Radiography 30 (2024) 440e447

Contents lists available at ScienceDirect

Radiography
journal homepage: www.elsevier.com/locate/radi

Systematic Review

Workplace violence in medical radiation science: A systematic review

K.A. Shah a, C.K.C. Ng a, b, *
a
Curtin Medical School, Curtin University, GPO Box U1987, Perth, Western Australia 6845, Australia
b
Curtin Health Innovation Research Institute (CHIRI), Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, Western Australia 6845, Australia

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/).

Introduction travelling to and from workplace, and implicit or explicit conflict

affecting their health, safety or wellness.1 Common examples of
According to World Health Organization (WHO), workplace WPV in healthcare include aggression, bullying, physical assault,
violence (WPV) is a significant issue in healthcare. WPV can be sexual harassment, and verbal abuse and threats initiated by per-
defined as healthcare workers being abused, assaulted or threat- petrators such as patients, visitors and co-workers. Affected
ened in work-related events which include but are not limited to healthcare workers can experience from unnoticeable effects to
fatality. Usually, these WPV incidents result in healthcare worker
burnout, sleep disorder and stress, leading to reduction of their
* Corresponding author. Curtin Medical School, Curtin University, GPO Box work performance as well as commitment and satisfaction. Hence,
U1987, Perth, Western Australia 6845, Australia. the WPV not only affects individual healthcare workers but also
E-mail addresses: [email protected], [email protected] impacts on healthcare quality which in turn becomes academic,
(C.K.C. Ng).

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

clinical, professional, ethical, societal, political and government Article selection

concerns.1e5
As a result of its significance, a number of systematic reviews Two reviewers (KAS and CKCN) independently selected the ar-
about the WPV in healthcare have been published.2e5 According to ticles with any discrepancy resolved through discussion.3,5 Only
an umbrella review of meta-analyses covering 674,266 healthcare peer-reviewed original research papers written in English and
workers published in 2022, overall WPV prevalence was 58.7 % and focused on the WPV in any settings of MRS (against diagnostic
commonest incidents were verbal abuse and threats (66.8 %), radiographers, NMTs, medical sonographers and radiation thera-
physical assault (20.8 %) and sexual harassment (10.5 %), respec- pists) were included. Grey literature, conference abstracts, edito-
tively.2 These findings are consistent with those of a previous sys- rials, review, perspective, opinion, commentary, and non-peer-
tematic review and meta-analysis covering 331,544 healthcare reviewed articles were excluded. This is because well-developed
workers published in 2019 (overall prevalence: 61.9 %, verbal methodological guidelines for appropriate selection of the grey
abuse: 57.6 %, physical violence: 24.4 %, and sexual harassment: literature were unavailable. Also, complete study information was
12.4 %). However, it also highlighted that different countries and not given in the conference abstracts. The editorials, review,
professions had variations of the WPV prevalence.3 Hence, there perspective, opinion, and commentary papers only provided sec-
are some literature reviews focussed on specific countries or re- ondary information. Unsubstantiated information was presented in
gions, e.g. Africa,6 Italy,7 South-East Asian and Western Pacific Re- the non-peer-reviewed papers.11,25e27
gions,8 etc. and professions such as emergency medical services The article selection process is shown in Fig. 1. After duplicate
(EMS),9 nursing8 and pharmacy.10 articles were removed from the results of the database search,
To the best of our knowledge, no systematic review on WPV in article titles, abstracts and full texts were assessed against the se-
medical radiation science (MRS) has been published yet. However, lection criteria subsequently. Each non-duplicate paper within the
MRS is an indispensable part of modern healthcare.11 Medical ra- search results was kept unless a decision on its removal could be
diation practitioners (MRPs) including diagnostic radiographers, made. Additional, relevant papers were identified by checking
nuclear medicine technologists (NMTs), medical sonographers and references lists of the included articles.11,25e27
radiation therapists work in various clinical areas such as radiology,
nuclear medicine, emergency and radiation oncology departments, Data extraction
intensive care units and operating theatres.12e23 As per the previ-
ous systematic reviews in healthcare, various clinical settings Two systematic and one scoping reviews on the WPV in
would have different risk levels. Common high risk areas that are healthcare were used to devise a data extraction form (Table 1).4,6,7
related to MRS practice include emergency department (ED), eve- The data, namely author name and country, publication year, MRS
ning shift work, and waiting room.3e5 Although International La- division (diagnostic radiography, medical sonography, nuclear
bour Office (ILO)/International Council of Nurses (ICN)/WHO/Public medicine or radiation therapy), study purpose and design, sample
Services International (PSI) framework guidelines have provided size and characteristics, and key findings, were extracted from the
suggested strategies to reduce the WPV in healthcare,1 without included papers.
understanding of the WPV prevalence and risk factors in MRS,
effective strategies for reducing the incidents of WPV in this pro- Data synthesis
fession could not be determined.2,3 Hence, it is timely to conduct a
systematic review on the WPV in MRS. The purpose of this sys- To facilitate comparisons of the WPV prevalence and relative
tematic review is to explore the published papers to answer the importance of individual risk factors across the included studies,
question “What was the prevalence of WPV in MRS and its risk their reported absolute figures of findings were used to synthesize
factors?” respective percentages (if not stated) as per the PRISMA guide-
lines.24 Quality assessment tool for studies with diverse designs
(QATSDD) was used to determine quality percentage of each article
Methods with <50 %, 50e70 % and >70 % representing low, moderate and
high study quality, respectively.11,25,27,28 The study quality per-
Preferred reporting items for systematic reviews and meta- centages are presented in Table 1 as well.
analyses (PRISMA) guidelines were used for conducting this sys-
tematic review on the WPV in MRS.24 Several major processes, Results
namely literature search, article selection, and data extraction and
synthesis, were involved.11,25e27 Twelve papers which met the selection criteria were included
in this review. Table 1 shows the characteristics of these stud-
ies.12e23 All but one study investigated the prevalence of WPV
Literature search with the use of questionnaire,12,13,15e23 and the only exception
focused on the risk factors of WPV determined through a quali-
The electronic scholarly publication databases, namely EBSCO- tative approach (interview).14 Nonetheless, the WPV risk factors
host/Cumulative Index of Nursing and Allied Health Literature were also covered in all survey studies except the one by Trad
(CINAHL) Ultimate, PubMed/Medline, ScienceDirect, Scopus, and and Johnson.12,13,15e23 The included studies were mainly about
Wiley Online Library, were used for literature search on 21st April the WPV situations in Africa (n ¼ 4),13e15,18 and North America
2023 to identify papers about the WPV in MRS published over the (n ¼ 4).12,19,21,23 A quarter of them focused on the United States of
last 10 years. The search statement, (“Workplace Violence” OR America (USA) situation.12,21,23 Two thirds of the included studies
“Bullying” OR “Harassment”) AND (“Radiographer” OR “Radiation were published from 2019, indicating an increase of researchers'
Therapist” OR “Nuclear Medicine Technologist” OR “Sonographer”) attention to the WPV issue recently.12e16,18,20,23 Also, two thirds
was used. The publication year range was used for ensuring find- of them focussed on diagnostic radiography12e15,17,18,20,22 with
ings of this review relevant to current situation.4,5 The search the others about radiation therapy,19,21 medical sonography,16
keywords were based on the review focus and the previous sys- and nuclear medicine,23 reflecting the typical characteristics of
tematic reviews in healthcare.2,3 MRS.
441
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.

The overall WPV prevalence in diagnostic radiography was Discussion

69.2e100 % for radiographers' whole career12,15,18,20 while it was
46.1e83.0 % for last 12 months.13,17,22 For radiation therapy, WPV prevalence
63.0e84.0 % of respondents experienced WPV in their career.19,21
Similar prevalence percentages are noted in the medical sonogra- To the best of our knowledge, this is the first systematic re-
phy (57.6 % in last 12 months)16 and nuclear medicine studies view on the WPV in MRS. When compared with the overall
(46.8 % in last 6 months).23 The prevalence of common WPV types prevalence figures from the two systematic reviews on the WPV
were verbal abuse and threats (32.0e100 %),12,13,15e20,22,23 sexual in healthcare published in 2022 (58.7 %)2 and 2019 (61.9 %),3 the
harassment (10.3e84.6 %),12,15,19,22 and physical assault WPV prevalence in diagnostic radiography (69.2e100 %) and
(3.0e51.0 %).12,13,15e19,22 The WPV risk factors identified by the radiation therapy (63.0e84.0 %) reported by the included studies
highest proportions of studies' participants included intoxicated seems concerning.12,15,18e21 Although the WPV prevalence range
patients (100 %),15 staff stress (80.0 %), feeling of inadequacy for diagnostic radiography over the last 12 months (46.1e83.0 %)
resulting in self-protection (80.0 %),17 more vulnerable MRPs (less was lower and more comparable to those figures for healthcare
than 40 years old [77.3 %]20 and female [68.9 %]),23 working in ra- in general, the WPV prevalence for diagnostic radiographers'
diation therapy treatment room (68.0 %),19 long patient waiting whole career should not be ignored because the aforementioned
time (61.5 %),15 working in ED (56.5 %), examination room (54.1 %), systematic reviews combined the prevalence figures for the 12-
and general radiography (46.8 %),22 less than 5-year work experi- month and whole career periods from individual studies to
ence (46.4 %), night shift (43.6 %),20 working in public hospital determine the overall WPV prevalence in
(39.4 %),16 overcrowding environment (30.8 %),15 working in non- healthcare.2,3,12,13,15,17,18,20,22 Usually, the literature including ILO/
examination and waiting area (23.9 %),22 unable to meet pa- ICN/WHO/PSI framework guidelines for addressing WPV in the
tients'/family members' expectations (23.1 %),15 miscommunication health sector indicates that nurses encounter WPV more
(21.0 %),22 patient handling (14.0 %),18 inadequate staff (14.0 %),22 frequently than other healthcare professionals.1,3,5,8 As per the
inadequate security measures (12.6 %),20 interaction with col- ILO/ICN/WHO/PSI framework guidelines, both nurses and EMS
leagues (12.0 %),18 and lone working (11.8 %).22 Although the major responders are classified as extremely high risk professions with
focus of all included studies was the WPV prevalence and/or risk regard to the WPV.1 However, Varghese et al.'s systematic review
factors, some reported the WPV impacts such as more irritable on the WPV in nursing which covered 13 countries with 42,222
(65.0 %), difficult to concentrate (63.0 %),21 affecting patient care participants published in 2022 showed that the overall preva-
(57.3 %),23 more forgetful (46.1 %),21 anxiety and stress (26.4 %), lence was only 58 %,8 matching the figures for the whole
work motivation reduction (25.2 %), lower energy level (21.0 %),22 healthcare sector reported by Sahebi et al.2 (58.7 %) and Liu et al.
and decrease of self-worth (24.5 %),21 and coping strategies, e.g., (61.9 %).3 It is well known that nursing is the largest healthcare
nothing (72.7 %),15 experience sharing with colleagues and family workforce.29e31 Hence, the figures of WPV prevalence in
members (27.3 %),15 calming down perpetrators (19.1 %), seeking healthcare would be more representative for this profession.2,3
help from colleagues (13.6 %), self-defence (12.7 %), being angry Nonetheless, the overall WPV prevalence in diagnostic radiog-
(12.7 %), and legal action (9.1 %) as well.20 raphy (69.2e100 %) and radiation therapy (63.0e84.0 %) appears
For the quality of included studies, all but two were at least more similar to the one reported in a systematic review on the
moderate.12e23 Excluding the qualitative study by Chinene et al.,14 WPV in EMS (57.0e93.0 %) published in 2020 which covered 104
their sample sizes ranged between 13 and 870 with the median articles.9 Based on the ILO/ICN/WHO/PSI framework guidelines,
size of 100.12,13,15e23 Also, a wide range of response rate, 1.9e100 % the WPV risk in diagnostic radiography and radiation therapy
is noted.12,13,15,17e23 should be considered extremely high.1

442
 Table 1

K.A. Shah and C.K.C. Ng

Characteristics of workplace violence (WPV) studies in medical radiation science (MRS).

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 %)

Radiography 30 (2024) 440e447

LloydeJones et al. Medical sonography Determination of - Prospective 33 out of all Australasian - 57.6 % experienced WPV in last 12 months High (71.4 %)
(2021)-Australia16 prevalence of WPV - Cross-sectional Sonographers Association - Prevalence of WPV types: verbal abuse
- Questionnaire (unvalidated members (57.6 %), threatening behaviour (21.2 %), and
and without piloting but physical violence (3 %)
based on established - Risk factors: work environment (public
questionnaire) hospital) (39.4 %), >20-year experience
(24.2 %), and 25e34 years old (15.2 %)
Nyhsen et al. (2016)- Diagnostic radiography Determination of - Prospective - 44 and 5 out of 51 general - 57 % experienced WPV initiated by junior Low (45.2 %)
United Kingdom17 prevalence of WPV - Cross-sectional and 7 CT radiographers of 1 doctors in last 12 months
(continued on next page)
 Table 1 (continued )

K.A. Shah and C.K.C. Ng

Author, year and MRS division Study purpose Study design Sample size and characteristics Key findings Quality
country

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 %],

Radiography 30 (2024) 440e447

therapy with piloting) examination room [54.1 %], general
radiography [46.8 %], location other than
examination room and waiting area [23.9 %],
and waiting area [19.6 %]), long patient
waiting time (21.6 %), miscommunication
(21.0 %), influence of alcohol (19.7 %), lack of
staff (14.0 %), and lone working (11.8 %)
- Impacts: anxiety and stress (26.4 %), work
motivation reduction (25.2 %), and lower
energy level (21.0 %)
K.A. Shah and C.K.C. Ng Radiography 30 (2024) 440e447

Common WPV types

The most common WPV type noted in the included studies was
High (76.2 %)

verbal abuse and threats,12,13,15e20,22,23 which is consistent with the

findings from the systematics reviews in healthcare and
nursing.2,3,8 However, sexual harassment and physical assault were
the second and third commonest WPV types in MRS.12,13,15e19,22 In
- Prevalence of WPV types: ignorance (61.2 %),

- Risk factors: female (68.9 %), position (NMTs

- Impacts: affecting patient care (57.3 %) and

- WPV policy awareness: NMTs (38.0 %) and

performance (57.2 %), highlighting mistakes/

contrast, an opposite order of these two types is found in the whole

roles such as students [59.9 %]), and 36e45
(53.1 %), constant criticism (50.1 %), hostile
response (47.1 %), insult (46.6 %), and loud

more likely to experience WPV than other

healthcare and nursing sectors.2,3,8 This could be attributed to

- 46.8 % experienced WPV in last 6 months

errors (57.0 %), rumour/gossip spreading

lower awareness of sexual harassment of MRPs and perpetrators,

information withholding for affecting

resulting in more incidents in MRS.15 Table 1 shows that four

studies investigated the impacts of WPV on radiographers, NMTs
and radiation therapists. All of them belong to psychological
impacts,19,21e23 and also match those stated in the systematic re-
verbal abuse (42.3 %)

views on the WPV in healthcare, EMS, nursing and pharmacy

attention (39.6 %)
years old (55.7 %)

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

ciated with intoxication.33e35 Hence, our findings of working with

- Response rate: 4.3 %

intoxicated patients as the most important WPV risk factor in MRS

(NMTs) in USA

appear in line with the aforementioned literature reviews that

working in ED and with patients having mental health conditions
being the major risk factors.3e8 Nonetheless, every WPV risk factor
listed in Table 1 should not be ignored because the ILO/ICN/WHO/
PSI indicated that the WPV has already spread from ED to all other
areas of healthcare institutions. Also, all risk factors identified in
- Questionnaire (unvalidated

questionnaire with piloting)

this review are covered in their framework guidelines for

addressing WPV in the health sector.1
but based on established

WPV coping strategies

- Cross-sectional
- Prospective

For the WPV coping strategies, only two included studies

investigated these.15,20 The most common coping strategy was
CT, computed tomography; ED, emergency department; MRI, magnetic resonance imaging.

doing nothing which is concerning.15 However, several systematic

reviews on the WPV in healthcare, nursing and EMS showed that
not reporting WPV incidents was common.6,8,9 This could be
prevalence of WPV and

attributed to the general perception of healthcare professionals

that the WPV is an inherent element of healthcare and such inci-
awareness of WPV
Determination of

risk factors, and

dent reporting can imply their lack of competence in delivering

patient care and performing routine duties.9 Such phenomenon is
also consistent with the findings of Youngblood's study that only
policy

about one third of their NMTs aware of existence of WPV policy in

the clinical workplace.23 Similarly, less than 30 % of participants of
Hattingh et al.'s15 and Tohidnia et al.'s20 studies were able to apply
appropriate strategies such as experience sharing with colleagues
and family members, calming down perpetrators, seeking help
Nuclear medicine

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)-

1. Intoxicated patients, working in radiation therapy treatment

room, ED, examination room, general radiography, public hos-
pital, non-examination and waiting areas, patient handling, and
USA23

inadequate security measures: Provision of security services at

departments' main entrances, multiple area accesses for staff
but limiting public access and separate area for managing
445
K.A. Shah and C.K.C. Ng Radiography 30 (2024) 440e447

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,
etc.). References
4. More vulnerable MRPs (female, <40-year-old and <5-year
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