Healthcare settings are notorious for exposing their employees to high levels of violence; with violence related injury rates reported to be four times higher than any other employment setting . Violence encompasses verbal abuse, physical assault as well as sexual harassment; with the former being the most commonly reported type of violence [2-7]. There is a consensus in literature that ED workers have a disproportionally higher exposure to violence compared to other hospital departments and that nurses are the most vulnerable to violent incidents [2-4].
Exposure to violence precipitates serious physical, psychological and professional consequences on healthcare workers, including: impaired job performance, moderate to severe and long-term psychological effects, burnout and turnover [6, 8, 9]. Despite its serious consequences, most healthcare workers tend to underreport their exposure to violent incidents [4, 6, 10, 11]; thus it becomes important to probe them systematically in order to unearth their true rate of exposure to violence.
Within the Lebanese context, a recent study entitled “Occupational violence at Lebanese emergency departments: prevalence, characteristics and associated factors” which examined health workers’ exposure to violence at Lebanese emergency departments (EDs) revealed that 70% of surveyed ED workers were exposed to violence at least once over the last twelve months. The study further unearthed three main findings; first, nurses were disproportionally exposed to physical violence with more than a third of surveyed nurses subjected to at least one incidence of physical violence over the last 12 months. Second, public hospitals displayed a significantly higher level of exposure to occupational violence compared to academic medical centers and private hospitals. Finally, the study revealed that many of the root causes of violence are amendable to interventions, yet would require a multi-disciplinary approach in the design of these interventions .
Prompted by the results of the aforementioned study, the authors of this paper organized and facilitated a multi-stakeholder Policy Forum on Violence and Aggression in Emergency Departments (ED) in Lebanon in April 2011. The aim of the forum was to engage with policymakers, decision makers and other concerned actors on possible changes to reduce the exposure of healthcare workers to violence. More specifically, the forum was designed to address the underlying causes of violence in EDs and engage in possible solutions at three levels: societal, health care facility and public policy.
Participating stakeholders were selected based on their constituency representation. State actors included the Ministry of Public Health and the Internal Security Forces (Police Department). The latter were represented by a senior staff member in the police medical corps. Non-state actors included international Non Governmental Organizations (NGOs), national NGOs, representatives of major media channels, and representatives of the main stewardship bodies including the Order of Physicians, Syndicate of Nurses and Syndicate of Private Hospitals. Other stakeholders who participated in the discussion forum included leaders and administrators from major public and private hospitals. The total number of participants in the discussion was 25 stakeholders.
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(Author: Mohamad Alameddine, Nasser Yassin