Violence Against Healthcare Workers in Turkey and Globally: A Narrative Review

Öz

Purpose: Violence against healthcare workers (HCWs) represents a critical global public health concern with significant individual and institutional consequences. The World Health Organization reports that HCWs face up to 16 times higher risk of violence compared to other service sectors. Despite increasing attention to this issue, comprehensive reviews addressing the unique challenges faced by healthcare systems providing universal free care remain limited. This narrative review aims to examine the types, risk factors, and consequences of violence against HCWs, and to evaluate prevention strategies within the framework of Turkey's White Code system and international practices. Methods: A comprehensive literature search was conducted in PubMed, Web of Science, Scopus, ULAKBIM (Turkish National Database), and Google Scholar for English and Turkish articles published between January 2010 and December 2024. Search terms included "workplace violence," "violence against healthcare workers," "White Code," and "sexual harassment healthcare" in English, and corresponding Turkish terms. The Social Ecological Model was employed as the theoretical framework to analyze violence at individual, interpersonal, organizational, community, and policy levels. Results: The prevalence of workplace violence against HCWs ranges from 9.5% to 74.6% globally, with verbal abuse being the most common type (42.1%–94.3%), followed by threats (14.0%–57.4%) and physical assault (0.5%–15.9%). Turkey's White Code system, implemented since 2013, shows low reporting rates due to fear of retaliation (reported by 68% of non-reporters) and distrust in legal processes. Sexual harassment affects 71.7% of Turkish nurses, with 40% of victims considering leaving the profession. Violence significantly increases burnout levels, decreases job satisfaction, and negatively affects healthcare quality and patient safety. Conclusions: Prevention of violence against HCWs requires multidisciplinary approaches combining strengthened institutional policies, effective reporting systems, psychological support services, and public awareness programs. Healthcare systems providing universal free care face unique challenges that necessitate context-specific interventions.

Anahtar Kelimeler

• Violence against healthcare workers
• Workplace violence
• White Code
• Patient safety
• Turkey

Etik Beyan

Not applicable. This narrative review is based solely on previously published studies and does not involve human participants, patient data, or primary data collection. Therefore, ethics committee approval and informed consent were not required.

Türkiye'de ve Küresel Ölçekte Sağlık Çalışanlarına Yönelik Şiddet: Anlatısal Bir İnceleme

Öz

Amaç: Sağlık çalışanlarına yönelik şiddet, önemli bireysel ve kurumsal sonuçları olan kritik bir küresel halk sağlığı sorunudur. Dünya Sağlık Örgütü, HCW'lerin diğer hizmet sektörlerine kıyasla 16 kat daha fazla şiddet riskiyle karşı karşıya olduğunu bildirmektedir. Bu konuya olan ilginin artmasına rağmen, evrensel ücretsiz bakım sağlayan sağlık sistemlerinin karşılaştığı benzersiz zorlukları ele alan kapsamlı incelemeler sınırlı kalmaktadır. Bu anlatımsal inceleme, HCW'lere yönelik şiddetin türlerini, risk faktörlerini ve sonuçlarını incelemek ve Türkiye'nin Beyaz Kod sistemi ve uluslararası uygulamalar çerçevesinde önleme stratejilerini değerlendirmek amacıyla yapılmıştır. Yöntemler: PubMed, Web of Science, Scopus, ULAKBIM (Türk Ulusal Veritabanı) ve Google Scholar'da Ocak 2010 ile Aralık 2024 arasında yayınlanan İngilizce ve Türkçe makaleler için kapsamlı bir literatür taraması yapılmıştır. Arama terimleri arasında İngilizce olarak “işyerinde şiddet”, “sağlık çalışanlarına yönelik şiddet”, “Beyaz Kod” ve “cinsel taciz sağlık hizmetleri” ve bunlara karşılık gelen Türkçe terimler yer almıştır. Bireysel, kişilerarası, örgütsel, toplumsal ve politika düzeylerinde şiddeti analiz etmek için teorik çerçeve olarak Sosyal Ekolojik Model kullanılmıştır. Bulgular: Sağlık çalışanlarına yönelik işyerinde şiddet yaygınlığı küresel olarak %9,5 ile %74,6 arasında değişmektedir. En yaygın şiddet türü sözlü taciz (%42,1–%94,3) olup, bunu tehditler (%14,0–%57,4) ve fiziksel saldırı (%0,5–%15,9) izlemektedir. Türkiye'de 2013 yılından beri uygulanan Beyaz Kod sistemi, misilleme korkusu (bildirimde bulunmayanların %68'i tarafından bildirilmiştir) ve yasal süreçlere güvensizlik nedeniyle düşük bildirim oranları göstermektedir. Cinsel taciz, Türk hemşirelerin %71,7'sini etkilemekte ve mağdurların %40'ı mesleği bırakmayı düşünmektedir. Şiddet, tükenmişlik düzeylerini önemli ölçüde artırmakta, iş memnuniyetini azaltmakta ve sağlık hizmetlerinin kalitesini ve hasta güvenliğini olumsuz etkilemektedir. Sonuçlar: Sağlık çalışanlarına yönelik şiddetin önlenmesi, güçlendirilmiş kurumsal politikalar, etkili bildirim sistemleri, psikolojik destek hizmetleri ve halkı bilinçlendirme programlarını bir araya getiren çok disiplinli yaklaşımlar gerektirir. Evrensel ücretsiz sağlık hizmeti sunan sağlık sistemleri, bağlama özgü müdahaleler gerektiren benzersiz zorluklarla karşı karşıyadır.

Anahtar Kelimeler

• Sağlık çalışanlarına yönelik şiddet
• İşyeri şiddeti
• Beyaz Kod
• Hemşirelik
• Türkiye

Etik Beyan

Uygulanamaz. Bu anlatımsal derleme çalışması yalnızca daha önce yayımlanmış araştırmalara dayanmaktadır ve insan katılımcılar, hasta verileri veya birincil veri toplama sürecini içermemektedir. Bu nedenle etik kurul onayı ve bilgilendirilmiş onam gerekmemektedir.

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