INTRODUCTION

Work Place Violence WPV is defined as the intentional use of physical or psychological force to injure, intimidate, or attack an individual in a work atmosphere. It is often known as any threat or physical abuse, assault, bullying, or other intimidating disrupting behavior that happens at the workplace [1]. It has been reported that 4.9–65% of health care professionals have been exposed to physical injury in their workplace and 1.2% of workplace homicide victims in the USA. Other studies reported a higher incidence of WPV [2].

HCWs are mostly vulnerable to reactive violence on the part of patients and their companions, affecting their physical and mental well-being, as patients and their families who are subject to mental stress due to hospitalization or disease may use violence against healthcare workers [3-6]. Job fatigue, customer demands, and declining patient-staff relationships have been linked with physical abuse against health care workers in the workplace [7].

It is categorized as physical and psychological violence. Physical abuse requires the use of physical force against someone or the use of objects to strike someone. It involves hitting, kicking, slapping, pulling, biting, pinching, wounding with sharp sticks, and sexual assault [8]. It may result in severe injury, dysfunction, permanent disability, or no harm at all. Non-physical aggression may involve bullying, slurs, threats, or sexual harassment; it does not cause physical injuries but may cause psychological damage, such as stress, anxiety, low job satisfaction, and low work performance [9].

Also, WPV has many negative effects, resulting not only in physical consequences but also in relational consequences for healthcare workers at work, correlated with the decision to leave, stress out, and minimize career success for medical practitioners [10]. These effects of aggression in the workplace can lead to a loss in efficiency and also affect the quality of treatment. Additionally, the shortage of workers and the investment of defensive tactics induced by abuse in the workplace will practically raise health costs [11].

In outpatient clinics, pediatrics care services are now diminishing and pediatrics outpatient clinics were even discontinued, resulting in a drastic rise in the number of outpatient clinics in children's hospitals, overworked medical personnel, inadequate quality behaviors, crowded conditions, and extended waiting times; these factors contribute to frustration and dissatisfaction among pediatrics patients' families which may lead to increased risk of violence [12].

Surveys were undertaken to examine the occurrence and intensity of physical violence toward health care workers committed by patients and tourists at the workplace. It is becoming an important research topic in Saudi Arabia, where cultural and ethical standards may vary dramatically from other locations Occupational abuse (WPV) committed by patients and tourists against nurses and doctors is a concern in adult emergency rooms (EDs), but largely unrecognized and unreported in pediatric EDs [13, 14].

Pediatric nurses working in hospital inpatient units have been under-studied in respect to their understanding of abuse in the workplace. Few studies were found in the pieces of literature that concentrate on occupational abuse against pediatrics nurses by patients and tourists [15].

Aim of the Study

Up to our knowledge; there's a lack of studies reporting violence against pediatric staff in Saudi hospitals, so the main objective of the study is to study the updates on violence against pediatric physicians and nurses.

MATERIALS AND METHODS

A systematic review was carried out, including PubMed, Google Scholar, and EBSCO using the following terms in different combinations: violence against healthcare workers, workplace violence in pediatric departments, pediatric staff and workplace violence, WPV in Saudi Arabia. Figure 1 is a flow chart that illustrates the data extraction process of the study. We included all full texts [randomized controlled trials, observational, and experimental studies which study violence against healthcare practitioners in pediatric departments. The authors extracted the data, and then the author's names, year, and region of publication, the study type, period of study, and the result were reported (Table 1).

Statistical Analysis

No software has been utilized to analyze the data. The data was extracted based on a specific form that contains (Author’s name, publication year, country, methodology, and results). These data were reviewed by the group members to determine the initial findings and the modalities of performing the surgical procedure.  Double revision of each member’s outcomes was applied to ensure the validity and minimize the mistakes.

RESULTS AND DISCUSSION

The search of the mentioned databases returned a total of 66 studies that were included for title screening. 49 of them were included for abstract screening, which leads to the exclusion of 24 articles. The remaining 25 publications full-texts were reviewed. The full-text revision leads to the exclusion of 19 studies, and 6 were enrolled for final data extraction (Table 1). The included studies had different study designs.

Gillespie, G. (2010) found that; both genders and all professional categories were at risk of witnessing verbal and physical WPV. Popular features of the suspects included patients undergoing a psychological examination and visitors suffering acute anxiety. Effects have been witnessed by staff, offenders, patients, and health employers [16].

Li, Zhe et al. (2017) found that; 68.6% of respondents experienced at least one WPV event in the past year. (94.9%) of offenders were family members of patients. Most of the WPV happened during the day shift (70.7%). Males were almost twice as females at risk to experience violence. As a consequence of WPV, aggression, anger, the decline in work, and work efficiency was reduced [17].

Shaw J. (2015) reported that; At least 26% of the workers shared worry about protection every week. Twenty-seven percent witnessed fear-causing conditions at least weekly. The primary causes of fear were patient or guest frustration (with the possibility of violence) and ED weapons. Respondents would be safer" with increased involvement of hospital security personnel (55%) and local police officers (71%) [18].

 Strollo, Bonnie A., et al. (2011) in New York suggested that there is violence in the workplace and a great deal needs to be done to deter and control violence in the workplace toward nurses who serve in inpatient pediatrics hospital units [19].

Hein PT, et al. (2019) reported that; the rate of occupational violence among nurses was 72.7%. More than 75% of nurses witnessed violence, and the verbal assault was the most frequent. Around 25% of participants were victims of sexual assault. The regression study found that nurses working in the emergency room and outpatient clinic were 1.92 times more likely to have verbal harassment than people working in other units. They were also 3.02 times statistically more likely to have physical abuse [20].

Alkorashy, H. et al.  (2016) reported that; about 50 % of participants had witnessed violence in the workplace during the 12 months before the study. Much of the respondents interpreted brutality in the workplace as physical harassment. Almost all nursing practitioners described patients as the leading cause. Slightly more than half of the understaffing, disagreements, long delays for service, and lack of staff preparation and crisis prevention policies have been listed as contributing factors [21].