This article, titled “Dimensions of violence against healthcare workers in emergency departments: a cross-sectional comparative study” by Motasem Hamdan and colleagues, addresses the critical global issue of workplace violence (WPV) against healthcare workers (HCWs) in hospital emergency departments (EDs).
Background and Significance: Workplace violence is defined as “any activity associated with the job or any event that occurs in the work environment that involves the intentional use of physical force or emotional abuse against an employee and results in physical or emotional injury and consequences”. It is a common public health problem worldwide and negatively influences HCWs, leading to increased stress, fatigue, job dissatisfaction, burnout, decreased productivity, reduced quality of care, and higher turnover rates. EDs are particularly critical units where HCWs face a greater risk of violent attacks, mainly from patients and their relatives/companions, due to the serious conditions of patients and high-stress environments.
Study Aim and Design: Recognizing the lack of adequate data and systematic investigations on this issue, this comparative cross-sectional study aimed to assess the differences in the patterns, magnitude, effects, and underlying reasons for violence against health workers in the EDs of Palestine and Türkiye. The researchers chose these two countries due to some social and cultural similarities, despite their significant economic and political differences, which could influence healthcare system structures and WPV patterns.
Methodology: The study collected data between June and November 2024 using a self-administered survey from a convenience sample of 377 health workers (227 in Palestine and 150 in Türkiye) across 14 EDs in the West Bank and 3 in Isparta Province. The sample included 97 physicians, 198 nurses, and 82 other administrative and support health personnel. The survey tool, adapted from international guidelines, collected information on participant characteristics, exposure to physical and nonphysical violence, perpetrators, timing, place, reasons for violence, reporting behavior, and the impact of violence. Data were analyzed using SPSS, with Chi-square and Fisher’s exact tests to assess differences between the two countries.
Key Findings:
- High Prevalence: 68.7% of participants reported exposure to workplace violence in the past year, with a significantly higher prevalence among Palestinian participants (84.6%) compared to Türkiye (44.7%).
- Types of Violence: Nonphysical violence was more prevalent (65.3% overall) than physical violence (28.1% overall). Verbal abuse was the most common nonphysical type (77.5% in Palestine, 39.3% in Türkiye). For physical violence, pushing/pulling was most common (58.2% overall), though kicking/hitting and throwing instruments/equipment were also noted.
- Most Affected Groups and Perpetrators: Physicians were the most vulnerable to aggression (77.3% overall), followed by nurses. The main perpetrators were patient families/companions (79.0%) and patients themselves (14.2%).
- Reasons for Violence: The top reported reasons for violence were long waiting times to receive services, unmet expectations of patients and families, and a lack of violence prevention measures.
- Underreporting: Approximately 80.0% of violent events were not reported (86.3% in Palestine, 62.1% in Türkiye). The primary reasons for not reporting included a lack of follow-up and actions taken against aggressors, considering events trivial or part of the job, or fear of consequences.
- Impact of Violence: Violence led to significant negative psychological effects such as hopelessness, disappointment, fear, and anxiety. It also affected the delivery of care, leading to minimized communication and time spent with patients and companions. Furthermore, violence was associated with a strong intention of HCWs to leave their jobs in emergency services, with 59.6% of those exposed expressing this intention.
- Prevention Measures: The study highlighted a notable lack of violence deterrent elements, policies/procedures, and training on violence prevention and management in Palestinian EDs compared to Turkish EDs.
Conclusions: The study concludes that despite contextual differences, the underlying reasons and impacts of violence are common across both countries. Both Palestine and Türkiye face considerable levels of WPV and its negative consequences on HCWs and healthcare services, compounded by insufficient preventative measures. The findings underscore the urgent need for actions such as establishing efficient triage systems, increasing ED capacity and staffing, providing specialized training, strengthening security measures, improving communication skills, and implementing effective incident reporting systems with deterrent laws and follow-up actions against aggressors. A collaborative approach involving policymakers, hospital administrations, and the public is crucial to mitigate this public health problem.
Reference: Hamdan, M., Erdem, R., Toraman, A., Ceylan, H., Rashed, A., & Jawabreh, B. (2025). Dimensions of violence against healthcare workers in emergency departments: a cross-sectional comparative study. BMC Public Health, 25, Article 1370. https://doi.org/10.1186/s12889-025-22558-x
