Table 3 Predisposing factors, impact, and coping mechanisms regarding WPV among primary healthcare workers

1.

Abed et al. (2016)

Victims’ characteristic:

Female nurses were more predisposed to experience violent incidents than male physicians

–

–

2.

Demeur et al. (2018)

Victims’ characteristics (personality traits):

GPs with “reserved” and “careless” personality types were likelier to experience aggression

GPs with “innovative”, “challenging”, or “confident” personality types were also at increased risk, but to a lesser extent than those with “reserved” and “careless” personalities

GPs with “efficient” and “innovative” personalities were likelier to report incidents

Male GPs and those with “efficient” personalities felt safer. GPs with “confident” and “cautious” personalities were likelier to feel unsafe

–

–

3.

Elston and Gabe (2016)

Victims’ characteristics:

Physical assaults and threats were much rarer and more likely to be reported by men

Female GPs’ lower risk of threats and assaults might partly reflect their greater likelihood of adopting specific personal risk reduction measures than their male colleagues

Implications of violence:

A few assault cases that resulted in physical injury

Female GPs were significantly more likely to report feeling afraid of becoming a victim of violence in the future

Specific incidents were mostly rated as having no lasting effect on GPs’ mental or physical health or professional practice

A few older male doctors took early retirement due to being assaulted

Safety measures:

Female doctors consistently adopted the following safety measures:

Checking patient notes in advance

Leaving the door ajar when seeing certain patients

Accompanied when seeing certain patients

Accompanied on visits to certain patients

Leaving visit schedule with a colleague

Carrying a personal alarm

Attending self-defence course

4.

Gan et al. (2018)

Victims’ characteristics:

Physical violence was positively associated with:

Male GPs

Higher professional level

Non-physical violence was positively associated with:

Less-experienced GPs

Those with administrative responsibility

Work-related factors:

Physical violence was positively associated with:

Lower average monthly income

–

–

5.

Joa and Morken (2012)

Victims’ characteristics:

Significantly more nurses were associated with verbal abuse

Males had a higher risk for physical abuse

Higher age was associated with a lower risk for sexual harassment

–

–

6.

Ko and Dorri (2019)

Victims’ characteristics:

A minority group who self-identified as female, non-white, and with a certain sexual orientation experienced WPV in their professional relationships with colleagues and health care staff

Discriminatory acts against members of sexual and gender minority groups were the most severe, and included threats to licensure and denial of hospital admitting privileges

Post-violence events:

Minority groups described burnout from bias, harassment, and hostility in their professional relationships with colleagues and healthcare staff

Harassment and institutional discrimination were factors in respondents’ decisions to change practices or leave the region entirely

–

7.

Pina et al. (2022)

Victims’ characteristics:

Inappropriate HCW attitude, lower motivation, lack of communication skills, problem-solving deficits

Administrative staff lacked communication skills, assertiveness, or empathy

Post-COVID-19 adaptation: Users noted that medical staff were perceived as distant and occasionally did not provide sufficient information on users’ health status

Perpetrators’ characteristics:

Primary health care users’ inappropriate attitude; demanding users, disrespecting rules, apathetic users, language barrier

Work-related factors:

Organisational deficit: Management of medical appointments by telephone, with users reporting great difficulties in being attended. Online appointments were not a suitable alternative for all users, as it was difficult for low-income and elderly users to use this method

Management of emergencies in primary care: Triaging was conducted by non-health administration staff in a low-privacy or less confidential context

Uncertain waiting time for consultations: Users reported not seeing the doctor or not being informed of the additional waiting time despite having an appointment at a specific hour. A variant of this also occurred for telematic consultations, where it was uncertain when the call would be received

–

–

8.

Pina et al. (2022)

Work-related factors:

Professionals perceived a lack of training or education in themselves, causing violence

Absence of functional multidisciplinary teams; deficits in coordination and communication between professionals. A user might receive different, occasionally contradictory messages from different professionals. This could be annoying and confusing, causing violent situations

The time allocated to each consultation could be unrealistic, causing overload, poor attendance, and care delays, ultimately causing user conflicts

Victims’ characteristic:

WPV was due to depersonalised or dehumanised treatment by some professionals, which resulted in communication and empathy deficits

Perpetrators’ characteristics:

Poor patient–professional relationship induced violence during certain points as follows:

Inappropriate use of primary care, especially use of the emergency system. Some users claimed that their consultation was serious with the intention of avoiding making an appointment and waiting to be seen

Some users used the service to avoid facing external conflict. For example, using sick leave for malingering

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–

9.

Sturbelle et al. (2019)

Victims’ characteristic:

WPV victims were mainly younger workers and nursing staff

Social factor:

Locations in areas of trafficking were related to professionals’ exposure to violence

Work-related factors:

The reception unit was at the greatest risk of aggression compared to other units as it is an environment that requires staff to listen to users’ chief complaints, and the first point to determine the patient’s treatment flow

The lack of human and material resources generated exhaustion among professionals and user dissatisfaction, causing poor patient–professional relationships and inducing WPV

Implications of violence:

Violence caused damage that influenced work productivity and quality

This resulted in dissatisfied professionals who did not feel recognised and had fragile emotions, and decided to leave their job

Conflicted relationships with colleagues, bosses, and users

–

10.

Vorderwülbecke et al. (2015)

Social factor:

Financially weaker practice clientele were associated with WPV

–

–

11.

Rajakrishnan et al. (2022)

Social factor:

WPV prevalence in the past 12 months was highest among HCWs working in larger districts (77.7%) compared to smaller districts (22.3%). Large districts: district health offices with > 500 HCW and serving a population of ≥ 500,000 people

Work-related factor:

Low level of organisational safety climate was significantly associated with WPV

–

–

12.

Al-Turki et al. (2016)

Work-related factors

WPV was significantly associated with working multiple shifts, and evening or night shifts

WPV was significantly associated with the lack of an supportive environment to report violence

Implications of WPV:

No change: 56.6%

Reduced work performance: 31.1%

Feeling shame or guilt: 4.9%

Feeling sadness or stress: 2.5%

Other consequences: 4.9%

Post-violence events:

Coping mechanism: 48.0% of HCWs who experienced violence did nothing, 38.2% actively reported it to their supervisors (30.9%), the police (4.9%), 14.5% passively reacted by consulting a colleague or friend (13.8%) or discussing the violence with the offender and resolving the conflict (0.8%)

Reasons for underutilising reporting systems: belief that reporting was not an efficient reaction (69.4%), fear of losing their job (12.5%), unknown reasons (11.1%), other causes (6.9%)

Most HCWs who experienced violence were either unsatisfied (45.9%) or very unsatisfied (25.4%) with how the violent event was managed

13.

Alsmael et al. (2020)

NA

Implications of WPV:

None: 73.8%

Decreased work performance: 17.3%

Feeling punished: 2.4%

Feeling shame or guilt: 1.8%

Absenteeism: 1.2%

Injury (did not need medical care): 0.6%

Injury (needed medical care): 0.6%

Other: 13.1%

Post-violence event:

Reaction to the event: none (46.7%), reported to supervisor (46.2%), requested to move from workplace (4.7%), consulted colleague or friend (5.9%), reported to police (5.9%), other (4.7%)

Reason for not reporting: fear of revenge (1.2%), fear of losing job (3.0%), feeling ashamed/guilty (3.0%), not efficacious (39.1%), do not know (21.4%)

14.

Irwin et al. (2013)

Work-related factor:

Uncertain waiting times were the main reason for WPV

Perpetrators’ characteristics:

Lack of understanding of the pharmacist’s role in supplying medication was a main reason for WPV

Patients became aggressive when answering questions related to their medication

Impacts of violence:

Physiological effects: Aggressive incidents remained in victims’ thoughts persistently after the event, while a few developed anxiety

Cognitive impact: Potential risk of dispensing error or near miss occurred. Others reported reduced concentration or requiring a “time-out” after the incident due to inability to focus

Emotional effect: Emotional distress (upset and crying), followed by mild distress (discomfort), witnessing emotional distress in other staff members, self-directed anger

Social impact: Hesitancy to engage with patients, deciding to change careers, concerned about patients after the event

During violence event:

Pharmacists described using non-technical skills in response to aggressive behaviour:

Leadership: most interviewees felt that part of their job role was to take the lead in any aggressive interaction, protect junior members, and take control of the situation

Task management: The pharmacists considered management of an aggressive incident to include three key factors: Management of pharmacy staff, management of the aggressive patient, and prescription processing

Situational awareness: Maintaining clear exits and positioning staff next to the telephone were vital to maintain pharmacists’ and staff members’ safety. Respondents needed to monitor other staff members’ actions during an incident to ensure that they could maintain a clear idea of what the staff would be able and unable to do if the incident escalated

Decision-making: Refusing to interact with the aggressive patient further by asking them to leave the shop premises. However, several pharmacists knew that refusing medication due to aggression might provoke the patient further

15.

Jatic et al. (2019)

Victims’ characteristic:

Female gender was significantly associated with verbal violence

Workplace factor:

Workplace setting (urban) was significantly associated with indirect physical violence

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–

16.

Miedema et al. (2012)

Work-related factors:

Abusive behaviour was regularly modelled in the workplace, which contributed to abuse being perpetuated across generations. One respondent reported that abusive behaviour started in medical school

Professional hierarchy discrimination within the medical community, in which specialists are highly valued and family physicians less valued

Different pay schedules and scales were important factors in perpetuating professional hierarchies

Shortage of physicians was also an important factor contributing to abusive experiences within the medical system

Lack of policy and follow–up procedure were not mentioned

–

–

17.

Toro et al. (2015)

Victims’ characteristics:

Coercion was less frequent when the worker was female

Women more frequently inflicted insults

Workers aged < 30 years were at greater risk of material damage at consultation, which increased further for medical staff

Perpetrators’ characteristics:

Physical assault by patients was almost three times more frequent than that by accompanying persons

WPV was frequent when the aggressor was between 51 and 60 years

Aggressors aged between 19 and 60 years coerced workers 2–3 times more than those aged > 60 years

Work-related factors:

Non-medical staff were at lower risk of being physically assaulted than medical staff

Medical staff experienced more than twice the risk of experiencing coercion than non-medical staff

Impacts of violence on professionals:

No consequences: 90.4%

Psychological impact: 5.8%

Injuries: 3.6%

Work leave: 0.9%

Post-assault intervention:

Letter: 50.2%

Organisational measures in health centre: 11.2%

Change of professional requested by assaulted worker: 18.2%

Change of health centre: 0.9%

Change of doctor or nurse by patient’s choice: 20.3%

Other: 11.6%

18.

Cecilia et al. (2017)

Victims’ characteristic:

Women reported more exposure to non-physical violence than men

Work-related factors:

Professionals with fewer years of professional experience presented higher scores for non-physical violence

Professionals who did not receive continued training presented higher scores for non-physical violence

Non-health staff were prominent among the professions most exposed to non-physical user violence, followed by doctors, and finally nursing staff

Impact of violence on professionals’ well-being:

Psychological well-being: Higher General Health Questionnaire (GHQ) score (indicating poor psychological well-being) among HCWs who experienced WPV

Job satisfaction: Higher GHQ score among HCWs dissatisfied with aspects related to their work

Empathy: Higher scores in empathy factors were related to lower scores on the total GHQ scale (indicating better psychological well-being). Greater empathy prevents psychological distress in primary care professionals

–

19.

Marina et al. (2017)

Work-related factors:

WPV was positively associated with:

Interaction with patients between 6 PM and 7 AM

Interaction with patients during work

–

Coping mechanism post-violence event:

Most respondents (70.1%) did not take any action following WPV

Source of action taken: management (67.7%), employer (24.0%), union (0%), association (0%), police (4.2%)

Most respondents (44.6%) were highly dissatisfied with the manner in which the incident was handled

Main reason for not reporting the incident: it was not important (14.8%), feeling ashamed (2.5%), feeling guilty (0%), afraid of negative consequences (19.2%), feeling useless (74.9%), did not know to whom to report (15%)

20.

Marina et al. (2015)

Work-related factors:

WPV was positively associated with:

Interaction with patients between 6 PM and 7 AM

Nurses as a professional group

Working with preschool children

WPV was negatively associated with:

Encouragement to report violence

Number of staff in the same work setting (> 20 staff)

–

–

21.

Pina et al. (2022)

Work-related factor:

Non-physical violence and low intrinsic and extrinsic job satisfaction modulated non-physical violence, cynicism, and emotional exhaustion

–

–

22.

Feng et al. (2022)

Victims’ characteristic:

Female GPs were less likely to encounter WPV

Social factor:

GPs practising in rural areas were less likely to encounter WPV

Work-related factors:

Less likely to encounter WPV:

Made occasional home visits

Worked in a fair or good practice or work environment

Had a fair or good relationship with patients

GPs who served > 20 patients per day and worked overtime occasionally

–

Coping mechanism post-violence event:

No action taken: 31.92%

Tried to pretend it never happened: 14.82%

Stopped the perpetrators: 29.80%

Told friends/family: 9.28%

Told colleagues: 24.92%

Sought help from managers: 33.55%

Sought help from union: 5.54%

Called the police: 17.79%

Transferred to another position: 0.80%

Completed a WPV report: 11.38%

Prosecuted: 0.64%

23.

Delak and Širok (2018)

–

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Physician–nurse conflict resolution style:

The most predominant conflict resolution styles were compromising (44.3%) and avoiding (42.3%)

The next most predominant conflict resolution styles were accommodating (7.7%), collaborating (3.4%), and competing (2.3%)

The nurses’ and physicians’ predominant conflict resolution styles were avoiding and compromising, respectively, but there were no statistically significant differences

Conflict resolution style were statistically significantly different according to gender, education, and tenure

Men mainly chose compromising (58.3%) over avoiding (20.8%), and women preferred avoiding (44.2%) slightly more than compromising (43.1%)

Those with a vocational secondary education (3 years) preferred compromising (66.7%), while those with a PhD mostly chose avoiding (66.7%)

Longer tenure was significantly related to the predominant conflict resolution style