World population has been growing over the past years. This has led to establishment of vast healthcare facilities such as hospitals and pharmacies to accommodate the growing number of people. Violence in these settings can be attributed to external incidents by intruders like muggers and robbers, and internal incidents by fellow staff members, patients and their families. Working in a setting which has poorly lit rooms, unkempt premises among others could also instigate violence. Health care facilities through their related departments should take responsibility to formulate measures to curtail workplace violence by colluding with law enforcers and through effective training of staff, which should include recognition and management of work related assaults.
Health is an essential condition for human beings. To promote good health, people need to have basic requirements such as food, shelter and health care. Health care facilities include institutions such as hospitals, hospice, pharmacies, home nursing agencies and other examination and treatment facilities. Without health care it would be impossible to treat even the slightest infection and death would occur easily. Maintaining good health through treatment of illness or medical examinations is a factor that has led to establishment of these facilities. The facilities need to be free of workplace violence for effective attendance to patients or clients.
Workplace violence is those acts directed toward people at work, with intent to cause injury. Acts of violence range from threats, for instance, harmful expressions whereby a victim is threatened orally, through written material or body language; physical attacks when the victim is beaten, raped, stabbed, shot or bombed (Risk Reporter, 2003, p.2). Workplace violence often results to low motivation of the staff. The workers become demoralized and stressed due to hostile working conditions Violence incidents contribute to resignation of staff which lead to high turnover rates.
- There are escalated incidents of workplace violence in health care facilities lately.
- Majority of work related assaults are related to areas of high risk.
The research was a low-constraint one and had sweeping generalization. The representation was not extensive since the sampling did not cover a wide area.
Causes of workplace violence in a health care setting
Violence in health care setting can occur in various departments such as emergency, psychiatric or geriatric sections. At the emergency room, especially in the event of accidents or disasters, long queues of patients may frustrate relatives of the patient and violence could occur. In cases where mentally ill patients are isolated with doctors / nurses, physical confrontation is likely to occur.
Exposure to workplace violence can be determined by the type of setting. For instance, in Kenya, most public health care facilities are congested because common people are unable to meet the high costs for services offered in private health care facilities. Therefore patients and their families feel desperate and frustrated over inability to acquire needed services urgently. Low remuneration can lead to violence. Staff feels less valued for their work thereby directing their anger and stress to patients and their clients, who would respond viciously depending on their mental condition.
Possession of weapons among patients and clients can lead to staff being assaulted by patients or family members who may be armed with knives, guns, bombs or any other potential weapon (National Security, 1995, p.50). This can result to sexual attacks and robbery.
Inadequate staff training. In this case, workers fail to envisage or manage any activity that is seemingly abusive. The staff will not have skills to recognize rising violence behavior in the health care facility.
Improper staffing especially in durations of increased activity such as emergency periods in case of accidents, visiting hours, dining times and occasions of delayed service, where there are many patients waiting to be served.
Hospitals hold valuable items such as drugs, money, equipment and personal belonging. Without proper security, these items will become robbery targets. Insecurity can also encourage drug / alcohol abusers to enter health care premises when they find that there is unrestricted movement to the health facility.
Isolation of workers can occur in two ways: Firstly, during sessions of examination or treatment. Violence may erupt in places where a doctor is confined with patients or clients, especially when the patient is mentally challenged or is naturally violent (Chavez, 2001, p.42). The attendant may assault the patient by administering improper injection or prescription. Secondly, workers may be isolated in health care facilities with no back up systems such as alarms for alert in case of assaults, mainly in remote locations.
Prevention of workplace violence
Health care facilities can formulate guidelines and ensure that they are sternly adhered to by all workers, patients clients and other visitors. Established regulations can be pinned on notice boards for everyone to see.
Health care workers need to undergo comprehensive training to acquire necessary skills. Authority and responsibility should then be assigned to qualified staff. Increased training of staff may reduce the likelihood of occurrence of violence incidents (Carmel & Hunter, 1990, p.43).
Through establishment of briefing committee, workers can share opinions as regards to matters of safety, suggestion of methods of minimizing violence and support of affected workers through counseling.
Provision of adequate security in and out of workplace may be achieved by working together with the police or security firms, which can install devices like security cameras for round-the-clock surveillance of health care premises. This helps apprehend perpetrators of violence. Proper security could encourage staff and patients to report any incidents of assault. Cases of revenge on incident reporters, robbery and physical attacks will be avoided this way (Worthington & Franklin, 1990, p.43).
The study involved visiting both public and private hospitals. Method of stratified random sampling was employed. Acquisition of data was performed using questionnaires that included both open-ended and close-ended questions. Data was also collected by direct observation and face-to-face interviews in cases where workers, patients and clients were unwilling to express their opinion in written form.
Results and Analysis
Data obtained was presented in tabular form. Analysis of variance was used to compare the variance of data of response to each question in the questionnaire.
The study found out that violence of bosses toward junior workers was most prevalent, with majority of victims being women. Most of the violence incidents brought about by patients or clients involved verbal attacks.
Occurrences of assaults at working areas were high in public than in private hospitals.
Workplace violence can be attributed to factors that pose increased risk of work related abuse. These factors include areas of high risk, where workers deal with people who abuse drugs or have records of violence, emergency and psychiatric sections.
Terminally ill, physically challenged and elderly patients are the most vulnerable to work related violence since they are unable to defend themselves in cases of physical attacks.
Carmel, H. and Hunter, M. (1990). Staff Injuries from Impatient Violence, Hospital and
Community Psychiatry, 40(1): 42 – 45
Chavez, L. J., Workplace Violence, (2001) Journal of Psychosocial Nursing and Mental Health
Services, 35(8) 42 – 43
National Security (1995) Workplace Violence: Journal of Nursing Administration,
22(9): 42 – 57
Risk Reporter, (2003). September – October Issue, 1 – 4
Worthington, K. and Franklin, P. (2001). Workplace Violence: What to do if you are assaulted.
American Journal of Nursing, 101(4): 73