HEALTH MATTERS: Workplace violence in healthcare is a global phenomenon, undermining staff retention and the delivery of quality healthcare, according to a recent World Health Organisation (WHO) report.countries investigated. In all the studies, nurses and physicians alsoreport very high levels of exposure'

Violence in the healthcare workplace is an epidemic in all societies, including the developing world, irrespective of countries, work settings or occupational groups, says the WHO.

More than half of health personnel surveyed in developing and transition countries had experienced at least one incident of physical or psychological violence in the past year.

In South Africa 61 per cent of healthcare workers had experienced violence in the previous 12 months. In Thailand, the figure was 54 per cent, while in Portugal 60 per cent of 212 respondents from a large urban health centre said they had suffered at least one incident of violence in the previous year.

The research was commissioned by the WHO, the International Labour Office, the International Council of Nurses and Public Services International. The survey aims to provide guidance for the development and implementation of policies to eliminate workplace violence in the healthcare sector.

The research found that workplace violence in the health sector was universal, despite local characteristics. The evidence showed "violence is far too high, and that interventions and preventative measures are urgently needed".

It found a high prevalence of psychological violence, as well as physical violence. In an observation with which Irish healthcare workers will concur, the WHO says: "Many health workers reported that the violence in the streets is spilling over to the hospital."

Stress resulting from health systems being restructured is also seen by the WHO as a major contributing factor to the generation of violence.

Workplace violence affects all health workers, both women and men, while some workers are exposed to greater risk. "Ambulance staff exposure to violence is extremely high in all countries investigated. In all the studies, nurses and physicians also report very high levels of exposure," according to the WHO.

Violence in the healthcare sector can result in the "deterioration of the quality of care provided and the decision by health workers to leave the healthcare professions", resulting in a reduction in the availability of health services to the public and increased health costs, says the WHO.

There were no specific workplace policies in place to prevent or respond to workplace violence in most countries. This resulted in under-reporting of violent incidents, poor follow-up of reported incidents, no sanction of the perpetrators and dissatisfied victims.

The research emphasised the interrelationship between stress and violence. For instance, in South Africa a significant number of victims reported suffering symptoms of post-traumatic stress disorder after experiencing violence in a healthcare setting. Being the victim of violence in the workplace causes high levels of stress, while stress itself can create violent behaviour.

The data also confirmed that witnesses are often stressed by their exposure to workplace violence.

The Health and Safety Authority's (HSA's) recently published annual report for 2001 shows that 90 inspections took place last year dealing specifically with violence in healthcare.

These inspections were carried out "specifically to check for control measures for violence prevention. As a result, 32 improvement notices were issued."

Seventeen of the inspections were reactive in nature, that is, following a complaint, accident or request. The HSA inspected casualty departments, drug rehabilitation centres, residential centres for persons with profound handicap, general practice surgeries and psychiatric services.

Factors causing concern identified by the HSA report included the lack of communication systems, no secure, lockable place for staff to work in and no use of CCTV at entry points.

Mr Liam Doran, general secretary of the Irish Nurses' Organisation (INO), told The Irish Times that the INO concurred fully with the WHO findings. "Physical assault on nursing staff, on healthcare staff in general, is now - and I say without hesitation - a daily occurrence within the Irish health service."

And while it has been like that for a long time "certainly it's getting worse", he says. "The willingness, the responsiveness of employers to deal adequately with it and to minimise the risk - no one says you can eliminate it - but to minimise the risk has been very disappointing. They have been very slow to react and they have only reacted really when there have been incidents and when the INO and other bodies have challenged them and raised it with them."

A spokesperson for the Health Service Employers' Agency was unavailable for comment.