Investigating the incidence of violence towards nurses working in medical training centers in Rasht city and related factors from their point of view in 2013

Dissertation

To receive a master's degree in nursing education

(internal surgical orientation)

Abstract: Violence in the workplace is considered an important risk factor all over the world, and employees face all kinds of violence (verbal, physical, threats, sexual, etc.) in the workplace. are Nurses are also exposed to violence even more than other categories of medical personnel due to their presence and activity in the emergency room and direct contact with patients and due to being exposed to all kinds of tensions. Given that extensive studies have not been done on the factors that can facilitate the occurrence of violence in the workplace, this study tries to provide preliminary information to help think of a solution to deal with this problem in this province and across the country.

Purpose: The purpose of this research was to determine the incidence of violence towards nurses and factors related to it among nurses working in the educational and therapeutic centers of Rasht city in 2013.

Materials and methods: This study is a cross-sectional study of a descriptive and analytical type, and the number of samples is 442 nurses working in the educational and therapeutic centers of Rasht city with at least 6 months of work experience. were selected systematically. The sampling tool was taken from Nakringer and Usha Varhmani's tool. The findings of this study were analyzed using Spss software version 19, and using the method of exploratory and confirmatory factor analysis to determine the most important related factors and the severity of each of them regarding the incidence of violence towards nurses, according to them. After determining the most important factors based on exploratory factor analysis, confirmatory factor analysis was carried out under Lisrel software version 8 to confirm the most important factors related to the occurrence of violence.

Chapter One

- Statement of the problem

Violence in the workplace in the form of aggressive actions towards people who It is defined as being on duty at work (1). Nowadays, health care workers and nurses are exposed to various risks, including violence, more than in the past. Nursing personnel in hospitals are often faced with people who have recently experienced crises and problems. In this situation, the patient and his companions face various tensions, and since aggression is one of the most common reactions of humans in critical situations, there is a possibility of violence at any moment (2). Because of their direct contact with patients, nurses are exposed to violence more than other categories of medical personnel, and various researches have reported the prevalence of this phenomenon between 57 and 93 percent among nurses in different countries (4, 3). Of course, it should be acknowledged that it is not only nursing that has increased exposure to violence, but the statistics of violence in general have also been growing in the world, and there are reports confirming the occurrence of 10 to 15 cases of violence against employees of all kinds in a year. (2 and 5). Between 1992 and 1993, more than two million violent attacks against health care workers occurred (3). Aiken et al., in a 2000 study in America, stated that 52.7% of health workers in America and 61.2% of workers in Canada were subjected to verbal violence, and in Brazil, 50% of health workers were exposed to at least one type of violence during a year (6). In Turkey, the rate of verbal violence against nurses was 98.5% and the rate of physical violence was 19.7% (7). In Iran, Salimi's research has shown that 97.8% of nurses working in Tehran hospitals were subject to verbal violence and 39.7% of them had experienced physical violence as well (3). The results of Rahmani et al.'s research in 1386 on the personnel of the emergency medical unit in East Azerbaijan Province indicated that that 37.7% of people in this job category were subject to physical violence (8). In Gilan, in a research conducted by Asgharzadeh in 2018, the rate of occurrence of all types of violence was estimated at 74.6% and 92.7% of nurses working in the emergency department expressed concern about this issue (4).Of course, this category is sometimes different and is divided into: verbal, emotional, physical, even sexual violence (9). Violence in hospitals is often considered a part of the daily work of nurses and is rarely reported, while this violence is considered one of the important sources of occupational injuries (4, 2) and can cause a decrease in concentration and motivation, a decrease in activity, financial-psychological and life injuries, resorting to sedatives and an increase in the amount of leave (2). Other numerous physical and psychological complications in nurses include physical injuries, occurrence of illness or its symptoms (migraine, vomiting), Anger, fear, depression, anxiety, feelings of guilt and decreased self-confidence, decreased work morale, increased job stress, increased desire to leave the job, decreased trust in managers and colleagues, and creating an unfriendly work environment, pointed out that all of these are negative results of violence, and in addition to the nurse herself, it will have a great impact on the efficiency and success of the organization (2).

And studies show that the current face of occupational violence against these people is only the tip of a huge iceberg (10). Estimates of the costs of violence against nurses in England show that due to the costs of absenteeism and treatment and the reduction of their activity and concentration, thirty million pounds of damage is caused to the treatment sector in England annually (1). The issue of occupational violence in the workplace is so important that the term "Crisis of Civilization" is used about it. Sometimes the specific behaviors of nurses cause violence by companions and patients towards nurses. In a research conducted in 2007 in Australia, the term STAMP (Staring and eye contact, Tone and volume of voice, Anxiety, Mumbling and Pacing) was used as an acronym for eye contact and staring, tone and volume of voice, anxiety.

STAMP rtl;">he and his chattering and walking have been mentioned as effective factors in the occurrence of violence among patients and their companions (11). Some other things that cause violence among patients and their companions towards nurses include: waiting for a doctor's visit, transfer of the patient to another department or hospital, death of the patient, problems with services and guards, consumption of alcohol, consumption of drugs and brain problems (9). In many studies, the fear of violence in nurses who have previously faced violence is also It has been mentioned as a factor related to the occurrence of violence (12.4).

Of course, many and various factors can cause the occurrence of violence by the patient and his companion towards the nurse. These related factors can be divided under the headings of individual factors, organizational factors and psycho-social factors (21). In Dantella's study1, which was conducted in 8 European countries, it was found that there is a relationship between effective organizational factors and psycho-social factors with the occurrence of violence towards nurses(21).

has been (12). Unfortunately, many nurses who have not been exposed to violence may not have specific ideas about the factors related to the occurrence of violence, and this lack of knowledge of the effective factors can make the conditions for the occurrence of violence against them smoother. Of course, it seems that training on ways to deal with crisis and violence and reducing crisis situations can also help reduce the incidence of violence, if the result of a research shows that when 60% of the personnel of a department have completed the training course on dealing with violence, the number of cases of violence in that department has decreased to a third compared to other departments (2), in addition, the lack of instructions to prevent violence in the place can increase violence by 93.5% (10).