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Table of Contents   
ORIGINAL RESEARCH  
Year : 2021  |  Volume : 32  |  Issue : 3  |  Page : 276-279
Workplace violence among dental surgeons - A survey


1 Department of Oral and Maxillofacial Pathology, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Velappanchavadi, Chennai, Tamil Nadu, India
2 Department of Oral and Maxillofacial Pathology, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India

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Date of Submission25-Nov-2019
Date of Decision26-May-2020
Date of Acceptance30-Nov-2020
Date of Web Publication14-May-2021
 

   Abstract 


Background: Workplace violence is a multi-causal, multifaceted, public health, legal and social problem faced by all occupations worldwide. Recently, there has been an increase in the prevalence of workplace violence against doctors. Even though the government has attempted to address these problems in India, doctors are still experiencing violence in their workplaces. Aim: The aim of this survey was to determine the prevalence and awareness of workplace violence among dental surgeons. Methodology: This cross-sectional study was conducted among the dental surgeons. A self-administered questionnaire containing 15 questions was made and validated. A Web-based questionnaire was developed using Google forms and was circulated. A total of 112 responses were obtained. Questions were answered with “yes” “no” or by marking the correct responses. Frequency analysis and percentage analysis were done with the obtained results. Results: Our study showed that 74.1% of the participants heard about the workplace violence and 30.4% faced violence in their clinic. The nature of the violence was physical in 0.9%, verbal in 39.3%, and sexual in 0.9% among the participants who faced violence. A total of 92.9% of the participants reported that they require policies and guidelines against this workplace violence. Conclusion: Dental surgeons should have proper knowledge about the work-related violence and methods to control this violence. Policies, procedures, and intervention strategies should be undertaken to manage this alarming issues.

Keywords: Dental surgeon, physical, sexual, verbal, violence

How to cite this article:
Krishnan RP, Ramani P, Sukumaran G, Ramasubramanian A, Karunagaran M, Hannah R. Workplace violence among dental surgeons - A survey. Indian J Dent Res 2021;32:276-9

How to cite this URL:
Krishnan RP, Ramani P, Sukumaran G, Ramasubramanian A, Karunagaran M, Hannah R. Workplace violence among dental surgeons - A survey. Indian J Dent Res [serial online] 2021 [cited 2022 May 21];32:276-9. Available from: https://www.ijdr.in/text.asp?2021/32/3/276/338141



   Introduction Top


Recently, there has been an increase in the prevalence of physical and verbal violence against doctors in their workplaces.[1] The National Institute of Occupational Safety and Health (NIOSH) defines the workplace violence as violent acts (including threats of assaults and physical assaults) directed toward a person at the work or on duty.[2] Health care workers face an increased risk of work related violence primarily from violent behaviour of their patients, clients or residents. The impact of workplace violence has widespread consequences.[3] This increases the anxiety and also affects the health worker ability to focus on the delivery of effective, safe and competent care.[4]

Workplace violence includes threats and verbal abuse to physical assaults and homicide.[3] Most common workplace violence is likely to be verbal abuse.[4] Factors that make healthcare workers prone to the acts of violence are unrestricted movement of people to clinics and hospitals,[2] working with people under the influence of drugs of abuse, long waiting time and alcohol intoxication.[5]

Though central and state governments have attempted to address these problems in India, doctors are still experiencing assaults and workplace violence.[6] Awareness of this workplace hazard is important for all dental surgeons. This survey was carried out to identify the magnitude and cause of workplace violence among dentists and to assess the attitude of dentists against this violence.


   Methodology Top


This cross-sectional study was conducted among the dental surgeons. Dental surgeons who were presently working or had worked in a private clinic/hospital before were included in the study. Undergraduates and dental surgeons who have never worked in a private clinic/hospital were excluded from the study. In order to evaluate the prevalence and awareness of workplace violence among the participants, a self-administered questionnaire containing 15 questions was made. This elicited information about the workplace violence among the participants and their attitude towards this violence. The questionnaire was validated. A Web-based questionnaire was developed using Google forms. A total of 150 questionnaires were circulated and 112 responses were obtained. The participation of the subjects was kept voluntary and was not obliged to fill the form. Questions were answered with “yes” “no” or by marking the correct responses. Frequency analysis and percentage analysis was done with the obtained results.


   Results Top


The overall response and the percent analysis were calculated for each question in the survey. 98.6% of the responses came from Tamil Nadu. 52.7% of the participants worked full time, 16.1% only in the mornings and 31.3% worked only in the evenings. 79.5% were employees in the clinic, 11.67% owned their clinic, and 8.9% were consultants in various clinics. Work force available in the clinic was one in 8%, two in 41.1%, three in 16.1%, and more than three in 34.8%. And 28.6% of the participants were males and 71.4% of the participants were females. 74.1% heard about the workplace violence and 30.4% faced violence in their clinic. 17.9% of the perpetrators were patients, 8.9% were patient relatives, 8.9% supervisors and 1.8% were others. 15.2% faced the violence once, 9.8% faced twice, 5.4% thrice and 8.9% more than thrice. Nature of the violence was physical in 0.9%, verbal in 39.3% and sexual in 0.9% among the participants who faced violence. The reasons for the violence were found to be high cost in 8%, long waiting time in 14.3%, cancellation of appointment in 1.78%, alcohol intoxication in 3.57% and 10.71% were because of other reasons. Impact of violence among the dental surgeons were fear in 8%, disappointment in 17.9%, low self-esteem in 10.7%, impaired job performance in 8% and 2.67% were others. 92.9% of the participants reported that they require policies and guidelines against this workplace violence.


   Discussion Top


Healthcare and social service workers face a significant increase in work-related violence.[2] The increasing incidences of violence against the doctors in their clinics are very important reason for stress among these health care workers. To ensure that dentists stop being victims of these events, a sound research and awareness is very important.

Locality of the clinic plays an important role in workplace violence. In our study, 98.6% of the participants worked in clinics in Tamil Nadu. It is better to keep the clinic in a crowded area which is clearly visible from the street. Working in neighbourhoods with increased crime rates can also increase the incidence of work place violence.[2] Timings of the clinic also play a major role in these violences. In our study, 52.7% dentists worked full time in the clinics. Late night and early mornings are seen to have increased incidence of violence.[2] Understaffing, especially during meal times and visiting hours, is associated with a higher risk of assaults on the health workers.[2]

The owner, employee and consultant are all at risk of this workplace violence. Among the respondents in our study 79.5% were employees and 8.9% consultants. Employee/consultant should be aware of the safety measures available in the clinic. When the workforce available is less, there are more chances of violence.[2] In our study, work force available was one in 8% and two in 41.1% was observed in our study. Thus, assigning responsibility to every staff in all aspects of violence is very important preventive measure.[2]

Awareness of this professional hazard is important for all dental surgeons.[7] In our study, only 74.1% heard about workplace violence. In order to stop being the victims of these events, preventive measure and awareness is an important step. 30.4% participants had faced work place violence as per the results of our study. This can be because of communication gap, working alone, poor environmental design and psychiatric patients. Several preventive measures by using panic buttons,[8] barrier protection, bright effective lighting and liaison with local police[2] would significantly reduce the incidence of the violence. Moreover, poor environment design of the workplace may block employees' vision and interfere with the escape from a violent incident[2] and thus it is mandatory that proper standards of design are in place.

Healthcare and social service workers face an increased risk of work place violence mainly from patients and their relatives/friends.[4],[9],[10],[11],[12],[13],[14],[15],[16] In our study, it was seen that patients were responsible for 17.9% and patient relatives for 8.9% of violence. Violence can be reduced by avoiding uncomfortable and overcrowded waiting rooms,[2] minimizing stress, informing about cost, number of appointments and cancelation of the appointment earlier. Discussions and assessments to improve the policies and procedures including complaint and suggestion programs should be designed to improve the safety and security of the clinic.[2]

Frequency of episodes doctors fall prey to violence has recently started increasing in numbers.[1] In our study, the frequency of violence was observed more than three times in 8.9% of individuals. The reason could be perception that violence can be tolerated and victims will not be able to report the violence because of social stigma.[2] This can be reduced by better communication with the patient and training for self-defence.[8] Providing panic button systems at workstations[8] where there can be direct contact with the patient and personal alarm devices can be given worn by the employees to reduce the hazard.

Healthcare professionals are at risk of both fatal and non-fatal violence-related injuries. In our study nature of abuse was verbal in 39.3%, physical in 0.9% and 0.9% respondents faced sexual violence. This can be because of lack of safety measures, dental surgeons not trained for self-defence, lack of security personal and lack of counselling professional in the clinic. The reason for verbal abuse turning into a physical one can be explained because of lack of safety measures in the hospital premises where patients and their relatives feel dominant mostly when they are in greater numbers compared to the staffs on duty.[17]

A variety of reasons have been found to be responsible for instigating a violent episode. The incidence are often linked to disinhibition caused by taking alcohol or drugs,[18] long waiting time or mental illness.[5],[19] In our study, reasons for violence was found to be long waiting time in 16.96% and high cost in 8%. This is because of lack of proper allotment of time to each patient and discussing the treatment plan, approximate number of appointments and the cost before starting the treatment.

Violence has negative effect on mental health and well-being of the workers and is manifested by disappointment, fear and feelings of guilt.[20] Low self-esteem was seen 16.96% and disappointment in 8%. The effects of violence include illness, demotivation and employee attrition.[7] Variability of the impact could be due to the fact that victims respond differently to violence and the support received by them may be contributory.[3]

A variety of reasons have found to be responsible for instigating a violent episode. 92.9% of the participants reported that they require policies and guidelines from government authorities against this workplace violence. Articulating a policy and establishing goals, allocating sufficient resources, uphold program and performance expectations can be implemented to reduce this violence.

Occupational violence is not accepted, no matter how frequently or infrequently it occurs.[3] Effective management of violence begins by recognizing that workplace violence is a safety and health hazard.[2] Commitment of the management, including the endorsement and the visible involvement of the top management, provides the motivation and resources for workers and their employees to deal effectively with this workplace violence.[2] Proper policies and guidelines should be established by the government against this workplace violence.

Work place violence can be reduced by better understanding of the risk factors associated with this violence and by providing a checklist that will be effective to analyse and reduce the incidence of work related violence in the dental clinics. Based on the obtained results, we have designed a checklist [Table 1] which can help the dental surgeons evaluate and prevent this violence in the dental clinic. This should be used widely by the clinic supervisors as a part of regular inspection to identify situations that can put the employees at risk of violence.
Table 1: Checklist

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   Conclusion Top


Change always requires identification of root causes of the work-related violence and cross-functional team involvement. Locality of the clinic, timing and the number of staffs plays an important role in workplace violence. All the staffs should be aware of the safety precautions available in the clinic. Discussions and assessments to improve the policies and procedures including complaint and suggestion programs should be designed and evaluated. Checklist can be used widely by the clinic supervisors as a part of regular inspection to identify situations that can put the employees at risk of violence.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

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Kumar M, Verma M, Das T, Pardeshi G, Kishore J, Padmanandan A. A study of workplace violence experienced by doctors and associated risk factors in a tertiary care hospital of South Delhi, India. J Clin Diagn Res 2016;10:LC06-10.  Back to cited text no. 17
    
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Knott JC, Bennett D, Rawet J, Taylor DM. Epidemiology of unarmed threats in the emergency department. Emerg Med Australas 2005;17:351-8.  Back to cited text no. 18
    
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Ness GJ, House A, Ness AR. Aggression and violent behaviour in general practice: Population based survey in the north of England. BMJ 2000;320:1447-8.  Back to cited text no. 19
    
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Top
Correspondence Address:
Reshma Poothakulath Krishnan
Department of Oral and Maxillofacial Pathology, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Velappanchavadi, Chennai, Tamil Nadu - 600 077
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijdr.IJDR_880_19

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