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Table of Contents
ORIGINAL ARTICLE
Year : 2021  |  Volume : 4  |  Issue : 2  |  Page : 165-169

Prevalence of workplace-related violence among otorhinolaryngology residents in Riyadh, Saudi Arabia


Department of Otolaryngology.Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia

Date of Submission24-Aug-2020
Date of Decision26-Aug-2020
Date of Acceptance08-Oct-2020
Date of Web Publication13-Apr-2021

Correspondence Address:
Ahmed Saleh Alsaleh
College of Medicine and Surgery, King Saud University, Riyadh
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jnsm.jnsm_102_20

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  Abstract 


Background: Violence is one of the prevalent public health concerns that healthcare staff face; a serious problem needs to be focused. Objective: The objective of the study is to estimate the prevalence of workplace-related violence among ear, nose, and throat (ENT) residents in Riyadh, capital of the Kingdom of Saudi Arabia, and to identify the common types, perpetrators, and precipitating risk factors of workplace violence (WPV). Design: This was a cross-sectional, self-administered questionnaire study. Settings: The study was conducted at King Saud University Medical City. Subjects: The study subjects were Riyadh's ENT residents. Intervention: All Riyadh's ENT residents were invited to participate in the survey in which 80 out of 90 residents participated. Our questionnaire included two domains: one includes demographic data and other includes occupational characteristics and some details related to violence. Main Outcome Measures: (1) Prevalence of WPV among Riyadh's ENT residents. (2) Identification of types and risk factors of WPV. Results: More than half of our sample had been through a violent experience before, with 60% experiencing it at least once. Most of the violent experiences were with the adult age group of 25–55 years. Male and companions of the patients were found to the most common offenders, and the most leading factors for violence are misunderstanding and miscommunication being at the top of the list at 20%. Conclusion: As more than half of the sample has experienced violence, hence, this issues needs to be focused on through different ways, including improving resident's communication skills and improving the reporting system for violent behaviors.

Keywords: Otorhinolaryngology, residents, violence, workplace


How to cite this article:
Alsaleh AS, Almotairi AI, Alim BM, Alroqi AS. Prevalence of workplace-related violence among otorhinolaryngology residents in Riyadh, Saudi Arabia. J Nat Sci Med 2021;4:165-9

How to cite this URL:
Alsaleh AS, Almotairi AI, Alim BM, Alroqi AS. Prevalence of workplace-related violence among otorhinolaryngology residents in Riyadh, Saudi Arabia. J Nat Sci Med [serial online] 2021 [cited 2021 Jun 13];4:165-9. Available from: https://www.jnsmonline.org/text.asp?2021/4/2/165/313635




  Introduction Top


Violence is defined by the WHO as “The intentional use of physical force or power, threatened or actual, against another person or against oneself or a group of people that results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment or deprivation.”[1]

Violent behavior is one of the biggest public health concerns that healthcare staff face; a serious problem that we must focus on and study from all aspects as it affects the organization's performance negatively. It could lead to reduced employee productivity and creativity, low morale, increased desire to quit jobs, or nonproductive environment.[2],[3],[4],[5] Workplace violence (WPV) is a common event that healthcare workers face during duties, with the nurses being the most vulnerable, though physicians are not immune. The incidence of WPV at healthcare facilities is under reported; only one-quarter of all such incidents in healthcare settings are reported.[2],[6],[7],[8]

The main causes of WPV in otorhinolaryngology physicians and nurses are due to patients underestimating diseases and being unsatisfied by treatment outcomes or physicians in the otorhinolaryngology department being less skilled compared to other departments.[2]


  Materials and Methods Top


This is a cross-sectional, self-administered questionnaire study. The aim of the study is to assess the prevalence of WPV among among ear, nose, and throat (ENT) residents in Riyadh, Saudi Arabia, and to look for risk factors within the study participants. The questionnaire was distributed in February 2019 and all Riyadh's ENT residents were invited to participate in the survey.

A minimum sample size of 73 residents out of the total residents' population (90) was needed as indicated by power analysis:



We developed a paper-based questionnaire by reviewing previous, similar articles and the International Labour Office/International Council of Nurses/WHO/Public Services International's questionnaires.[2],[6] The questionnaire was in English.

Regarding validation, ENT consultants and expert researchers in the same field reviewed the questionnaire. The questionnaire was modified based on the experts' suggestions to fit our target population and our research objectives.

Instrument test–retest reliability was achieved with a Cronbach's alpha level of 0.705. Our questionnaires included two domains:

  1. The demographic data which included date of birth, gender, marital status, nationality, year of graduation from college, GPA, and year of services before attending the ENT program
  2. Occupational characteristics and some details related to violence, if applicable:


    1. Have you had an experience of violence?
    2. How many times?
    3. What was the place of violence?
    4. What was the age of the offender?
    5. What was the gender of the offender?
    6. Was the offender a patient or companion?
    7. What was the ENT subspecialty where the violence happened?
    8. What was the cause of violence?
    9. What were the consequences?
    10. Was it preventable?


Ethical consideration

Ethical approval was granted by the Institutional Review Board (IRB) of the College of Medicine, King Saud University, Riyadh, Saudi Arabia (19/0540/IRB, Research Project Number E-19-3833). All the participants voluntarily agreed to participate in the study. The confidentiality and anonymity were kept by following the regulations provided by the Ethics Committee at King Khalid University Hospital. Written informed consent was obtained.

Statistical procedures

The Chi-square test was used to examine the relationship between variables; the Fisher's exact test was used to examine the relationship between variables when the expected frequency is less than 5. P < 0.05 of the test measures was considered statistically significant.

The SPSS Version 19.0 statistical package (IBM Corporation, Armonk, NY, USA) was used for all statistical calculations. Descriptive analyses were performed based on the calculations of frequencies and percentages. In the bivariate analysis, Chi-square or Fisher's exact test was used to calculate the association between exposure to each of the physical, verbal, and other abuses and the participants' characteristics. The multivariate logistic regression model was used to examine the risk factors associated with exposure to physical and verbal abuse. A significant difference was assumed when P < 0.05.

Analysis was used to determine the association of demographic data and occupational characteristic for WPV in the previous 12 months.


  Results Top


The sociodemographic data of our participants are presented in [Table 1], which shows that 48 out of 80 otorhinolaryngology residents who participated in the present study were males and the remaining were females. The majority of the samples, 27.5%, were in R3 level with only six R1 residents. Of the respondents, 73.8% had no working experience in the ENT field before the residency program.
Table 1: Patient's sociodemographic data

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When we focused on the experiences of violence among ENT residents, which is the main scope of this study, we found that more than half of our sample had been through a violent experience before. As mentioned in [Table 2], about 11% of the participants had experienced violence three times during their residency with 60% experiencing it at least once.
Table 2: Characteristics of the violent experience

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Verbal violence was experienced more than physical violence, with outpatients' clinics being the most common location of violent experiences among our sample (46.5%). Most of the violent experiences were with the adult age group of 25–55 years, whereas the adolescents and those aged less than 18 years were the least likely to be involved in WPV. Male and companions of the patients were found to the most common offenders, at 73.3% and 51.1%, respectively, as represented in [Table 3].
Table 3: Characteristics of the offender

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Head-and-neck outpatient oncology clinics were the most common subspecialty location to house a violence experience, as shown in [Figure 1], with otology clinics being the least common location. When a direct question was asked about the cause of the violent experience, in the participants' opinion, the majority responded that it could be due to a combination of several factors, with misunderstanding and miscommunication being at the top of the list at 20%, as written in [Table 4].
Figure 1: Violence location

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Table 4: Causes of violence

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Using descriptive analyses of the variables and cross-tabulations, we found that males, at 24%, were more exposed to violence than females, at 21%, in our sample. Years of experience in ENT did not have a statistically significant impact on decreasing the prevalence of violence; however, having a high GPA in medical school was found to be a statistically significant risk factor in lowering the risk of violence. According to our results, the typical scenario of violence would be a middle-aged male companion waiting long time in the head-and-neck clinic with mistrust and misunderstanding as the predisposing factors to verbally abuse the resident.


  Discussion Top


The prevalence of WPV varies among countries as per the estimation of several studies. However, because of differences in study methodologies, targeted sample of healthcare workers, and geographical regions, generalizing the previous results to our center was not possible and it was necessary to come up with our own results.

The study results showed that WPV against ENT residents frequently occurs, and it is important to address and solve this issue. However, there are very limited previous studies that address WPV among residents to compare our results with. Because of this, we compared our findings with studies that examined healthcare workers (HCWs), in general. In the current study, we found that the overall prevalence of WPV among 80 ENT residents in Riyadh was 56.3%. The prevalence of WPV in our study was relatively similar to the prevalence mentioned in the literature.[9] Al-Turki et al. published a study stating that the rate of WPV against primary HCWs in family medicine centers is 46%.[6] However, Algwaiz et al. reported 67.4% of HCWs in two public hospitals in Riyadh exposed to WPV, and this is a higher rate than our current study.[10] Other international studies, as one reported in Turkey,[11] found that the prevalence of WPV among 194 EM residents is 35.2%, and we think that the reason for this variation is because of the differences in the targeted groups of healthcare workers and the geographical regions of the included studies. A study conducted in Ismailia, Egypt,[12] concluded that 59.7% of HCWs had an exposure to WPV.

Regarding the gender variation, we found around two-thirds of female residents reported exposure to WPV, on the other hand, only half of the male residents were exposed to violence. However, other studies reported the opposite; these studies found that males were more frequently exposed to WPV than females.[3],[6],[10],[11]

The majority of respondents indicated that the most common causes of WPV were: 1 - misunderstanding (communication issues) (20%), 2 - long waiting times (15.6%), 3 - patients not trusting residents due to a lack of medical knowledge (15.6%), 4 - overcrowding (4.4%), and 5 - lack of penalty for perpetrator (2.2%). These findings were similar to several other studies.[1],[6],[10],[12]

Regarding the frequency of exposure to WPV, in the current study, we found that 60% of the 45 residents reported exposure to WPV only once, 20% of them reported exposure twice, 11.1% reported exposure three times, and 8.9% reported more than four times. However, a study that examined emergency physicians in Turkey[11] reported that 65.9% had an exposure more than once and 12.2% only once. This can be explained by the fact the emergency physicians usually face more angry patients and relatives than outpatient clinics.

We found that among those who reported WPV, the offenders were as follows: patients (40%), companions (51.1%), physicians (2.2%), and both patient and companion (6.7%).

However, Al-Turki et al. found that the biggest offenders of WPV toward physicians were patients (71.5%), companions (20.3%), HCWs (4.9%), and both patient and companion (3.3%).[6] Algwaiz et al. more than 70% of respondents reported violence from patients' relatives/friends or visitors, 60% of the sample studied reported that patients were the offenders, and 14% of the sample studied reported that the offenders were coworkers in the hospital.[10] Kitaneh et al. reported in their study that patients' companions account for 48%, followed by patients (38%) and finally coworkers (14%).[4] El-Gilany et al., in Saudi Arabia, reported offenders as patients (23.3%), companions (68.1%), and colleagues (7.1%).[1] This can be attributed to the fact that the misunderstanding usually happens from the companion's perspective rather than the patients who usually are in pain and want to be treated with less focus on other issues.

Verbal violence in our study was found to be five times higher than physical violence; many studies reported approximately the same results.[6],[10],[13],[14] Similar findings were found in a study conducted in Saudi Arabia that included 270 HCWs in 12 family medicine centers that reported verbal violence to be five times more common than physical violence.[6] Another study conducted by Kasai et al. found that verbal violence was eight times higher than physical violence.[13] However, physical violence in the emergency departments (EDs) was reported to be higher than in other medical specialties.[11],[12] A study conducted in EDs in Turkey reported a higher percent of physical violence and assault, 31.1% and 29.3% of the participants, respectively, while verbal violence and threats were 94.5% and 76.4%, respectively.

We examined new, different aspects of the occupational characteristics of residents who participated in our study, and we could not compare our results with other studies as none mentioned these characteristics. We found no significant association between being a victim and occupational characteristics such as GPA, residency level, or ENT service before starting the ENT program.

We found that a large proportion of participants (46.6%) have been a victim of violence in the clinic, 23.3% were victims only in the inpatient setting, and the smallest percentage was in the ED, where only 7% of the participants were exposed to violence. Algwaiz et al., in their study, reported that the highest percent of violence was inpatient at 38.3%.[10] However, El-Gilany et al. stated that the most prevalent place that participants had experienced violence was the ED, 67.5%, and the outpatient clinic was 27% only.[1]

The current study has several strong points worth mentioning. The most important is exploring WPV within the ENT field. This survey looked into WPV characteristics against ENT residents who represent the backbone in conducting healthcare services within the subspecialty. Limitations are expected as this study is the first to be conducted and recall bias is a challenge for this type of study design. Finally, this study highlights the importance of implementing measures to prevent these events from affecting doctors' performance. This can be done through improving the reporting system and preparing the residents by enhancing their skills to control these events.


  Conclusion Top


We concluded that more than half of our sample had been through a violent experience before; this highlights the importance of implementing measures to prevent these events from affecting doctors' performance. This can be done through improving the reporting system and preparing the residents by enhancing their skills to control these events.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
El-Gilany AH, El-Wehady A, Amr M. Violence against primary health care workers in Al-Hassa, Saudi Arabia. J Interpers Violence 2010;25:716-34.  Back to cited text no. 1
    
2.
Fang H, Zhao X, Yang H, Sun P, Li Y, Jiang K, et al. Depressive symptoms and workplace-violence-related risk factors among otorhinolaryngology nurses and physicians in Northern China: A cross-sectional study. BMJ Open 2018;8:e019514.  Back to cited text no. 2
    
3.
Ayranci U. Violence toward health care workers in emergency departments in west Turkey. J Emerg Med 2005;28:361-5.  Back to cited text no. 3
    
4.
Kitaneh M, Hamdan M. Workplace violence against physicians and nurses in Palestinian public hospitals: A cross-sectional study. BMC Health Serv Res 2012;12:469.  Back to cited text no. 4
    
5.
Rafeea F, Al Ansari A, Abbas EM, Elmusharaf K, Abu Zeid MS. Violence toward health workers in Bahrain Defense Force Royal Medical Services' emergency department. Open Access Emerg Med 2017;9:113-21.  Back to cited text no. 5
    
6.
Al-Turki N, Afify AA, AlAteeq M. Violence against health workers in Family Medicine Centers. J Multidiscip Healthc 2016;9:257-66.  Back to cited text no. 6
    
7.
Phillips JP. Workplace Violence against Health Care Workers in the United States. N Engl J Med 2016;374:1661-9.  Back to cited text no. 7
    
8.
Paola F, Malik T, Qureshi A. Violence against physicians. J Gen Intern Med 1994;9:503-6.  Back to cited text no. 8
    
9.
Sun P, Zhang X, Sun Y, Ma H, Jiao M, Xing K, et al. Workplace violence against health care workers in North Chinese hospitals: A cross-sectional survey. Int J Environ Res Public Health 2017;14:96  Back to cited text no. 9
    
10.
Algwaiz WM, Alghanim SA. Violence exposure among health care professionals in Saudi public hospitals. A preliminary investigation. Saudi Med J 2012;33:76-82.  Back to cited text no. 10
    
11.
Bayram B, Çetin M, Çolak Oray N, Can İÖ. Workplace violence against physicians in Turkey's emergency departments: A cross-sectional survey. BMJ Open 2017;7:e013568.  Back to cited text no. 11
    
12.
Abdellah RF, Salama KM. Prevalence and risk factors of workplace violence against health care workers in emergency department in Ismailia, Egypt. Pan Afr Med J 2017;26:21.  Back to cited text no. 12
    
13.
Kasai Y, Mizuno T, Sakakibara T, Thu S, Kyaw TA, Htun KA. A survey of workplace violence against physicians in the hospitals, Myanmar. BMC Res Notes 2018;11:133.  Back to cited text no. 13
    
14.
Muzembo BA, Mbutshu LH, Ngatu NR, Malonga KF, Eitoku M, Hirota R, et al. Workplace violence towards Congolese health care workers: A survey of 436 healthcare facilities in Katanga province, Democratic Republic of Congo. J Occup Health 2015;57:69-80.  Back to cited text no. 14
    


    Figures

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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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