Original Article
Low reporting of violence against health-care workers in India in spite of high prevalence

https://doi.org/10.1016/j.mjafi.2018.11.011Get rights and content

Abstract

Background

Violence against health-care workers has become a great issue in health-care organizations. This study was conceptualized with the aim to know the prevalence of violence and to identify gap between rate of reporting of an incident of violence at a tertiary care hospital in India.

Methods

The study was descriptive and cross-sectional; a validated questionnaire was used as a tool. Reported incidents of violence against workers were collected. P value <0.05 was considered statistically significant in the analysis. A Z test for proportion at 95% confidence interval was applied to analyze the level of difference between prevalence, rate of reporting, and their level of awareness.

Results

Of 394 respondents, 136(34.5%) workers had experienced workplace violence in the last 12 months. It was found that total 32 incidents of workplace violence were reported to the concerned authority. The reporting rate of violence is significantly low (23.5%), in spite of high prevalence (34.5%). Level of awareness regarding the reporting mechanism and regulations for the safeguard of health-care workers against workplace violence is only 24.6 %.

Conclusion

This study concluded that the prevalence of violence among health-care workers is quite high, but the reporting rate is significantly low. The low rate of reporting is because of lack of awareness about the reporting mechanism of workplace violence. It is recommended that sensitizing workshops should be conducted to increase the level of awareness, which will result in reduction in the prevalence of violence and building a safe and secured workplace for health-care providers.

Introduction

Workplace violence against health-care workers (HCWs) at health-care organizations (HCOs) is spreading globally, and because of being at high risk of being a victim, it has become a leading concern for the doctors, nurses, hospital administrators, politicians, and other staff working in the hospitals.1 The consequences of workplace violence in the health sector have a significant negative impact on the health of the staff2 and the effectiveness of delivery of health services3, especially in developing countries such as India. There is an interrelationship between stress and violence in the workplace. The psychological violence of any nature in a workplace may lead to stress in employees which can adversely affect the delivery of services.

The World Health Organization (WHO) defines workplace violence as the intentional use of power against another person in work-related circumstances that can either result in injury, death, psychological harm, or maldevelopment.4 Violence occurring at any of these places comes under the ambit of workplace violence, i.e, a restaurant, office, taxi, factory, store, hospital, school, hotel, bar, or social service agency.5

HCWs are more predisposed to workplace violence than workers in other industries. Major reason for the same is that HCWs work closely with their patients and their families during the time when they are not only physically but psychologically weak. Patients may show violent behavior because of not only their medical condition but also the medication they are taking. Patients may also have the past medical history of violent behavior due to some other underlying causes.6 Although many studies have been conducted in different parts of the world which show that the prevalence of verbal and physical violence is increasing globally2, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20 furthermore, only a handful of studies12, 20, 21, 22 are there to know the level of awareness among HCWs about the proper reporting mechanism of such incidents in their organizations. The law23 provides a safeguard to HCWs against any act of violence; however, owing to lack of awareness among HCWs about their rights and privileges, these incidents are never reported; thus, the perpetrators of violence are not booked by law. Lack of any action against perpetrators not only encourages them but also other people who also engage in acts of violence which demotivates HCWs.

The aim and objective of this study were to measure the prevalence of violence and to analyze the reported cases in a tertiary care public hospital. In addition to this, awareness regarding reporting of such incidences was also estimated.

Section snippets

Materials and methods

A cross-sectional study was conducted over a period of 10 months, i.e, May 2014–August 2015, after clearance from the institutional ethics committee. Purpose of the study was to determine the prevalence of workplace violence among hospital staff at a tertiary super specialty care center in India and to estimate the rate of reporting of the incident. Another objective of the study was to find the gap between the reporting rate and the prevalence of violence if any. All the doctors, nurses, and

Results

The response rate was 90% (405 filled questionnaires were received). Of which, 11 questionnaires were rejected for being incomplete, and the rest were analyzed. The sociodemographic profile of respondents is shown in Table 1.

Out of 394 respondents, 136 (34.5%, 95% CI, 29.94–39.31) of HCWs experienced workplace violence in the last 12 months and 50 (12.7%, 95% confidence interval 9.67–16.25) were those who had experienced physical violence. Category-wise prevalence of workplace violence (WPV)

Discussion

Workplace violence against HCWs by patients and their relatives is a big problem in health-care organizations. From the study, it was found that prevalence of verbal violence is 34.5% and 12.7% of respondents reported being physically attacked. As compared with other studies conducted in Australia, Mid-Atlantic region of the US, Brazil, Bulgaria, the UK, Palestinian, Hong Kong, China, Japan, Kuwait, and Taiwan, our neighboring countries such as Pakistan and Nepal found that the annual

Limitation

Findings of the study are limited to the HCWs of public hospitals only. Private Health Care Organizations (HCOs) including nursing homes and clinics were excluded.

Conclusion

This study has concluded that the prevalence of violence among HCWs is quite high, but the reporting rate is significantly low level of awareness regarding reporting system, and regulations for the safeguard of HCWs against workplace violence is only 24.6% with the highest among nurses (41.4%) and the lowest among group C employees (10.4%).

The low rate of reporting of WPV is because of lack of awareness about the reporting system. Low reporting also creates a false sense of security in the

Conflicts of interest

The authors have none to declare.

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