الفهرس 
Introduction and Aim of the WorkOnly 14 pages are availabe for public view
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Abstract
Workplace violence is a frequently encountered issue in the healthcare industry. There are various types of occupational violence, the most faced form is verbal aggression, followed by physical, and sexual.
The objective of this study was to determine the prevalence of violence against HCWs in different health sectors in the Arab region, and to identify the causes of violence against HCWs and to determine the impact of violence on work performance and quality of care provided to patients.
The current study employed a systematic review and meta-analysis design, a search of all relevant studies was done using four databases, namely PubMed, Google Scholar, Scopus, and Web of Science, from the period between 2006 to 2021. The search yielded a total of 4209 studies (179 from PubMed, 525 from Google Scholar, 3097 from Scopus and 408 from Web of science). The analysis was done on 78 studies that met the inclusion criteria.
Prevalence of violence exposure among healthcare workers varies according to type of violence, work setting, provider’s profession, and personal characteristics such as age, sex, experience, and specialty. A considerable variation was reported by studies conducted in the Arab region, where the prevalence of violence was estimated to range between 60% and 99% percent reflecting an incredibly wide interval.
Underreporting is a major contributor to the underestimation of the occupational violence problem. It is estimated by the literature that more than 80% of incidents are unreported. Violent incidents are often dismissed by health professionals on the basis of being “part of the job”. Other attributing factors are the vague, time consuming and complicated reporting procedures.
Certain settings raise the risk for violence exposure such as: working in rural areas, in the public sector, in specific hospital departments such as Mental Health units, Emergency Departments, Geriatric Units, and Outpatient clinics.
Reasons for violence initiation were identified by many studies. One of the most mentioned causes is prolonged waiting time, followed by staff insufficiency, miscommunication, failure to meet patient’s needs, absent security, and overcrowding.
The impact of occupational violence on providers’ health has been discussed by a few studies, including elevated burnout levels, job dissatisfaction, absenteeism, and job turnover. Workplace violence has also been linked to some psychological disorders such as post traumatic stress disorder, anxiety, depression, and sleep disturbances.
The most prevalent type of violence is verbal violence including swears, insults, and threats. The prevalence of verbal violence was estimated to be around 40% globally, and 65% regionally. The second most prevalent type of violence is physical aggression, its reported global figures were about 25%, while regionally it was found to be 20%. The least common type of violence is sexual violence, which reported prevalence worldwide was 14%, while that estimated regionally is 10%.
Risk factors for violence exposure have been identified by the literature and studied repeatedly, however some major discrepancies were noted in the literature. Combining the results of several studies highlighted some of the most important factors that are frequently discussed and reported. Age is one of the most influencing factors, where providers of younger age group were reported to have higher odds of violence compared to their older counterparts. As for gender, males are found to be more exposed to violence than females. Working in the public sector posed a significantly higher risk for its employees compared to the private sector. Emergency department workers suffered higher odds of violence exposure compared to all other departments. Also, working night shifts exposed workers to higher odds of violence compared to morning shifts.
Regarding the impact of violence experience on healthcare worker’s burnout levels, the odds of suffering high levels of emotional exhaustion were three times as high in those experiencing workplace violence. Similarly, workers were more than three and a half times more likely to have higher levels of depersonalization after exposure to violence. Moreover, workers exposed to violence had 20% decrease in the levels of self-efficacy compared to unexposed.
Another important impact identified by studies was the negative effect on work performance, where a moderate proportion of HCWs, around 20% of HCWs reported that their work performance was negatively affected by occupational violence.