Reviewer’s report
Title: 
The Components of Workplace Violence against Nurses from the Perspective of Women Working
in a Hospital in Tehran: A Qualitative Study
Version: 
2 
Date: 
05 Nov 2020
Reviewer's report:
The violence suffered by nurses in the workplace is a phenomenon that has appeared in previous literature
since the 1970s but has been more widely studied in the last two decades. In the case of Iran violence
against nurses in hospitals can be found in some studies published in the last decade, but most of the
studies have been published only two years ago. Therefore, this study is relevant because it offers
qualitative evidence of the existence of this problem, as well as the perception that nurses themselves have
of this issue.
However, I point out some aspects of the article that would need to be improved for publication. I will
also provide some suggestions that researchers could consider if they wish to deepen their research on the
problem of violence against nurses in Iranian hospitals.
Background
You define the violence suffered by nurses as violence in the workplace. Therefore, you start from the
definition made by the WHO (lines 2-7). It is obviously violence in the workplace. But, concretely, the
violence that nurses suffer is because they are women in a situation of vulnerability in their workplace.
Being a woman nurse puts them in a situation of vulnerability to some men who exercise violence against
them because they are women. The UN defined violence against women as any act of gender-based
violence that results in, or is likely to result in, physical, sexual or psychological harm or suffering to
women, including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in
public or private life; Among the types of VAW the UN states physical, sexual and psychological violence
occurring within the general community, including rape, sexual abuse, sexual harassment and intimidation
at work.
It would be necessary to specify on what evidence this statement is based; "Similar to other forms of
violence, workplace violence and aggression is on the rise. (line 9). It is necessary to clarify that evidence
because another interpretation can be given, such as that violence in the workplace is not growing but is
being reported more because it was previously hidden. The same thing would happen with sexual
harassment in the workplace. This problem has always existed. However, it is not that sexual harassment
in the workplace is increasing, but rather that the silence on this issue has been broken. A clear example of
this is the #MeToo movement that has made visible the sexual violence suffered by actresses in the film
industry. But similar movements are continually appearing that make visible and report the violence
against women in universities and other places such as the workplace. It is not that there is now more
sexual harassment, but rather women have broken the silence and a social problem that was previously
hidden has become visible.
The same clarification is needed for the following statement: "Nowadays, health care workers are also
more exposed to violence and face harsher treatments than the past time. (7) (lines 39-41) Is this really so?
Is it a phenomenon for which there is international evidence? Or is it a phenomenon that is growing in
Iran? Or is it not that there is more violence against nurses but rather that in the last two years there have
been many more studies that have made this problem visible?
The sentence in lines 41-45 would need to be revised taking into account what I have exposed before, that
the violence faced by nurses is not mere violence in the workplace but is gender violence. They suffer
physical, sexual and psychological violence because they are women in a vulnerable situation in their
workplace.
It would also be appropriate to review the following statement: "Quantitative studies fail to explain
violence, because this phenomenon is based on the culture and context in which one lives, so perceptions
of violence vary in different cultures (11). (lines 45-47). There are definitions that are internationally
agreed upon and supported by international organizations such as WHO or the UN so that what is
considered violence in the workplace and violence against women are not relativized, regardless of the
country, territory or culture in which it occurs. It is necessary to specify why quantitative studies fail if
they really fail. Quantitative data are necessary. But in order to delve into the causes and possible
solutions to a problem such as violence against women, qualitative studies are necessary; both types of
studies complement each other.
Method
It is a qualitative study designed in a correct way and with the acceptance of the ethical committee of their
University.
However, the process through which interview analysis has been validated could be explained more
accurately, since it is one of the fundamental components in a qualitative study. You expose: "In the
present study, for strengthening and confirming the results and research accuracy, the author used the data
credibility, acceptability validity, accuracy, believability, verifiability, reliability, and transferability. The
participants were in constant conflict with the data and the data confirmation for the data acceptability and
accuracy, and the researchers attempted to achieve new information at all research stages and even after
data analysis process. (lines 10-20)" but you do not explain how you did it What was the process whereby
the participants (nurses) in the interview validated the interpretation that has been made of these
interviews?
Results
In order to make the results better understood by an international audience, it would have been useful to
have some data on the public health situation in hospitals in Iran. That way, it would be possible to better
understand under what hard working conditions nurses are working.
As for the analysis of the quotes from the interviews, they are a little out of context. Although I think it is
important that these testimonies have been collected to contribute towards the visibility of the violence
that nurses experience in this hospital in Teheran.
Regarding the findings related to "Hidden violence against female nurses in the workplace" Why is it
categorized as organizational violence when it seems to be interpersonal violence? In this same subsection
of the results, the analysis is very general when "hidden violence" is one of the main problems in
eradicating violence against women in workplace. What do they mean by harassment here? What kind of
harassment? By whom? Why do you refer to this harassment as "indirect violence" if harassment is direct
violence?
Discussion
Such "hidden violence" would perhaps be the topic that needs further research, and sexual harassment
within it, as you point out in the discussion. If you consider it, you could include references on existing
literature on sexual harassment and other types of gender-based violence in the workplace that has
indicated addressing this problem requires 1) recognition by the institution that this type of violence exists
within the institution, and that this recognition enhances its reputation as an institution that wants to fight
violence against women; 2) Bystander intervention: to foster networks of solidarity with women suffering
violence, encouraging people who witness such situations or know that such violence is occurring to
report it instead of looking the other way; and 3) to also support people who show solidarity with the
direct victims of violence. If those who report or sympathize with the victims are attacked, no one will
want to support the victims or report the cases.
I hope that my comments have been useful to you. Good luck!
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Is the study design appropriate to answer the research question (including the use of appropriate controls),
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