Workplace violence among health care workers in emergency departments of public

hospitals in Dammam, Saudi Arabia

Moussa M. Harthi1, Mohammed A. Olayan1, Hassan A. Abugad1 and Moataza M. Abdel

Wahab1

1Department
of Family and Community Medicine, Imam Abdulrahman Bin Faisal University,
Dammam, Saudi Arabia (Correspondence to: M.M. Harthi: [email protected]).

Abstract
Background: Workplace violence is a serious occupational health problem. Emergency
healthcare workers (HCWs) have a high risk of exposure to violence with negative personal
consequences.
Aims: To estimate the prevalence and possible associated factors of workplace violence
among HCWs in emergency departments (EDs) of public hospitals in Dammam, Saudi Arabia.
Methods: A cross-sectional study was conducted during August to October 2018 at 4 EDs of
public hospitals belonging to the Saudi Ministry of Health. Data were collected using a self-
administered questionnaire.
Results: Of 380 questionnaires distributed, 324 were returned (85% response rate). Almost
two thirds of the participants were women (66.4%) and more than half (54%) were nurses. A
total of 155 HCWs (47.8%) had experienced at least 1 type of violent incident in the preceding
12 months. Of the total violence incidents, 52% were verbal abuse, 19% were physical
violence, and sexual harassment (3%) was the least common. Lack of encouragement to
report incidents and Saudi nationality were the only significant variables associated with
workplace violence.
Conclusions: Workplace violence was prevalent, and verbal abuse was the commonest type
among HCWs in emergency departments of Saudi hospitals. Encouragement to report violent
incidents and raising awareness among HCWs about violence reporting systems are important
strategies to improve workplace safety.

Keywords: emergency departments, healthcare workers, Saudi Arabia, reporting, workplace

violence

Citation: Harthi MM; Olayan MA; Abugad HA; Abdel Wahab MM. Workplace violence among
health care workers in emergency departments of public hospitals in Dammam, Saudi Arabia.
East Mediterr Health J. 2020;26(x):xxx-xxx http://doi.org/10.26719/emhj.20.069

Received: 30/05/19; accepted: 27/11/19

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Copyright © World Health Organization (WHO) 2020. Open Access. Some rights reserved.
This work is available under the CC BY-NC-SA 3.0 IGO license
(https://creativecommons.org/licenses/by-nc-sa/3.0/igo)

Introduction
Health care workers (HCWs) are among the groups most experiencing violence and aggressive
behaviour at work, especially those who work in emergency departments (EDs) in public
hospitals (1). Workplace violence has negative consequences on safety and workplace
activities of HCWs (2). However, the estimated prevalence of violence against HCWs is still
unknown because there is no clear definition of a violent incident (1,2). The World Health
Organization (WHO) defined violence as “The intentional use of physical force or power,
threatened or actual, against another person or against oneself or a group of people that
results in or has a high likelihood of resulting in injury, death, psychological harm,
maldevelopment or deprivation” (3). The National Institute for Occupational Safety and
Health defines workplace violence as “violent acts (including physical assault and threats of
assault) directed towards persons at work or on duty” (4). According to WHO, physical or
psychological violence can appear in different forms, which may often overlap (4,5). Physical
violence is defined as the use of physical force against another person or group that results in
physical, sexual or psychological harm, and such violence includes beating, kicking, slapping,
stabbing, shooting, pushing, biting and pinching (3,5). Psychological violence is defined as
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.
Psychological violence includes verbal abuse, bullying/mobbing, harassment (including sexual
and racial) and threats.

Many studies worldwide have examined the prevalence of workplace violence among HCWs
(2). A survey of workplace violence across 65 American EDs conducted in 2008 showed that
the violence and weapons in the EDs were common, and nurses were less likely to feel safe
than other staff were (6). A cross-sectional study in 2009 in Tokyo, Japan revealed that 36.4%
of 11 095 HCWs in 19 hospitals experienced workplace violence by patients or their relatives;
15.9% experienced physical aggression, 29.8% experienced verbal abuse and 9.9%
experienced sexual harassment (7). In another large study conducted between October 2012
and July 2013 at primary healthcare centres in Belgrade, Serbia, the prevalence of workplace
violence was 52.6% among 1757 HCWs (8). In the Middle East, workplace violence has been
investigated in several studies. An Iranian cross-sectional survey in 2011 among 196 nurses in
11 EDs in teaching hospitals in Tehran, showed that 19.7% of nurses faced physical violence
and 91.6% experienced verbal abuse (9). Another cross-sectional study in Jordan in 2011
among 227 nurses in 12 provinces revealed that 75.8% were exposed to at least 1 type of
violence (10). A comprehensive survey of workplace violence among 713 physicians in EDs in
Turkey found that 78.1% had experienced violence (11).

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Factors related to the increased the risk of workplace violence are related to the offenders,
HCWs or the workplace environment (2). Personality and mental health disorders (such as
schizophrenia, paranoia, anxiety, antisocial attitude, dementia and alcohol abuse) are the
most significant factors related to the offenders (7). HCW-related factors include understaffed
working conditions, working alone and long working hours (7,12). Factors related to the
workplace include long waiting times, overcrowding, inadequate security, and lack of policies
for preventing violence (12).

In a few studies in Saudi Arabia, there was difficultly in estimating the magnitude of the
problem due to lack of reporting and other factors (2,13). In 2009, a self-reporting
questionnaire study in Al-Hassa of 1091 primary health care professionals revealed that 28%
suffered from workplace violence (12). A cross-sectional study in Riyadh in 2011 of 600
physicians and nurses found that 67.4% were exposed to workplace violence, and that nurses
were more susceptible than physicians (14). In another cross-sectional study in 2014 in 12
family medical centres in Riyadh, 45.6% of 270 HCWs experienced some sort of violence
during the 12 months prior to the study (2). Three studies were conducted in Saudi Arabia in
2015. A cross-sectional study at King Fahd Hospital showed that 30.7% of 391 nurses were
exposed to verbal abuse (13). In EDs of 3 hospitals in Riyadh, 89.3% of 121 nurses experienced
a violent incident in the 12 months prior to the study (15). In EDs in Tabuk, 90.7% of 129 had
history of workplace violence (1). EDs are in operation 24 hours a day, 7 days a week (16).
Patients usually come to EDs with relatives or friends with expectations of a rapid response
and good service from HCWs regardless of the severity of the case (12). EDs receive a huge
number of patients, therefore, the chance of HCWs being exposed to violence is high (1,12).

This study was conducted to estimate the prevalence of workplace violence among HCWs in
EDs in public hospitals in Dammam, Saudi Arabia and to determine possible associated
factors.

Methods
This was a cross-sectional survey conducted during August to October 2018 at 4 public
hospitals belonging to the Ministry of Health in Dammam, Saudi Arabia: Dammam General
Medical Complex, Dhahran Eye Specialist Hospital, Maternal and Children’s Hospital and Al-
Amal Complex for Mental Health). All HCWs in all duty shifts (morning, evening and night) in
EDs were invited to participate, with exclusion of those with work experience < 1 year. The
sample size was calculated using epi info, assuming the level of violence among HCWs was
89% from previous data (15), with an accepted margin of error 4%. The sample by population
survey was 235 HCWs at 95% confidence level and was increased to 294 HCWs, expecting
80% response.

Data were collected from 324 participants, using a self-administered questionnaire that was
based on questionnaires developed by WHO (5) and was modified by the researchers. The

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English language questionnaire was translated into Arabic by the authors and validated by 3
experts in the Department of Family and Community Medicine, Imam Abdulrahman Bin Faisal
University. The questionnaire consisted of 8 sections. The first part included demographic
information such as age, sex, marital status, occupational title, nationality, educational level,
and years of work experience. The second part consisted of items that addressed
occupational characteristics (working multiple shifts, shift time worked, number of coworkers
in the same work area, encouragement to report violent events, and availability of a violence
reporting system). The other sections consisted of items that addressed the characteristics of
the violent acts experienced (time, place and frequency of violence) and the identity, age and
sex of the offender. There were also questions about reasons for violence (e.g., lack of security
and absence of punishment) and the consequences for the HCWs and the offenders. Finally,
there was a question about reasons for not reporting acts of violence. Types of violence were
classified into physical, verbal, bullying, and sexual and racial harassment (5). A pilot study
was carried out on 10 HCWs in 1 public hospital on 1 day, to check the clarity of the language
used and estimate the average time to answer the questionnaire. The participants in the pilot
study were not included in the present study.

All statistical analyses were conducted using SPSS version 25, setting our level of confidence
at 95%. Descriptive statistics by frequency and percentage were used for categorical
variables, while continuous variables were assessed for normality. The frequency of
workplace violence was calculated by dividing the number of those who had experienced
violence during the preceding 12 months by the total number of HCWs in the study. The χ2
and independent samples t test were used to assess the relation between demographic and
occupational characteristics and workplace violence. Logistic regression analysis was used to
assess factors independently associated with the occurrence of workplace violence. Adjusted
odds ratios with corresponding 95% confidence intervals were presented.

Results
Demographic and occupational characteristics
Of 380 questionnaires distributed, 324 were returned (85% response rate). The age of
participants ranged between 22 and 55 years, with a mean of 32.7 (standard deviation, 6.2)
years, and 215 were women (66.4%) (Table 1). The majority (78.1%) of HCWs were Saudis and
almost two thirds were married. The largest proportion had a diploma (50.3%) followed by a
bachelor’s degree (43.5%). More than half the HCWs (54%) were nurses and 40.1% had work
experience of 6–9 years.

Report encouragement and system availability

One hundred and ninety-three (59.6%) of 324 respondents stated that they were encouraged
to report workplace violence and 131 (40.4%) that they were not encouraged. Two hundred
and twenty-five (69.4%) HCWs reported that a system was available for reporting violence
and 99 (30.6%) reported no such system.

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Frequency and type of violent incident
Out of 324 HCWs, 155 (47.8 %) had experienced at least 1 type of violent incident during the
preceding 12 months. Among 241 incidents, 126 (52%) were verbal abuse, 45 (19%) physical
violence, 39 (16%) bullying, 24 (10%) racial harassment and 7 (3%) sexual harassment (Table
2). Ninety-five (39.4%) violent incidents happened in the morning and the same number in
the evening. Almost all (n = 232, 96.3%) of the violent incidents occurred in the workplace.
Ninety-nine (41.1%) violent incidents occurred once a year and 73 (30.3%) more than once a
month. Most (n = 102, 42%) of the offenders were patients, followed by relatives of patients
(n = 75, 31%). The majority (n = 197, 82%) of the offenders were aged 21–45 years and 41
(17%) were ≥ 46 years. Both men and women committed the violent act in 97 (40.25%) cases,
men only in 95 (39.42%) and women only in 49 (20.33%). Most (n = 180, 74.7%) of the
participants exposed to violence believed that the incident could have been prevented. The
violence incident ended with the following consequences for the offenders: none (n = 154,
63.9%), verbal warning (n = 51, 21.2%) and reported to the police (n = 16, 6.6%). The
consequences for HCWs were: none (n = 112, 46.5%), reduced work performance (n = 107,
44.4%), documented complaint against HCWs (n = 20, 8.3%) and injuries (n =2, 0.8%). Almost
all (n = 41, 91.1%) incidents of physical violence happened without a weapon and 23 (51.1%)
were committed by men. Most physical (n =22, 48.9%) and verbal abuse (n = 55, 43.7%)
occurred in the evening. The majority (n = 29, 74.4%) of bullying incidents occurred in the
morning and managers were a major source (n = 22, 56.4%) of violent incidents, followed by
staff members (n = 14 ,35.9%). In 34 (87.2%) of those incidents, no action was taken. Sexual
harassment among staff members was the highest (n = 3, 42.9%). Decline in work
performance was reported in 20 (44.4%) HCWs who experienced physical violence and in 13
(54.2%) who were subjected to racial harassment.

Factors associated with workplace violence

HCWs who experienced violence reported that it was caused by absence of punishment
(67%), lack of security (51%), staff shortage (34%), long waiting time for patients (33%),
overcrowding (29%), personality type (17%), cultural beliefs (9%), lack of patient privacy (3%)
and language barrier (2%). Absence of punishment was the most common cause of verbal
abuse (61%), bullying (95%), sexual (71%) and racial (58%) harassment, whereas, lack of
security was the most common cause of physical violence (64%).

History of workplace violence related to characteristics of HCWs

Demographic and occupational features of HCWs who did and did not experience violence
are shown in Table 3. Sex was significantly associated with violence, with violence being more
frequent for men (n = 63, 57.8%) than women (n = 92, 42.8%). Nationality was significantly
associated with violence and was more frequent for Saudis (n = 131, 51.8%) than non-Saudis
(n = 24, 33.8%). Those who worked with ≤ 10 coworkers (n = 124, 53.4%) reported significantly
more frequent violence than those who worked with > 10 coworkers (n = 31, 33.7%). Those

5
who lacked encouragement to report violent acts (n = 79, 60.3%) reported significantly more
frequent violence than those who had such encouragement (n = 76, 39.4%). Those who
confirmed lack of availability of a system for reporting violence (n = 57, 57.6%) reported
significantly more frequent violence than those who confirmed system availability (n = 98,
43.6%).

Type of workplace violence related to characteristics of HCWs

Men (n = 22, 20.2%) experienced significantly more physical violence than women did (n = 23,
10.7%) (Table 4). Men (n = 51, 46.8%) also had significantly more verbal abuse than women
had (n =75, 34.9%). Violence was significantly more frequent for unmarried (n = 5, 5.1%) than
married (n =2,0.9%) HCWs. Saudi HCWs (n = 106, 41.9%) experienced verbal abuse
significantly more often than non-Saudis did (n = 20, 28.2%). Physical violence was
significantly more frequent in HCWs with < 10 coworkers (n = 38,16.4%) than in those with >
10 coworkers (n = 7, 7.6%). Verbal abuse was also significantly more frequent in HCWs with <
10 coworkers (n = 101, 43.5%) than in those with > 10 coworkers (n = 25, 27.2%). HCWs who
lacked encouragement to report violent incidents reported significantly more verbal abuse (n
= 65, 49.6%) than those who had encouragement (n = 61, 31.6%). Similarly, HCWs who lacked
encouragement to report violence reported significantly more bullying (n = 23, 17.6%) than
those who had encouragement (n = 16, 8.3%). In contrast, demographic and occupational
characteristics, such as age, occupation, shift time, direct contact with patient, and patient
types, were not significantly associated with general or specific types of violence.

Logistic regression analysis of workplace violence

After entering sex, nationality, number of coworkers, lack of report encouragement and
system availability into the regression model, the only independent variables significantly
associated with general violence were lack of report encouragement and Saudi nationality
(Table 5). For physical violence, the only significant independent factor was male sex. Lack of
report encouragement was the only variable that remained significantly associated with
verbal abuse and bullying.

Discussion
The main aim of this study was to estimate the prevalence of workplace violence in a sample
of 324 participants working in EDs in 4 public hospitals in Dammam, Saudi Arabia. The study
showed that the prevalence of violence among HCWs was 47.8%, which was considerably
lower than 89.3% in nurses in the EDs in 3 public hospitals in Saudi Arabia (15). However, our
result was closer to the prevalence of 57.5% in HCWs in 2 government hospitals and 10
primary healthcare centres in Saudi Arabia who experienced at least 1 violence incident (22),
and similar to the prevalence of 45.6% among HCWs in 12 family medical centres in Riyadh
(2).

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Most studies have shown that psychological violence (especially verbal abuse) was higher
than physical violence (15,21,26). The number of incidents of verbal abuse was approximately
5-fold that of the number of incidents of physical violence among nurses in several EDs in
Jordan (10), which can be explained by the stress of acute illness experienced by patients
and/or families at the time of the violent act. In the current study, verbal abuse formed 52%
of the violent incidents, physical violence 19%, bullying 16%, racial harassment 10% and
sexual harassment was the least common (3%). Similarly, a study in Macau revealed incidents
of verbal abuse (53.4%), physical assault (16.1%), bullying (14.2%), sexual harassment (4.6%)
and racial harassment (2.6%) among physicians and nurses (24). Verbal abuse was the most
common form of violence because it was easy to perpetuate and could not be controlled by
any sort of security measures. The majority (74.4%) of bullying incidents occurred in the
morning and managers were a major source (56.7%) of incidents followed by staff members
(35.9%), which is often explained by the presence of most managerial staff in the morning.
Moreover, interprofessional violence may have played a role in these incidents.

Most of the workplace violence was experienced by Saudi nationals, which is explained mainly
by the high number of Saudi participants in the study. The majority of offenders were patients
(42%) followed by their relatives (31%), which was similar to some previous studies (2,15,
20,25,26) but contrary to others (1,14,23), in which the companions of the patients were the
main offenders. The fact that patients were the major aggressors in the current study could
be explained by the absence of deterrent action (63.9%) towards violent incidents as
supported by management in the workplaces, following the rule “the patient is always right”.

Workplace violence had negative consequences on HCWs, such as reduced work performance
(44.4%), complaints against HCWs (8.3%) and injuries (0.8%), which is supported by previous
studies (1,2,18,19). Reduced work performance could be explained by feeling unsafe, anger,
anxiety or distress or performing duties in an unprofessional way. Some previous studies
suggested that the reasons for violence in EDs were staff shortage, absence of punishment,
lack of security, and long waiting times for patients. Certain characteristics of HCWs, including
age, sex, years of experience and marital status, have been associated with increased
workplace violence (27,28). In the current study, the frequency of physical violence was high
among men (20.2%) and sexual harassment was high among unmarried HCWs (5.1%).

More than half of violent incidents (66.7 %) were not reported and the main reason was the
feeling that reporting was useless. This could be related to the existing system that includes
reporting the incident to a supervisor, duty director, or the police. Most HCWs (n = 57, 57.6%)
exposed to workplace violence questioned the availability of a violence reporting system.
Moreover, the majority (75.9%) raised queries about the efficiency of the security measures
applied in EDs of the studied hospitals. Our results could be explained by lack of awareness
of the reporting systems and inefficient security measures. Hogarth et al. (29) noted that the

7
solution agreed upon by HCWs to decrease workplace violence was encouragement by
management to report violent incidents and to develop preventative measures.

The current study is one of few to cover all types of violence (physical and psychological,
including verbal threats, bullying, and sexual and racial harassment) and used the standard
WHO definition of violence. Additionally, all HCWs in EDs of public hospitals were targeted.
However, limitations cannot be excluded. The size of the sample may limit generalization of
the results. The questionnaire was self-administered and recall bias could not be excluded, as
in most similar surveys.

Conclusions
In this study, workplace violence was prevalent among HCWs, and verbal abuse was the
commonest type. The most important associated factor was absence of punishment, which
was agreed upon by the majority of HCWs. Creation of an environment that encourages HCWs
to report violent incidents and raising awareness of HCWs about violence reporting systems
in EDs are recommended. Ensuring the reporting of all violent incidents and follow-up of the
appropriate actions are essential. Supporting programmes to help and provide HCWs with the
knowledge to manage and control incidents are needed.

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(29) Hogarth KM, Beattie J and Morphet J. Nurses’ attitudes towards the reporting of
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Table 1. Demographic and occupational characteristics of HCWs in EDs, Dammam
HCW characteristics No. %
Occupation
Physician 63 19
Nurse 175 54
Othersa 86 27
Sex
Male 109 33.6
Female 215 66.4
Age (yr)b
≤ 30 153 47.2
31–40 136 42
> 40 35 10.8
Marital status
Married 226 69.8
Unmarried 98 30.2
Nationality
Saudi 253 78.1
Non-Saudi 71 21.9
Education
Diploma 163 50.3
Bachelor’s 141 43.5
Master’s 12 3.7
Boardc 8 2.5
Work experience (yr)
1–5 126 38.9
6–9 130 40.1
> 10 68 21
Multiple shifts
Yes 292 90.1
No 32 9.9
Shift time
Morning 42 13
Alternate 282 87
No. of coworkers
Mean (standard deviation) 9 (5)
≤ 10 232 71.6
> 10 92 28.4

a
Pharmacists, technicians and clerical workers.
b
Mean age 32.7 (6.2) years.
c
Medical degree for physicians to receive privileges and to practice medicine in a particular field.
ED = emergency department; HCW = healthcare worker.

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Table 2. Characteristics and types of workplace violence among HCWs in EDs, Dammam

Physical Verbal Bullying Sexual Racial Total

Characteristics and n % n % n % n % n % n %
types of violence 45 19 126 52 39 16 7 3 24 10 241 100
Shift time
Morning 10 22.2 42 33.3 29 74.4 3 42.9 11 45.8 95 39.4
Evening 22 48.9 55 43.7 6 15.4 3 42.9 9 37.5 95 39.4
Night 13 28.9 29 23 4 10.3 1 14.3 4 16.7 51 21.2
Location
Inside 40 88.9 123 97.6 38 97.4 7 100 24 100 232 96.3
Outside 0 0 1 0.8 1 2.6 0 0 0 0 2 0.8
Both 5 11.1 2 1.6 0 0 0 0 0 0 7 2.9
Frequencya
Once a year 24 53.3 39 31 21 53.8 5 71.4 10 41.7 99 41.1
Once a month 14 31.1 39 31 9 23.1 0 0 7 29.2 69 28.6
More than once per 7 15.6 48 38 9 23.1 2 28.6 7 29.2 73 30.3
month
Offender identity
Patient / client 24 53.3 65 51.6 0 0 2 28.6 11 45.8 102 42
Relatives 16 35.6 48 38.1 0 0 1 14.3 10 41.7 75 31.1
Staff memberb 1 2.2 5 4 14 35.9 3 42.9 0 0 23 10
Management 0 0 1 0.8 22 56.4 0 0 3 12.5 26 10.8
External colleague 1 2.2 1 0.8 3 7.7 0 0 0 0 5 2
General public 3 6.7 6 4.8 0 0 1 14.3 0 0 10 4.1
Offender age
< 20 years 0 0 3 2.4 0 0 0 0 0 0 3 1
21–45 years 42 93.3 100 79.4 30 76.9 7 100 18 75 197 82
≥ 46 years 3 6.7 23 18.3 9 23.1 0 0 6 25 41 17
Offender sexa
Male 23 51.1 40 32 18 46.2 5 71.4 9 37.5 95 39.42
Female 7 15.6 24 19 11 28.2 2 28.6 5 20.5 49 20.33
Both 15 33.3 62 49 10 25.6 0 0 10 41.7 97 40.25
Could have been
prevented 41 91.1 91 72.2 28 71.8 4 57.1 16 66.7 180 74.7
Yes 4 8.9 35 27.8 11 28.2 3 42.9 8 33.3 61 25.3
No
Consequences on
attacker 19 42.2 80 63.5 34 87.2 4 57.1 17 70.8 154 63.9
None 13 28.9 29 23 2 5.1 3 42.9 4 16.7 51 21.2
Verbal warning 9 20 7 5.6 0 0 0 0 0 0 16 6.6
Reported to police 4 8.9 10 7.9 3 7.7 0 0 3 12.5 20 8.3
Do not know
Consequences on
HCW 16 35.6 61 48.4 20 51.3 5 71.4 10 41.7 112 46.5
None 20 44.4 54 42.9 18 46.2 2 28.6 13 54.2 107 44.4
Reduce work 7 15.6 11 8.7 1 2.6 0 0 1 4.2 20 8.3
performance 2 4.4 0 0 0 0 0 0 0 0 2 0.8
Incident form against
HCWs
Injured

a
Percentage calculated from HCWs that could have been subjected to > 1 incidence of violence.
b
Physicians, nurses, pharmacists, technicians and clerical workers.
ED = emergency department; HCW = healthcare worker.

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Table 3. History of workplace violence related to characteristics of HCWs in EDs, Dammam

History of exposure to violence Total

HCW characteristics Yes No 324 χ2 P
n % n % n %
Sex
Male 63 57.8 46 42.2 109 33.6 6.528 0.01
Female 92 42.8 123 57.2 215 66.4
Age 155 169 324 0.622
Mean (SD) 32.5 (5.7) 32.9 (6.6)
Age group, yr
≤ 30 70 45.8 83 54.2 153 47.2
31–40 71 52.2 65 47.8 136 42 2.168 0.338
> 40 14 40 21 60 35 10.8
Marital status
Married 109 48.2 117 51.8 226 69.8 0.046 0.831
Unmarried 46 46.9 52 53.1 98 30.2
Nationality
Saudi 131 51.8 122 48.2 253 78.1 7.179 0.007
Non-Saudi 24 33.8 47 66.2 71 21.9
Occupation
Physician 34 54 29 46 63 19
Nurse 84 48 91 52 175 54 1.75 0.417
Others 37 43 49 57 86 27
Shift time
Morning 17 40.5 25 59.5 42 13 1.048 0.306
Alternate 138 48.9 144 51.1 282 87
No. of coworkers
≤ 10 124 53.4 108 46.6 232 71.6 10.3 0.001
> 10 31 33.7 61 66.3 92 28.4
Report encouragement
Yes 76 39.4 117 60.6 193 59.6 13.69 <0.001
No 79 60.3 52 39.7 131 40.4
System availability
Yes 98 43.6 127 56.4 225 69.4 5.41 0.02
No 57 57.6 42 42.4 99 30.6

ED = emergency department; HCW = healthcare worker; SD = standard deviation.

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Table 4. Type of workplace violence related to characteristics of HCWs in EDs, Dammam
HCW Physical
characteristics Yes % No % Total χ2 P
324
Sex
Male 22 20.2 87 79.8 109 5.442 0.02
Female 23 10.7 192 89.3 215
No. of coworkers
≤ 10 38 16.4 194 83.6 232 4.237 0.04
> 10 7 7.6 85 92.4 92
Verbal
Sex
Male 51 46.8 58 53.2 109 4.314 0.038
Female 75 34.9 140 65.1 215
Nationality
Saudi 106 41.9 147 58.1 253 4.397 0.036
Non-Saudi 20 28.2 51 71.8 71
No. of coworkers
≤ 10 101 43.5 131 56.5 232 7.420 0.006
> 10 25 27.2 67 72.8 92
Report
encouragement
Yes 61 31.6 132 68.4 193 10.653 0.001
No 65 49.6 66 50.4 131
Bullying
Report
encouragement
Yes 16 8.3 177 91.7 193 6.329 0.012
No 23 17.6 108 82.4 131
Sexual
Marital status
Married 2 0.9 224 99.1 226 0.028
Unmarried 5 5.1 93 94.9 98

ED = emergency department; HCW = healthcare worker; SD = standard deviation.

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 Table 5. Logistic regression analysis of workplace violence using significantly associated characteristics of
HCWs in EDs, Dammam
95% CI
Variables B SE Wald df Sig Exp(B) for Exp(B)
test Lower Upper
Saudi nationality 1.015 0.438 5.375 1 0.020 2.759 1.170 6.507
General Lack of report −0.915 0.375 5.945 1 0.015 2.497 1.197 5.209
encouragement −0.351 0.723 0.236 1 0.627 0.704
Constant
Physical Male sex 1.045 0.485 4.632 1 0.031 2.842 1.098 7.358
Constant −2.380 0.331 51.824 1 < 0.001 0.093
Verbal Lack of report 0.887 0.425 4.350 1 0.037 2.428 1.055 5.589
encouragement −2.260 0.595 14.448 1 <0.001 0.104
Constant
Bullying Lack of report 0.857 0.348 6.074 1 0.014 2.356 1.192 4.657
encouragement −3.260 0.570 32.676 1 < 0.001 0.038
Constant

df = degrees of freedom; ED = emergency department; HCW = healthcare worker; SE = standard error; Sig =
significance.

15