Elsevier

Aggression and Violent Behavior

Volume 19, Issue 5, September–October 2014, Pages 492-501
Aggression and Violent Behavior

The aftermath of workplace violence among healthcare workers: A systematic literature review of the consequences

https://doi.org/10.1016/j.avb.2014.07.010Get rights and content

Highlights

  • Workplace violence is a major health and safety issue for healthcare workers.

  • Symptoms of posttraumatic stress disorder and depression are frequent among victims.

  • Anger, sadness, fear, disgust and surprise are common emotions felt by victims.

  • Major consequences of workplace violence relate to work functioning.

Abstract

Workplace violence is an important health and safety issue. Healthcare workers are particularly at risk of experiencing workplace violence. Despite the research that was conducted in this domain, little is known about the consequences of being a victim of workplace violence, specifically in the healthcare sector. Therefore, this article aims to review the literature regarding the consequences of exposure to workplace violence in the healthcare sector. Sixty-eight studies were included in the review and they were evaluated according to 12 criteria recommended for systematic reviews. The studies identified seven categories of consequences of workplace violence: (1) physical, (2) psychological, (3) emotional, (4) work functioning, (5) relationship with patients/quality of care, (6) social/general, and (7) financial. Psychological (e.g., posttraumatic stress, depression) and emotional (e.g., anger, fear) consequences and impact on work functioning (e.g., sick leave, job satisfaction) were the most frequent and important effects of workplace violence. In conclusion, this paper recommends further research, particularly longitudinal studies, in order to better grasp the direct and indirect effects of workplace violence.

Introduction

Work plays a major role in our society where employment is considered to be the norm. It has been established that work has several benefits on health (Waddell & Burton, 2006). However, when the workplace becomes a “toxic environment”, job tenure becomes a complex problem, such as when a worker is the victim of workplace violence. Indeed, workplace violence constitutes a serious safety and health hazard and in the last decade, it has become a major issue.

Prevalence estimates of workplace violence vary considerably from one study to another, depending on the specific type of violence measured, the employment sector, the country in which the study was conducted, and the definition and measures that were used for workplace violence. According to the U.S. Bureau of Labor, Bureau of Justice Statistics (Harrell, 2011), a rate of 4 violent crimes per 1000 employed persons was perpetrated while the victims were working. A European study found that the prevalence of physical violence in the workplace is 5% (Parent-Thirion, Macias, Hurley, & Vermeylen, 2007). In Canada, workplace violence incidents represent 17% of all self-reported incidents of violent victimization (which represents over 356 000 acts per year). A recent systematic review of the literature found that verbal abuse was the most prevalent form of workplace violence (Guay, Goncalves, & Jarvis, 2014).

Several studies have demonstrated that some employment sectors are more at risk of exposure to workplace violence: healthcare (de Léséleuc, 2007, Foley and Rauser, 2012), psychiatric wards/hospitals (Chen et al., 2010, Nolan et al., 2001), elderly care facilities (Åström et al., 2002, Sharipova et al., 2008), transportation sector (André et al., 1997, Couto and Lawoko, 2011), teaching (Buck, 2006, Wilson et al., 2011), law enforcement (Dussault et al., 2010, Konda et al., 2012), and retail sales (Menéndez et al., 2013, Peek-Asa et al., 1999). In their systematic review of the literature on workplace violence, Piquero, Piquero, Craig, and Clipper (2013) stated that workers within the healthcare, education, public safety, retail and justice industries are more prone to experience workplace violence. However, throughout the world, healthcare is the sector where workplace violence is constantly a major problem. Indeed, a large proportion of workers have experienced at least one incident of physical violence within the previous year (75.8% Bulgaria, 67.2% Australia, 61% South Africa, 60% Portugal, 54% Thailand, 46.7% Brazil) (Di Martino, 2002). Elliott (1997) found that healthcare workers are 16 times more at risk of experiencing violence from patients or clients than other service workers. A review of the literature on the risk factors of workplace violence perpetrated by patients and visitors toward hospital staff revealed that the prevalence of verbal abuse ranges from 22 to 90%; threat of violence from 12 to 64% and physical assault from 2 to 32% (Pompeii et al., 2013). In their systematic review of literature on patient and visitor violence in general hospitals, Hahn et al. (2008) found that health professionals are at higher risk of experiencing various forms of workplace violence, particularly verbal abuse. As for workplace violence in clinical medical practice, a review of research established that 15–75% of workers were victims of verbal aggression and 2–29% of workers were victims of physical aggression (Hills & Joyce, 2013).

Workplace violence, like violence in general, can have multiple consequences not only on the physical but also on the psychological health of the victim (Hogh & Viitasara, 2005). Indeed, Steffgen (2008) pointed out that the consequences of workplace violence affect not only the worker himself, but also the organization and even the society as a whole. However, despite the evidence portrayed by the literature that suggests that workplace violence is a major issue in terms of health and safety, little is known about the consequences of exposure to workplace violence. Therefore, the aim of this article is to review the literature that examines the consequences of workplace violence specifically among employees in the healthcare sector. Findings from this review will be particularly useful for healthcare administrators interested in developing appropriate intervention strategies aiming at diminishing workplace violence in the healthcare sector.

To date, there is still no consensus on how to define workplace violence. The International Labour Organization defines workplace violence as “Any action, incident or behavior that departures from reasonable conduct in which a person is assaulted, threatened, harmed, injured in the course of, or as a direct result of, his or her work” (Organization, 2003). Workplace violence includes different forms of violence: physical assault, homicide, verbal abuse, bullying/mobbing, and sexual, racial, and psychological harassment (Chappell & Di Martino, 2006). There are four types of workplace violence: (1) violent acts by criminals who have no other connection with the workplace; (2) violence directed at employees by customers, clients, patients, students, or any others for whom an organization provides services; (3) violence against coworkers, supervisors, or managers by a present or former employee; (4) violence committed in the workplace by someone who does not work there but has a personal relationship with an employee. In the current review, only the literature addressing workers who were victims of type 2 violence will be analyzed.

Section snippets

Methods

A systematic review of the literature was conducted for research on workplace violence in the healthcare sector (Petticrew & Robert, 2006).

Results

Fig. 1 depicts the flow diagram of our search strategy, which yielded a total of 7078 references. After assessing the articles for relevance based on the inclusion/exclusion criteria, 68 articles were deemed eligible for this review. Descriptive statistics of the selected studies are shown in Table 2.

The methodological quality assessment of the included studies reveals that the median quality score obtained was 10, with a range from 4 to 12. There were 35 studies that had an excellent score, 24

Discussion

Since the deadly Edmond, Oklahoma post office tragedy in 1986 that raised public awareness of workplace violence, workplace violence has been of concern to numerous researchers and organizations, such as the International Labour Organization. However, research involving the investigation of the consequences of workplace violence is still in its infancy. The aim of this study was to review the literature on consequences of exposure to workplace violence. Consequences of workplace violence have

Conclusions

Although gaps still exist in our understanding of the consequences of workplace violence, this review clearly demonstrates that there is a growing body of evidence suggesting that the outcomes of workplace violence are not only profound but also multiple. This review shows that there are variations in the way employees react to workplace violence incidents, depending on the severity of the assault and the cumulative effect of multiple events. Implications in terms of work rehabilitation of

Acknowledgments

Nathalie Lanctôt is funded by a research grant from the Institute of Gender and Health (201202GWH-278184-172129) of the Canadian Institutes of Health Research. The authors wish to thank Jane Goncalves and Myra Gravel-Crevier for their invaluable contribution to the evaluation process of the studies selected in this review.

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