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Sousa LS de, Oliveira RM, Ferreira YC et al. Workplace violence in the hospital...
English/Portuguese
J Nurs UFPE online., Recife, 12(10):2794-802, Oct., 2018 2794
ISSN: 1981-8963 ISSN: 1981-8963 https://doi.org/10.5205/1981-8963-v12i10a236958p2794-2802-2018
WORKPLACE VIOLENCE IN THE HOSPITAL OBSTETRICS VIOLÊNCIA NO TRABALHO EM OBSTETRÍCIA HOSPITALAR VIOLENCIA EN EL TRABAJO DE LA OBSTETRICIA HOSPITALARIA
Luana Silva de Sousa1, Roberta Meneses Oliveira2, Yane Carmem Ferreira Brito3, Bruna Karen Cavalcante Fernandes4, Francisca Gomes Montesuma5, Regina Cláudia Melo Dodt6
ABSTRACT
Objective: to identify the manifestations of workplace violence in hospital obstetrics, as well as their related factors, consequences, and management strategies. Method: this is an integrative review, with search of MEDLINE, Lilacs, CINAHL, SciVerse Scopus and SciELO virtual libraries. After reading the articles, the data were extracted and analyzed. Results: the sample consisted of 11 articles, most of them from Australia. The main types of workplace violence in obstetrics were verbal abuse, intimidation, humiliation, and bullying; related to: workers with high level of negative affectivity; older and/or hierarchically superior co-workers; day shift; patients and/or companions under stress or with mental disorder; overburdened environments/staff shortages; consequences included the personal, professional and organizational spheres; and managerial strategies involved incident reports, peer/family dialogues, safety protocols, continuing education. Conclusion: there is evidence of workplace violence in hospital obstetrics with negative impact on professionals, patients, and institutions. Studies about this phenomenon in Brazil are suggested, enabling to apply them in the management of obstetric units. Descriptors: Nursing; Workplace Violence; Incivility; Obstetrics; Obstetric Nursing; Delivery Rooms.
RESUMO
Objetivo: identificar os modos de manifestação da violência no trabalho em obstetrícia hospitalar, bem como seus fatores relacionados, consequências e estratégias de gerenciamento. Método: trata-se de revisão integrativa, com busca nas bases de dados MEDLINE, Lilacs, CINAHL, SciVerse Scopus e biblioteca virtual SciELO. Após a leitura dos artigos, efetuaram-se a extração e a análise dos dados. Resultados: constituiu-se a amostra de 11 artigos, a maioria de origem australiana. Os principais tipos de violência no trabalho em obstetrícia foram abuso verbal, intimidação, humilhação e assédio moral; relacionados a: trabalhadores com nível elevado de afetividade negativa; colegas de trabalho mais velhos e/ou hierarquicamente superiores; plantão diurno; pacientes e/ou acompanhantes sob estresse ou com transtorno mental; ambientes sobrecarregados/escassez de pessoal; as consequências incluíram os âmbitos pessoal, profissional e organizacional; e as estratégias gerenciais envolveram relatórios de incidentes, diálogos com colegas/familiares, protocolos de segurança, educação permanente. Conclusão: há evidências de violência no trabalho em obstetrícia hospitalar com impacto negativo sobre profissionais, pacientes e instituições. Sugerem-se estudos acerca desse fenômeno no Brasil, possibilitando aplicá-los na gestão de unidades obstétricas. Descritores: Enfermagem; Violência no Trabalho; Incivilidade; Obstetrícia; Enfermagem Obstétrica; Salas de Parto.
RESUMEN
Objetivo: identificar los modos de manifestación de la violencia en el trabajo de la obstetricia hospitalaria, así como sus factores relacionados, consecuencias y estrategias de gerenciamiento. Método: revisão integrativa, com busca nas bases de dados MEDLINE, Lilacs, CINAHL, SciVerse Scopus y biblioteca virtual SciELO. Após a leitura dos artigos, efetuaram-se a extração e a análise dos dados. Resultados: la muestra fue de 11 artículos, la mayoría de origen australiana. Los principales tipos de violencia en el trabajo en obstetricia fueron abuso verbal, intimidación, humillación y asedio moral; relacionadas a: trabajadores con nivel elevado de afectividad negativa; colegas de trabajo más viejos y/o jerárquicamente superiores; guardia diurna; pacientes y/o acompañantes sobre estrés o con trastorno mental; ambientes sobrecargados/escasez de personal; las consecuencias incluyeron los ámbitos personal, profesional y organizacional; y las estrategias gerenciales envolvieron informes de incidentes, diálogos con colegas/familiares, protocolos de seguridad, educación permanente. Conclusión: hay evidencias de violencia en el trabajo en obstetricia hospitalaria con impacto negativo sobre profesionales, pacientes e instituciones. Se sugieren estudios acerca de ese fenómeno en Brasil, posibilitando aplicarlos en la gestión de unidades obstétricas. Descriptores: Enfermería; Violencia Laboral; Incivilidad; Obstetricia; Enfermería Obstétrica; Salas de Parto. 1Specialist, State University of Ceará/UECE. Fortaleza (CE), Brazil. E-mail: [email protected] ORCID iD: https://orcid.org/0000- 0002-6203-0024; 2Ph.D., Department of Nursing, Federal University of Ceará/UFC. Fortaleza(CE), Brazil. E-mail: [email protected] ORCID iD: https://orcid.org/0000-0002-5803-8605; 3Master´s student, State University of Ceará/PPSAC/UECE. Fortaleza (CE), Brazil. E-mail: [email protected] ORCID iD: https://orcid.org/0000-0003-4362-0296; 4Ph.D. student, State University of Ceará/PPCCLIES/UECE. Fortaleza (CE), Brazil. E-mail: [email protected] ORCID iD: https://orcid.org/0000-0003-2808-7526; 5Ph.D., State University of Ceará/PPSAC/UECE. Fortaleza (CE), Brazil. E-mail: [email protected] ORCID iD: https://orcid.org/0000-0002-5838-7821; 6Ph.D., Federal University of Ceará/UFC. Fortaleza (CE), Brazil. E-mail: [email protected] ORCID iD: https://orcid.org/0000-0002-8323-8465
INTEGRATIVE REVIEW ARTICLE
Sousa LS de, Oliveira RM, Ferreira YC et al. Workplace violence in the hospital...
English/Portuguese
J Nurs UFPE online., Recife, 12(10):2794-802, Oct., 2018 2795
ISSN: 1981-8963 ISSN: 1981-8963 https://doi.org/10.5205/1981-8963-v12i10a236958p2794-2802-2018
Hospital institutions face changes in work
processes and people management, such as
the precariousness of labor relationships and
the need to deal with demand that is always
greater than the supply of services. This
situation has been associated with conflicting
situations and ethical dilemmas that directly
interfere with the care provided.
The daily work of health workers has been
configured as the scenario conducive to the
study of practices and behaviors translated
into risks for patients and organizations. The
destructive behavior in health work is
highlighted, which is about disrespectful
behaviors adopted in the practice
environment, involving complex multi-
professional interactions that harm workers,
patients, and organizations.1
The work in the context of hospital
obstetric care is highlighted, where multi-
powers are evident, as the scene of
institutional violence involving parturients,
doctors, and obstetricians. This scenario is
related to the fact that delivery and birth
have undergone transformations that reveal
its medicalization and migration to hospitals,
making some obstetric practices problematic
and triggering debates about delivery and
birth care.2
Thus, the University of Iowa's Harm
Prevention Research Center classified violence
in four types to better determine the forms of
violence in the work context.3
This study focuses on type III violence,
which involves co-workers, including
physicians, nurses and nursing technicians,
students, and residents in hospital obstetrics.
There are also other widely publicized
concepts in the literature that permeate the
phenomenon of violence at work, such as
occupational violence and bullying at work,
which will be addressed in this research.
● To Identify the manifestations of
workplace violence in hospital obstetrics, as
well as their related factors, consequences,
and management strategies.
This is an integrative review of the
literature, guided by six steps: (1)
identification of the problem and definition of
the guiding question; (2) search and selection
of studies according to sampling criteria; (3)
data extraction; (4) critical analysis of the
selected studies; (5) interpretation of the
results and (6) preparation of the synthesis
and final report.4
A survey of scientific articles was carried
out in December 2017 in journals indexed in
the databases to compose the study sample:
Medical Literature Analysis and Retrieval
System Online (MEDLINE), Latin American and
Caribbean Literature in Health (LILACS),
Cumulative Index to Nursing and Allied Health
Literature (CINAHL), SciVerse Scopus and the
Virtual Library Scientific Electronic Library
Online (SciELO).
As search strategies, descriptors of the
theme registered in the Health Sciences
Descriptors (DeCS) and the Medical Subject
Headings (MeSH) were selected. The
descriptors related to violence at work were:
Workplace Violence, Bullying, Workplace
Bullying (MeSH only). The descriptors related
to the area of interest of the research were:
Obstetrics, Midwifery, Obstetrics, and
Gynecology Department, Obstetric
Departments and Nursing.
Then, the pairing of the descriptors with
the Boolean operator "AND" was performed,
with the objective of identifying studies that
contained one and another themes, always
considering a descriptor related to violence at
work and another related to the area of
interest. The combination of descriptor pairs
was performed in the title, abstract, and
subject fields.
The articles should answer the following
guiding question: how does the phenomenon
of violence at work in hospital obstetrics
occur, considering its modes of manifestation,
related factors, and impacts for those
involved?
Original articles of primary research,
available in full, published in Portuguese,
English or Spanish; and that responded to the
guiding question of the research were
included. Duplicate articles and those that,
after being screened and read in full, did not
address the purpose of the study were
excluded.
It should be emphasized that the inclusion
of temporal clipping regarding the period of
publication of the articles was not delimited,
since the purpose was to cover as many
manuscripts as possible on the theme,
considering the contemporaneity of the
phenomenon studied.
A data collection instrument was
elaborated for the analysis of the evidence
and construction of the synthesis of the
integrative review, with the purpose of
gathering the following information from the
articles: title, authors/year, journal,
INTRODUCTION
OBJECTIVE
METHOD
Sousa LS de, Oliveira RM, Ferreira YC et al. Workplace violence in the hospital...
English/Portuguese
J Nurs UFPE online., Recife, 12(10):2794-802, Oct., 2018 2796
ISSN: 1981-8963 ISSN: 1981-8963 https://doi.org/10.5205/1981-8963-v12i10a236958p2794-2802-2018
design/sample, objectives, and level of
evidence of the search.
Excerpts referring to variables of interest
in the review were also extracted from the
articles: ways of manifestation of violence at
work; sources; professionals involved and
contexts; characteristic behaviors and
impacts; management strategies.
The studies were analyzed critically by
reading in full. After analysis, a synthesis of
the selected studies was carried out, which
were later discussed, observing their
confluences and divergences.
Eleven articles were included in the
sample. Figure 1 shows the results of the
search.
Figure 1. Flowchart of study selection according to the Preferred Reporting Items for Systematic Reviews and
Meta-Analyzes (PRISMA). Fortaleza (CE), Brazil, 2017.
Title Authors, Year
Journal Design and Sample
Objectives Level of evidence
Consultants as victims of bullying and undermining: a survey of Royal College of Obstetricians and Gynaecologists consultant experiences
Shabazz et al., 2016
BMJ Open Cross-sectional study with 278 physicians experienced in obstetrics and gynecology.
To explore incidents of bullying and humiliation to physicians experienced in obstetrics and gynecology.
VI
Midwifery student exposure to workplace violence in clinical settings: an exploratory study
McKenna; Boyle, 2016
Nurse Education in Practice
Cross-sectional study with 52 students of obstetric nursing.
To examine the exposure of obstetric nursing students to violence in a maternity hospital
VI
Psychosocial Antecedents and Consequences of Workplace Aggression for Hospital Nurses
Demir; Rodwell, 2012
Health Policy and Systems
Cross-sectional study with 207 general nurses and obstetricians.
To test a two-stage model of the antecedents and consequences of workplace violence among nurses
VI
Midwifery student reactions to workplace violence
Shapiro; Boyle; McKenna, 2017
Women Birth
Cross-sectional study with 52 students of obstetric nursing.
To explore the responses of obstetric nursing students to workplace violence, as well as to assess their impact
VI
Workplace aggression, including bullying in nursing and midwifery: a descriptive survey (the SWAB study)
Farrell; Shafiei, 2012
Internation al Journal of Nursing Studies
A descriptive study with 1495 general nurses and obstetricians.
To report on the nature and extent of workplace violence experienced by nurses and midwives.
VI
Paramedic and midwifery student exposure to workplace violence during clinical placements in
Boyle; McKenna, 2016
Internation al Journal of Medical Education
Cross-sectional study with 393 students of paramedics and obstetric nursing.
To identify the type of violence in the work experienced by paramedical and obstetric nursing students.
VI
RESULTS
Articles identified in databases (n=30)
Publications after removing the
duplicates (n=25)
Articles included in the review (n=11)
Publications excluded after reading abstracts (n=12)
-Article not found in full for free (n=4) -News/comment type article (n=3) - Items that did not respond to the guiding question (n=5)
Id e n ti
fi c a ti
o
n
S c r e e n in
g
In c lu
d e d
E li g ib
il it
y
Articles evaluated in full (n=13) Full-text articles excluded (n=2)
It did not specifically examine or address violence at
work in obstetrics, or only address violence by
patients/visitors.
Sousa LS de, Oliveira RM, Ferreira YC et al. Workplace violence in the hospital...
English/Portuguese
J Nurs UFPE online., Recife, 12(10):2794-802, Oct., 2018 2797
ISSN: 1981-8963 ISSN: 1981-8963 https://doi.org/10.5205/1981-8963-v12i10a236958p2794-2802-2018
Regarding the distribution of the articles,
Figure 2 shows the articles inserted in the
review according to the variables of
methodological interest.
It was verified that the articles included in
the review were all in English, most of them
of Australian origin (7), showing that this is a
topic of interest by the researchers of that
country.
Regarding to the period, all have been
published since 2012, which coincides with
the recent mobilization of researchers around
the world in search of public policies and
studies on violence in the workplace,
including its consequences for those involved
in hospital settings and in general health.
Also, the journals in which these articles
were published are from different areas,
ranging from medical and nursing education to
journals geared to clinical practice. This
demonstrates that this problem is being and
should be increasingly addressed in the
educational and care spheres.
The most used methodology in the articles
(9) was cross-sectional studies involving
physicians specialized in gynecology and
obstetrics (2), general nurses and
obstetricians (5), obstetric nursing students
(2) and obstetric and paramedical nursing
students (1). One study used descriptive
research as a design.
In general, studies have emphasized the
types of workplace violence (9), their
antecedents (2) and consequences (5), as well
as the reactions and attitudes of the victims
(2).
A synthesis of the results of the research
was based on the variables of interest of the
review: main types of violence in work in
obstetrics and vulnerable groups; related
factors, perpetrators, and the work impact of
violence in obstetrics; and strategies for
management.
Australia – A pilot study Oppression and exposure as differentiating predictors of types of workplace violence for nurses
Rodwell; Demir, 2012
Journal of Clinical Nursing
Cross-sectional study with 273 general nurses and obstetricians.
To provide a background model of bullying at work to apply to a wider range of workplace assaults, including bullying and different types of violence among nurses.
VI
Nurses’ attitudes and reactions to workplace violence in obstetrics and gynecology departments in Cairo hospitals
Samiret al., 2012
Eastern Mediterrane an Health Journal
Cross-sectional study with 416 nurses from gynecology and obstetrics departments.
To identify forms of workplace violence against obstetric nurses and to assess their reaction and attitudes.
VI
A Study of Workplace Violence Experienced by Doctors and Associated Risk Factors in a Tertiary Care Hospital of South Delhi, India
Kumar et al., 2016
Journal of Clinical and Diagnostic Research
Cross-sectional study with 151 physicians directly involved in patient care.
To examine the types of violence experienced by physicians in various departments, along with possible causes and effects on work performance, incident treatment, and recommendations for violence prevention.
VI
Bullying workshops for obstetric trainees: a way forward
Cresswell et al., 2015
The Clinical Teacher
Intervention study (workshop), involving obstetricians and gynecologists, trainees and other professionals.
To hold a workshop to address the issue of bullying and humiliation within the specialty.
VI
Occupational Violence and Aggression Experienced by Nursing and Caring Professionals
Shea et al., 2016
Journal of Nursing Scholarship
Cross-sectional study through online research with nursing workers, totaling 4,891 members of the Australian Federation of Nursing and Obstetrics.
To examine the extent and source of occupational violence (OVA) experienced by nursing professionals. And to examine the contributions of demographic characteristics and safety factors in the workplace and individual in the prediction of OVA.
VI
Figure 2. Distribution of articles analyzed according to variables of interest of the research. Fortaleza (CE), Brazil, 2017.
Sousa LS de, Oliveira RM, Ferreira YC et al. Workplace violence in the hospital...
English/Portuguese
J Nurs UFPE online., Recife, 12(10):2794-802, Oct., 2018 2798
ISSN: 1981-8963 ISSN: 1981-8963 https://doi.org/10.5205/1981-8963-v12i10a236958p2794-2802-2018
Initially, the main types of workplace
violence in the area of hospital obstetrics
were identified, as well as the groups most
vulnerable to this type of occupational
aggression.
According to the studies, the types of
violence that most occur in work in obstetrics
are: psychological, physical and sexual.5-6-7
The most common form of violence is
psychological violence, which includes
behaviors such as verbal abuse, humiliation,
and intimidation, which are also recognized as
forms of moral harassment at work.5,8
Psychological violence occurs in half or in
most meetings with perpetrators.6 Evil,
humiliation, sarcasm, and unjustified criticism
are also forms often found in the workplace.
In addition, attitudes of eye rolling, exclusion,
isolation and gossip were found in the
studies.7
Physical violence mainly involved drilling,
striking, pushing, scratching, and grabbing,
but less frequently cited in the literature.7,8
Studies have pointed to a small proportion of
sexual violence, most of which is instigated by
colleagues. 9,5 In the study, women
experienced sexual harassment more
frequently than men.5
Researchers say that students are also
subjected to sexual harassment in the
workplace. In addition, there seems to be a
lack of confidence in them to report such
behavior for fear of retaliation or not wanting
to be disinclined in an institution where they
may be applying for a job.9
For the most vulnerable groups to suffer
such violence, studies have shown that
students/trainees are the most verbally
abused and intimidated.9 One study also
showed that physicians are also victims of
workplace violence, unlike most studies that
point them out as perpetrators.6
In another study, statistically significant
differences were observed for gender,
function, and type of workplace. Male
respondents and those who were employed as
nurses were more subject to violence and
occupational aggression, as well as those
working in public hospitals or nursing homes.10
In addition, workers in the older age group
(56 or older) were more likely than younger
workers (18-25 years old) to experience
occupational violence. Those working in
private hospitals, general practice, local
government, and community services were
less likely to experience such violence than
those employed in public hospitals.
Respondents with the highest levels of job
overload were more likely to have
experienced occupational violence in the past
12 months.10
In the same study, a rather important
finding concerns the fact that workplace
safety factors, particularly prioritization of
employee safety, have been more important
in reducing the likelihood of occupational
violence than individual safety factors. These
findings are important to the health sector
because they highlight ways in which
policymakers and employers can address
violence in the workplace. For example,
strengthening factors in the workplace,
particularly greater prioritization of staff
safety in relation to patient safety, will
reduce the likelihood of violence against
health professionals.10
Regarding the related factors and
perpetrators of workplace violence in
obstetrical services, a study pointed out that
this may include a series of behaviors, such as
bullying. Although researchers have not yet
agreed on uniform definitions of these types
of aggression, there are consistent features
across all definitions of bullying and
violence.11
Bullying in the workplace was defined as
repeated and unreasonable behavior that
occurs among peers.7 The nature of bullying
included both psychological and physical acts.
Sources of bullying are distinct from violence,
with bullying being more from internal sources
(for example supervisors and co-workers) and
violence potentially originating from internal
or external sources (for example patients or
family members and friends of the patient).12
Given these differences in the concepts
that compose violence in the workplace, it is
important to consider all types of bullying and
violence in trying to understand and
investigate the antecedents and consequences
of these acts in the workplace among nurses.11
In this context, knowing the factors that
are related to workplace violence in obstetrics
can help in the investigation of the causes
that lead the perpetrators to adopt
undesirable behaviors, besides providing an
adequate management of this problem
considering the different scenarios in which
violence at work appears.
Thus, with regard to factors related to
violence at work, a study pointed to some
causes, highlighting internal and external
factors and their interaction. For example,
internal influences refer to characteristics
that affect the patient, such as their
personality or the effects of their illness.
DISCUSSION
Sousa LS de, Oliveira RM, Ferreira YC et al. Workplace violence in the hospital...
English/Portuguese
J Nurs UFPE online., Recife, 12(10):2794-802, Oct., 2018 2799
ISSN: 1981-8963 ISSN: 1981-8963 https://doi.org/10.5205/1981-8963-v12i10a236958p2794-2802-2018
External influences are concentrated on the
environment, such as noisy environments or a
shortage of personnel. In addition, drug abuse
by professionals, patient frustration due to
inadequate resources and intoxication were
also cited as contributing factors.7
Other research has stated that the main
factors contributing to experiences of
workplace violence are: the perpetrator's
personality or mental illness, stressful and
overworked environments, including lack of
training, management support, and poor
communication among the staff.7
In a study of 207 general nurses and
obstetricians, different combinations of
working conditions (demands, control, and
support) and individual levels of negative
affect were associated with violence.11
There is a positive relationship between
the negative affectivity of the perpetrator and
the practice of bullying. The higher the level
of negative affectivity, the greater the
likelihood of practicing such violence. In
addition, there is a positive relationship
between morning shift work and bullying, with
morning shift workers more prone to bullying
than other shift workers.12
In the profile of these perpetrators, the
articles have shown that most of them are a
higher or older co-worker, and the main
culprits are physicians, clinical directors,
clinical secretaries, patients and family
members, managers and supervisors, and
executives.5, 6,7,8
Contributing to such findings, one of the
articles added that the biggest perpetrators
are co-workers. Also, women and people over
40 years old were the most likely and most
distressing perpetrators to deal with.7
In another research, both men and women
were reported as perpetrators. The study also
pointed out that violence at work is often
practiced by one or more individuals acting
independently.6
The perpetrator usually has a profile
already known and determined in
occupational relationships and it is more likely
that he can act allied to colleagues than
alone. This proves what the studies bring
about people who adopt these behaviors,
which hampers healthy interpersonal
relationships.
There are also studies addressing violence
by patients and family members of
services.7,9,10 Researchers point out that
obstetric nurses often work in enclosed areas
and confined to women, their partners and
families, as delivery rooms. Thus, labor and
birth can be stressful events for women and
their families, and it is not surprising that
professionals and students in the category
report verbal abuse and intimidation of
women, partners, and families in such clinical
contexts.9
Thus, perpetrators are not only those in the
position of health workers but also makeup
patients and their families, depending on the
form of violence to which the victims are
subjected. Therefore, knowing the root cause
of violence at work becomes fundamental and
urgent.
Another variable studied in this review is
the impact of violence in work on obstetrics,
including the reactions and consequences for
workers, organizations, and patients.
Research has pointed out that workplace
violence not only has short-term repercussions
but can also cause long-term harm that
reduces the quality of care provided by health
professionals as well as financial damage to
health care institutions that interfere with
productivity.13
In addition to harming one's health, acts of
violence at work, directly and indirectly,
interfere with workers' daily lives, as they give
rise to difficulties of confrontation,
organizational retaliation, demotivation,
fatigue, dissatisfaction, feelings of guilt, fear,
anguish. All this leads to the sickness of the
organization as a whole, which can generate
burden on the quality of care and patient
safety.
A study conducted with physicians
experienced in obstetrics and gynecology has
demonstrated the reported impact on
professional and personal life, which
encompasses a broad spectrum of suicidal
ideation, depression, sleep disturbance, and
loss of confidence. When the victims were
asked if the problem was being solved, most
answered no.6
Corroborating with the above research,
authors have identified that, in addition to
the anguish experienced by victims, patient
safety is compromised by the effects of these
negative attitudes. Those who report such
behaviors are rarely professionally satisfied.6
A study of obstetric nursing students
revealed that for some of them, experiences
of violence resulted in becoming more closed
of interactions and cautious.9 Consequently,
negative emotions are experienced at high
levels and the cycle repeats.11
Violence in the workplace tends to cause
students to show signs of posttraumatic stress,
permeating more intrusive behaviors than
evasion. In addition, undue suffering can be
Sousa LS de, Oliveira RM, Ferreira YC et al. Workplace violence in the hospital...
English/Portuguese
J Nurs UFPE online., Recife, 12(10):2794-802, Oct., 2018 2800
ISSN: 1981-8963 ISSN: 1981-8963 https://doi.org/10.5205/1981-8963-v12i10a236958p2794-2802-2018
generated and affect the way students view
the chosen profession.13
Another study identified that students do
not report acts of workplace violence against
them since they do not want to jeopardize the
opportunity to obtain a job.5 Therefore, it
becomes essential to raise awareness about
this issue from professional training to the
postgraduate level, besides the performance
of the permanent education in the health
institutions to guarantee spaces of discussion
and construction of formal communication
channels that permeate the inter-professional
relationships.
Although they do not perceive that they
are suffering some kind of violence at work or
do not attach importance to these episodes,
the existence of destructive behaviors in
health work that have several consequences
for the individual (professional or student) is
noticed. Therefore, understanding the impact
that this violence generates is essential to the
development of strategies that can prevent or
even deny these negative attitudes.
Finally, the strategies to combat violence
at work in obstetrics were raised.
Researchers have argued that while
workplace violence is an important welfare
issue that needs to be addressed, it is useful
to explore effective ways to deal with
workplace violence.13
Two things are clear: First, most of these
interventions focus on the victim, or the
organization, rather than prioritizing the
perpetrator. Second, it is true that the victim
needs support because, within the
organization, he has less support than the
perpetrator.6
Often victims do not receive adequate care
from institutions that do not know the
problems. Structures/policies need to be put
in place to enable people to feel free to
report violence in the workplace and access
the help they need.13
Such interventions need to involve health
professionals and universities including a
review of current reports and inadequate
investigative processes that not only leave
those who complain dissatisfied with the
outcome but also harm others involved. Both
preventive and disciplinary interventions
require effective evaluation through effective
feedback monitoring.6
Institutions need a reporting process where
students and other workers have confidence in
using it and where appropriate action will be
taken. More comprehensive information on
available units and occupational health and
safety protocols, both at the workplace and at
university, can provide the victims with
confidence to report such incidents.5,9,13
Given this high rate of violence in the
workplace and relatively low rate of reporting
of incidents of violence, hospitals should
develop effective guidelines to restrict
workplace violence and protect nursing staff
and students through a mandatory incident
reporting, review of safety team
responsibilities, and incident follow-up by
management.14
Facing this, integrating universities and
health institutions in the management of
violence at work becomes an appropriate
means to adopt more ethical and humanized
postures from training to professional
performance.
Another point is the need for training and
sensitization of health workers and students
before attending training sessions on how to
deal with workplace violence and the
importance of reporting exposure to these
behaviors.5
Researchers point to the need for training
to improve the safety of staff at work, as well
as raise staff awareness of acceptable
workplace behaviors to combat bullying.7
Educational seminars are recommended in
which health workers develop communication
and stress management techniques or conflict
resolution anger to effectively manage
violence in the workplace.14
Managers must recognize that not only
working conditions are important, but
individual variations from personal
dispositions can often play a role and
individual reactivity can influence
perceptions. Management can act to address
the cause and pay special attention to the
demands.11
The active participation of managers in
policies to prevent and combat violence at
work is a preponderant factor for the use of
knowledge, skills, and attitudes that allow the
appropriate decision making regarding
violence management.
Increasing the support of the supervisor
and colleague seems to be important in
preventing certain types of workplace
aggression, bullying, and internal emotional
abuse. Also, the negative effects of bullying
and internal emotional abuse on
organizational commitment can be reduced.11
Investigating a workplace model in a
variety of types of violence increases the
understanding of workplace-related areas to
reach and intervene, with the aim of reducing
the occurrence, and associated negative
consequences, of violence in the workplace.12
Sousa LS de, Oliveira RM, Ferreira YC et al. Workplace violence in the hospital...
English/Portuguese
J Nurs UFPE online., Recife, 12(10):2794-802, Oct., 2018 2801
ISSN: 1981-8963 ISSN: 1981-8963 https://doi.org/10.5205/1981-8963-v12i10a236958p2794-2802-2018
Psychological aggression is the type of
workplace violence most commonly
experienced by professionals in the field of
hospital obstetrics, with vulnerable groups
being students/trainees and nurses. The
personality of the perpetrator, stressful and
overworked environments are contributing
factors to this type of violence. Most of the
perpetrators are medical, managerial, but
may involve patients and family members. As
a consequence, this type of violence
generates difficulties of confrontation,
retaliation, demotivation, fatigue,
dissatisfaction, feelings of guilt, fear and
anguish to the victims.
Management strategies include reporting
system, occupational health and safety
protocols, training and awareness raising for
health workers and students, and conflict
management.
It is worth mentioning the need for studies
aiming to deepen the analysis of the thematic
with practical application of these strategies,
as well as evaluation and feedback of the
professionals involved in the area. We also
suggest studies about this phenomenon in the
Brazilian context of obstetric care, enabling
to apply it in the management practice in this
area.
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Oliveira ACS, Sánchez RG, Torres RAM.
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CONCLUSION
REFERENCES
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Submission: 2018/06/08 Accepted: 2018/07/28 Publishing: 2018/09/01
Corresponding Address
Bruna Karen Cavalcante Fernandes Rua Michele, 30 Bairro Passaré CEP: 60861-444 ― Fortaleza (CE), Brazil
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