An Epidemiological Study Of Hospital Workplace Violence In Guangzhou City

Background and Objective:Violence inevitably is a serious problem to social security for a country or district. And violence, which has permeated everywhere, in fact, can be probed in all kinds of hospitals. The main cause why violence was neglected by all is the shortage of an obvious definition. There was no complete and suitable definition in the past few years on violence although it is always needed. The only one was given by World Health Organization in the year of 2005 like this:Incidents where staff are abused, threatened or assaulted in circumstances related to their work, including commuting to and from work, involving an explicit or implicit challenge to their safety, well-being or health. Three key points should be included on this term of definition.1 the incident of violence is found out in the very workplace,2 the duration of time is completely unanimous to the work shift, and 3 health staffs are the only victims. Workplace violence is classified in three different types according to the accurate body locations about violence experience:Physical violence, psychological violence and sexual violence. Physical violence is the use of physical force against another person or group, which results in physical, sexual or psychological harm. It includes among others, beating, kicking, slapping, stabbing, shooting, pushing, biting and pinching. Psychological violence is intentional use of power, including threat of physical force, against another person or group, which can result in harm to physical, mental, spiritual, moral or social development. It includes verbal abuse, bullying/mobbing, harassment and threats. Sexual harassment is any unwanted, unreciprocated and unwelcome behavior of a sexual nature that is offensive to the person involved, and causes that person to feel threatened, humiliated or embarrassed. Physical and psychological violence often overlap in practice making any attempt to categorize different forms of violence very difficult. Some of the most frequently used terms relating to violence are presented below. Assault/attack is intentional behavior that harms another person physically, including sexual assault. Abuse is behavior that humiliates, degrades or otherwise indicates a lack of respect for the dignity and worth of an individual. Bullying/mobbing is repeated and over time offensive behavior through vindictive, cruel or malicious attempts to humiliate or undermine an individual or groups of employees. Threat is promised use of physical force or power (i.e. psychological force) resulting in fear of physical, sexual, psychological harm or other negative consequences to the targeted individuals or groups. While the existence of personal physical violence at the workplace has always been recognized, the existence of psychological violence has been long under-estimated and only now receives due attention. Psychological violence is currently emerging as a priority concern at the workplace. It is also increasingly recognized that personal psychological violence is often perpetrated through repeated behavior, of a type which by itself may be relatively minor but which cumulatively can become a very serious form of violence. Although a single incident can suffice, psychological violence often consists of repeated, unwelcome, unreciprocated and imposed upon action which may have a devastating effect on the victim. So far, workplace violence problem is still not be paid so much attention on in China and no regulations or laws on it is found either. Professional studies on workplace violence in the field of epidemiology is not launched at all. At the same time, the result of research of workplace violence from abroad is not for sure fit for us China because of the special culture background, health facility and administrative regulation. A well-designed survey to a group of representative sample from a definite scope might show the prevalence and risk factors on workplace violence. All in one word, the basic objective of this project is to probe into prevalence of workplace violence in hospitals and analyze its related factors to lay a basis for maintaining normal working order in hospital and lawmaking against workplace violence.Method:Guangzhou City governs ten districts and other two counties. This research aimed on 7 198 hospital staff from 20 different health facilities located in Guangzhou city and all violence experiences received by them in the past 12 months were investigated. Every employee is eligible to this survey following the statistic method of cluster sampling and sratified sampling at the same time. The definition is given according to the latest definition of workplace violence from World Health Organization as below:any events that occurred to hospital staff, who suffered psychological, physical and/or sexual violence at work or on duty during the past 12 months preceding the survey. Social statistic database software tool SPSS 17.0 is used to analyze relative factors of workplace violence. All statistic variables include the epidemiological features of workplace violence from descriptive study, relative character variables from Chi-square test, and some risk factors from logistic regression model. Quality control were also considered in this research like:1 Closed questionnaire is used to reduce the subjective declare and aim of investigation, require and approach of finishing the form are given at the same time in the content; 2 Only the events occurring in the past 12 months proceeding this research are investigated to avoid the recalling bias; 3 Support and comprehension are gained from the supervisors from every hospital to make the survey work smooth; 4 The sample of research are large enough to represent all health facilities in Guangzhou city although we chose 20 health units with different grade, nature, level and location; 5 All questionnaires are held in and determined using the only criteria made before the stage of research design. Authorized professionals were charge in typing every questionnaire after deleting some which were thought invalid according to the criteria.Results:7 198 health staff from 20 hospitals with different grade, level, and location were involved in this investigation. Only 3 hospitals were rejected from this research because of the low receiving rate with the number of one hundred and eleven. The terminal objective populations were the 5950 health workers from seventeen hospitals.5147 survey forms are received with a replying rate 86.50 percent (5147/5 950). After screening following the defined principle,5 061 questionnaires were left eventually as valid forms and the valid replying rate was 98.33 percent (5 061/5 147). Among 5 061 hospital staffs investigated,2 947 have been subjected to workplace violence in the last 12 months preceding the survey, with a rate of 58.23%, accounting for 56.85% of psychological violence,12.85% of physical violence and 6.99% of sexual violence respectively. At least 14 health staff at various hospitals had been disabled or suffering from physical handicap due to violence, and 7 were victims of rape or attempted rape. Psychological violence occurred mostly to those working in the Emergency Departments,83.02% of the total, and physical and sexual assaults usually happened to staff in psychiatric hospitals,45.10% and 20.23% for each. Staffs who were most prone to violence in hospitals were those working in the Emergency Departments, psychiatrists, doctors and nurses, permanent staff, male below 30. Those who were apt to commit such violence to staff at work were relatives of patients, aged below 40, especially male between 31 and 40. Wards and day shifts were the location and time most likely for violence in hospital. The causes of such violence might be what happened to patients:their death, loss of consciousness, intoxication or abuse of drugs, committers' mental problems, lack of improvement in the patients' conditions, high treatment cost, lengthy waiting queues, dissatisfaction with the service or their requirements unmet, etc.Conclusion:Prevalence of violence in hospitals all over Guangzhou city was quite high, recorded at 58.23%, and psychological violence,56.85%, was the major form. The rate of physical violence is 12.85 percent, which is suitable to peer result from other countries. Sexual violence, with a rate of 6.99%, is almost the only result about violence in hospital professional groups all around the world so far. Psychological violence has the highest rate, especially in Emergency Department, which is 83.02 percent, so that no staff working there can avoid not being harmed by the very kind of violence. Although the rates of physical violence and sexual violence do not go that high, these two types of violence do much harm to the victims of violence at degree of injuries. Among 2 661 hospital staff victims investigated in this research 14 were heavily harmed to disability or death for violence and other 7 were raped or attempted to rape. Harm from violence in workplace should never be belittled, for such violence might cause physical, mental and psychological trouble to the victims, bringing out heavy economic burden to the victims themselves, their hospitals or even the state as a whole. Staff in the Emergency Departments of hospitals, psychiatrists, doctors and nurses, permanent staff and male below 30 should be protected. We suggest that hospitals at grade 2 or above should strengthen safety security and all employees should learn to protect themselves against workplace violence. The causes of violence in hospitals might come from both the hospitals (the management and medical staff) and the patients like:death of patient, unconscious of patient, abuse of alcohol or drugs, mental disorder of perpetrator patient, no recovering or turning better as expected, high price on medicine or treatment, long time duration for clinic, dissatisfaction on serving from health staff, and patients' require not hitting its need. Amongst all factors listed above, high price on medicine or treatment, no recovering or turning better as expecting, and patients' require not hitting its need were more likely to bring about workplace violence. And the last one was responsible to 23.40 percent of violence found in this research. Results from this project show that administrators of hospitals should work hard in regulation, quality, and technology, and supervisors supervising hospitals should deepen to reform the health policies. Workplace violence does not yet catch the public's eyes so far and violence is considered one common phenomenon happening at hospitals.1/5 of health staff investigated in this research has never heard about this professional term workplace violence at all in his working career. Prevention and control of such violence was a complex system work, calling for working from various aspects such as policy, management, engineering as well as education and so forth. Furthermore, education on occupation moral, professional safety, and respect to health staff could assist in making better social circumstance and preventing and controlling workplace violence.