Violence Against Healthcare Professionals: A Retrospective Review of a University Hospital in Turkey
Year 2025,
Volume: 32
Ali Kaplan
,
Merve Ataç Öksüz
Abstract
Objective: Workplace violence (WPV) against healthcare professionals (HCPs) is increasing globally. This study retrospectively examines White Code Records (WCR) of WPV cases reported at a university hospital in Turkey.
Material and Method: The study analyzed 106 WCR cases recorded between January 2018 and September 2024. Data included the content and timing of violent incidents, along with demographic details of HCPs and perpetrators. Descriptive statistics, Monte-Carlo simulation, and Fisher's exact test were used to understand the differences by years and logistic regression was used to analyze the conditions affecting the type of violence.
Results: The analysis revealed that the highest incidence of violence occurred in 2022 (25.5%), coinciding with the post-COVID-19 period. Verbal violence was predominant, comprising 83% of cases. WPV incidents were most frequently reported in outpatient polyclinics and imaging departments (42.5%). More than half of the cases (55.7%) occurred in the second half of the year, with 68.9% taking place during daytime hours. Behavioral problems of perpetrators were identified as the leading cause (39.6%) of violent events.
Healthcare professionals involved in the incidents had an average age of 31 ± 6.55 years, with 61.3% being female. A majority (67.9%) of HCPs had postgraduate education, with physicians constituting a significant proportion. The average age of perpetrators was 40.1 ± 12.2 years, and 68.9% were male. Notably, 67% of the perpetrators were relatives of patients. Statistically significant year-by-year variations were observed in the type of violence reported. Variables such as daytime incidents, HCP education levels, and perpetrator gender significantly influenced the type of violence (p < 0.05).
Conclusion: The findings reveal key trends in WPV in healthcare, with incidents primarily caused by behavioral issues of male relatives of patients. Most affected HCPs are young, female, and physicians. This suggests that gender norms influence violence in healthcare.
Ethical Statement
The Ethics Committee of Çanakkale Onsekiz Mart University Institute of Postgraduate Education granted approval for this clinical research on April 28, 2022, with the decision number 09/52. As suitable for GDPR principles, the data were protected by masking.
References
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- 39. Özen Bekar E, Çalış E. Beyaz kod verileri ışığında Düzce ilindeki sağlık çalışanlarına yönelik şiddet. Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi 2021;11(3):298-304. (Turkish)
- 40. Torun N. Şiddete yönelik beyaz kod verilerin değerlendirilmesi. Cukurova Medical Journal 2020;45(3):977–984. (Turkish)
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- 48. Kafle S, Paudel S, Thapaliya A, et al. Workplace violence against nurses: A narrative review. J Clin Transl Res 2022;8(5):421-424.
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52. Askin R, Vahapoglu F, Onen S, et al. Psychopathology in violent offenders against healthcare workers. Violence and Victims 2019;34(5):786-803.
- 53. Viottini E, Politano G, Fornero G, et al. Determinants of aggression against all health care workers in a large-sized university hospital. BMC Health Services Research 2020;20:1-9.
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Year 2025,
Volume: 32
Ali Kaplan
,
Merve Ataç Öksüz
References
- 1. Khan MN, Haq ZU, Khan M, et al. Prevalence and determinants of violence against health care in the metropolitan city of Peshawar: a cross-sectional study. BMC Public Health 2021;21:1–11.
- 2. Vento S, Cainelli F, Vallone A. Violence against healthcare workers: a worldwide phenomenon with serious consequences. Front Public Health 2020;8:570459.
- 3. Ferri P, Silvestri M, Artoni C, et al. Workplace violence in different settings and among various health professionals in an Italian general hospital: A cross-sectional study. Psychol Res Behav Manag 2016;263–275.
- 4. Bitencourt MR, Alarcão ACJ, Silva LL, et al. Predictors of violence against health professionals during the COVID-19 pandemic in Brazil: A cross-sectional study. PLoS One 2021;16(6):e0253398.
- 5. Alsmael MM, Gorab AH, AlQahtani AM. Violence against healthcare workers at primary care centers in Dammam and Al Khobar, Eastern Province, Saudi Arabia, 2019. Int J Gen Med 2020;667–676.
- 6. Hairunisa N. Workplace Violence in Healthcare Service. J Biomedika dan Kesehat 2023;6(2):142-145.
- 7. Wax JR, Pinette MG, Cartin A. Workplace violence in health care-it’s not “Part of the Job.” Obstet Gynecol Surv 2016;71(7):427–434.
- 8. Li YL, Li RQ, Qiu D, et al. Prevalence of workplace physical violence against health care professionals by patients and visitors: A systematic review and meta-analysis. Int J Environ Res Public Health 2020;17(1):299.
- 9. Liu J, Gan Y, Jiang H, et al. Prevalence of workplace violence against healthcare workers: A systematic review and meta-analysis. Occup Environ Med 2019;76(12):927–937.
- 10. Wang M, Wang H, Wei Z, et al. Association between workplace violence and depressive symptoms among primary healthcare professionals in Shandong, China: Meaning in life as a moderator. Int J Environ Res Public Health 2022;19(22):15184.
- 11. Al-Qadi MM. Workplace violence in nursing: A concept analysis. J Occup Health 2021;63(1):e12226.
- 12. Cebrino J, Portero de la Cruz S. A worldwide bibliometric analysis of published literature on workplace violence in healthcare personnel. PLoS One 2020;15(11):e0242781.
- 13. Chirico F, Afolabi AA, Ilesanmi OS, et al. Workplace violence against healthcare workers during the COVID-19 pandemic:A systematic review. J Health Soc Sci 2022;7(1):14–35.
- 14. Ramzi ZS, Fatah PW, Dalvandi A. Prevalence of workplace violence against healthcare workers during the COVID-19 pandemic: a systematic review and meta-analysis. Front Psychol 2022;13:896156.
- 15. Zhang S, Zhao Z, Zhang H, et al. Workplace violence against healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis. Environmental Science and Pollution Research 2023;30(30):74838–74852.
- 16. Gacki-Smith J, Juarez AM, Boyett L, et al. Violence against nurses working in US emergency departments. JONA 2009;39(7/8):340–349.
- 17. Llor-Esteban B, Sánchez-Muñoz M, Ruiz-Hernández JA, et al. User violence towards nursing professionals in mental health services and emergency units. The European Journal of Psychology Applied to Legal Context 2017;9(1):33-40.
- 18. Li P, Xing K, Qiao H, et al. Psychological violence against general practitioners and nurses in Chinese township hospitals: Incidence and implications. Health Qual Life Outcomes 2018;16:1–10.
- 19. Xing K, Jiao M, Ma H, et al. Physical violence against general practitioners and nurses in Chinese township hospitals: A cross-sectional survey. PLoS One 2015;10(11):e0142954.
- 20. Aksakal FNB, Karaşahin EF, Uğraş Dikmen A, et al. Workplace physical violence, verbal violence, and mobbing experienced by nurses at a university hospital. Turk J Med Sci 2015;45(6):1360–1368.
- 21. Barros C, Meneses RF, Sani A, et al. Workplace violence in healthcare settings: Work-related predictors of violence behaviors. Psych 2022;4:516–524.
- 22. Qadri U, Hussain A, Shaikh S. Effects of low-cost violence prevention intervention on perception and behavior of patients/attendants and healthcare workers in the emergency department in a tertiary-care setting in Karachi. Pakistan Journal of Public Health 2021;11(4):255–260.
- 23. Adeniyi OV, Puzi N. Management approach of patients with violent and aggressive behaviour in a district hospital setting in South Africa. South African Family Practice 2021;63(4).
- 24. Wassell JT. Workplace violence intervention effectiveness: A systematic literature review. Saf Sci 2009;47(8):1049–1055.
- 25. Al-Turki N, Afify AAM, AlAteeq M. Violence against health workers in Family Medicine Centers. J Multidiscip Healthc 2016;257–266.
- 26. Lanza ML, Zeiss RA, Rierdan J. Non-physical violence: a risk factor for physical violence in health care settings. AAOHN Journal 2006;54(9):397–402.
- 27. Bellizzi S, Pichierri G, Farina G, et al. Violence against healthcare: A public health issue beyond conflict settings. Am J Trop Med Hyg 2022;106(1):15–26.
- 28. Liang L, Zheng XY, Wu X, et al. Does workplace violence affect healthcare workers’ turnover intention? Jpn J Nurs Sci 2023;e12543.
- 29. Yeşilbaş H. A general overview of violence in healthcare. Journal of Health and Nursing Management 2016;3(1):44–54.
- 30. Gülpınar S, Bulut YE, Çıtıl R. Retrospective evaluation of white code-based files in Tokat province between 2012 and 2014. Turkish Journal of Family Medicine and Primary Care 2019;13(2):142–150.
- 31. Resmi Gazete. Hasta ve çalışan güvenliğinin sağlanmasına dair yönetmelik [Internet]. 2011 [cited 16 March 2024]. Available from: https://www.resmigazete.gov.tr/eskiler/2011/04/20110406-3.htm (Turkish)
- 32. Eğici MT, Öztürk GZ. Beyaz kod verileri ışığında sağlık çalışanlarına yönelik şiddet. Ankara Medical Journal.2018;18(2):224–231. (Turkish)
- 33. Mento C, Silvestri MC, Bruno A, et al. Workplace violence against healthcare professionals: A systematic review. Aggression and Violent Behavior 2020;51:101381.
- 34. Cai R, Tang J, Deng C, et al. Violence against health care workers in China, 2013–2016: Evidence from the national judgment documents. Human Resources for Health. 2019;17:103.
- 35. Cohen J. Statistical power analysis for the behavioral science. The USA: Lawrence Erlbaum Associates Publishers; 1988.
- 36. Sahebi A, Golitaleb M, Moayedi S, et al. Prevalence of workplace violence against health care workers in hospital and pre-hospital settings: An umbrella review of meta-analyses. Front Public Health 2022;10:895818.
- 37. Mutlu H, Bahadır Yılmaz E, Yüksel A. Retrospective evaluation of white code data regarding violence experienced in a training and research hospital: A cross-sectional study. Turkiye Klinikleri Journal of Forensic Medicine and Forensic Sciences 2021;18(3):197–204. (Turkish)
- 38. Oral R, Günaydın H, Mazı Mİ. Çalışan hakları ve güvenliği birimlerinin işleyişi ile beyaz kod başvurularının retrospektif olarak değerlendirilmesi (Konya ili örneği). Sağlık Akademisyenleri Dergisi 2018;5(2):142–153. (Turkish)
- 39. Özen Bekar E, Çalış E. Beyaz kod verileri ışığında Düzce ilindeki sağlık çalışanlarına yönelik şiddet. Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi 2021;11(3):298-304. (Turkish)
- 40. Torun N. Şiddete yönelik beyaz kod verilerin değerlendirilmesi. Cukurova Medical Journal 2020;45(3):977–984. (Turkish)
- 41. Savage J, Ferguson CJ, Flores L. The effect of academic achievement on aggression and violent behavior: A meta-analysis. Aggression and Violent Behavior 2017;37:91-101.
- 42. Turkstat. Gender Statistics [Internet]. 2022 [cited 16 March 2024]. Available from: https://www.tuik.gov.tr/media/announcements/toplumsal_cinsiyet_istatistikleri.pdf. (Turkish)
- 43. Turkstat. Educational Statistics [Internet]. 2023 [cited 16 March 2024]. Available from: https://data.tuik.gov.tr/Bulten/Index?p=National-Education-Statistics-2022-49756 (Turkish)
- 44. Mshweshwe L. Understanding domestic violence: Masculinity, culture, traditions. Heliyon 2020;6(10).
- 45. Fleming PJ, Gruskin S, Rojo F, et al. Men’s violence against women and men are inter-related: Recommendations for simultaneous intervention. Soc Sci Med 2015;146:249–256.
- 46. Gillespie GL, Gates DM, Miller M, et al. Workplace violence in healthcare settings: Risk factors and protective strategies. Rehabilitation Nursing 2010;35(5):177–184.
- 47. Maran DA, Varetto A, Zedda M, et al. Gender differences in reporting workplace violence: a qualitative analysis of administrative records of violent episodes experienced by healthcare workers in a large public Italian hospital. BMJ Open 2019;9(11):e031546.
- 48. Kafle S, Paudel S, Thapaliya A, et al. Workplace violence against nurses: A narrative review. J Clin Transl Res 2022;8(5):421-424.
- 49. Ahmed F, Memon MK, Memon S. Violence against doctors, a serious concern for healthcare organizations to ponder about. Annals of Medicine & Surgery 2018;25:3–5.
- 50. Eurofound. European working conditions telephone survey 2021 [Internet]. 2022 [cited 16 March 2024]. Available from: https://www.eurofound.europa.eu/publications/series/european-working-conditions-telephone-survey-2021
- 51. Liang Y, Wang H, Tao X. Quality of life of young clinical doctors in public hospitals in China’s developed cities as measured by the Nottingham Health Profile (NHP). Int J Equity Health 2015;14:1–12.
52. Askin R, Vahapoglu F, Onen S, et al. Psychopathology in violent offenders against healthcare workers. Violence and Victims 2019;34(5):786-803.
- 53. Viottini E, Politano G, Fornero G, et al. Determinants of aggression against all health care workers in a large-sized university hospital. BMC Health Services Research 2020;20:1-9.
- 54. Taylor JL, Rew L. A systematic review of the literature: Workplace violence in the emergency department. J Clin Nurs 2011;20(7–8):1072–1085.
- 55. Liu X, Wang L, Chen W, et al. A cross-sectional survey on workplace psychological violence among operating room nurses in Mainland China. Applied Nursing Research 2021;57:151349.