Workplace Violence against Jordanian nurses in Emergency Departments prepared by Dr. Mohammed ALBashtawy Al al-Bayt University Jordan

Backgrounds Nowadays, hospital violence against health care providers, especially nurses, is a significant concern in every health care setting in the world.

Workplace violence against nurses is not an uncommon phenomenon; it is a current problem in all countries, having been noticed as early as 1824 (Whelan, 2008)Whelan, 2008

Workplace violence is defined by the National Institute for Occupational Study and Health as “Violent acts directed towards a person at work on duty” (CDC, 2002).

It is also defined, by the American Nurses Association (ANA), as “A range of behavior from verbal abuse, threats, and unwanted sexual advances to physical assault and at the extreme, homicide” (ANA, 1994).

Workplace violence affects nurses’ job performance and nursing care as the following: Increase absenteeism Influence nurses’ personal and professional lives Increase stress and mistrust of administration Increase burnout and staff turnover. This may lead to dissatisfaction during work, thus resulting in a decrease in the general nursing care level (Hesketh et al., 2003, CDC, 2002).

In Jordan, as in many countries, physical and verbal violence have increased, not just in the workplace but also in all community settings. A few studies were conducted to explore that issue among nurses

Therefore, this study was conducted in order to assess the workplace violence, verbal and physical, committed against nurses in Hospital Emergency Departments in Jordan

Subjects and Methods A cross-sectional study was carried out over a period of three months, from May 1 to July 31, 2011

The study included the 12 provinces of Jordan by randomly choosing one hospital (governmental or private) from each province. All selected hospitals-8 governmental, 4 private- were notified of the nature and objectives of the study

follow-up calls were made to all chosen hospitals to identify their willingness to participate, and to determine suitable times to visit the hospitals in order to conduct the study. Approval of the study protocol was obtained from the Ethical Approval Committee in Al al-Bayt University.

All nurses who work in emergency departments in the selected hospitals, and who understand the Arabic language, were notified and invited to participate in this study

A field supervisor working in the emergency department in each selected hospital was chosen to arrange and coordinate the distribution of questionnaires and to collect them at the end of the week.

During the period of the study, a convenient sample of 313 nurses was chosen to participate. Of those, only 227 (response rate was 72.5%) met the inclusion criteria, and they completed most of the needed parts after a full explanation of the objectives of the study was given by two trained nurses.

Informed consent was obtained from all participants before the questionnaire was completed. The questionnaires used in this study were guided and developed by reviewing the literature for related work conducted worldwide;

the questionnaires were then pre-tested and modified by a panel of experts in the field. They were then revised on the basis of the results of a pilot study of 20 emergency staff nurses who were excluded from the final analysis of this study.

The questionnaires have 4 parts containing a total of 14 questions The first part (6 questions) covered the participants’ demographic and professional characteristics. The second part (6 questions) was comprised of questions about experiences of verbal or physical violence and other context of violent incidents (frequency, time, and place) and the nature of the perpetrators. The third part asked about the type of physical violence. The fourth part asked about factors that contributed to workplace violence from the participants’ perspectives during the last year

Data Analysis Data were entered, computed, and analyzed using the Statistical Package for Social Sciences (SPSS). Descriptive statistics mean, standard deviation, and frequencies were used.

Mean(SD) DistributionVariable 82(36.1) 145 (63.9) Sex Male Female 30.3 years (8.4) 121 (53.3) 106 (46.7) Age Less than and more 97 (42.7) 126 (55.5) 4 (1.8) Marital status Single Married Divorce or widow 2.95 years (0.97) 70 (30.8) 98 (43.2) 36 (15.9) 23 (10.1) Experiences in emergency department Less than 1 year 1-5 years 6-10 years More than 10 years 181 (79.7) 46 (20.3) Work sector Governmental private 3(1.3) 85(37.4) 135(59.5) 4(1.8) Education Less than diploma Diploma Bachelorette More than Bachelorette Table 1: Demographical and professional characteristics of surveyed nurses in emergency departments in Jordanian hospitals (N=227)

Not exposed to violenceExposed to violenceGender 16(19.5) 39 (26.9) 66(80.5) 106(73.1) Male (n=82) Female (n=145) 55(24.2)172(75.8)Total (n=227) Table 2: Distributions of violence by gender (N=227)

Physical violenceVerbal violenceContext 27(11.9)145(63.9)N (% of the participant) 13(48.1) 9(33.3) 2(7.4) 3.7))1 64(44.1) 59(40.7) 3(2.1) 16(11.0) 3(2.1) Perpetrator of the violence Patient Family Friends Co-workers Not specified 9(33.3) 12(44.4) 4(14.8) 7.4))2 51(35.2) 63(43.4) 24(16.6) 7(4.8) Time of the incidents Morning shift (7 am-3pm) Afternoon shift (3pm-11pm) Night shift (11pm-7am ) Not specified Table 3: Context of violent incident experienced by EDN during last one year

percentagenumberTypes Grabbed, pushed, punished, or kicked Instrument such as knife or stick Threaten by gun Other types Did not respond Table 4: Type of physical violence (N=27)

Distributions (%)*Reasons Waiting time Overcrowding Patient and family expectation Lack of resources Emergence staff attitude Bad communication Deficient staff Lack of effective antiviolence polices Poor administration Lack of penalty for perpetrators Other reasons *More than one response Table 5: Reasons contributing to work place violence from nurses perspective during the past one year

Discussion Violence in the health care setting in developing countries is neither well studied nor documented (Algwaiz, 2012).

The findings of this study reveal that male nurses are more likely to be exposed to violence than female nurses; This finding is similar to that which was published by El-Gilany et al. (2010). This can be explained by the nature of male nurses, which makes them more vulnerable to violence by the perpetrators; male nurses feel masculine and are less likely to allow others to give them orders or criticize their work

Additionally, violence against females is culturally and religiously unacceptable behavior in Jordan. For these reasons, male nurses provoke perpetrators to commit violence against them

Regarding the context of violent incidents, it was found that most of these were verbal acts committed by the patients themselves or by their family members, Due to the stress of acute illness experienced by patients and/or families at the time of the violent act

Most of the violent incidents happened during the afternoon shifts (3 p.m.–11 p.m.) for two reasons. The first reason is the absence of administrative personnel, who leave their jobs at around 4 o’clock p.m.; presence of administrative personnel sometimes works to prevent people from committing unacceptable acts.

The second reason is the large numbers of patients who visit the emergency department in the afternoon, after the outpatient clinics close their doors and leave patients with no choice other than the emergency department

Regarding the factors contributing to workplace violence from nurses’ perspectives, this study shows that: Increased waiting time Overcrowding High expectations of clients and their families are perceived as major contributors to the enhancing and stimulation of violent acts.

Limitations Although the questionnaire that was developed in this study was used in both governmental and private hospitals, it needs greater standardization to be suitable for application to other locations of clinical health care, such as health centers..

Conclusions In Jordanian hospitals, physical and verbal violence is a serious and alarming phenomenon experienced by all emergency staff departments, especially nurses. Policies and legislation targeting violence should be instituted and developed.