Violence in health institutions: A survey of health care workers in west Turkey

To th e Editor: Violent, aggressive or abusive behaviour towards health care workers is an ever-increasing concern in today’s health care workplace.1 Some studies in connection with violence conducted in Turkey show that the frequency of violence has increased recently.23 Health care workers are particularly vulnerable due to the nature of their jobs, which include dealing with clients who may be emotionally disturbed.4 O ne of the most difficult situations that health care workers face is the threat o f physical harm at the hands o f a patient, a patients’ relatives, a colleague or superior.5 Job conditions such as working alone or in small numbers, working late at night, working in high-crime and unsecured areas, work load, job-related stress, role conflict, lack of supervisor support, low visibility, and poor lighting,6 8 which have been associated with workplace violence, may signal opportunity for the perpetrator. We conducted a study to learn more about the prevalence rates and risk factors for violence in various workplace conditions, providing a specific focus on the extent and nature of violence against health care workers. O ur study was carried out in the cities o f Eskisehir, Ankara, Kutahya and Bilecik, in the western part o f Turkey. The study population was comprised of staff at 34 health institutions. All 1368 health care workers working in the four study areas were recruited randomly during routine visits to local health institutions, and of these, 1209 workers agreed to participate. We evaluated the prevalence o f violence towards health care workers in a oneyear period, regardless o f the types of violence at the time o f the interview. This study was approved by Osmangazi University Management and the Turkish Medical Association. We used a Form of Violence Experience (FVE), a self-report questionnaire developed from the Violent Incident Form (VIF). 9 Health care workers were asked to recall physical, sexual and emotional experiences o f violence directed at them at work over the previous year. The data were analyzed by a binary logistic regression model when appropriate to examine group disparities. The overall response rate was 88.4% (1209/1368). Ages of respondents ranged 16 to 73 years (mean, 32 years). Female health care workers constituted 38.9% of the total. Nearly 50% [n=598 (49.5%)] o f the respondents had experienced one or more types o f violence during the past year at work: 14.5% once, 33.8% between twice and five times, and 51.7% six or more times. The most frequent form of violence was emotional/verbal (72.4%) compared to physical (11.7%) and physicalemotional/verbal (15.9%). O f 598 violent events, 47.7% were reported in men, and 50.7% in women, which did not show a significant difference with regards to women. Compared with Eskisehir, which has the best socio-economic development, the risk of being exposed to violence in Bilecik, Kutahya and Ankara was reduced (odds ratio=0.46, 0.41, 0.75, respectively). Compared with specialist physicians, ancillary health personnel, dentists, pharmacists, security guards and academic staff were at a higher risk o f experiencing violence while the potential for exposure to violence was lower for assistant doctors, nurses and general practitioners. However, attendants experienced nearly the same risk of violence as that o f specialist doctors. Only emergency service was associated with significantly less exposure to violence compared with other services (7V0.05). Length of time working in the health care sector proved a risk factor in being exposed to violence (7V0.05). M ost aggressors were patient relatives/visitors (57.5%). The most common aggressors were men (76.9%), between 31 to 50 years o f age (55.3%), and those with a regular income (19.2%), not counting those for whom income was unknown (63.6%). Health care workers in this region of Turkey work in an environment in which they are constantly exposed to situations with aggressive/violent individuals. O ur findings are consistent w ith previous studies suggesting a 25% to 88% incidence of any form of violence in the previous year.13,10,11 The results presented in these studies show that workplace