Violence in healthcare: A case study on the perspectives of physicians, patients and managers

This thesis study evaluates the phenomenon of violence in healthcare from the perspectives of physicians, patients/patient relatives, and administrators, thus aiming to examine in depth the underlying causes and the factors effective in its occurrence, and to develop comprehensive solution proposals against violence. Within the scope of the study, the causes of violence in healthcare are evaluated based on conflicts between physicians and patients/patient relatives: in terms of physicians, through their professional experiences; in terms of patients and patient relatives, through their perceptions and attitudes regarding the difficulties they encounter in the process of receiving healthcare services; and in terms of administrators, within the context of the administrative level at which they serve. In addition, by evaluating from the administrators' point of view the effectiveness of the current policies and practices in force in Turkey for preventing violence in healthcare, the structural adequacy of the policies and the problems at the level of implementation are analyzed. In this study, the "case study design" was adopted, and within this design, data collection methods such as literature review, observation, and interviews based on the method of data triangulation were used. The universe of the study consisted of the Emergency Department and Outpatient Clinics of a Training and Research Hospital in Amasya, while the sample was created by purposive sampling method; including patients and patient relatives who experienced problems in the emergency and outpatient clinics and applied to the Patient Rights Unit (HHB), physicians working in the relevant units, hospital administrators, and representatives of the affiliated provincial health directorate and the local administrative authority. In order to address the phenomenon of violence in healthcare in a multidimensional way, three separate semi-structured interview forms were prepared for patients/patient relatives, physicians, and administrators. In the first two groups, the underlying causes of violence and the factors effective in its occurrence were evaluated, while for administrators, the causes of violence, the effectiveness of current policies, and proposals for the prevention of violence were assessed. The data obtained were subjected to content analysis, and as a result of the analysis, it was determined that the causes of violence in healthcare originated, in terms of patients and their relatives, from problems experienced in access to healthcare services and interpersonal communication disorders; in terms of physicians, from lack of institutional support, communication problems, devaluation of the professional role, and negativities in social perception; and in terms of administrators, from a combination of institutional and structural problems such as insufficient institutional infrastructure to prevent violence, preventive policies not directed toward the source of violence, and lack of communication. Furthermore, according to the evaluations of administrators, the current policies and practices in Turkey remained insufficient in preventing violence in healthcare; in particular, the lack of comprehensive policies addressing the structural problems that produce violence, deficiencies in the implementation of legal sanctions, lack of coordination within and between institutions, and the establishment of intervention mechanisms within the framework of a reactive approach reduce the effectiveness of the practices. In this context, it was concluded that more comprehensive, holistic, and sustainable strategies are needed in the fight against violence in healthcare. Key Terms: Violence, Violence in Healthcare, Health Policies, Preventing Violence in Healthcare