___________________________________________________________ Violence in the Healthcare Workplace
in residential settings had experienced a physical injury by a patient in the previous year [92]. In 2019, the Bureau of Labor Statistics reported 5,650 intentional injuries and 2,170 unin- tentional or unclear-motive injuries to nursing and residential care facility personnel [135]. In a study conducted by Snyder, Chen, and Vacha-Haase of 76 certified nursing assistants working in geriatric residential care facilities, 4,833 incidents of workplace violence in which the perpetrator was a patient occurred during the two-week study period [27]. Interestingly, 95% of total incidents were not reported to human resources or the proper workplace authority. Incidents of verbal abuse were reported most often (11.9%), while only 2.1% of physical incidents were reported. When questioned regarding their decision not to report the incidents, the most common response was the patients’ lack of intent or understanding. Most violence experienced by caregivers in residential facilities occurs when the caregiver is providing basic care, such as assisting the patient/client in dressing, washing, feeding, or changing [26]. In a study conducted by Gates et al. of 138 nursing assistants working in nursing homes, 43% of violent incidents occurred while the patient was being dressed [26]. In a retrospective study of 3,919 nursing home care providers, more than 66% reported having experienced verbal abuse by residents and 42% experienced physical aggression. When staff sensed there was sufficient staffing and resources, they were also perceived less workplace violence [143]. International Workplace Violence Internationally, workplace violence among nurses has received an increasing amount of attention. It is impossible to review every international context; however, this section should provide a sense that workplace violence is not unique to any particular country. One systematic review and meta-analysis compared workplace violence in different regions and found that studies conducted in Europe and Pacific regions showed the highest prevalence rates of workplace violence, followed by North America, the Middle East, and North Africa [179]. In a survey study with Lebanese nurses, workplace verbal and physical abuse was reported by 62% and 10% of respondents, respectively [115]. In an Italian survey, researchers found that 34% of nursing students and 43% of nurses had experienced at least one episode of physical or verbal abuse in a clinical setting during their lifetime [93]. The nurses tended to expe- rience violence perpetrated by patients or patients’ family members, while the nursing students reported more verbal abuse perpetrated by colleagues and staff. In a survey study with 521 Taiwanese nurses, 19.6% disclosed experiencing physical violence and 51.4% reported experienc- ing verbal abuse at work [94]. The majority of the perpetrators were patients. Shift also appeared to have an impact on the type of violence experienced, with those who worked the night shift more likely to report sexual harassment [94]. This was partially attributed to lower staff-to-patient ratios and more alone time with patients at night. A survey of 850 nurses in Hong Kong
found that 44.6% had experienced workplace violence in the preceding year. Verbal abuse was the most common type, and perpetrators were more often patients. In this study, male nurses were more likely to be victims than female nurses [144]. A survey of nurses working in Tehran, Iran, found that 19.1% had been victims of physical (non-weapon-related) violence at work in the last year [95]. In addition, 91.6% reported having experienced verbal abuse in the last year. In this study perpe- trators were predominantly family members of patients and the most common setting for the abuse occurred was at the patient’s bedside or at the nurses’ station. In a cross-sectional survey study with 601 physicians and other healthcare workers in North India, 75% reported having experienced some type of workplace violence and more than 30% expressed discomfort with reporting the incidence(s) [180]. Although the majority of research on international healthcare violence focuses on nurses, physicians are also affected. In a study of 1,015 physicians in central China, almost two-thirds reported experiencing some sort of workplace violence in the preceding year [145]. SOCIAL WORK Every year, 18.3 out of every 10,000 social service workers had at least one day of work missed due to an incident of workplace violence [96]. Several national studies have been conducted to ascertain the scope of workplace violence in the field of social work. Beaver conducted a study with members of the National Association of Social Workers (NASW) and found that more than one-half of the sample had been verbally abused and almost one-fifth (19.9%) experienced physical assault by a client [29]. Jayaratne, Vinokur-Kaplan, Nagda, and Chess conducted a national study with social workers focusing on aggression perpetrated by clients or service recipients (i.e., type III violence as defined by OSHA) [30]. Forty-two percent of the sample disclosed that they had been verbally abused by clients; 17.4% had been threatened physically, and 2.8% had been physically assaulted. In a 2005 study, Ringstad randomly sampled 3,000 members from the NASW; a total of 1,029 social workers responded to the survey [31]. In this study, Ringstad asked both about abuse perpetrated by and against clients. Consistent with earlier stud- ies, 86% of the sample stated they had experienced some type of violence from their clients during their social work career. Again, psychological forms of violence, such as verbal threats, abuse, and property damage, were the most common types of violence experienced. Overall, 85% stated that they expe- rienced psychological violence perpetrated by clients during their career, with 62% reporting psychological violence in the last 12 months. Finally, 30% had experienced physical assaults by clients at some point during their career; 14.7% had expe- rienced physical assaults by clients in the last 12 months [31]. In a longitudinal study of 1,501 child protection workers, 75% reported non-physical violence perpetrated by clients in the first six months of their employment, 37% of which involved threats of physical violence [146].
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