Evaluation of workplace violence exposure of doctors, intern doctors and nurses working in Akdeniz University Faculty of Medicine Hospital in a forensic medicine perspective and determining the effect of workplace violence on job satisfaction and burnout levels

Studies shown that violence against healthcare workers is increasing year by year in the world, and exposure to violence at work causes psychological problems, decreased job satisfaction, and increased thoughts of leaving the institution or quitting the job. In our study, it was aimed to determine the job satisfaction and burnout levels of doctors, intern doctors and nurses working in Akdeniz University Faculty of Medicine Hospital, the effects of exposure to workplace violence on these parameters and mental health, and the characteristics of workplace violence by using a descriptive cross-sectional research method. For this purpose, a total of 759 volunteers (279 doctors, 271 nurses, 209 intern doctors) working at Akdeniz University Faculty of Medicine Hospital were reached and the data were collected through the questionnaire. The questionnaire included questions about sociodemographic information, exposed violence, working conditions, General Health Questionnaire (GHQ-28), Minnesota Job Satisfaction Questionnaire (MSQ), Maslach Burnout Inventory (MBI). Doctors comprises 36.8% (n=279) of the participants, 35.7% (n=271) of participants were nurses and the rest were intern doctors (27.5%; n=209). Sixty-nine percent (n=524) of all participants were female, 31% (n=235) were male, and the mean age was 30.6±7.9 years. In our study, 84.9% of the doctors (n=237), 81.2% of the nurses (n=220), 40.7% of the intern doctors (n=85), and 71.4% of all participants (n=542) were exposed to any type of workplace violence at least once in their professional life. Additionally, 56.3% of the doctors (n=157), 55.7% of the nurses (n=151), 36.8% of the intern doctors (n=77) and 50.7% of all participants (n=385) were exposed to workplace violence at least once in the last 12 months, and it was determined that the burnout, job dissatisfaction, and mental complaints of the group subjected to workplace violence were statistically significantly higher. In general, the frequency of encountering workplace violence according to the type of violence was found 70.8% for verbal violence (n=537), 14.9% for physical violence (n=113), and 3.2% for sexual violence (n=24). Although it was determined that perpetrator of the any type of workplace violence was mostly 30 to 44 year-old (n=328, 48.7%) male (n=437; 64.8%), a relative of patient (n=475; 70.5%), the most common place of violence was inpatient room (n=209; 31%), and healthcare workers were mostly violated by patients' relatives while examining and treating their cases (n=260; 38.6%). The characteristics of the perpetrators such as type of violence (verbal, physical and sexual) were varried among the doctor, nurse and intern doctor groups. When compared with the doctors, interns and nurses were more likely exposed to verbal violation by other healthcare workers in addition to patient and their relatives. It was determined that the frequency of taking violent incidents to the judicial authorities, calling "code white" and calling security was higher in doctor group, and a very small part of the intern doctors was using these mechanisms. It was noted that those who use verbal and physical violence against healthcare professionals in the workplace were mostly the relatives of the patients, and those who use sexual violence were mostly the patients. It was also determined that in cases of physical violence, measures such as calling security and taking these incidents to the judicial authorities are used more compared to the other two types of violence, and attitudes such as not reporting or not taking any legal accuisation or action were preferred more frequently for verbal violence and especially for sexual violence. While 70.6% (n=476) of the participants stated that nothing happened to the perpetrator after the workplace violence incident, only 13.1% (n=88) of the workplace violence incidents were taken to the judicial process, in 16.6% (n=112) of the incidents "code white" were called, the frequency of people who reported an incident of violence in the workplace (witnessed or personally exposed) in the last 12 months was 6.2% (n=47), and more than half of the participants (n=306, 56.3%) stated that they did not report the incident, as they thought that the process would not work. There is a negative relationship between burnout levels and job satisfaction, a positive relationship between burnout levels and psychological complaints, and a negative relationship between job satisfaction and psychological symptoms. As the type and number (not exposed to any type of violence vs exposed to all three types of violence) of violence increased, job satisfaction decreased, burnout levels and mental complaints increased. Compared with the men, women had lower levels of burnout in the MBI depersonalization and personal accomplishment sub-dimension, higher somatic symptom levels from the GHQ-28 sub-dimension, unmarried people had higher burnout levels in the MBI depersonalization and personal accomplishment sub-dimensions than the married ones, and nurses had higher somatic symptom levels in GSA-28 sub-dimensions, but job satisfaction was lower than the other two groups, and the level of burnout and psychological symptoms decreased as age and duration of employment increased. As the anxiety about being exposed to violence increases, job satisfaction decreases, burnout levels and mental complaints increase. It was determined that people who were exposed to domestic violence or partner violence in their past have higher mental complaints. About 42.3% (n=18) of the doctors and 19.2% (n=146) of the all participants had received at least once complaint through BIMER, CIMER, SABIM units or the management of the health institution etc., and compared with the noncomplained heathcare workers, emotional burnout and depersonalization levels were found to be statistically significantly higher in these previously complained groups. As a result of this study, it was determined that some characteristics of the violence, especially the types, places and conditions of the violence which the participants exposed, had differences according to the occupational group. It has been revealed that it would be appropriate to provide specific trainings for each group in addition to the trainings that should be given to all health workers in order to prevent violence and protect themselves. Since the reporting level of violent incidents was quite low, training of employees on their legal rights and incident reporting procedures is also required. It is thought that supporting and facilitating the legal struggles of healthcare professionals regarding exposure to violence, punishing at the highest limit of perpetrators of these crimes, and making the widely known of these effective penalties will play an important role in reducing/preventing violence against healthcare professionals. For the diagnosis and proof of violence and the compensation of the victimization, it should not be forgotten that the determination of psychological effects of the workplace violence are important in the forensic report process as much as the physical findings.