In this study, two hundred nursing staff working in Imam Hossain hospital in Shahroud participated in the study and completed the questionnaire. The results of this study showed that psychological violence with the prevalence of 68.5% during the last year was the most violent occurrence against the nurses working in this center. The results of this study are in line with other studies, like Olashore and Chen (15–16).
In a review study by Najafi et al., it was noted that among studies conducted using the WHO-designed Health Workplace Violence Questionnaire, questions about sexual and racial violence were excluded because of cultural sensitivity in the articles. In the present study, sexual violence was present in 1.5% of participants and racial harassment in 7%. It is likely that the reported cases of these two cases are less than the actual level due to the cultural issues prevailing in the community (17).
Eighty percent of nurses working at Imam Hossain hospital in Shahroud have suffered at least one type of occupational violence during the past year. As noted in other similar like Bjorkly, Peek-Asa and Ness studies, workplace violence is a serious and common problem among health care workers (18–20).
In the study of Hsieh et al., that was done 147 nurses, 87.7% of participants reported verbal violence and 23.1% physical violence. Patients' associates were also responsible for 89.8% of verbal violence and 23.8% of physical violence against nurses (21). In a cross-sectional study of AbuAlRub et al., which reported workplace violence over the past year using the WHO standard questionnaire on 183 nurses, 93.4 percent reported psychological violence and 71.6 percent physical violence against employed nurses. Racial and sexual violence was 19.1% and 5.5%, respectively (22). A study by Gillespie et al., conducted using WHO standard questionnaires on all nurses working in teaching hospitals, showed that 78.5% of nurses had been subjected to psychological violence by patients or their relatives at least once during the past year (23). In the present study, out of two hundred nurses, 126 (62%) stated that the most hospitalized area that experienced violence was hospitalized ward and 28.5% emergency ward. Therefore, there are many similarities between our study and those mentioned.
In a study by Bracken et al., it was noted that the highest rate of verbal violence occurred in the emergency, internal, surgical, and the lowest in the intensive care unit (24).
In a study by Salimi et al., which included 136 nursing staff working in Tehran hospitals, the most common site of violence was the emergency clinic and then the emergency department. 67.6% of those who had been subjected to psychological violence and 74% of those who had been subjected to physical violence reported that it occurred in the emergency department (25). These results are largely consistent with the findings of our study.
In the study of Shiao et al., 88 nurses were evaluated. The results of this study indicated that the highest rate of psychological violence was in emergency and internal wards (31.25%) and the lowest in the special wards (26).
In the study of Estryn-Behar et al., that was done of 180 nursing students, the highest rate of physical assaults occurred by the patients themselves (66.7%) and the second degree by the patient's companions with 18.1% (27). In the study of Teymoorzadeh et al., a census of nurses working in one of the hospitals in Tehran, the most reported reports of violence by the patient's companions were 57% and the patients themselves 28% (28). In the study of Eriksen et al., which included 302 nursing colleagues, it was noted that the highest rate of violence against nursing staff occurred by patients' companions (29). In the present study, patient companions were responsible for 44% of cases of violence against nurses. This is a much higher rate of workplace violence than the studies mentioned above, which may be due to the geographical, cultural and economic conditions of the studies concerned.
The gender of the perpetrators was reported male in 75% of the cases. In the Kwok et al., study 45% of men were violent and the Gerberich et al., study 38% of men were violent which are less male than our study, probably related to the type of hospital and clients (30–31).
Also in the present study, the highest proportion of patients presenting at the hospital during the violence was 20% at discharge time. In the Erkol and Mireille studies, the most frequent violence was related to the time of referral and hospitalization. This discrepancy is probably related to the employment rate of the study centers and the cost of treatment (32–33).