Keywords
Dear Editor,
We read with great interest the study conducted by Sahraian et al. on “Workplace Violence against Medical Students in Shiraz, Iran,” published recently in the Shiraz E-Medical Journal (1). Workplace violence (WPV) in health care is a growing phenomenon worldwide, having assumed the dimensions of a real epidemic (2). The international literature clearly shows how nurses in many countries, especially in emergency and psychiatric settings (3), are the professionals most exposed to violence and aggression (4). Physicians are also at a high risk in these particular health contexts, as shown Table 1. Unfortunately, however, it is not uncommon that even medical students are victims of aggression in the hospital. Therefore, we agree with Sahraian and colleagues when they state that little research has been done on violence toward medical students. The perspective offered by their study is interesting because, in addition to highlighting the factors that contribute to WPV in the Iranian health sector, it analyzes the potential preventative strategies addressed to the students. It is crucial that medical students, especially in view of their clinical internship, are prepared to recognize the risk factors for patient-related violence and that they are trained to handle violent situations, strengthening their nontechnical skills such as, for example, communication and interpersonal skills, violence-related specific abilities, and de-escalation or defusion techniques. Of course, as is also evident in the article, these interventions are not sufficient to reduce the problem of violence but need further precautions within both the organization and the health environment. These include such things as cameras and alarm systems in high-risk areas, the availability of 24-hour on-site security, proper reporting systems, and risk minimization program evaluation, without forgetting to increase the support to victims of violence provided by supervisors and hospital authorities.
We believe that the WPV phenomenon is complex and that there is a strong interrelation between the different causal factors. For this reason, we stated that the issue of violence in the health sector could be effectively faced only with multiple strategies based on a “multidimensional” analysis of the operating environment and interventions (5). Global and comprehensive approaches for managing aggression will allow us to achieve helpful outcomes (6).
| N. | Year | Country | ED Worker | WPV Exposure | Verbal Violence | Physical Violence | Period | Source |
|---|---|---|---|---|---|---|---|---|
| 1 | 2011 | USA | 263 physicians | 205/263 (78) | 197/263 (74.9) | 56/263 (21.3) | 12 months | Behnam M, Tillotson RD, Davis SM, Hobbs GR. (7) |
| 2 | 2004 | Australia | 71 nurses | 50/71 (70.4) | 67/71 (94.3) | 17/71 (23.9) | 5 months | Crilly J, Chaboyer W, Creedy D. (8) |
| 3 | 2005 | UK | 218 ED staff | 218 episodes | 196/218 (89.9) | 70/218 (32.1) | 12 months | James A, Madeley R, Dove A. (9) |
| 4 | 2006 | Brazil | 33 nurses; 14 physicians | 33/33 (100); 12/14 (85.7) | 28/30 (93.3); 12/12 (100) | 5/30 (16.7); 2/12 (16.7) | 12 months; 12 months | Cezar ES, Marziale MH. (10) |
References
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1.
Sahraian A, Hemyari C, Ayatollahi M, Zomorodian K. Workplace Violence Against Medical Students in Shiraz, Iran. Shiraz E-Med J. 2016;17(4-5):35754. https://doi.org/10.17795/semj35754.
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2.
Gates DM. The epidemic of violence against healthcare workers. Occup Environ Med. 2004;61(8):649-50. [PubMed ID: 15258269]. https://doi.org/10.1136/oem.2004.014548.
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3.
Camerino D, Estryn-Behar M, Conway PM, van Der Heijden BI, Hasselhorn HM. Work-related factors and violence among nursing staff in the European NEXT study: a longitudinal cohort study. Int J Nurs Stud. 2008;45(1):35-50. [PubMed ID: 17362960]. https://doi.org/10.1016/j.ijnurstu.2007.01.013.
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4.
Gillespie GL, Gates DM, Berry P. Stressful incidents of physical violence against emergency nurses. Online J Issues Nurs. 2013;18(1):2. [PubMed ID: 23452198].
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5.
Ramacciati N, Ceccagnoli A, Addey B, Giusti GD. Comment on: "Nurses' perceptions of the factors which cause violence and aggression in the emergency department: a qualitative study". Int. Emerg. Nurs. 22(3) (2014), 134-139 by Angland, S., et al. Int Emerg Nurs. 2014;22(4):232-3. [PubMed ID: 24768530]. https://doi.org/10.1016/j.ienj.2014.04.001.
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6.
Ramacciati N, Ceccagnoli A, Addey B, Lumini E, Rasero L. Interventions to reduce the risk of violence toward emergency department staff: current approaches. Open Access Emerg Med. 2016;8:17-27. [PubMed ID: 27307769]. https://doi.org/10.2147/OAEM.S69976.
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7.
Behnam M, Tillotson RD, Davis SM, Hobbs GR. Violence in the emergency department: a national survey of emergency medicine residents and attending physicians. J Emerg Med. 2011;40(5):565-79. [PubMed ID: 20133103]. https://doi.org/10.1016/j.jemermed.2009.11.007.
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8.
Crilly J, Chaboyer W, Creedy D. Violence towards emergency department nurses by patients. Accid Emerg Nurs. 2004;12(2):67-73. [PubMed ID: 15041007]. https://doi.org/10.1016/j.aaen.2003.11.003.
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9.
James A, Madeley R, Dove A. Violence and aggression in the emergency department. Emerg Med J. 2006;23(6):431-4. [PubMed ID: 16714500]. https://doi.org/10.1136/emj.2005.028621.
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10.
Cezar ES, Marziale MH. [Occupational violence problems in an emergency hospital in Londrina, Parana, Brazil]. Cad Saude Publica. 2006;22(1):217-21. [PubMed ID: 16470300].