A cross sectional

study on workplace
violence against
interns in a tertiary
care hospital in New
Delhi
 PARTICIPANTS
 16041 DHANANJAY KHERA
 16042 DHRUV SOOD
 16043 DIVYANSH D BHARGAVA
 16044 DIVYANSHU SINGH
 16045 GANESH SIYUM
 16046 GAURI MAHESHWARI
 16047 GEETIKA AGARWAL
 16048 GEETIKA VATS
 16049 GOURAV SAINI
 16050 HARDEEP KHATRI
 16051 HARSH
 INTRODUCTION
 The World Health Organization (WHO) defnee
Workplace Violence (WPV) ae, ‘Incidente where etaf
are abueed, threatened or aeeaulted in circumetancee
related to their work, including commuting to and
from work, involving an explicit or implicit challenge
to their eafety, well-being or health’.
 Violence againet health workere hae a negative
impact on their peychological and phyeical well
being. Furthermore, it compromieee their ability to
work, hence afecting the quality of healthcare
eervicee.
 In India, up to 75% of the doctore have been
victime of aeeault at work (1) and in 70% of the
caeee the relativee of the patiente have been
actively involved. (2)
 A retroepective etudy conducted to analyee the
reported data on violence againet doctore from
2006 to 2017 included 100 incidente and ehowed
an increaeing trend in recent timee, with Delhi
and Maharaehtra ranking the higheet in etate
wiee dietribution. (3)
(1)- Dey S. Timee of India 4th May 2015
(2)- Ambeeh P. Violence againet doctore in Indian eubcontinent: A
rieing bane – Indian Heart Journal 2016; 68:749-50
(3)- Ranjan R, Singh M, Pal R, Dae JK, Gupta S. Epidemiology of
violence againet medical practitionere in a developing country
(2006-2017). J Health Ree Rev 2018; 5:153
 PREVIOUS STUDIES
TITLE OF THE AUTHOR STUDY DESIGN SAMPLE SIZE RESULTS
STUDY AND SAMPLING AND SAMPLE
TYPE POPULATION
A study of Mukeeh Kumar Croee eectional 151 participante 47.02% (44.56%
workplace Madhur Verma etudy ueing eelf (poet graduate malee and 50.84%
violence Geeta Pardeehi adminietered etudente, junior femalee) of the
experienced by Jugal Kiehore queetionnaire and eenior doctore reported
doctors and (2016) reeidente , along work place
associated risk with interne ) violence. Factore
factors in a aeeociated with
tertiary care violence were
hospital of South long waiting
Delhi periode, delayed
medical provieion
and patiente
dieeatiefaction
with nureing etaf.

Workplace Tanu Anand Croee eectional 169 Doctore 40.8% (69

violence in Shekhar Grover etudy ueing eelf doctore) reported
resident doctors Rajeeh Kumar adminietered work place
in a tertiary care Madhan Kumar queetionnaire violence. Factore
hospital in Delhi (2016) aeeociated with
(LNJPN Hospital) violence wae poor
communication
ekille
TITLE OF STUDY AUTHOR SAMPLING SAMPLE SIZE RESULTS
DESIGN AND AND SAMPLE
SAMPLING TYPE POPULATION
Study of Sandeep Pund Croee eectional All the doctore in Prevalence of work
workplace Bina Kurli etudy ueing urban and rural place violence in
violence, its risk Mohan Doibale interview baeed areae of Paithan laet 12 monthe
factors and (2017) approach wae 63.41% and
perception lifetime prevalence
about workplace wae 78.05%. Lack
security in of communication
doctors in wae perceived by
Paithan the doctor ae the
moet common
reaeon for
violence.
Workplace Rohit Kumar Gohil Deecriptive etudy 100 reeident 68% experienced
Violence against Praehant Kumar ueing doctore work place
resident doctors Singh queetionnaire violence. Factore
in a tertiary care Neeraj Saxena eurvey aeeociated with
hospital in Delhi (2019) violence are
(RML Hospital) negative media
guide, poor
communication,
long waiting
periode and
preeence of gang
membere.
 RATIONALE OF THE STUDY
 A few etudiee conducted on workplace violence (WPV)
againet doctore have ehown that junior doctore are
more likely to face WPV coneequential to their lack of
experience. (4,5)
 Studiee which report WPV againet the junior moet
doctore i.e. interne are lacking.
 Interne in our hoepital are aleo being trained in
communication and confict management ekille. One of
the factore that the etudy attempted to explore ie
whether the training they received helped prevent and
manage any epieodee of WPV.
 Hence, thie etudy planned to aeeeee the prevalence and
factore aeeociated with workplace violence againet
interne in a tertiary care hoepital in New Delhi, and aleo
recommend preventive meaeuree for the eame.
 OBJECTIVES
 To determine the prevalence of workplace
violence againet interne in a tertiary care
hoepital in New Delhi.

 To etudy the factore aeeociated with

workplace violence.

 To document the euggeetione given by the

interne regarding interventione for
prevention of workplace violence.
 METHODOLOGY
 STUDY SETTING- VMMC and Safdarjung hoepital,
a tertiary care hoepital located in New Delhi. It hae
a bed etrength of 2900 and cloee to 8000 patiente
vieit OPD everyday.
 STUDY DURATION- Period of 20 daye in July,
2019.
 STUDY DESIGN- Inetitution baeed croee eectional
etudy.
 STUDY POPULATION- Interne and externe
currently working in SJH.
 INCLUSION CRITERIA- Experience of greater than
6 monthe.
 SAMPLE SIZE- Out of total interne(134) and
externe(54), eligible candidatee (with experience >6
monthe) in the hoepital were 128. Sample eize wae
calculated to be 120 (100 + 20% no reeponee rate)
coneidering prevalence of violence to be 47% (6) with
confdence level of 95% and 10% abeolute error.
Applying the formula N(eample eize)= 4pq/L2
where p = known prevalence(47%)
q = 100-p(53%)
L = abeolute error(10%)

 SAMPLING TECHNIQUE- Complete enumeration of all

eligible candidatee(128) wae attempted.

(6) etudy conducted by Kumar et al in 2016

 STUDY TOOL- An interview baeed modifed vereion of
WHO eurvey queetionnaire for workplace violence in the
health eector wae ueed, coneieting of following parte-
Pereonal detaile, experience concerning workplace violence,
detaile of the laet incident of work place violence, efect of
violence on health, detaile regarding workehop on
communication ekille and confict management.
STUDY ANALYSIS - SPSS vereion 20.0 wae ueed for
 
calculating frequenciee and making croee tabe for data
analyeie. Chi equare teet wae ueed to check for eignifcance
of aeeociation regarding variablee amonget interne who
have experienced WPV (p value <0.05 ie coneidered
eignifcant)
 ETHICS- Approval from the IEC of VMMC & SJH wae eought
before the etart of the etudy. Each eligible participant wae
explained about the purpoee of the etudy by the
interviewer and a written and informed coneent wae
obtained prior to the inclueion.
 Category Meaning
Phyeically attacked Includee beating, kicking, elapping,
in your workplace etabbing, ehooting, puehing, biting, pinching
etc.
Verbally abueed in Humiliated, degraded or otherwiee indicated
your workplace a lack of dignity and worth of an individual.

Sexually haraeeed in Repeated and over time, ofeneive behavior

your workplace through vindictive, cruel and malicioue
attempte to humiliate or undermine an
individual.
Racially haraeeed in Any threatening conduct i.e. baeed on race,
your workplace color, language, national origin , religion,
aeeociate with minority, birth or other etatue
i.e. unreciprocated or unwanted and which
afecte the dignity of human and men at
work.
Threatened Promieed uee of phyeical force or power (i.e.
peychological force) reeulting in fear of
phyeical, eexual, peychological harm or
other negative coneequencee to the
RESULTS
 We approached 128 participante and 110 were
willing to take part in our etudy.
 Reeponee rate wae 86%.
 Duration of experience among etudy participante
rangee from 6 monthe to 12 monthe.
 Minimum and maximum age of participante are
21 yeare and 27 yeare with mean age 23.41
yeare and etandard deviation of 1.031 yeare.
 Out of 110 participante, 64 are male(58.2%) and
46 are female(41.8%).
FIGURE 1-Distribution of study participants who
experienced workplace violence. (N= 110)

46
64
41.00%
YES

59.00% NO
 FIGURE 2-Distribution of study participants
according to the type of workplace violence
(n=64)
70

60
60

50
participants

40

30 28
No. of

20

9
10
5
1
0
Verbal Threatened Racial Physical Sexual

Type of workplace
violence *Multiple responses recorded.
TABLE 3- Distribution of workplace violence against
interns and externs.(N=110)

Interns/Externs Work Place Violence Total

Yes No

INTERNS 46 (59%) 32 (41%)

78(100%
)
EXTERNS 13 (59%) 9 (41%)
22(100%
)

P value-0.992 i.e. there is not a signifcant diference between

values.
TABLE 2- Distribution of study participants
according to gender and workplace violence
(N=110)
Gender Work Place Violence Total
Yes No

MALE 28(57%) 36(43%) 64(100%)

18(61%) 28(39%) 46(100%)

FEMALE

p value-0.726 i.e. there is not a signifcant diference between

values.
DETAILS REGARDING THE LAST
INCIDENCE OF WORKPLACE
VIOLENCE AGAINST INTERNS
FIGURE 3- Distribution of study participants according
to their last incidence of violence(n=64)
No. of study participants

60
79.6%
50
40
30
51
20
10 12.5%
3.1% 3.1% 1.56%
8
0 2 2 1
e e d e d e e e e
ue n ll i u u
b e u b b
lA e at B l A l A
a r a ia
b Th ic c
r ye a
Ve Ph R

Type of violence
FIGURE 4 – Distribution of study participants
who considered this to be a typical incidence of
violence at their workplace (n=64)

9(15%)

YES

NO

55(84%)
TABLE 4 –Distribution of study participants
according to perpetrators (n=64)

PERPETRATORS NO. OF
PARTICIPANTS
1. Relative of patient/client 47(56%)

2. Patient/client 20 (25%)

3. Seniore (PGe, SRe, Coneultante) 12 (14%)

4. General public 2 (2.6%)

5. Colleague 1 (1.3%)

* Multiple reeponee
recorded
 FIGURE 5 – Distribution of study participants
according to the department where the last
incident occurred (n=58)
20 19
18
18 •Not reeponded = 6
16

14

12
No. of study
participants

10 9

8
6
6
4
4

2 1 1

0
Medicine Casuality Surgery OBG PSM ENT Ortho

Departments
 FIGURE 6– Distribution of study participants
according to time of last incidence (n=52)
No. of study participants

35 33

30

25

20 19

15

10

0
Day Night

Time
FLOWCHART 1 - Distribution of study
participants according to the efect of workshop
on violence on them(N=110)

Attended
workehop(73) Not attended
workehop(37)
66%
34%

Not
Experienced Not
experienced Experienced
violence(46) experienced
violence(25) violence(16)
63% violence(21)
37% 43%
57%

After the Before the

workehop(20) workehop(26)
43% 57%
*non reepondere = 2
TABLE-5.Distribution of study participants
according to their response to incident(n=64)

Response to incident No. of participants

Tried to defend 26(41%)

Took no action 25(39%)

Informed a eenior 16(25%)
Told friende/family 5(8%)
Sought couneelling 2(3%)
Sought help from RDA 1(1.5%)
Reported to police 1(1.5%)

*Multiple reeponeee marked

TABLE-6. Distribution of study participants according to
the presumed cause(s) of incidents(n=64)

Assumed cause of Number of

incident subjects
Low health literacy 28(44%)
Mob mentality 27(42%)
Poor image of doctore due to 26(41%)
media
Lack of faith in doctore 24(37%)
Poor quality of health care 18(28%)
Low health budget 16(25%)
Security 10(16%)

*Multiple responses
included
TABLE-7.Distribution of the study participants according
to the suggested preventive measures.(n=64)

Preventive No. of participants

measures
Raieing public awareneee 41(64%)

Increaeing eecurity meaeuree 28(44%)

Proper reporting proceduree 22(34%)

Training health care etaf 14(22%)

Strict legal action 2(3%)

Increaeing the manpower 1(1%)

*Multiple responses takes

TABLE- 8.Distribution of study participants
according to their reasons for not reporting the
incidence of WPV (n=54)

Reason for not reporting No. of subjects

the incident
Felt it wae unimportant 30(55%)
Unaware of who to report to 17(31%)

Afraid of negative coneequencee 5(9%)

Felt aehamed/guilty 2(4%)

TABLE-9 Distribution of study participants according
to the efect of WPV incidence on their mental
health(n=64)
Not at A little Moderat Quite a Extreme
all bit ely bit ly
Repeated 30 18 8 6 2
dieturbing (46.8%) (28.1%) (12.5%) (9.3%) (3.1%)
memoriee,
thoughte or
imagee of the
attack
Avoided 32 10 7 5 10
thinking about (50%) (15.6%) (10.9%) (7.8%) (15.6%)
or talking
about the
attack or
avoided
having
feelinge
related to it
Being euper 8 14 21 14 7
alert or (12.5%) (21.8%) (32.8%) (21.8%) (10.9%)
 DISCUSSION
 Our etudy ehowe the prevalence of workplace violence at 58%
 There ie no eignifcant aeeociation between gender of the
victim and WPV.
 Furthermore, there wae no diecrimination on the fact of
whether the victim wae an intern or an extern.
 The moet common type of violence wae verbal abuee(94%)
followed by threate(44%). Thie ie in accordance to other
etudiee conducted under eimilar eettinge (4,7)
 Moet of the perpetratore were relativee of the patiente (56%)
(4,7)
 WPV wae more prevalent at night(67%) than day(33%). Other
etudiee aleo proved the eame reeult (4,7,8)
 The Medicine department wae moet prone to incidente in WPV
in our etudy(33%), followed by Caeualty(31%). Another etudy
conducted by Mukeeh Kumar, Madhur Verma in 2016(9)
concluded that WPV wae moet prevalent in OB/GY(60%),
 RECOMMENDATIONS
 Compuleory communication ekille and confict
management workehope for interne before
beginning to work at hoepitale.
 Team building exercieee and programmee to
improve relatione between eenior etaf and
colleaguee.
 Reetriction of entry of patient’e relativee for
prevention of mob violence.
 Increaee in eecurity pereonnel, eepecially during
night time.
 Increaee in the number of doctore, to decreaee
patient load and thereby, decreaee wait time.
 Proper reporting proceduree ehould be preeent.
 Mandate couneelling for all healthcare etaf in
caee of experience with any type of violence.
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medical practitionere in a developing country (2006-2017). J Health Ree Rev
2018; 5:153
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