title: Workplace violence towards workers in the emergency departments of Palestinian hospitals: a cross-sectional study.
abstract: BACKGROUND
  Workplace violence (WPV) in hospital emergency departments (EDs) is a common problem. The objective of this study was to assess the characteristics (level and type), associated risk factors, causes, and consequences of WPV against workers in Palestinian EDs.
  
  
  METHODS
  A cross-sectional study was conducted in 14 out of the available 39 EDs in Palestine: 8 from the West Bank and 6 from the Gaza Strip. Data were collected using a self-administered questionnaire between July-September 2013. Multivariate logistic regression models were used to examine risk factors associated with exposure to WPV.
  
  
  RESULTS
  A total of 444 participants (response rate 74.5%): 161 (32.0%) nurses, 142 (32%) physicians, and 141 (31.7%) administrative personnel. The majority (76.1%) experienced a type of WPV in the past 12 months: 35.6% exposed to physical and 71.2% to non-physical assaults (69.8% verbal abuses, 48.4% threats, and 8.6% sexual harassments). Perpetrators of physical and non-physical violence were mainly patients' families/visitors (85.4% and 79.5%, respectively). Waiting time, lack of prevention measures, and unmet expectations of patients and their families are the main reasons for WPV. The multivariate regression analysis showed that younger personnel (OR = 2.29 CI 95% 1.309-4.036), clinicians (nurses and physicians) (OR = 1.65 CI 95% 0.979-2.797) comparing with administrative, and less experienced ED personnel (OR = 2.39 CI 95% 1.141-5.006) are significantly at higher risk of exposure to WPV (P < 0.05). Low level (40%) of violence reporting is evident, largely attributed to not enough actions being taken and fear of consequences. Violence has been shown to have considerable consequences for workers' well-being, patient care, and job retention.
  
  
  CONCLUSIONS
  Violence against workers in Palestinian EDs is highly common. The effects of violence are considerable. Multiple factors cause violence; however, EDs' internal-system-related factors are the most amenable to change. Attention should be given to strengthening violence prevention policy and measures and improving incident-reporting system.
authors.affiliation: School of Public Health, Al-Quds University, Jerusalem, occupied Palestinian territory. mhamdan@med.alquds.edu.
authors.forename: Motasem
authors.initials: M
authors.lastname: Hamdan
authors.affiliation: School of Public Health, Al-Quds University, Gaza, Palestine. asmaa.hamra@gmail.com.
authors.forename: Asma'a
authors.initials: A
authors.lastname: Abu Hamra
mesh_terms: D000288:Administrative Personnel; D000328:Adult; D000374:Aggression; D018912:Arabs; D019548:Crime Victims; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital; D005260:Female; D006761:Hospitals; D006801:Humans; D008297:Male; D008877:Middle East; D009726:Nurses; D016273:Occupational Exposure; D010564:Personnel, Hospital; D000066550:Physical Abuse; D010820:Physicians; D011795:Surveys and Questionnaires; D014937:Work; D017132:Workplace; D064450:Workplace Violence