequency of exposure to forms of violence from different perpetrators as

reported by nurses who experienced violence
Variables By Family or Physician Others NA
Patient Friends
Spit on 4(3.1) 6(4.0) 0 0 115(88.5)
Objects were thrown 0 6(4.0) 7(5.4) 4(3.1) 113(87)
at me
Beaten 5(3.8) 3(2.3) 0 5(3.8) 116(89)
Assaulted with 3(2.3) 0 0 6(4.0) 119(91.5)
weapon
Verbally Abused 21(16.2) 24(18.5) 11(8.5) 9(7) 74(56.9)
Verbally threatened 21(16.2) 25(17.7) 0 6(4.0) 73(56.1)

All participants identified the patient's relatives and friends as the main perpetrators 24
(17.7%). Followed by patients 21(16.2%) and Physicians 11(8.5%). Verbal abuse was
the most common form of violence.
Table 5. Incidence of workplace violence
Variables Frequency Percent
Violent incidents that occurred in the past two years
Yes 67 (51.5)
No 63 (48.5)
Continue working after the incident?
Yes, I continued working 57 (43.8)
No, I refused to continue working. 7 (5.4)
No, I was sent home. 6 (6.9)
Not Applicable 39 (30)
Others 18 (13.8)
Was relief provided so that you could leave after the
incident?
Yes 53 (40.8)
No 19 (14.6)
Not Applicable 58 (44.6)
How did that affect your later work performance if
you have been attacked/abused at the workplace?
No effect. 13 (10%)
Difficulty concentrating on the job. 35 (26.9)
Hypervigilance easily startled 24 (18.5)
Physical symptoms such as headaches, and stomach 4 (3.1)
aches. 5 (3.8)
Difficulty working in an environment that reminds me of
past incidents. 8 (3.1)
Not fearful but physical injuries have decreased my 31 (23.8)
ability to work. 14 (10.8)
Not Applicable
Others 31 (23.8)
14 (10.8)

1834
Kholood Mohammad Mugharbel1, Suad Saif Aldossary2, Afaf Saeed Alsadoun3, Raja Khamis Alshamsi4,
Hussein Ali Alojayan5, Ameenah Mohammed Alsawad6, Amani Fareed Almutlaq7, Arwa Mohammed
Aldosari8, Dana Bader Aloramy9, Horiya Abdulaziz Alzuwaiyed10, Meaad Yaqub Alyousef11, Rana Ali
Alkhumairi12

10.Reporting
Report an incedint to management

40%
49.20%

4.60%
6.20%

I reported all incidents to management. I reported some incidents

I did not report any incidents Not Applicable

Figure.1 Report an incident to management

Regarding reporting violence, the researchers noted that 64 (49.2%) of the participants
reported assault incidents, while 8 (6.2%) of them reported some incidents, 6 (4.6%)
did not report, and 52 (40%) did not have a reporting system.
Responce get from management when reported an
ancedint

40.80% 42.30%

13.10%
0%
1.50% 2.30%

Management was supportive and tried to find solutions

Management was supportive but nothing was done to solve the problem
Management was neither supportive nor blaming.
Management intimidated or discouraged me from reporting incidents.
Management harassed or blamed me when I reported incident.
Not Applicable

Figure 2. Response gets it from management when reported an incident

This study determined that 42.3% of the participants indicated that the administration
was supportive and worked hard to solve the violence problem. In comparison, 13.1%
indicated that the administration was supportive but unable to find solutions, and 40 did
not apply to them because there was no system for Reporting.

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 Incidence of workplace violence against Nursing in
Eastern Province, KSA

11.Discussion
This study examined workplace violence among healthcare nurses in hospitals
affiliated with the Ministry of Health. Only a few other studies have addressed this topic
in the Kingdom of Saudi Arabia, and the studies were conducted in hospitals affiliated
with the health clusters in the Eastern Province.
A total of 51% of nurses in this study had experienced workplace violence during the
previous 2-year period. This is very similar to reports of a study conducted in Turkey
The last survey in Turkey (2011) indicated that the majority of nurses (85.2%) stated
that they had been exposed to some type of violence; The kinds of violence were
physical at 41.1%, verbal abuse at 79.6%, and verbal threats at 55.5% of the total
reported cases (Talas et al., 2011) [11].
This study showed that the majority of nurses were exposed to violence and that
most of them were exposed to violence more during the past two years. Verbal violence
was the most common type of violence, with more than half of the sample reporting
that they had been exposed to this type of violence (95.4%). Verbal assault was the
most common form of psychological violence; while pushing and slapping was the
most common form of physical violence, at a rate of 73%. This result is consistent with
other studies that found that most nurses were exposed to psychological violence
followed by physical violence. Approximately 45.4% reported that violent incidents
were initiated by patients' family and friends, while 41.6% reported that violent
incidents were initiated by patients and 22.3 by doctors. This study also showed that
nurses with less than five years' work experience were more they are vulnerable to
exposure to violence, as nurses have work experience ranging from 6 to 10 years. While
nurses with more than 10 years of experience were rarely exposed to violence. This
finding is consistent with previous studies that found that shorter professional nursing
experience was significantly associated with increased risk of exposure to all types of
workplace violence.
These violations and violence may be due to the low ratio of nurses to patients and
the nursing shortage in our hospitals. As the current study revealed, the ratio of nurses
to patients is 1:10. This is a significant shortage in nursing and was the leading cause
of the violence. There was also poor training among nurses to confront assault, as 60
reported. % of nurses said that they did not receive training to confront violence nor
familiarize themselves with the legal system for such attacks.
Also, 49.2% reported being exposed to psychological and physical violence through
the official system, while about 4.6% were unable to report.
Some hospitals lack a formal system for reporting violence, with a 40% rate. Also,
42.3% reported that the administration was supportive in finding solutions to such
attacks, while 13.1% reported that the administration was supportive but did not
respond to reports.
12.Conclusion
The results of the study indicate that violence represents a significant problem for
nurses, as they suffer from high pressure and workload, and lack good management
policies and support, as they are exposed to professional violence in hospitals.
Therefore, reducing the efficiency, productivity, job satisfaction and quality of a nurse's
work life is inevitable. Serious steps must be taken to avoid an increase in the number
of violent incidents. Abuse training should be an essential part of on-the-job training.
A comprehensive program of support services must also be provided for nurses who
have been assaulted.

1836
Kholood Mohammad Mugharbel1, Suad Saif Aldossary2, Afaf Saeed Alsadoun3, Raja Khamis Alshamsi4,
Hussein Ali Alojayan5, Ameenah Mohammed Alsawad6, Amani Fareed Almutlaq7, Arwa Mohammed
Aldosari8, Dana Bader Aloramy9, Horiya Abdulaziz Alzuwaiyed10, Meaad Yaqub Alyousef11, Rana Ali
Alkhumairi12

The results indicate the need to recognize that incidents of violence in the workplace
are frequently observed. There should also be a policy on workplace violence and how
to avoid it.
Quality health care delivery is the primary goal of any health system, and workplace
violence is a significant factor in reducing quality. Since the prevalence of violence in
the workplace is high and affects the quality of the nurse's working life; As well as the
violence that occurs by patients and their companions, awareness and education are an
absolute necessity. Therefore, it is essential to adopt a policy to reduce violence in
hospitals. As such, policy makers in health facilities should pay great attention to this
critical issue. Adopting appropriate policies to protect nurses to create a safe work
environment. Organization officials must also ensure that nurses are aware of their
plans to reduce violence in the workplace. (Teymourzadeh et al., 2014) [12]
13.Limitation
This exploratory study was conducted in four hospitals in the Eastern Province of
The Kingdom of Saudi Arabia. The relatively small number of participants may be a
Drawback. Therefore, more research involving larger numbers of participants is
Needed. The study is also limited because data were collected via electronic
Questionnaire results. Ideally, future studies should include analysis of the formal
Reporting system of nursing experience of violent incidents. However, this will
Depend on these reporting mechanisms in place at participating hospitals.
14.Ethical considerations
The content and method of this study were approved by the ethics committee (IRB
# DESH 1136) of the target hospital before the study was conducted. Participants
Signed a consent form to participate in the research after being informed of them
Information's anonymity and voluntary participation.
15.Conflict of interest
Authors have no conflict of interest regarding this study.
16.Acknowledgement
The authors wish to acknowledge all of the nursing whose contribution enabled the
production of this article.

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