European Journal of Molecular & Clinical Medicine (EJMCM)

ISSN: 2515-8260 Volume 06, Issue 01, 2019

Assessment of Prevalence of Workplace Violence among Nurses

and Physicians at Emergency Department in Primary Health
Care Centers, Makkah, 2019
Zahid Mohammed Zahid Serdar1, Mane Mueen Shalah Alotaibi2, Adnan Awadh Alwuthaynani3, Hanan
Abdullah Turkstani4, Sara Mohammed Barahim4, Hadi Helal Alotaibi5, Abdullah Abed Alotaibi6, Hayat
Abdullah Alzahrani6, Ahlam Yahya Baksh7, Ahmed Saeed Babaynjy4
1
Medical laboratory specialist, MOH MAKKAH, Saudi Arabia.
2
Nursing technician, MOH MAKKAH, Saudi Arabia.
3
Pharmacy technician, MOH MAKKAH, Saudi Arabia.
4
Dentist, MOH MAKKAH, Saudi Arabia.
5
Administration hospitals, MOH MAKKAH, Saudi Arabia.
6
Nursing technician, MOH MAKKAH, Saudi Arabia.
7
Dental technician, MOH MAKKAH, Saudi Arabia.
Abstract
Background
Workplace violence (WPV) is a serious worldwide concern, especially for health care professionals when
compared with workers in other industries. Violence in the health care sector harms both patients and health
care professionals and causes enormous economic losses. Victims of WPV show signs of anxiety, depression,
and low efficiency in their work performance, which may decrease the quality of the service that they provide.
Among health care professionals, nurses who have direct contact with patients face numerous risks related to
WPV. Therefore, it is important to recognize risk factors that can be used to reduce the incidence of WPV
against nurses. Emergency healthcare workers (HCWs) have a high risk of exposure to violence with negative
personal consequences. Violence is an occupational hazard in hospitals. Occupational researches have gradually
shifted focus from traditional, visible environmental risk factors, such as physical, chemical, biological exposure
or ergonomic problems, to the invisible, psychological harm that maybe present in the workplace.
Aim of the study: To assessment of Prevalence of Workplace Violence among and Nurses and Physicians at
Emergency Department in Primary Health Care Centers and confirm the factors influencing such violence.
Method: Cross-sectional analytical study has been conducted at emergency departments (EDs), Primary Health
Care Centers in Makkah city, during data collection period 2019, the total sample has been (400) nurses and
physicians.
Results: Regarding the age the highest age were (35.0%) were (30-40) years and the data ranged from (22-57)
by mean ±SD (38.315±9.816), were females (57.0%)while males. The majority of the participated nurse were
(67.0%), followed by doctor were (33.0%). Regarding the qualification, the majority of participated heave
Bachelor were (28.0%) followed by Resident (21.0%), the participated experience in from 6-10 years were (31.
0%).More than half of the participants were yes to physical or verbal violence and their percentage was (75.
0%).Conclusion: Workplace violence was prevalent, and verbal abuse was the commonest type among HCWs in
emergency departments of PHC. Workplace violence, a possible cause of job stress, has recently become an
important concern in occupational health. Almost half of the ED nurses and physicians experienced one or more
WPV incident.

Keywords: Assessment, Prevalence, Emergency Department, Nurses, Physicians Violence, Saudi Arabia.

1. INTRODUCTION
Every year, approximately 1.3 million people die worldwide due to interpersonal violence, accounting for 2.5%
of the total number of deaths. [1] as with all forms of violence, workplace violence against healthcare
personnel is an important problem, and it has been spreading worldwide. Workers in the psychiatry, emergency
departments (EDs) and general care fields are believed to have the highest risk of such violence. [2]
Workplace violence, a potential reason for work pressure, has as of late become a crucial worry in related
occupational health. The prevalence of Workplace violence fluctuates with the occupational setting, as does
the as does the type of violence. For national case studies conducted in Australia, Brazil and Bulgaria as a rule
emergency clinic [3,4]. The World Health Organization (WHO) indicated that violence is the purposeful
utilization of power that makes dangers to people or gatherings, which may bring about injury, psychological
harm, or death [5]. In the studies, the expression "violence" was frequently utilized interchangeably as
"aggression" and will in general happen along a continuum from verbal to physical attacks[6] found that the
yearly pervasiveness paces of physical violence (PV) went from 3% to 17%, boisterous attack (VA) 27.4% to

351
 European Journal of Molecular & Clinical Medicine (EJMCM)
ISSN: 2515-8260 Volume 06, Issue 01, 2019
67%, bullying/mobbing (BM), which is characterized as a rehashed, unreasonable behavior directed toward a
worker, 10.5% to 23%, sexual harassment (SH) 0.7% to 8%, and racial harassment (RH) 0.8% to 2.7%[7]
Burn out syndrome is defined as “a syndrome of emotional exhaustion (EE), depersonalization (DP)
(impersonal response towards patients), and reduced personal accomplishment (PA) among individuals who
work with people” [8]. Clinical symptoms of burnout syndrome are nonspecific and include headaches, loss of
energy, tiredness, lack of motivation, eating problems, irritability, insomnia, negative attitudes towards others,
rigidity in relationships with other people, physical illness, and emotional instability [4, 5]
Primary Health Care Centers that is at greatest risk of experiencing WPV can provide reference information for
decision makers, allowing them to direct the appropriate measures to the correct people. Previous studies related
to the incidence of WPV involving nurses varied from one district to another and according to the different
levels of the hospitals and PHC. Tiruneh et al. found that independent factors associated with WPV included
“age, with older workers being more prone to experiencing WPV”, “single marital status” and “working in a
male patient ward”. Additional factors included “relatively understaffed work shifts” and “having a history of
experiencing WPV” [9]. Moreover, another study's identifying factors associated with WPV for nurses included
the factors “age, with younger workers being more prone to experiencing WPV”, “working with elderly patients
(over 65 years old)” and “working in emergency rooms”, “outpatient units” and “intensive care units
(ICUs)”[10]. No data or research was found that explored the relationship of risk factors among nurses at top-
level, the status of WPV may vary based on the different levels of PHC and hospitals. However, a significant
factor that might be neglected is worker training on how to recognize and deal with the potentially violent
patient/family. [11] disclosed under 50% of staff underwent any training. [12]
Patients may have character and conduct issues, for example, alcoholism and drug abuse while some
hospital members of employees have poor angle and approach in relating with patients. [13]
Animosity might be more a lot of serious at the accident and emergency unit.
Policy and methodology tending to workplace violence in the healthcare setting has been recorded in several
developed countries [14] however is nearly non-presence in developing. Many violence and harassment against
the health professionals go frequently unreported officially. [15,16]
2. LITERATURE REVIEW
In Riyadh 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. Because of the increased risk factors
associated with violence, the US Department of Labor Occupational Safety and Health Administration (OSHA)
have made an effort to establish guidelines for the prevention of workplace violence. The National Institute for
Occupational Safety and Health (NIOSH) characterized workplace violence as "act or danger of violence, going
verbal abuse to physical assaults directed toward people at work or on the job" [16]
The following is outline of the foremost important studies in Saudi Arabia:
As of late in Riyadh (2017), Alharthy N and her studies group researched the prevalence of workplace violence
about emergency medical services laborers. They reasoned that the prevalence of workplace violence was 65%.
Concerning the type, verbal abuse was the commonest (61%). Most of the perpetrators were patients’ family
members relatives (80%) followed by patients themselves (51%). More youthful (<30 years), lower experienced
staff (≤10 years) had fundamentally higher violent incidents than their partners. Reporting the incidents, the
occurrences to a more significant position authority was referenced by just 10% of the victims. [17]
At a university hospital, Eastern area (Khobar), Al-Shamlan et al (2017) gauges the prevalence of verbal
abuse about nurses. Over a time of one year, the pervasiveness of verbal abuse was 30.7% about nursing.
Greater part of them didn't report the incidents; Majority because they believed that reporting would yield no
positive results. Male nurses, nurses in the emergency department, and those who indicated that there were
procedures for reporting violence in their workplace were more likely to have verbal abuse.[18] This study is
limited by the fact that they included all nursing staff not only those working in emergency departments and also
it focused on nurses only.
2. INTERNATIONAL STUDIES
In Bahrain, Rafeea F, et al (2017) completed a cross-sectional at the ED of the Bahrain Defense Force to assess
frequency of violence in the workplace. Results uncovered that the most regular frequent reported type of
violence in the past 12 months was verbal abuse (78%), trailed by physical abuse (11%) and sexual abuse (3%).
most than half (53%) of instances of violence happened during night shifts, while physical abuse was accounted
for to happen during all the shifts. An extensive extent (40%) of the staff didn't know about the strategies
against workplace violence, and 26% of the staff thought about fined employment elsewhere. The most elevated
reasons of violence revealed by the staff were long holding up time and patient expectations. [19] However, this
research's was directed in one healthcare facility which could influence the generalizability of its outcomes in
USA, Kowalenko et al (2013) have implemented a longitudinal study to estimate the incidence and distinguish
the determinants of violence in ED working staff more than nine months. The normal violence insult affront rate
per individual per nine months was 4.15. Physical violence rate was 3.01 per individual. Men executed 52% of

352
 European Journal of Molecular & Clinical Medicine (EJMCM)
ISSN: 2515-8260 Volume 06, Issue 01, 2019
physical assaults. There was a significant difference between physicians and nurses and patient. The nurses felt
less safe than the physicians. The physicians felt additional assured than the nurses in managing violence
situations. The nurses were more possible to possess acute stress than the physicians. [20] Brunetti and Bambi
(2013) completed a survey concerning the greatness of violence affronts towards attendants working in EDs and
violence the results of these abuses on casualties and medical services associations. The prevalence rate of
verbal abuses among ED nurses varied between 50% and 100% whereas that of physical violence ranged from
16.7% to 72% . Patients and family members were the primary culprits, trailed by doctors, and, at long last by
medical attendant's associates. Liquor, drugs misuse, and congestion in EDs were the fundamental encouraging
elements for brutal abuses. Under-announcing of affronts came to the 80%, and a few examinations report that
medical caretakers consider savagery functions as a typical aspect of their responsibilities. [21]
1.2 Rationale:

Many of studies done showed nurses followed by physicians are at high risk of violence, and as emergency
department is the point of first contact with wards health care worker, workers at ED have a high risk of
workplace violence. Globally, workplace violence toward health care workers are an area of concern based on
literature review. ED workplace violence needs to be addressed urgently through continued research as up to the
researcher's knowledge there are few studies on workplace violence among nurse sand physician. Because of a
lack of standardized measurement and reporting mechanisms for violence in ED settings, data are scarce
particularly in Saudi Arabia.

1.3 Aim of the study:

To assessment of Prevalence of Workplace Violence among and Nurses and Physicians at Emergency
Department in Primary Health Care Centers Makkah, 2019 and confirm the factors influencing such violence.

1.4 Objectives:
To assessment of Prevalence of Workplace Violence among and Nurses and Physicians at Emergency Department
in Primary Health Care Centers Makkah, 2019 and confirm the factors influencing such violence 2019.
 To identify of physical and verbal workplace violence among physicians and nurses in emergency
department at Primary Health Care Centers Makkah, 2019
3. M ETHODOLOGY
3.1. Study Design
Cross-sectional descriptive study design has been adopted.
3.2 Study Area
The study has been carried out in emergency departments (EDs) in the Primary Health Care in the city of Makkah
Al-Mokarramah Makkah is the holiest spot on Earth. which is the largest city in Makkah Province, the largest seaport
on the Red Sea, and with a population of about four million people, (as of 2017 estimation) This study was conducted
in Makkah primary health–care centers at saudi Arabia, The current study was conducted at Al-Aziziyah Al-shargiah
Primary Health Care Center The primary health care centers in Makkah included under seven supervisory sectors:
three of them inside Makkah (Al Zahir, Al Kakia and Al Adel)with 37 PHCC while four supervisory sectors located
outside Makkah with 48 PHCC, it offers different services including general clinic, chronic disease clinic, antenatal
clinic, well baby clinic and vaccination, as well as pharmacy, radiology and laboratory services.
3.3 Study population:
All nurses and physicians working at emergency departments (EDs) in the Primary Health Care in the city
of Makkah (males and females) have been included in the study.
3.4 Eligibility Criteria
Inclusion criteria:
 All physicians and nurses working at emergency departments (EDs) in the Primary Health Care in
the city of Makkah.
 Male and female.
 All nationalities.
Exclusion criteria:
 No exclusion criteria.
3.5 Sample Size
The prevalence of workplace violence at emergency department 50% [8]. Dependent on 50% prevalence, 95%
confidence level, 5%error and 10% f or defaulter and non-respondent by using Raosoft website for sample size
calculation the sample size is 400 physicians and nurses, the total sample has been (400) physicians and nurses the
sample size has be 400 nurses and physicians. Multistage sample technique has been used.
3.6 Sampling Technique
Multistage sample technique.
Stage I : Stratified sampling techniques (selection of the Primary Health Care )

353
 European Journal of Molecular & Clinical Medicine (EJMCM)
ISSN: 2515-8260 Volume 06, Issue 01, 2019

The Primary Health Care has been divided into strata :

three of them inside Makkah (Al Zahir, Al Kakia and Al Adel) with 37 PHCC while four supervisory sectors
located outside Makkah with 48 PHCC, it offers different services including general clinic, chronic disease
clinic, antenatal clinic, well baby clinic and vaccination, as well as pharmacy, radiology and laboratory services.
The total number has been taken from each selected Primary Health Care based on proportion to sample
size. Then the health workers) has been divided into two strata. Doctors and nurses .From each stratum the
sample has been calculated based on proportion to size.

3.7. Data Collection Tool

A self-administered questionnaire distributed to all working physicians and nurses in the EDs departments,
Primary Health Care chosen for the study. The questionnaire was mainly developed from literature review and
the WHO survey questionnaire about violence in health care settings. validity has been taken by 3 consultants.
The first section of questionnaire includes demographic data of the respondents (age, gender, nationality, job
title, qualification, marital status and years of experience).
The second section has been consist of questions to estimate physical abuse , how many time ,during
which shift, type and place of violence, source of violence , reasons , outcome of violence, reported or not ,
if reported to whom and if not why .
The third section has been consist of questions to estimate verbal abuse , how many time ,during which
shift, type and place of violence, source of violence , reasons , outcome of violence , reported or not, if
reported to whom and if not why.
3.8 Data Collection Technique
The researcher has been visit the chosen EDs, Primary Health Care after getting official permissions to
conduct the study .
They hhas been explaining the purpose of the study to the ED head in each setting. Then, the questionnaire
has been distributed on physicians and nurses after explaining the purpose of the study and how to fill the
questionnaire to them.
3.9 Study Variables
Dependent variable: Insult of workplace violence
Independent variables: Age, gender, nationality, job title, qualification, marital status, years of experience
and shift time.
3.10 Data Entry and Analysis
Data has been collected, reviewed, coded and entered into the personal computer. Data has been presented in
the form of frequencies and percentages. Chi-squared test (χ2) has been used for comparing qualitative data.
Other statistical tests has been applied whenever appropriate. Statistical significance has been considered at p-
value ≤0.05. Analysis has been done using SPSS program version 25.
3.11. Pilot Study
A pilot study on 10% of physicians and nurses in one of the non-selected Primary Health Care has been
conducted to test the feasibility of the methodology and wording of the questionnaire as well as to estimate the
average time to complete it. A necessary modification has been done, based on pilot study results. Their results
has been not included in the final report .
3.12 Ethical Considerations
 Approval from the Research and Ethical Committee Joint Program of Family Medicine was taken.
 Approval from the director of Primary Health Care has been obtained.
 All collected data has been kept confidential and will not use except for research purposes.
3.13 Relevance & Expectations
 The researcher expects from the study, present of workplace violence
 Physicians and Nurses at Emergency Department
 The researcher expects from the study, low level of reported about the violence.
 The researcher expects to raise the importance of reporting violence.
3.14 Limitations
 The researcher expects there may be limitation in time.
3.15 Budget
 The research will be self-funded

Result

Table 1. Distribution of Socio-demographic characteristics of the studied population (400)

354
 European Journal of Molecular & Clinical Medicine (EJMCM)
ISSN: 2515-8260 Volume 06, Issue 01, 2019
N %
Age
<30 92 23
30-40 140 35
40-50 112 28
>50 56 14
Range 22-57
Mean±SD 38.315±9.816
Gender
Female 228 57
Male 172 43
Nationality
Non-Saudi 172 43
Saudi 228 57
Marital status
Single 120 30
Married 192 48
Widowed 36 9
Divorced 52 13
Job title
Doctor 132 33
Nurse 268 67
Your qualification is
Diploma 44 11
Bachelor 112 28
Resident 84 21
Specialist 60 15
Master 76 19
Consultant 24 6
Years of experience in ER department
Under 1 year 48 12
1 - 5 years 92 23
6 - 10 years 124 31
11 - 15 years 96 24
16 - 20 years 40 10

Regarding the age, the highest age were (35.0%) were (30-40) years and the data ranged from (22-57) by mean
±SD (38.315±9.816), were females (57.0%)while males. (43.0%) while(57.0%) Saudi. Majority of the
participant married (48.0%)and (30.0%)were single. The majority of the participated nurse were(67.0%),
followed by doctor were(33.0%). Regarding the qualification the majority of participated heave Bachelor
were(28.0%) followed by Resident(21.0%), the participated experience in from 6-10 years were(31.0%)
Table 2 Distribution of the characteristic of experienced and type of workplace

violence.

N %
Exposure to physical or verbal violence or both
No 100 25
Yes 300 75
If yes what is the type of violence
Physical 12 3
Verbal 332 83
Both 56 14

355
 European Journal of Molecular & Clinical Medicine (EJMCM)
ISSN: 2515-8260 Volume 06, Issue 01, 2019
More than half of the participants were yes to physical or verbal violence and their percentage was(75.0%).
Regarding the type of violence most of violence were verbal their percentage was(83.0%). Followed by both
physical and verbal was(14.0%)

Figure 1 Distribution of the Exposure to physical or verbal violence or both

Figure 2 Distribution of the type of workplace violence.

356
 European Journal of Molecular & Clinical Medicine (EJMCM)
ISSN: 2515-8260 Volume 06, Issue 01, 2019
Table 3 Description the estimate physical of the workplace violence.(how many time, during which shift,
type and place of violence, source of violence, reasons , outcome of violence) .

If yes what is the ype of violence N %

How many times did you face physical violence in the last 12 months
Once 105 35
2-4 times 60 20
5-10 times 18 6
Several times a month 72 24
About once a week 18 6
Daily 27 9
Where did the physical violence occurred
Inside your workplace 228 76
Both 72 24
The last time you were physically abused in your place of work, who physically abused you?
Relative 102 34
Patient 198 66
The gender of the abuser
Female 87 29
Male 213 71
Which time did it happen?
04.00 pm - 12.00 Am 186 62
12.00 Am - 08.00 Am 114 38
Reasons of physical violence
Excessive waiting time 132 44
shortage of staff 117 39
Unmet patient demands 63 21
poor organization of work 87 29
overcrowding 93 31
lack of security 177 59
Patient health condition 69 23
lack of patient or relative education 90 30
Outcome of physical violence
minor or major physical injury 117 39
physical disability 54 18
Psycho-social trauma 159 53
reduces job performance 102 34
quitting of job 30 10

Regarding the how many times did you face physical violence in the last 12 months participants answer once
times were(35.0%) follow by several times a month then 2-4 times were respectively(24.0%, 20.0%) during the
past 12 months, regarding Where did the physical violence occurred, the most of violence inside your
workplace occurred were(76.0%) but both were(24.0). Most of the violence were patients (66.0%), followed by
relatives of patients (34.0%), the gender of the abuser the most of them male were(71.0) , followed by female,
most of the violent incidents happened in the 04.00 pm - 12.00 Am were (62.0%) but the number in the 12.00
Am - 08.00 Am were(38.0%).
Regarding the reasons of physical violence the most of the reasons were lack of security were(59.0%),
followed by excessive waiting time were(44.0%) then shortage of staff were(39.0%) then lack of patient or
relative education, overcrowding. The Outcome of physical violence were: psycho-social trauma(53.0%), minor
or major physical injury(39.0%), reduces job performance(34.0)

357
 European Journal of Molecular & Clinical Medicine (EJMCM)
ISSN: 2515-8260 Volume 06, Issue 01, 2019
Table 4 Description the estimate physical of the workplace violence (reported or not if reported to whom
and if not why)

N %
Did you report the event?
No 114 38
Yes 186 62
If yes: To whom reported
Direct supervisor 158 84.95
Head of department 21 11.29
Hospital management 7 3.76
If yes: Any action taken
No 82 44.09
Yes 104 55.91
If no, why not reported
It was not important 33 28.95
Felt ashamed 13 11.40
felt guilty 22 19.30
Afraid of negative consequences 14 12.28
useless 22 19.30
Didn't know who to report 10 8.77

Regarding you report the event the answer was the same were (38% Yes and62% No), most of the reported
to the direct supervisor were(82.95%), regarding the action taken most of participant answer yes action was
taken were(55.91%) but no action taken were(44.09%). Why not reported about the violence incident one of the
most important reasons It was not important were(28.95%), felt guilty were (19.30%)
Table 5 Description of the relation between Socio-demographic data and Exposure to physical or verbal
violence or both

Exposure to physical or verbal

Total Chi-square
violence or both
Yes No
N % N % N % X2 P-value
<30 85 28.33 7 7.00 92 23
30-40 115 38.33 25 25.00 140 35
Age 88.126 <0.001*
40-50 85 28.33 27 27.00 112 28
>50 15 5.00 41 41.00 56 14
Female 205 68.33 23 23.00 228 57
Gender 62.886 <0.001*
Male 95 31.67 77 77.00 172 43
Non-Saudi 85 28.33 87 87.00 172 43
Nationality 105.318 <0.001*
Saudi 215 71.67 13 13.00 228 57
Single 101 33.67 19 19.00 120 30
Married 130 43.33 62 62.00 192 48
Marital status 13.979 0.003*
Widowed 25 8.33 11 11.00 36 9
Divorced 44 14.67 8 8.00 52 13
Doctor 80 26.67 52 52.00 132 33
Job title 21.770 <0.001*
Nurse 220 73.33 48 48.00 268 67
Diploma 35 11.67 9 9.00 44 11
Bachelor 95 31.67 17 17.00 112 28
Resident 46 15.33 38 38.00 84 21
Qualification 26.018 <0.001*
Specialist 49 16.33 11 11.00 60 15
Master 57 19.00 19 19.00 76 19
Consultant 18 6.00 6 6.00 24 6
Under 1 year 41 13.67 7 7.00 48 12
Years of 1 - 5 years 79 26.33 13 13.00 92 23
experience in 6 - 10 years 113 37.67 11 11.00 124 31 85.035 <0.001*
ER department 11 - 15 years 55 18.33 41 41.00 96 24
16 - 20 years 12 4.00 28 28.00 40 10

358
 European Journal of Molecular & Clinical Medicine (EJMCM)
ISSN: 2515-8260 Volume 06, Issue 01, 2019
Regarding age results show a significant relation between physical or verbal violence or both and age were X2
88.126 and P-value=0.001, increase (in the age 30-40 answer Yes were 38.33% ). Gender was significantly
associated with physical or verbal violence or both, with violence being more frequent for female(68.33%) than
male, show a significant relation were P-value < 0.001 and X2 62.886. Nationality was significantly associated
with physical or verbal violence or both were X2 105.318 and P-value=0.001 and was more frequent for Saudis
answer yes (71.67%%) than non-Saudis (28.33%), regarding Job title results show a significant relation between
physical or verbal violence or both and Job title were X2 21.770 and P-value <0.001 increase nurse were 73.33%
, but doctor answer were 26.67%, regarding Qualification results show a significant relation between physical or
verbal violence or both and Qualification were X2 26.018 and P-value <0.001 increase Bachelor were 31.67% ,
regarding Years of experience in ER department results show a significant relation between physical or verbal
violence or both and Years of experience in ER department were X2 85.035 and P-value <0.001 increase 6 - 10
years were 37.67% .
Figure 3 Distribution of the relation between Socio-demographic data and Exposure to physical or verbal
violence or both

Discussion
Workplace Violence among Nurses and Physicians is a serious phenomenon that affects the patient
experience as well as the quality of practice for healthcare providers. The aim of this study was to explore the
prevalence of physical and verbal workplace violence among nurses and physicians in 2019 years. Our study
showed that the age the highest age was (35.0%) were (30-40) years and the data ranged from (22-57) by mean
±SD (38.315±9.816), were females (57.0%)while males. (43.0%) while (57.0%) Saudi. Majority of the
participant married (48.0%)and (30.0%)were single. The majority of the participated nurse were (67.0%),
followed by doctor were (33.0%). Regarding the qualification, the majority of participated heave Bachelor
were (28.0%) followed by Resident (21.0%), the participated experience in from 6-10 years were (31.0%) (see
Table1). The study showed that the prevalence of workplace Violence was physical or verbal violence which
was considerably lower than verbal violence More than half of the participants were yes to physical or verbal
violence and their percentage was (75.0%). Regarding the type of violence most of violence were verbal their
percentage was (83.0%). Followed by both physical and verbal was (14.0%) (see Table 2). However, 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 [24]. Also, the results of our study are similar to a study that
was conducted in KSA the findings provide evidence of a relatively high prevalence of WPV (physical, verbal,
confrontations outside the workplace, or stalking), in the past 12 months against physicians and nurses working
in 37 EDs (45% in total, 47% for the physician group, and 41% for the nurse group) in the three provinces in
Saudi Arabia. [25]. Most studies have shown that psychological violence (especially verbal abuse) was higher
than physical violence.[24,26] 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[27]. which can be explained
by the stress of acute illness experienced by patients and/or families at the time of the violent act.

359
 European Journal of Molecular & Clinical Medicine (EJMCM)
ISSN: 2515-8260 Volume 06, Issue 01, 2019
In the current study, verbal abuse in the last 12 months formed 52.7% of the violent incidents, while physical
violence 27.3% Several times a month but once 31.8%. Similarly, a study in Macau revealed incidents of verbal
abuse (53.4%) [28]. Most of the violence were patients (66.0%), followed by relatives of patients (34.0%), the
gender of the abuser the most of them male was (71.0), followed by female, most of the violent incidents
happened in the 04.00 pm - 12.00 Am were (62.0%) but the number in the 12.00 Am - 08.00 Am were (38.0%).
Regarding the reasons of physical violence, the most of the reasons were lack of security were (59.0%), followed
by excessive waiting time were (44.0%) then shortage of staff were (39.0%) then lack of patient or relative
education, overcrowding. The Outcome of physical violence were: psycho-social trauma (53.0%), minor or
major physical injury (39.0%), reduces job performance (34.0) which was similar to some previous studies
[25,26,29] but contrary to others [30,31], in which the companions of the patients and patient's relative were the
main source of incidents. health care workers report the event the answer was the same were (38% Yes and62%
No), most of the reported to the direct supervisor were (82.95%), regarding the action taken most of participant
answer yes action was taken were (55.91%) but no action taken were (44.09%). Why not reported about the
violence incident one of the most important reasons It was not important were (28.95%), felt guilty were
(19.30%). Workplace violence had negative consequences on Physicians and Nurses at Emergency Department,
which is supported by previous studies [11,12,28]. (see Table 4). Relation between Socio-demographic data and
workplace physical or verbal violence or both are shown the age results show a significant relation between
physical or verbal violence or both and age were X2 88.126 and P-value=0.001, increase (in the age 30-40
answer Yes were 38.33%). Algwaiz et al. investigated the age as revealing that an age no significantly
associated with verbal violence [31]. physical or verbal violence or both was significantly associated with
married were respectively more than unmarried. which is consistent with a prospective cross-sectional survey
reporting a similar prevalence of violence against married more than unmarried participants [17]. also show
years of experience in ER department results show a significant relation between verbal violence and years of
experience in ER department were and P-value <0.001, show in our study also a significant relation between
Physical or Verbal violence and years of experience in ER department were P-value <0.001. Gender was
significantly associated with physical or verbal violence or both, with violence being more frequent for female
(68.33%) than male, show a significant relation were P-value < 0.001 and X2 62.886. Nationality was
significantly associated with physical or verbal violence or both were X2 105.318 and P-value=0.001 and was
more frequent for Saudis answer yes (71.67%) than non-Saudis (28.33%), regarding Job title results show a
significant relation between physical or verbal violence or both and Job title were X2 21.770 and P-value <0.001
increase nurse were 73.33% , but doctor answer were 26.67%, regarding Qualification results show a significant
relation between physical or verbal violence or both and Qualification were X2 26.018 and P-value <0.001
increase Bachelor were 31.67% , regarding Years of experience in ER department results show a significant
relation between physical or verbal violence or both and Years of experience in ER department were X2 85.035
and P-value <0.001 increase 6 - 10 years were 37.67%. (see Table 5). Hogarth et al. noted that the solution to
decrease workplace violence was encouragement by management to report violent incidents and to develop
preventative measures. [30]
Conclusions
Physical or Verbal violence was the commonest type. 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. Almost half of the ED physicians and nurses experienced one or more WPV incident during a 12-
month period. Workplace Physical or Verbal violence remains a significant concern in healthcare settings in
KSA. Supporting programmers to help and provide HCWs with the knowledge to manage and control incidents
are needed. should be prioritized to improve the working environment, the safety of healthcare providers, and the
quality of practice in EDs. Physicians and nurses who are at disproportionately high risk of WPV should
strengthen their stress-coping strategies and foster their level of resilience to minimize the negative
psychological consequences of violence that jeopardize their psychological and mental wellbeing.
REFERENCES
1. World Health Organization. (2016). Global status report on violence prevention 2014. Geneva: World Health
Organization; 2014. Accessed at January, 17, 292.
2. Dubb, S. S. (2015). It doesn't" come with the job": violence against doctors at work must stop. BMJ: British
Medical Journal (Online), 350.
3. Chen, W. C., Hwu, H. G., Kung, S. M., Chiu, H. J., & Wang, J. D. (2008). Prevalence and determinants of
workplace violence of health care workers in a psychiatric hospital in Taiwan. Journal of occupational
health, 50(3), 288-293.
4. Di Martino, V. (2002). Workplace violence in the health sector. Country case studies Brazil, Bulgaria, Lebanon,
Portugal, South Africa, Thailand and an additional Australian study. Ginebra: Organización Internacional del
Trabajo, 3-42.

360
 European Journal of Molecular & Clinical Medicine (EJMCM)
ISSN: 2515-8260 Volume 06, Issue 01, 2019

5. World Health Organization. (2019). INSPIRE handbook: action for implementing the seven strategies for ending
violence against children. World Health Organization.

6. Hutton, S. A., Vance, K., Burgard, J., Grace, S., & Van Male, L. (2018). Workplace violence prevention
standardization using lean principles across a healthcare network. International journal of health care quality
assurance.
7. Avander, K., Heikki, A., Bjerså, K., & Engström, M. (2016). Trauma nurses' experience of workplace violence
and threats: short-and long-term consequences in a Swedish setting. Journal of trauma nursing, 23(2), 51-57.
8. Hesketh, T., Wu, D., Mao, L., & Ma, N. (2012). Violence against doctors in China. Bmj, 345.
9. Todd, A., Akhter, N., Cairns, J. M., Kasim, A., Walton, N., Ellison, A., ... & Bambra, C. (2018). The pain divide:
a cross-sectional analysis of chronic pain prevalence, pain intensity and opioid utilisation in England. BMJ
open, 8(7), e023391.
10. Hahn, S., Müller, M., Hantikainen, V., Kok, G., Dassen, T., & Halfens, R. J. (2013). Risk factors associated with
patient and visitor violence in general hospitals: Results of a multiple regression analysis. International journal of
nursing studies, 50(3), 374-385.
11. Samir, N., Mohamed, R., Moustafa, E., & Abou Saif, H. (2012). Nurses' attitudes and reactions to workplace
violence in obstetrics and gynaecology departments in Cairo hospitals. EMHJ-Eastern Mediterranean Health
Journal, 18 (3), 198-204, 2012.
12. Gates, D., Gillespie, G., Kowalenko, T., Succop, P., Sanker, M., & Farra, S. (2011). Occupational and
demographic factors associated with violence in the emergency department. Advanced emergency nursing
journal, 33(4), 303-313.
13. Magnavita, N., & Heponiemi, T. (2012). Violence towards health care workers in a Public Health Care Facility in
Italy: a repeated cross-sectional study. BMC health services research, 12(1), 108.
14. Ferns, T. (2006). Under-reporting of violent incidents against nursing staff. Nursing Standard, 20(40).
15. Child, R. H., & Mentes, J. C. (2010). Violence against women: the phenomenon of workplace violence against
nurses. Issues in mental health nursing, 31(2), 89-95.
16. Sorensen, G., Sparer, E., Williams, J. A., Gundersen, D., Boden, L. I., Dennerlein T., & Pronk, N. P. (2018).
Measuring best practices for workplace safety, health and wellbeing: the workplace integrated safety and health
assessment. Journal of occupational and environmental medicine, 60(5), 430.
17. Alharthy, N., Mutairi, M. A., Alsahli, A., Alshehri, A., Almatrafi, A., Mahah, A., & Qureshi, S. (2017).
Workplace violence among emergency medical services workers in Riyadh, Saudi Arabia. Journal of Hospital
Administration, 6(3), 26-32.
18. Al-Shamlan, N. A., Jayaseeli, N., Al-Shawi, M. M., & Al-Joudi, A. S. (2017). Are nurses verbally abused? A
cross-sectional study of nurses at a university hospital, Eastern Province, Saudi Arabia. Journal of Family &
Community Medicine, 24(3), 173.
19. Rafeea, F., Al Ansari, A., Abbas, E. M., Elmusharaf, K., & Zeid, M. S. A. (2017). Violence toward health
workers in Bahrain Defense Force Royal Medical Services’ emergency department. Open access emergency
medicine: OAEM, 9, 113.
20. Rafeea, F., Al Ansari, A., Abbas, E. M., Elmusharaf, K., & Zeid, M. S. A. (2017). Violence toward health
workers in Bahrain Defense Force Royal Medical Services’ emergency department. Open access emergency
medicine: OAEM, 9, 113.
21. Brunetti, L., & Bambi, S. (2013). Aggressions towards nurses in emergency departments: an international
literature review. Professioni infermieristiche, 66(2), 109-116
22. Alsaleem, S. A., Alsabaani, A., Alamri, R. S., Hadi, R. A., Alkhayri, M. H., Badawi, K. K., ... & Al-Bishi, A. M.
(2018). Violence towards healthcare workers: A study conducted in Abha City, Saudi Arabia. Journal of family &
community medicine, 25(3), 188.
23. Al-Turki, N., Afify, A. A., & AlAteeq, M. (2016). Violence against health workers in Family Medicine
Centers. Journal of Multidisciplinary Healthcare, 9, 257.
24. Muzembo, B. A., Mbutshu, L. H., Ngatu, N. R., Malonga, K. F., Eitoku, M., Hirota, R., & Suganuma, N. (2014).
Workplace violence towards Congolese health care workers: a survey of 436 healthcare facilities in Katanga
Province, Democratic Republic of Congo. Journal of occupational health, 14-0111
25. Alyaemni, A., & Alhudaithi, H. (2016). Workplace violence against nurses in the emergency departments of three
hospitals in Riyadh, Saudi Arabia: A cross-sectional survey. NursingPlus Open, 2, 35-41.
26. Abbas, M. A., Fiala, L. A., Abdel Rahman, A. G., & Fahim, A. E. (2010). Epidemiology of workplace violence
against nursing staff in Ismailia Governorate, Egypt. J Egypt Public Health Assoc, 85(1-2), 29-43
27. Albashtawy, M. (2013). Workplace violence against nurses in emergency departments in J ordan. International
nursing review, 60(4), 550-555.
28. Cheung, T., Lee, P. H., & Yip, P. S. (2017). Workplace violence toward physicians and nurses: prevalence and
correlates in Macau. International journal of environmental research and public health, 14(8), 879..

361
 European Journal of Molecular & Clinical Medicine (EJMCM)
ISSN: 2515-8260 Volume 06, Issue 01, 2019

29. Speroni, K. G., Fitch, T., Dawson, E., Dugan, L., & Atherton, M. (2014). Incidence and cost of nurse workplace
violence perpetrated by hospital patients or patient visitors. Journal of emergency nursing, 40(3), 218-228.
30. Alshehri, F. A. (2017). Workplace violence against nurses working in emergency departments in Saudi Arabia: a
cross-sectional study (Doctoral dissertation).
31. Algwaiz, W. M., & Alghanim, S. A. (2012). Violence exposure among health care professionals in Saudi public
hospitals. Saudi medical journal, 33(1), 76-82.
32. Hogarth, K. M., Beattie, J., & Morphet, J. (2016). Nurses’ attitudes towards the reporting of violence in the
emergency department. Australasian emergency nursing journal, 19(2), 75-81.

362