The nature and pre-disposing factors of workplace violence: A qualitative study of how violence is experienced by ED personnel

Workplace violence (WPV) is a significant healthcare concern worldwide [1]. Violence in health care systems mainly occurs by patients and their relatives as threats, humiliating behaviors, verbal, psychological, physical, and sexual violence [2], [3]. The prevalence of WPV against healthcare workers (HCWs) was high in the United States, Australia, Europe, and Asia [4]. Various studies have also shown the high prevalence of WPV against HCWs in Middle Eastern countries [1], [5]. In a recent study, the prevalence of WPV against Iranian nurses was reported as 74% verbal violence and 28% physical violence [1].

The emergency departments (EDs) have the highest risk of violence compared to other hospital departments [4]. Nurses and physicians are at the highest risk of WPV among ED personnel and may be victims of WPV more than other HCWs [4], [6], [7]. Violence can adversely affect patients, HCWs, families, workplaces, and healthcare systems. Negative consequences of WPV on patients include decreased quality care, increased unintended medical accidents, and increased risks to patient safety [6], [7], [8]. The negative consequences of WPV against HCWs include physical effects, such as headache, difficulty sleeping, gastrointestinal symptoms, and nightmares [6], [9], and emotional effects such as anxiety, depression, shock, low self-esteem, fear of other patients, and strangers [6], [8], [9]. WPV can negatively affect personnel's families, such as changes in marital relationships and children and family relationships [6], [8], [9]. WPV can also negatively affect the workplace atmosphere and staff working conditions, such as changes in co-workers' relationships, loss of interest in work, having difficulty in returning to work [6], [8], [9], [10], reduced job satisfaction and productivity [6], [7], [10], increased staff turnover [6] and burnout [7]. WPV incurs tremendous financial costs for the patients, families, and healthcare systems. Violence against ED personnel is expensive, and billions of dollars worldwide are incurred directly for medical expenses or indirectly for employee psychological care and absenteeism [10], [11].

Considering the high prevalence of violence against ED personnel [1], [5] and its serious consequences [6], [8], [9], it seems necessary to conduct further research in this area and find the predisposing factors of WPV. Hence, a qualitative and in-depth study aiming to discover ED personnel's experiences about violence can be beneficial in adding new knowledge in this area. In reviewing the literature, it was found that most of the studies carried out in this field are quantitative and mostly on the prevalence of violence and evaluating the effect of violent events on the performance of personnel, especially their ability to perform high-quality care [4], [12]. Considering the environmental conditions, socio-cultural factors, complexity, and uncertainty of the dimensions of WPV, it seems that studying this issue is beyond the scope of quantitative research. Although few qualitative studies were conducted on violence against nurses in Iran [6], [8], no study explored ED personnel experiences regarding the predisposing factors of violence. This qualitative study aimed to discover the experiences of ED personnel on the nature of WPV and its predisposing factors. The researchers tried to answer the following question: What is the nature of WPV and its predisposing factors experienced by ED personnel?

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