Workplace Violence in Healthcare: A Literature Review

This paper analyzes the growing concern of workplace violence in healthcare, particularly for nurses and healthcare professionals. The types of violence faced by healthcare professionals are discussed along with the importance of the topic. A research question is proposed and a thorough literature review is provided.

Introduction
Violence is increasing day by day and the workplace violence is growing at an
alarming rate throughout the world irrespective of the area of profession. But, the most
sufferers are the workers of healthcare department who face lots of violence incidence at their
workplace whilst working. Due to the increase in violence, the healthcare professionals’ self-
esteem and jobs are getting affected and some of the violence is so risky that it can endanger
their lives also. Many previous studies have found that workplace violence is a growing
concern for all employees who directly works with the patients and their families (Arnetz et
al. 2015). Studies revealed that some minor verbal abuse has become common subject for the
workers and even sometimes, they are facing massive physical abuses from the patients and
their families as well (Blando et al. 2015). This paper is going to analyze the how workplace
violence has become one of the main concerns in healthcare from the previous research
papers on it. The importance of the chosen topic will also be described along with a probable
research question. Finally, the paper will conclude with a complete synopsis of the literature
review.
Research question
What are the types of violence that are being faced by the healthcare professionals and
nurses while working in the emergency departments of hospital and other healthcare
organization?
Literature review
Workplace violence in the healthcare profession is quite common and in many cases it
is considered as a part of the job. Nurse practitioners may be more likely to confront the
violence coming from the patients and their families. Studies showed that among all the

healthcare professionals, 61% are the nurses (Heckemann et al. 2015). Many case studies in
the healthcare industry are carrying the fact that violence is the most dangerous issue amongst
the working professionals. An incident happened in the year 2012, where, at an affiliated
hospital of Harbin Medical University, a 17 year old boy, violently and brutally stabbed an
interim who was not even involved in his treatment procedure (Hogarth, Beattie and Morphet
2016). In the year 2013, an angry patient fatally attacked three nurses in a hospital ad another
patient who was not satisfied with his nose surgery, stabbed a department head along with
two doctors (Jiao et al. 2015). Several other cases have been also found where the doctors
were beaten up by the patients’ families due to their dissatisfaction in the treatment procedure
(Keshavarzian and Mofidian 2015). Not only these cases, many cases are there where if the
patients are not satisfied on the services or quality care of the hospitals they protest violently
and attack the healthcare professionals who are involved with it directly or directly.
Additionally, studies disclosed that the hospitals that deal with most serious diseases mainly
face the violence from the patient parties due to their dissatisfaction (Moghadam, Pazargadi
and Khoshknab 2013). In many studies it has been analysed that which group of nurses are
most likely to experience workplace violence. Most of the violence and assaults occur in the
nursing related facilities and these are generally committed by the patients and their families
(Najafi et al. 2017). The productivity of any hospital or healthcare organization is largely
dependent on the quality of service of the nurses of it. So, job satisfaction of the nurses is
highly necessary to achieve the quality of service (Park, Cho and Hong 2015). Nurses
reported that most of the workplace violence they face in the emergency departments of the
hospitals. Nurses get threatening from the patient parties and even sometimes, due to over
stress they fear to come to their workplace and also they find symptoms related to post-
traumatic stress disorder. Providing respect and giving value to the dignity of work
encourages quality of care and the nurses and other healthcare professional sometimes

experience verbal abuses that hamper their service quality also which in turn produces
massive affect in the reputation of the hospital or the healthcare organization. In a study,
which was organized in a particular hospital of Italy, it has been found that 49% nurses
experienced physical abuses and 82% nurses were the victim of verbal violence from the
patients and their families (Phillips 2016). The characteristics of the patients are mostly
associated with the occurrence of violence as the nurses or other healthcare professionals
always get verbal abuses from the patients who are addicted by alcohol and sometimes
violence from the patients also depends upon the disease in which they are suffering from.
Studies revealed that lack of knowledge among patients and their relatives, and lack of
security these two are the main reasons of violence occurrence in the healthcare
organizations. So, in many research articles, it is well documented that nurses and other
healthcare professionals who are directly involved in the patient care practice are at
significant risk for violence exposure from the patient parties. Many qualitative as well as
quantitative studies have been organized in this matter and all those revealed that various
types of assaults are hampering the lives of nurses (Pouryaghoub, Mehrdad and Alirezaei
2017). Some violence they consider as a part of their job but some violence are so dangerous
that can bring their life at risk also. Several types of violence are there but the most
immediate concern is regarding physical violence and bullying. The repeated physical as well
as psychological violence is generally termed as bullying which can be very dangerous and
nurses get victimized by trauma as a result (Speroni et al. 2014). So, workplace violence in
the healthcare profession is not only confined to any particular country or religion, rather it
has become a concern for all the healthcare organizations and hospitals from all over the
world.

Importance of the topic
The job of nurses is never a cakewalk but the violence they are facing is the additional
harassment which is affecting their jobs as well as their lives. Even, many studies revealed
that nurses are reluctant to go their workplace and they are sometimes leaving their jobs out
of fear of getting attacked by the patient parties. Nurses and other healthcare professionals
always try to provide quality care to the patients which is not only beneficial for the patients
but also for the healthcare organization as quality service improves the reputation of it.
Violence in the emergency department is the rising concern for the healthcare industry
throughout the world. Starting from verbal abuse to slapping, pinching, kicking and even
attacking with knife and other harmful tool is also a part of this violence (Phillips 2016).
However, nurses are taught that this violence is the part of their working life but this should
be considered and handled with much care. Sometimes nurses and other staffs do not get
proper support to raise their voice against such assaults and it seems like they are always
working under pressure which is not providing them the job satisfaction. Even many people
avoid joining this profession due to its risk associated with the workplace violence (Phillips
2016). So, this is very much important to analyze what are the types of violence nurses and
other healthcare professionals are facing and after that it is necessary to find out the reasons
in order to resolve the issues from the root.
Synopsis of the literature review
From the literature review, it is found that many authors in their papers discussed their
concern regarding the workplace violence in the workplace of healthcare professionals. The
issue is rising at an alarming rate and it has created a barrier in the growth of hospitals and
other healthcare organizations. Authors in their articles revealed many cases where the
violence from the patients was so destructive that the lives of the nurses or other victims were

endangered. Authors of research papers also mentioned how the violence is affecting the
patients indirectly. The productivity, reputation and growth of any healthcare organization are
associated with the patients’ satisfaction regarding its quality service. But, if the patients are
not satisfied then also it is important to find the root cause of their dissatisfaction. Again,
improper security arrangement is also responsible for the assaults and violence in the
emergency departments. If the problem is not solved then it will come out as huge disaster for
this industry. So, it is highly necessary to look into the matter in order to fix it.
Conclusion
Workplace violence in the healthcare organization has become one of the largest
barriers in the quality healthcare service and its rapid growing is really bringing issue of
concern for all the professionals of this industry. The paper discussed a thorough literature
review on the issue and it disclosed many study reports that has revealed the destructiveness
of this issue. In the synopsis section, the literature review is also summarized to get the main
idea of the authors. The violence is not only limited to verbal assaults even physical violence
has also become a matter of issue for the healthcare professionals and the variety of violence
is explaining the research question which is mentioned at the beginning of the paper. Further
research is required in this regard in order to identify what are the solutions to avoid this issue
otherwise it can create massive disaster in the healthcare industry which will not only affect
the patients but also the other industry associated with it.

References
Arnetz, J.E., Hamblin, L., Ager, J., Luborsky, M., Upfal, M.J., Russell, J. and Essenmacher,
L., 2015. Underreporting of workplace violence: Comparison of self-report and actual
documentation of hospital incidents. Workplace health & safety, 63(5), pp.200-210.
Blando, J., Ridenour, M., Hartley, D. and Casteel, C., 2015. Barriers to effective
implementation of programs for the prevention of workplace violence in hospitals. Online
journal of issues in nursing, 20(1).
Heckemann, B., Zeller, A., Hahn, S., Dassen, T., Schols, J.M.G.A. and Halfens, R.J.G., 2015.
The effect of aggression management training programmes for nursing staff and students
working in an acute hospital setting. A narrative review of current literature. Nurse education
today, 35(1), pp.212-219.
Hogarth, K.M., Beattie, J. and Morphet, J., 2016. Nurses’ attitudes towards the reporting of
violence in the emergency department. Australasian emergency nursing journal, 19(2), pp.75-
81.
Jiao, M., Ning, N., Li, Y., Gao, L., Cui, Y., Sun, H., Kang, Z., Liang, L., Wu, Q. and Hao, Y.,
2015. Workplace violence against nurses in Chinese hospitals: a cross-sectional survey. BMJ
open, 5(3), p.e006719.
Keshavarzian, M. and Mofidian, S., 2015. An overview on Iran health care financing system:
challenges and solutions. Journal of Health Policy and Sustainable Health, 1(4).
Moghadam, M.F., Pazargadi, M. and Khoshknab, M.F., 2013. Iranian nurses’ experiences of
aggression in psychiatric wards: A qualitative study. Issues in mental health nursing, 34(10),
pp.765-771.

Najafi, F., Fallahi‐Khoshknab, M., Ahmadi, F., Dalvandi, A. and Rahgozar, M., 2017.
Human dignity and professional reputation under threat: Iranian Nurses' experiences of
workplace violence. Nursing & health sciences, 19(1), pp.44-50.
Park, M., Cho, S.H. and Hong, H.J., 2015. Prevalence and perpetrators of workplace violence
by nursing unit and the relationship between violence and the perceived work
environment. Journal of nursing scholarship, 47(1), pp.87-95.
Phillips, J.P., 2016. Workplace violence against health care workers in the United States. New
England journal of medicine, 374(17), pp.1661-1669.
Pouryaghoub, G., Mehrdad, R. and Alirezaei, P., 2017. Workplace violence in medical
specialty training settings in Iran: a cross-sectional study. International journal of
occupational hygiene, 9(1), pp.15-20.
Speroni, K.G., Fitch, T., Dawson, E., Dugan, L. and Atherton, M., 2014. Incidence and cost
of nurse workplace violence perpetrated by hospital patients or patient visitors. Journal of
emergency nursing, 40(3), pp.218-228.