1 s2.0 S1078817423002584 Main
1 s2.0 S1078817423002584 Main
1 s2.0 S1078817423002584 Main
Radiography
journal homepage: www.elsevier.com/locate/radi
Systematic Review
a r t i c l e i n f o a b s t r a c t
Article history: Introduction: According to World Health Organization (WHO), workplace violence (WPV) is a significant
Received 18 August 2023 issue in healthcare. However, no systematic review on WPV in medical radiation science (MRS) has been
Received in revised form published yet. The purpose of this paper is to systematically review prevalence of WPV in MRS and its
7 December 2023
risk factors.
Accepted 27 December 2023
Available online 9 January 2024
Methods: Electronic scholarly publication databases, namely EBSCOhost/Cumulative Index of Nursing
and Allied Health Literature Ultimate, PubMed/Medline, ScienceDirect, Scopus, and Wiley Online Library
were used for literature search to identify articles about WPV in MRS published over last 10 years as per
Keywords:
Bullying
preferred reporting items for systematic reviews and meta-analyses guidelines. To facilitate comparisons
Harassment of the WPV prevalence and relative importance of individual risk factors across the included studies,
Medical sonography their reported absolute figures of findings were used to synthesize respective percentages (if not stated).
Nuclear medicine Results: Twelve papers met the selection criteria and were included. This review shows that the WPV
Radiation therapy prevalence were 69.2e100 % (whole career) and 46.1e83.0 % (last 12 months) in diagnostic radiography,
Radiography 63.0e84.0 % (whole career) in radiation therapy, 57.6 % in medical sonography (last 12 months), and
46.8 % (last 6 months) in nuclear medicine. The identified WPV risk factors included intoxicated patients,
staff stress, feeling of inadequacy resulting in self-protection, more vulnerable practitioners (female, <40
years old and <5-year experience), working in radiation therapy treatment room, emergency depart-
ment, examination room, general radiography, public hospital, and non-examination and waiting areas,
long patient waiting time, night shift, overcrowding environment, unable to meet patients'/family
members' expectations, miscommunication, patient handling, inadequate staff and security measures,
interaction with colleagues, and lone working.
Conclusion: The WPV risk in diagnostic radiography and radiation therapy appears extremely high as a
result of the aforementioned risk factors. Nevertheless, these study findings should be used with caution
due to potential non-response bias.
Implications for practice: A WPV policy should be developed in every clinical workplace. Even if such
policy is available, its enforcement including policy awareness boosting, and encouraging incident
reporting and support seeking will be essential for reducing WPV. More survey studies based on WHO
WPV questionnaire should be conducted for strengthening evidence base.
© 2023 The Author(s). Published by Elsevier Ltd on behalf of The College of Radiographers. This is an
open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
https://doi.org/10.1016/j.radi.2023.12.018
1078-8174/© 2023 The Author(s). Published by Elsevier Ltd on behalf of The College of Radiographers. This is an open access article under the CC BY license (http://
creativecommons.org/licenses/by/4.0/).
K.A. Shah and C.K.C. Ng Radiography 30 (2024) 440e447
Figure 1. PRISMA flow diagram for systematic review of workplace violence in medical radiation science.
442
Table 1
Author, year and MRS division Study purpose Study design Sample size and characteristics Key findings Quality
country
Beam et al. (2022)- Diagnostic radiography Determination of - Prospective - 193 out of 10,000 randomly - 69.2 % experienced WPV in their career High (71.4 %)
United States of prevalence of WPV - Cross-sectional selected radiographers in - Prevalence of WPV types: verbal intimidation
American (USA)12 - Questionnaire (unvalidated, USA by patients (68 %) and physicians (60 %),
not based on literature but - Response rate: 1.9 % insulted by visitors (56 %), sexual harassment
with piloting) by patients (55 %), and verbally intimated by
visitors (54 %), physical assault by patients
(51 %), and threat by patients (47 %)
- Risk factor: work environment (increased
chance of insult by visitors in CT, adult ED
and MRI)
Chinene et al. (2022)- Mainly diagnostic Determination of risk - Prospective - 100 out of 110 randomly - 83 % experienced WPV in last 12 months Moderate (64.3 %)
Zimbabwe13 radiography but also factors of WPV - Cross-sectional selected radiographers of 3 - Prevalence of WPV types: verbal abuse (81 %),
covering medical - Questionnaire (unvalidated central hospitals in sexual abuse (21 %), and physical abuse (4 %)
sonography, nuclear but based on established Zimbabwe - Risk factors (scale 1e5): poor working
medicine, and radiation scale and literature with - Response rate: 91 % conditions leading to frustration (x: 3.93),
therapy piloting) long patient waiting time (x: 3.91), power
imbalance (x: 3.87), burnout/fatigue (x: 3.79),
narcissism (x: 3.79), communication style
difference (x: 3.68), opinion difference (x:
3.59), personal/family issues (x: 3.57),
inadequacy feeling leading to self-protection
(x: 3.42); poor workplace culture (x: 3.38)
and bias caused by culture/generation/gender
difference (x: 3.32)
Chinene et al. (2022)- Diagnostic radiography Determination of risk - Prospective 11 radiography managers Risk factors: work environment (lack of High (76.2 %)
443
Zimbabwe14 factors of WPV - Exploratory qualitative purposively selected from 3 leadership trust, radiographers' burnout/fatigue
- Individual semi-structured hospitals in Zimbabwe and low salary), power hierarchy (feeling of
interview (guide based on superiority, inappropriate professional
literature with piloting) boundary crossing and inadequate
radiographer representation in healthcare), and
lack of reporting framework (protocol and
culture)
Hattingh et al. (2019)- Diagnostic radiography Determination of - Prospective 13 out of 15 (all) night shift - 100 % experienced WPV in their career Low (42.9 %)
Namibia15 prevalence of WPV and - Cross-sectional radiographers of 1 state - Prevalence of WPV types: verbal abuse
coping strategies - Questionnaire (unvalidated, radiology department in (100 %) and threats (84.6 %), sexual
not based on literature but Namibia harassment (84.6 %), and physical assault
with piloting) - Response rate: 86.7 % (46.2 %)
- Risk factors: patients with intoxication
(100 %), long patient waiting time (61.5 %),
overcrowding environment (30.8 %) and
unable to meet expectations of patients/
family members (23.1 %)
- Coping strategies: Nothing (72.7 %), and
experience sharing with colleagues and
family members (27.3 %)
initiated by junior - Questionnaire (unvalidated large acute hospital in United - Prevalence of WPV types: loud verbal abuse
doctors and without piloting but Kingdom, respectively (57 %), verbal threat (51 %) and bullying
based on established - Response rate: 84.5 % (45 %), and physical threat (8 %)
questionnaire) - Risk factors: stress (80 %) and inadequacy
feeling leading to self-protection (80 %)
Sethole et al. (2019)- Diagnostic radiography Determination of - Prospective - 37 of 65 (all) radiographers of - 73 % experienced WPV in the career Moderate (68.3 %)
South Africa18 prevalence of WPV - Cross-sectional 2 tertiary public hospitals in - Prevalence of WPV types: verbal abuse (73 %),
- Questionnaire (unvalidated South Africa emotional abuse (46 %) and physical abuse
but based on established - Response rate: 57 % (27 %)
questionnaire with piloting) - Risk factors: patient handling for physical
abuse (14 %), and interaction with co-
workers for verbal (12 %) and emotional
abuse (10 %)
Sperduti et al. (2018)- Radiation therapy Determination of - Prospective - 78 out of 165 (all) radiation - 84 % experienced WPV in the career High (76.2 %)
Canada19 prevalence of WPV, risk - Cross-sectional therapists of 1 urban cancer - Prevalence of WPV types: verbal abuse (76 %),
factors and impacts - Questionnaire (unvalidated centre in Canada harassment (59 %), verbal threat (32 %), and
but based on established - Response rate: 47 % physical threatening (23 %) and assault (6 %)
questionnaire with piloting) - Risk factors: work environment (treatment
[68 %] and waiting areas [22 %])
- Impacts: anger, anxiety, depression, difficult
to concentrate and sleep, fatigue, fear,
flashback, frustration, headache, irritability,
low self-esteem, nightmare, sadness, shame,
and stress
Tohidnia et al. (2019)- Diagnostic radiography Determination of - Prospective - All (121) radiographers of 1 - 72.7 % experienced WPV in the career Moderate (61.9 %)
Iran20 prevalence of WPV and - Cross-sectional Iranian university's radiology - Common WPV type: verbal violence (77.3 %)
444
risk factors - Questionnaire (validated and department - Risk factors: <40 years old (77.3 %), female
based on established - Response rate: 100 % (63.6 %), <5-year work experience (46.4 %),
questionnaire with piloting) night shift (43.6 %), residents (42.7 %), over-
crowding environment (21.0 %), inadequate
security measures (12.6 %) and staff (11.7 %)
- Coping strategies: calming down perpetrators
(19.1 %), seeking help from colleagues
(13.6 %), self-defence (12.7 %), being angry
(12.7 %), legal action (9.1 %), and experience
sharing with family (5.5 %)
Trad and Johnson Radiation therapy Determination of - Prospective - 308 out of 665 radiation - 63 % indicated WPV presented in current/ Moderate (66.7 %)
(2014)-USA21 prevalence of WPV and - Cross-sectional therapists of 48 radiation previous centres
impacts - Questionnaire (unvalidated therapy centres in USA - Impacts: more irritable (65.0 %), difficult to
but based on established - Response rate: 46 % concentrate (63 %), more forgetful (46.1 %),
questionnaire with piloting) and decrease of self-worth (24.5 %)
Tung et al. (2015)- Mainly diagnostic Determination of - Prospective - 542 out of 4953 - 46.1 % experienced WPV in last 12 months High (71.4 %)
Taiwan22 radiography but also prevalence of WPV and - Cross-sectional radiographers randomly - Prevalence of WPV types: verbal abuse
covering medical risk factors - Questionnaire (unvalidated selected in Taiwan (65.6 %), physical assault (21.8 %), and sexual
sonography, nuclear but based on established - Response rate: 10.9 % harassment (10.3 %)
medicine, and radiation questionnaire and literature - Risk factors: work environment (ED [56.5 %],
The most common WPV type noted in the included studies was
High (76.2 %)
students (25.0 %)
because the verbal abuse and threats were the most common WPV
type which could only cause the psychological impacts.3e10
According to a number of literature reviews on the WPV in
healthcare and nursing, they highlighted that working in ED and
with patients having mental health conditions were the major risk
factors of WPV.3e8 Although this review's findings reveal that
working with intoxicated patients was the most important WPV
- 870 out of 20,385 nuclear
risk factor in MRS,15 ED is the major clinical area for managing these
patients.32e34 Also, mental health conditions are commonly asso-
medicine technologists
from colleagues, self-defence, and legal action for coping with the
WPV in MRS.1
As per the ILO/ICN/WHO/PSI framework guidelines for
addressing WPV in the health sector, a range of strategies could be
applied for addressing the WPV risk factors identified in this review
as follows1:
Youngblood (2021)-
mentally unstable patients, and installation of video surveil- developed in every clinical workplace. Even if such policy is avail-
lance and alarm systems. able, its enforcement including policy awareness boosting, and
2. Staff stress and feeling of inadequacy resulting in self- encouraging incident reporting and support seeking will be
protection: Avoidance of staff overload, provision of support essential for reducing the WPV in MRS.
workers, sufficient rest period, time for problem solving, expe-
rience sharing and consultation, recreational area, quiet space, Conflict of interest statement
flexible work arrangement and regular work time schedule if
feasible. None.
3. Long patient waiting time, overcrowding environment, unable
to meet patients'/family members' expectations and miscom- Acknowledgement
munication: Improvement of patient flow and appointment
scheduling, and timely information and comfortable waiting This research did not receive any specific grant from funding
area provided to patients and their families (e.g., television, agencies in the public, commercial, or not-for-profit sectors.
newspapers, magazines, healthcare service brochures, toys,
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