A Review on Violence Against Health Care Professionals in India and Its Impact
DOI:
https://doi.org/10.55489/njcm.140820233112Keywords:
Workplace violence, healthcare professionals, verbal abuse, attack on doctors, violence against NursesAbstract
Background: Workplace violence (WPV) is an emerging and contextually relevant public health problem among healthcare professionals (HCPs) globally, including in India. It is now recognized as a significant occupational hazard and an emergency public health problem. This study reviewed to identify the concept and prevalence of WPV, its trend, consequences, impact on healthcare professionals, and preventative measures in the Indian Context.
Methods: We searched Pub Med, Google Scholar, Scopus and other source, for the published articles between 2014 and 2022.
Results: We included 25 studies in total. Doctors and nurses are victims in Emergency Rooms, Intensive Care Units, and Outpatient departments (OPD). The majority of incidents across all contexts involved verbal violence. Patients and visitors are perpetrators of WPV and has impacts on service. Waiting time, poor communication, infrastructural issues, and negative media coverage are predisposing factors to WPV against HCPs.
Conclusion: While WPV showing increased trends, there is a need for a more systemic approach to reducing violence in the workplace that incorporates accountability at various tiers.
References
WHO. World Health Organization, Framework guidelines for addressing workplace violence in the health sector [Internet]. 2002 [cited 2022 Dec 23]. Available from: https://apps.who.int/iris/handle/10665/42617
Liu J, Gan Y, Jiang H, Li L, Dwyer R, Lu K, et al. Prevalence of workplace violence against healthcare workers: a systematic review and meta-analysis. Occupational and environmental medicine. 2019;76(12):927-37. Doi: https://doi.org/10.1136/oemed-2019-105849 PMid:31611310
Ghosh K. Violence against doctors: a wake-up call. The Indian journal of medical research. 2018;148(2):130. Doi: https://doi.org/10.4103/ijmr.IJMR_1299_17 PMid:30381535 PMCid:PMC6206759
Nagpal N. Incidents of violence against doctors in India: Can these be prevented? The National medical journal of India. 2017;30(2):97.
Striking Doctors Set Terms After Mamata Banerjee's Ultimatum [Internet]. 2019. Available from: https://www.ndtv.com/india-news/mamata-banerjee-issues-4-hour-ultimatum-to-junior-doctors-in-bengal-protesting-over-attack-on-collea-2052539
Hindustan Times, New Delhi. Doctors' strike highlights: Week-long strike called off after Mamata Banerjee accepts demands to scale up security [Internet]. 2019 Jun. Available from: https://www.hindustantimes.com/india-news/doctors-on-nationwide-strike-assault-on-doctors-in-west-bengal-live-updates/story-OMF8n4Qz1hRy0g9brr7b3I.html
Devi N, Singh A, Thongam K, Padu J, Abhilesh R, Ori J. Prevalence and attitude of workplace violence among the post graduate stu-dents in a tertiary hospital in Manipur. J Med Soc [Internet]. 2014 [cited 2022 Dec 3];28(1):25. Doi: https://doi.org/10.4103/0972-4958.135222
Visi V, Akoijam BS. Verbal and Physical violence towards junior doctors in a medical college in Manipur: A cross sectional study. 2018;
Dixit S, D'Souza B, Singh R, Thomas J, Kamath R. Factors Contributing to Workplace Violence Against Doctors in a Tertiary Care Teaching Hospital in South India. Indian Journal of Forensic Medicine & Toxicology. 2019;13(3). Doi: https://doi.org/10.5958/0973-9130.2019.00176.2
WHO. Preventing violence against health workers [Internet]. 2022 [cited 2022 Dec 23]. Available from: https://www.who.int/activities/preventing-violence-against-health-workers
Kengadaran S, Divvi A, Kengadaran S. Violence among healthcare workers during COVID-19 pandemic in India. Journal of family medicine and primary care. 2021;10(2):1066. Doi: https://doi.org/10.4103/jfmpc.jfmpc_2054_20 PMid:34041127 PMCid:PMC8138417
Garg N, Garg R, Sharma DK, Gupta SK, Dudeja P. Violence against health care workforce in COVID and non COVID times: Analysis of predisposing factors. Indian J Community Health [Internet]. 2020 Dec 31 [cited 2022 Dec 10];32(4):659-64. Doi: https://doi.org/10.47203/IJCH.2020.v32i04.009
ILO/ICN/WHO/PSI. ILO/ICN/WHO/PSI Workplace Violence in the Health Sector [Internet]. WHO; 2003 [cited 2022 Dec 23]. Avail-able from: https://www.who.int/docs/default-source/documents/violence-against-health-workers/wvmanagementvictimspaper.pdf?sfvrsn=7c9b3992_2
Lindquist B, Koval K, Mahadevan A, Gennosa C, Leggio W, Niknam K, et al. Workplace violence among prehospital care providers in India: a cross-sectional study. BMJ open. 2019;9(11):e033404. Doi: https://doi.org/10.1136/bmjopen-2019-033404 PMid:31772106 PMCid:PMC6886910
Singh A, Ranjan P, Sarkar S, Kaur TP, Mathew R, Gora D, et al. What do clinical resident doctors think about workplace violence? A qualitative study comprising focus group discussions and thematic analysis from a tertiary care center of India. Journal of family medicine and primary care. 2022;11(6):2678-84. Doi: https://doi.org/10.4103/jfmpc.jfmpc_1872_21 PMid:36119225 PMCid:PMC9480755
Hr S, Nekar MS, Bant DD. Prevalence of Violence against Health Care Personnel in a Tertiary Care Centre, Hubballi, India. Natl J Com-munity Med [Internet]. 2022 Feb 28 [cited 2023 Feb 3];13(2):79-84. Doi: https://doi.org/10.5455/njcm.20220109031701
Dora SSK, Batool H, Nishu RI, Hamid P. Workplace Violence Against Doctors in India: A Traditional Review. Cureus [Internet]. 2020 Jun 20 [cited 2022 Dec 11]; Doi: https://doi.org/10.7759/cureus.8706 PMid:32699702 PMCid:PMC7372195
Nagpal N. Incidents of violence against doctors in India: Can these be prevented? The National medical journal of India. 2017;30(2):97.
Datta M, Das A. Circumstances, Patterns, and Reporting of Incidents of Workplace Violence among Resident Doctors Posted at Se-lected Departments of a Tertiary-Care Hospital in Kolkata, India. J Health Sci Med Res [Internet]. 2021 Nov 5 [cited 2022 Dec 11];40(1):35-43. Doi: https://doi.org/10.31584/jhsmr.2021815
Joshi SC, Joshi R. Doctor becomes a patient: a qualitative study of health care work place violence related perception among junior doctors working in a teaching hospital in India. Int J Community Med Public Health [Internet]. 2018 Apr 24 [cited 2022 Dec 11];5(5):1775. Doi: https://doi.org/10.18203/2394-6040.ijcmph20181381
Kapoor M. Violence against the medical profession. J Anaesthesiol Clin Pharmacol [Internet]. 2017 [cited 2022 Dec 11];33(2):145. Doi: https://doi.org/10.4103/joacp.JOACP_102_17 PMid:28781436 PMCid:PMC5520583
Aatmika Nair AN. Solving systemic violence against healthcare workers in India [Internet]. The BMJ. 2021. Available from: https://blogs.bmj.com/bmj/2021/10/04/solving-systemic-violence-against-healthcare-workers-in-india/
Sharma S, Shrimali V, Thakkar H, Upadhyay S, Varma A, Pandit N, et al. A study on violence against doctors in selected cities of Guja-rat. Med J DY Patil Vidyapeeth [Internet]. 2019 [cited 2023 Apr 4];12(4):347. Doi: https://doi.org/10.4103/mjdrdypu.mjdrdypu_137_18
Gohil RK, Singh PK, Saxena N, Patel G. Work place violence against resident doctors of a tertiary care hospital in Delhi, India. Interna-tional Surgery Journal. 2019;6(3):975-81. Doi: https://doi.org/10.18203/2349-2902.isj20190834
Kumar M, Verma M, Das T, Pardeshi G, Kishore J, Padmanandan A. A study of workplace violence experienced by doctors and associ-ated risk factors in a tertiary care hospital of South Delhi, India. Journal of clinical and diagnostic research: JCDR. 2016;10(11):LC06. Doi: https://doi.org/10.7860/JCDR/2016/22306.8895 PMid:28050406 PMCid:PMC5198359
Jeffery R. Current challenges for doctors in India: Deprofessionalisation, reprofessionalisation or fragmentation. Sociology of Health & Illness. 2022; Doi: https://doi.org/10.1111/1467-9566.13564 PMid:36271825
Ranjan R, Meenakshi, Singh M, Pal R, Das J, Gupta S. Epidemiology of violence against medical practitioners in a developing country (2006-2017). J Health Res Rev [Internet]. 2018 [cited 2022 Dec 12];5(3):153. Doi: https://doi.org/10.4103/jhrr.jhrr_84_17
Reddy IR, Ukrani J, Indla V, Ukrani V. Violence against doctors: A viral epidemic? Indian journal of psychiatry. 2019;61(Suppl 4):S782. Doi: https://doi.org/10.4103/psychiatry.IndianJPsychiatry_120_19 PMid:31040474 PMCid:PMC6482703
Mishra S, Chopra D, Jauhari N, Ahmad A, Kidwai NA. Violence against health care workers: a provider's (staff nurse) perspective. Int J Community Med Public Health [Internet]. 2018 Aug 24 [cited 2022 Dec 10];5(9):4140. Doi: https://doi.org/10.18203/2394-6040.ijcmph20183609
Kar SP. Addressing underlying causes of violence against doctors in India. The Lancet. 2017;389(10083):1979-80. Doi: https://doi.org/10.1016/S0140-6736(17)31297-7 PMid:28534749
Shastri D. Violence Against Doctors. Indian Pediatr. 2019 Aug 15;56(8):629-31. Doi: https://doi.org/10.1007/s13312-019-1583-6 PMid:31477639
Kaur J, Sharma S, Singh MI, Sharma S. How trainee doctors and nurses react to simulated scenarios of violence against healthcare workers: A cross-sectional study. IJME [Internet]. 2022 Jul 23 [cited 2023 Feb 3];7(3):219-25. Doi: https://doi.org/10.20529/IJME.2022.009 PMid:35695854
Dora SSK, Batool H, Nishu RI, Hamid P. Workplace violence against doctors in India: a traditional review. Cureus. 2020;12(6). Doi: https://doi.org/10.7759/cureus.8706 PMid:32699702 PMCid:PMC7372195
Datta M, Das A. Circumstances, Patterns, and Reporting of Incidents of Workplace Violence among Resident Doctors Posted at Se-lected Departments of a Tertiary-Care Hospital in Kolkata, India. J Health Sci Med Res [Internet]. 2021 Nov 5 [cited 2022 Jul 8];40(1):35-43. Doi: https://doi.org/10.31584/jhsmr.2021815
Marathe S, Hunter BM, Chakravarthi I, Shukla A, Murray SF. The impacts of corporatisation of healthcare on medical practice and professionals in Maharashtra, India. BMJ Global Health [Internet]. 2020 Feb 1;5(2):e002026. Doi: https://doi.org/10.1136/bmjgh-2019-002026 PMid:32133190 PMCid:PMC7042603
Chauhan V, Galwankar S, Kumar R, Raina SK, Aggarwal P, Agrawal N, et al. The 2017 Academic College of Emergency Experts and Academy of Family Physicians of India position statement on preventing violence against health-care workers and vandalization of health-care facilities in India. International journal of critical illness and injury science. 2017;7(2):79. Doi: https://doi.org/10.4103/IJCIIS.IJCIIS_28_17 PMid:28660160 PMCid:PMC5479080
World bank. Current health expenditure India [Internet]. 2022. Available from: https://data.worldbank.org/indicator/SH.XPD.CHEX.GD.ZS?locations=IN
Grover S, Sahoo S, Bhalla A, Avasthi A. Psychological problems and burnout among medical professionals of a tertiary care hospital of North India: A cross-sectional study. Indian J Psychiatry. 2018;60(2):175-88. Doi: https://doi.org/10.4103/psychiatry.IndianJPsychiatry_254_17 PMid:30166673 PMCid:PMC6102958
Roy D. State of nursing in India: Persistent systemic challenges. The Lancet Regional Health-Southeast Asia. 2022;6. Doi: https://doi.org/10.1016/j.lansea.2022.100084 PMid:36249533 PMCid:PMC9547647
Kumari A, Kaur T, Ranjan P, Chopra S, Sarkar S, Baitha U. Workplace violence against doctors: characteristics, risk factors, and miti-gation strategies. Journal of postgraduate medicine. 2020;66(3):149.
Gadre A, Shukla A. Dissenting diagnosis. Random House India; 2016.
Davey K, Ravishankar V, Mehta N, Ahluwalia T, Blanchard J, Smith J, et al. A qualitative study of workplace violence among healthcare providers in emergency departments in India. International journal of emergency medicine. 2020;13(1):1-9. Doi: https://doi.org/10.1186/s12245-020-00290-0 PMid:32552677 PMCid:PMC7301447
Kumar M. A Study of Workplace Violence Experienced by Doctors and Associated Risk Factors in a Tertiary Care Hospital of South Delhi, India. JCDR [Internet]. 2016 [cited 2022 Jul 8]; Available from: http://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&volume=10&issue=11&page=LC06&issn=0973-709x&id=8895
Das N, Khar P, Karia S, Shah N. Suicide among Health Care Professionals-An Indian Perspective. In MDPI; 2022. p. 354. Doi:https://doi.org/10.3390/healthcare10020354 PMid:35206967 PMCid:PMC8871638
Reddy IR, Ukrani J, Indla V, Ukrani V. Violence against doctors: A viral epidemic? Indian journal of psychiatry. 2019;61(Suppl 4):S782. Doi: https://doi.org/10.4103/psychiatry.IndianJPsychiatry_120_19 PMid:31040474 PMCid:PMC6482703
Hossain MM, Sharma R, Tasnim S, Al Kibria GM, Sultana A, Saxena T. Prevalence, characteristics, and associated factors of workplace violence against healthcare professionals in India: a systematic review and meta-analysis. medRxiv. 2020; Doi: https://doi.org/10.1101/2020.01.01.20016295
Raveesh B, Lepping P, Lanka SV, Turner J, Krishna M. Patient and visitor violence towards staff on medical and psychiatric wards in India. Asian journal of psychiatry. 2015;13:52-5. Doi: https://doi.org/10.1016/j.ajp.2014.10.003 PMid:25466779
Anand T, Grover S, Kumar R, Kumar M, Ingle GK. Workplace violence against resident doctors in a tertiary care hospital in Delhi. Na-tional medical journal of India. 2016;29(6).
Gupta S, Sahoo S. Pandemic and mental health of the front-line healthcare workers: a review and implications in the Indian context amidst COVID-19. Gen Psych [Internet]. 2020 Oct [cited 2022 Dec 20];33(5):e100284. Doi: https://doi.org/10.1136/gpsych-2020-100284 PMid:34192235 PMCid:PMC7415074
Jain G, Agarwal P, Sharma D, Agrawal V, Yadav SK. Workplace violence towards resident doctors in Indian teaching hospitals: A quantitative survey. Trop Doct [Internet]. 2021 Jul [cited 2022 Dec 13];51(3):463-5. Doi: https://doi.org/10.1177/00494755211010005 PMid:33906545
Kaur A, Ahamed F, Sengupta P, Majhi J, Ghosh T. Pattern of workplace violence against doctors practising modern medicine and the subsequent impact on patient care, in India. Plos one. 2020;15(9):e0239193. Doi: https://doi.org/10.1371/journal.pone.0239193 PMid:32946495 PMCid:PMC7500628
Sanjay Nagral KD. Healers Or Predators? Corruption In India's Healthcare. 2021.
Priyanka Vora PV. India's hospital assaults: Patients blame doctors while doctors blame the broken health system. Scroll.in [Inter-net]. 2017 Mar 21; Available from: https://scroll.in/pulse/832349/hospital-violence-patients-blame-doctors-while-doctors-blame-the-broken-health-system
Lindquist B, Koval K, Mahadevan A, Gennosa C, Leggio W, Niknam K, et al. Workplace violence among prehospital care providers in India: a cross-sectional study. BMJ open. 2019;9(11):e033404. Doi: https://doi.org/10.1136/bmjopen-2019-033404 PMid:31772106 PMCid:PMC6886910
Sharma K, Kumar A, Kumar M, Bhogal RPSi. Indian Nurse's Diaspora in Global Health Care; Uncovering the Key Findings About Mi-gration of Nurses from Indian Perspective: A Review. Natl J Community Med [Internet]. 2022 Aug 31 [cited 2023 May 29];13(08):565-70. Doi: https://doi.org/10.55489/njcm.130820222124
Agarwal SK. Healthcare in India and violence against doctors: The missing links. Indian journal of nephrology. 2019;29(4):221. Doi: https://doi.org/10.4103/ijn.IJN_238_19 PMid:31423054 PMCid:PMC6668318
Raveel A, Schoenmakers B. Interventions to prevent aggression against doctors: a systematic review. BMJ open. 2019;9(9):e028465. Doi: https://doi.org/10.1136/bmjopen-2018-028465 PMid:31530592 PMCid:PMC6756459
Singh G, Singh A, Chaturvedi S, Khan S. Workplace violence against resident doctors: A multicentric study from government medical colleges of Uttar Pradesh. Indian J Public Health [Internet]. 2019 [cited 2022 Jul 8];63(2):143. Doi: https://doi.org/10.4103/ijph.IJPH_70_18 PMid:31219064
Chaudhary A, Barwal VK. Defensive Medicine in the Context of the Indian Health System. Indian pediatrics. 2022;59(11):882-4. Doi: https://doi.org/10.1007/s13312-022-2649-4 PMid:36370018 PMCid:PMC9748894
Kumar M, Verma M, Das T, Pardeshi G, Kishore J, Padmanandan A. A study of workplace violence experienced by doctors and associ-ated risk factors in a tertiary care hospital of South Delhi, India. Journal of clinical and diagnostic research: JCDR. 2016;10(11):LC06. Doi: https://doi.org/10.7860/JCDR/2016/22306.8895 PMid:28050406 PMCid:PMC5198359
Aparna Hegde AH. Violence in hospitals: Three steps towards mending doctor-patient relationships [Internet]. Scroll.in. 2017. Available from: https://scroll.in/pulse/837572/violence-in-hospitals-three-steps-towards-mending-doctor-patient-relationships
Ranjan R, Meenakshi, Singh M, Pal R, Das J, Gupta S. Epidemiology of violence against medical practitioners in a developing country (2006-2017). J Health Res Rev [Internet]. 2018 [cited 2022 Jul 8];5(3):153. Doi: https://doi.org/10.4103/jhrr.jhrr_84_17
Bhuyan A. Protests in India: doctors condemn police violence and restrictions on hospital access. BMJ [Internet]. 2020 Jan 3 [cited 2022 Dec 20];m13. Doi: https://doi.org/10.1136/bmj.m13 PMid:31900243
Thapar R, Hegde K, Bhat N, Kumar N, Unnikrishnan B, Mithra P, et al. Violence against doctors: Perception among doctors and pa-tient caretakers-A facility-based cross-sectional study in Mangalore. Journal of Datta Meghe Institute of Medical Sciences Universi-ty. 2022;17(2):249. Doi: https://doi.org/10.4103/jdmimsu.jdmimsu_381_21
Das N, Khar P, Karia S, Shah N. Suicide among Health Care Professionals-An Indian Perspective. In MDPI; 2022. p. 354. Doi: https://doi.org/10.3390/healthcare10020354 PMid:35206967 PMCid:PMC8871638
Garg R, Garg N, Sharma D, Gupta S. Low reporting of violence against health-care workers in India in spite of high prevalence. medi-cal journal armed forces india. 2019;75(2):211-5. Doi: https://doi.org/10.1016/j.mjafi.2018.11.011 PMid:31065192 PMCid:PMC6495456
Dixit S, D'Souza B, Singh R, Thomas J, Kamath R. Factors Contributing to Workplace Violence Against Doctors in a Tertiary Care Teaching Hospital in South India. Indian Journal of Forensic Medicine & Toxicology. 2019;13(3). Doi: https://doi.org/10.5958/0973-9130.2019.00176.2
Hossain MM, Sharma R, Tasnim S, Al Kibria GM, Sultana A, Saxena T. Prevalence, characteristics, and associated factors of workplace violence against healthcare professionals in India: a systematic review and meta-analysis. medRxiv. 2020; Doi: https://doi.org/10.1101/2020.01.01.20016295
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Suresh Gadapati, Shamanna BR
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
The authors retain the copyright of their article, with first publication rights granted to Medsci Publications.
