title: Health care personnel and workplace violence in the emergency departments of a volatile metropolis: results from Karachi, Pakistan.
abstract: BACKGROUND
  Workplace violence (WPV) is an important challenge faced by health care personnel in the emergency department (ED).
  
  
  OBJECTIVE
  To determine the prevalence and nature of WPV reported by physicians and nurses working in the EDs of four of the largest tertiary care hospitals in Karachi, Pakistan and to understand the mental health impact of experiencing WPV.
  
  
  METHODS
  This cross-sectional survey was conducted between September and November 2008 using a widely used questionnaire developed by the World Health Organization. Overall, 266 (86% response rate) questionnaires were included in this study.
  
  
  RESULTS
  A total of 44 (16.5%) physicians and nurses said they had been physically attacked, and 193 (72.5%) said that they had experienced verbal abuse in the last 12 months. Among those who reported physical attack, 29.6% reported that the last incident involved a weapon, and in 64% of cases the attacker was a patient's relative. Eighty-six percent thought that the last attack could have been prevented, and 64% said that no action was taken against the attacker. After adjusting for covariates, physicians were less likely than nurses to report physical attack (odds ratio [OR] 0.46; 95% confidence interval [CI] 0.2-1.0), and personnel with greater work experience (OR 4.8; 95% CI 2.0-11.7) and those who said that there were procedures to report WPV in their workplace (OR 3.2; 95% CI 1.6-6.5) were more likely to report verbal abuse. WPV was associated with mental health effects in the form of bothersome memories, super-alertness, and feelings of avoidance and futility.
  
  
  CONCLUSIONS
  WPV is an important challenge in the EDs of large hospitals in Karachi. A majority of respondents feel that WPV is preventable, but only a minority of attackers face consequences.
authors.affiliation: Department of Emergency Medicine, World Health Organization Collaborating Center for Emergency Medicine and Trauma Care, Aga Khan University, Karachi, Pakistan.
authors.forename: Waleed
authors.initials: W
authors.lastname: Zafar
authors.forename: Emaduddin
authors.initials: E
authors.lastname: Siddiqui
authors.forename: Kiran
authors.initials: K
authors.lastname: Ejaz
authors.forename: Muhammad Umer
authors.initials: MU
authors.lastname: Shehzad
authors.forename: Uzma Rahim
authors.initials: UR
authors.lastname: Khan
authors.forename: Seemin
authors.initials: S
authors.lastname: Jamali
authors.forename: Junaid A
authors.initials: JA
authors.lastname: Razzak
mesh_terms: D000328:Adult; D000374:Aggression; D002947:Cities / Q000453:epidemiology; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004651:Employment; D005260:Female; D006801:Humans; D008297:Male; D008505:Medical Staff, Hospital / Q000523:psychology / Q000706:statistics & numerical data*; D008875:Middle Aged; D009741:Nursing Staff, Hospital / Q000523:psychology / Q000706:statistics & numerical data*; D010154:Pakistan / Q000453:epidemiology; D015995:Prevalence; D011795:Surveys and Questionnaires; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D014754:Violence / Q000523:psychology / Q000706:statistics & numerical data*; D017132:Workplace / Q000523:psychology / Q000706:statistics & numerical data
keywords: Karachi; Pakistan; emergency department; mental health; workplace violence