565348

WHSXXX10.1177/2165079914565348Workplace Health & SafetyWorkplace Health & Safety research-article2015

vol. 63 ■ no. 1 Workplace HealtH & Safety

ARTICLE

Violence Against Nurses in Emergency

Departments in Jordan Nurses’ Perspective
Muhammad W. Darawad, rN, phD1, Mahmoud al-Hussami, rN, MpH, DSc, phD1, ali M. Saleh, rN, phD1, Waddah
Mohammad Mustafa, rN, phD1,2, and Haifa odeh, rN, MSN1

Abstract:
Violence against nurses in emergency
World Health Organization, 2005) that is more likely
to occur in departments (EDs) has become a widespread phenomenon
hospitals than in primary health care centers (Adib,
Al-Shatti, affecting nurses’ job satisfaction and work performance.
Kamal, El-Gerges, & Al-Raqem, 2002) and in EDs
and Literature is scarce regarding prevalence rates and causes
psychiatric units than other hospital units (Hesketh et
al., 2003). of violence directed toward nurses in Jordan. The present
Furthermore, violence and assault in hospital EDs is
one of the study investigated violence experienced by Jordanian nurses
most common occupational hazard for nursing
professionals in EDs and causes of violence from their perspectives. This
(Presley & Robinson, 2002). descriptive study
collected data from 174 Jordanian ED
Given that many incidents of violence against
nurses are nurses. The majority of the participants (91.4%) reported
unreported (Ergun & Karadakovan, 2005), it is
estimated that experiencing violence (verbal 95.3% vs. physical 23.3%).
35% to 80% of nurses have been assaulted physically
at least According to participants, the most common causes
once during their careers (Clements, DeRanieri, Clark,
Manno, & of violence in the ED were crowding and workload
Wolick Kuhn, 2005). The violence can be verbal,
physical, or (75.9%), and the least was care of patients with dementia
both. For instance, Celik, Celik, Agirbas, and
Ugurluoglu (2007) or Alzheimer’s disease (35.6%). Violence is common in
 reported that the prevalence rates of verbal and
physical Jordanian EDs, giving rise to many heath and behavioral
violence among Turkish nurses were reported to be
91.1% and consequences. Health care administrators are obligated to
33%, respectively. A previous Turkish study reported
a protect nurses from violent incidents by providing adequate
prevalence rate of 98.5% for verbal violence and
19.7% for safety measures, beneficial administrative procedures, and
physical violence (Ergun & Karadakovan, 2005). In
the United sincere efforts to overcome the causes of this phenomenon.
States, 25% of ED nurses reported experiencing physical violence more than 20 times in a 3-year period, and 20%
Keywords:
violence, emergency department, nurses, Jordan
reported experiencing verbal abuse more than 200 times during the same period (Gacki-Smith et al., 2009). In
Jordan, AbuAlRub The departments patients nature with of nurses’ (EDs) various includes work health in conditions
encountering hospital emergency
ranging a variety from of
mild
and Al-Asmar (2011) reported that 22.5% of Jordanian nurses experienced physical workplace violence and were
unsatisfied with the way incidents were handled.
Regarding the causes of violence, Gacki-Smith et
al. (2009) upper respiratory infections to life-threatening injuries and
reported crowdedness, long waiting times,
misconceptions of illnesses. Emergent patients might be accompanied by relatives
staff behaviors, perceiving staff as uncaring, holding
or boarding who have physical and emotional stress (Ergun & Karadakovan,
patients (in which patients who are classified as less
critical wait 2005). The emotional distress and prejudices of patients and
for longer time before being receiving care), nursing
shortage, their companions about emergency status can encourage them
and lack of strict visiting policy to be among the most
common to adopt an aggressive approach to staff. This approach has
causes of violence against ED nurses. Poor
communication, increased violence against nurses in EDs and has become a
including language barriers between nurses and
patients, along widespread phenomenon (Gillespie, Gates, & Berry, 2013;
with low opinions of the nursing profession were reported to
DOI: 10.1177/2165079914565348. From 1The University of Jordan and 2Al Farabi College. Address correspondence
to: Muhammad W. Darawad, RN, PhD, Associate Professor, Faculty of Nursing, The University of Jordan, Amman,
11942 Jordan; email: m.darawad@ju.edu.jo. For reprints and permissions queries, please visit SAGE’s Web site at
http://www.sagepub.com/journalsPermissions.nav. Copyright © 2015 The Author(s)
9
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10
January Workplace HealtH & Safety
2015 Applying Research to Practice Violence against nurses is common in hospital emergency departments. Such
incidents have both health and behavioral consequences for nurses. Healthcare administrators have the obligation to
eliminate violent incidents by providing adequate safety measures, beneficial administrative procedures, and sincere
efforts to overcome the causes of this phenomenon. Also, knowing that the perpetrators are almost always patients’
companions should encourage administrators to enact strict visiting policies. Further, the evening shift (3 p.m. to 11
p.m.) should be treated as high risk because most violent incidents occur during that shift. Finally, strict legislation
to protect nurses and punish perpetrators could prevent future violence against nurses in emergency departments.
be other possible causes of violence (Adib et al., 2002). Also, the incidence of physical abuse directed toward ED
nurses was found to be correlated with more years spent in the ED (Ergun & Karadakovan, 2005). Other factors
associated with workplace violence may include absence of effective legislation, inappropriate management of
violent incidents, limited resources, lack of cultural and social awareness, and inexperienced security staff
(AbuAlRub & Al-Asmar, 2011).
Increasing incidents of violence against nurses have negative effects on their job satisfaction and work
performance (Hesketh et al., 2003). According to Celik et al. (2007), verbal and physical violence against nurses can
have negative effects on their physical and mental health (e.g., headache), work (e.g., decreased productivity,
increased turnover intention), and social life (e.g., disrupted family life). Repeated disturbing memories and thoughts
of the attack, being “super-alert and on guard,” and feeling “everything to do is an effort” were among the
complaints of nurses who experienced these violent incidents (AbuAlRub & Al-Asmar, 2011). Furthermore,
violence negatively affects institutions by increasing turnover and decreasing quality of nursing care (Oweis &
Diabat, 2005).
Recently, Jordanian hospitals have witnessed an increasing number of violent incidents against nurses, some of
them lethal, which is consistent with the literature that demonstrates violence is present in almost every country.
However, literature is scarce regarding the prevalence and causes of both verbal and physical violence against nurses
in Jordan. This study investigated Jordanian nurses’ experience and perception of violence in Jordanian EDs. The
specific purposes of this study were to (a) determine the percentage of nurses who have experienced verbal and
physical violence while working in Jordanian EDs, (b) identify responses of these nurses, (c) determine the causes of
violence against ED nurses from nurses’ perspectives, (d) explore Jordanian nurses’ thoughts about violence and
legal procedures, and (e) identify differences in violence experience based on nurses’ demographic characteristics.

Method
A descriptive design using a self-reported cross-sectional survey was used to collect data from Jordanian ED
nurses between April and July 2013.
Setting and Population
According to the Ministry of Health (2010) Statistics, the Jordanian health care system is divided into
governmental, military, university, and private institutions. The government sector operates 27 hospitals, accounting
for 37% of all hospital bed capacity; the military sector operates 11 hospitals, providing 24% of all bed capacity;
university hospitals account for 3% of total bed capacity; and the private sector provides 36% of all hospital bed
capacity. Only those hospitals with more than 300 beds and large EDs were included in the study population, and
two hospitals within the study population in each sector were randomly selected from a list of sector-specific
hospitals.
Sample
To select participants for this study, the researchers first randomly selected participating hospitals from all
Jordanian hospitals stratified as governmental, university, and private hospitals using simple random sampling
techniques. Participants were recruited from the population of nurses who met the eligibility criteria. The eligible
nurses in this study included those who had earned a diploma (nursing assistant) or bachelor’s or master’s degrees
(registered nurse) in nursing, and worked in an ED for at least 3 months.
Instrument
Researchers used the questionnaire developed by Ergun and Karadakovan (2005) to measure study variables,
except for the causes of violence for which questions were adapted from Gacki-Smith et al. (2009). The study
survey had four parts; the first part measured the incidence of verbal (e.g., shouting, threatening) and physical (e.g.,
slapping, kicking) violence, and the conditions associated with those incidents (e.g., how many times, shift of
incidence, perpetrator identity); the second part explored responses of the affected nurses (e.g., sick leaves, incident
reporting); the third part assessed causes of violence against nurses from nurses’ perspectives; and the fourth part
assessed nurses’ beliefs about violence and legal procedures. Face and content validity were established by the
authors of the instruments. Participants’ demographics were gathered via a special data sheet developed by the
researchers and included participants’ ages, gender, marital status, titles, education levels, years of experience in
nursing and in ED, and training about violence management.
Ethical Considerations
This study was approved by the Scientific Research Committee at Faculty of Nursing, The University of Jordan,
and participating hospitals. Participation was voluntary and
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vol. 63 ■ no. 1 Workplace HealtH & Safety
anonymous (i.e., no personal identifiers were recorded). The researchers assigned nurses identification numbers
rather than using their names to access actual research data by the research team. Furthermore, detailed information
about the objectives of the study was provided to participants via the questionnaire cover letter; if the nurse agreed
to participate, returning the completed questionnaire was considered consent.
Data Collection Methods
A detailed explanation about the aims of and procedures for the study was given to nurse managers and charge
nurses on the participating units. A list of the estimated number of available nurses was prepared from the selected
hospitals 1 day before data collection. At the time of data collection, participants were personally interviewed and
invited to participate; those who agreed were given the questionnaire. Each questionnaire included a cover letter
explaining the study, its aims, and how to complete and return the survey. Self- completed questionnaires were
returned to the researchers in envelopes via special drop boxes. Participants completed the questionnaires during
their break times or at home.
Data Analysis
Descriptive statistics were used to describe participants’ characteristics and characterize the distribution of
variables. In addition, chi-square and point biserial correlations were calculated to test differences in violence
experience by participants’ demographics. All statistical procedures used the Statistical Package for the Social
Sciences Version 17 (SPSS Inc., Chicago, Illinois, the United States), and the significance level was set at p < .05
(two-tailed).
Results Sample Description
A total of 300 nurses were invited to participate in the study; 174 participated for a response rate of 58%. As
shown in Table 1, the mean age of the participants was 27.1 ± 4.4 years, 63.2% were single and 35.1% were
married, and 78.2% had earned a bachelor degree in nursing. Almost 80% of the participants had practiced in the ED
less than 5 years. Most of the nurses working in the EDs were anxious about potential verbal and/or physical
violence, 77% of respondents felt unsafe in the ED, and only 41.4% reported learning how to manage violence in the
workplace.
Violence Experience
When participants were asked about violence experience, the majority of them (91.4%) reported experiencing
workplace violence; 95.3% reported verbal violence compared with 23.3% reporting physical violence. Most of the
incidents occurred in the previous 3 months, which indicated that violence occurred frequently in the ED. Also,
more than half (50.3%) of the incidents occurred during the evening shift, and patients’
relatives or friends were commonly the perpetrators (51.1%). Finally, about half of the nurses (52.2%) reported
violence one to three times. Details of violence experiences are illustrated in Table 2.
Response to Violence
Regarding their response to violence, nurses reported the majority of these incidents (51.7%) via written formal
statements, and 69.5% of nurses reported satisfaction with the reporting procedures. Reasons given for not reporting
included legal procedures not accomplished (49.1%) and reports not considered (43.4%). Moreover, 69.8% of the
study participants reported taking sick leaves as a result of the inquiry.
Causes of Violence
Regarding the causes of violence reported by participants (Table 3), the most common cause of violence cited in
the ED was crowding/workload (75.9%), followed by shortages of both nursing and medical staff (69.5%).
However, the least common cause of violence in the ED was the care of patients with dementia or Alzheimer’s
disease (35.6%) and ED procedures (50%).
Nurses’ Thoughts About Violence and Legal Procedures
When asked about violence and legal procedures, the majority of nurses (64.4%) agreed they should be educated
about the prevention and management of assault as a part of in-service education. Although most of the participants
believed it was ethically appropriate (63.8%) and right (53.4%) for nurses to take legal action against patients or
relatives who physically assaulted them, the majority of the participants (66.1%) reported that they would not take
legal action if physically assaulted by a patient or a relative. Furthermore, most of the nurses (68.4%) did not believe
that being physically assaulted by patients or relatives affects nurses psychologically. However, more than half of
the nurses (50.6%) agreed that the same rights should apply to the patients and relatives if they experience similar
behaviors by nurses. Detailed responses about violence and legal procedures are shown in Table 4.
Differences in Violence Experience Based on Nurses’ Demographics
Chi square was used to examine the differences between nurses’ frequency of experiencing verbal violence
experiences by nurses’ gender, health care sector, marital status, educational level and career title. The results
showed a statistically significant difference in study settings, χ2(2) = 8.51, p < .05. However, the other demographic
characteristics showed no significant differences in the frequency of violence by gender, marital status, educational
level, or career title, χ2(1) = .013, p = .910; χ2(2) = 3.92, p = .141; χ2 (3) = 2.253, p = .324; χ2(1) = 1.730, p = .188,
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January Workplace HealtH & Safety
2015 Table 1. Demographical and Professional Characteristics of the Sample (N = 174)
Characteristics n (%) M (±SD)
Gender
Female 72 (41.4)
Male 102 (58.6)
Marital status
Single 110 (63.2)
Married 61 (35.1)
Other 3 (1.7)
Education
Diploma 34 (19.5)
Bachelor 136 (78.2)
Master 4 (2.3)
Staff training about the management of violence
Yes 72 (41.4)
No 102 (58.6)
Age 27.1 ± 4.4
ED experience 3.2 ± 2.7
Feel safe in ED
Yes 40 (23)
No 134 (77)
Note. ED = emergency department.
respectively (Table 5). Finally, a point biserial correlation between
The rate of physical violence found in this study
was close violence experienced and years of nursing experience,
to the rate (22.5%) reported in a previous Jordanian
study emergency experience, and age revealed a significant negative
(AbuAlRub & Al-Asmar, 2011), indicating that the
underlying relationship for all three variables (r = −.263, p = .000; r = −.218,
factors causing violence against nursing staff are still
prominent p = .004; r = −.203, p = .007, respectively).
in Jordan. Understanding the nature of work within Jordanian EDs could explain the rate of violence and the
similarity with Discussion
This study investigated the prevalence of violence against nursing staff in EDs in Jordan. The findings of this
study were similar to those reported in the literature. For instance, the rate of
the previous study. In general, Jordanian EDs are crowded and open; separate rooms are not used except in private
hospitals, with no limit on the number of visitors. In such units, it is easy to be influenced by noise and crowdedness
that lead to aggressive environments conducive to violence. Usually, patients violence was found to be 91.4%
(95.3% verbally, 23.3% physically).
are accompanied by many relatives, who do not want
to stay in The wide difference between verbal and physical violence could
the waiting rooms that are small and inconvenient;
little be attributed to most individuals expressing their anger verbally
information is conveyed to relatives regarding
patients’ rather than physically. These figures are close to those (98.5% and
conditions, which may lead to frustration and
aggressive 19.7%, respectively) reported by Turkish ED nursing staff (Ergun &
behaviors. No actual triage is used in Jordanian EDs,
and Karadakovan, 2005), which supports the international endemicity
patients are classified by type of service needed (e.g.,
medical, of this phenomenon (Gillespie et al., 2013).
surgical, pediatric, or gynecology). Finally, security guards are
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vol. 63 ■ no. 1 Workplace HealtH & Safety
hospital employees with no actual authority, and even they are sometimes victims of violence. Therefore, extra
efforts beyond these noted are needed to address this phenomenon, particularly modification of the entire Jordanian
ED structure.
Of concern are the findings that more than 50% of violent incidents took place during the evening shift, and
51.1% of the perpetrators were family members or friends. The same results were reported in other studies from
Jordan (AbuAlRub & Al-Asmar, 2011), Saudi Arabia (Almutairi, Alkhatib, Boran, & Mmbarak, 2013), and Turkey
(Ergun & Karadakovan, 2005). Such findings could result from high workloads during the evening shift compared
with other shifts, which indicate that nursing ED managers must pay special attention to assigning more nurses to
the evening shift, and nurses and security guards working the evening shift must be more cautious while
on duty. However, the risk of violence directed toward
ED Table 2. Details of Violence Experience
nurses is expected to negatively affect nurses’ organizational
n (%)
commitment and turnover intention (Al-Hussami, Darawad, Saleh, & Hayajneh, 2013). Violence experienced during
career
Many family members or friends accompanying patients in the ED, which can produce an aggressive volatile
environment, Yes 159 (91.4)
is a characteristic of Jordanian culture. Knowing that most
No 14 (8.6)
Jordanian EDs are open to the public explains why family members and friends are frequent perpetrators of
violence. Number of violent incidents
Similar results were found in previous studies in Jordan (Ahmad,
1-3 times 83 (52.2)
2012), Turkey (Celik et al., 2007), and the United States (Nachreiner et al., 2007). Therefore, the security
infrastructure 4-9 times 43 (27.0)
(e.g., doors, receiving system, and security guards) must be
10-15 times 12 (7.5)
reconstructed to overcome this problem.
It was noteworthy that high rates of experienced violence
>16 times 21 (13.2)
caused 30.2% of study nurses to take sick leaves. Knowing that Turkish ED nurses reporting no sick leaves after
experiencing Most recent incident
violence (Ergun & Karadakovan, 2005) may indicate the severity
0-3 months 90 (56.6)
of the violence experienced by Jordanian nurses. However, disturbed physical and emotional health is common after
4-6 months 40 (25.2)
experiencing violence (Celik et al., 2007; Nachreiner et al.,
7-11 months 17 (10.7)
 2007). Another remarkable result is that 56.6% of the affected nurses reported the incidents, and 76.1% were
satisfied with the 1-5 years 12 (7.5)
outcome. This finding was contrary to the results of a previous
Time of incidence
Jordanian study that found 71.5% of Jordanian nurses were dissatisfied with how incidents were handled
(AbuAlRub & Morning shift 35 (22.0)
Al-Asmar, 2011). A possible explanation could be increased awareness among nurses regarding the importance of
reporting Evening shift 80 (50.3)
violent events because violence against ED nurses has become
Night shift 44 (27.7)
a widespread phenomenon in Jordan.
When asked about the causes of violence in EDs,
Perpetrator
participants ranked “crowdedness/workload in [the] ED” as the
Patient 37 (21.3)
most common cause followed by “staff shortage,” which is associated with more violent incidents occurring during
the Family or friends 89 (51.1)
evening shift (i.e., the most crowded shift). The major causes of
Both 33 (19.0)
violence in this study were different than those reported by Gacki-Smith et al. (2009) who found “patients being
under the influence of alcohol” and “illicit drugs” as major causes, reflecting a cultural difference in violence against
ED nurses. However, the least common causes were “care of patients with dementia [and] Alzheimer’s [disease] in
[the] ED” preceded by “ED procedures.” Similarly, Gacki-Smith et al. (2009) reported “care of patients with
dementia [and] Alzheimer’s [disease] in ED” and “no [or] poorly enforced visiting policy as the least common
causes of violence in their study. This discrepancy indicates that it is not patient care or nursing procedures that
result in violence, but rather the conditions in which nursing staff are providing care or performing procedures. This
finding confirms the responsibility of hospital and nursing administrators to provide a safe working environment for
nurses.
Nurses’ responses about violence and legal recourses were contradictory. Although most of the participants
thought it ethical and right for them to take legal action after being assaulted, most of them also reported that they
would not do
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January Workplace HealtH & Safety
2015 Table 3. Causes of Violence in ED
Causes Disagree (%) Neutral (%) Agree (%)
Crowding/workload in ED 6.3 17.8 75.9
Shortage of ED staff (nurses and physician) 5.7 24.7 69.5
Patients/visitor under influence of alcohol 12.1 20.7 67.2
Drug-seeking behavior 6.8 28.2 64.9
No/poorly enforced visitor or staff behavior 4 31.6 64.4
Patients/visitors under influence of illicit drugs 7.5 29.9 62.6
Misconception by patients/visitors that staff is uncaring 5.5 33.9 60.9
Poor communication between health care provider and patient/
family
so. They further reported that nurses are not psychologically affected by such events. Self-blame was also evident in
nurses’ responses. Similar contradictions were reported by Ergun and Karadakovan (2005) who explained this
phenomenon by the relatively short duration of experience and the lack of continuing education that could influence
nurses’ professional response and reaction to violent episodes. In the same vein, 58.6% of participants reported no
staff training about violence management in spite of the high frequency of violent events. Therefore, ongoing staff
development about occupational stress and violence management, which should focus specifically on younger
nurses and new ED nurses, is needed.
Examining categories of nursing staff with the highest rates of violence showed that nurses in both university and
government hospitals had more violence experiences than nurses in private hospitals. This finding was similar to the
results of previous studies in Jordan (AbuAlRub & Al-Asmar, 2011) and Australia (Hegney, Plank, & Parker, 2003)
and may be attributed to less safety measures at both university and government hospitals (e.g., being open to the
public and caring for more patients from lower socioeconomic status because the cost of care is much higher in
private hospitals). Therefore, health care administrators in both university and government hospitals have an
obligation to provide more security measures in their EDs, especially limiting access by larger numbers of
nonpatient individuals. Also, the government hospitals should adopt effective policies for preventing and managing
violent
17.2 21.8 60.9
Patients/visitor perception that staff is uncaring 12.6 30.5 56.9
Care of psychiatric patients in ED 13.8 32.8 53.4
Emergency department procedures 16.1 33.9 50
Care of patients with dementia/Alzheimer’s disease in ED 25.3 39.1 35.6
Note. ED = emergency department.
incidents, as well as enacting legislation to punish aggressors (AbuAlRub, Khalifa, & Habbib, 2007).
Similarly, younger nurses, new nurses to the ED, and less experienced nurses reported more violent incidents
than their older, more seasoned counterparts. These results were consistent with those reported by Australian nurses
(Hegney et al., 2003) but contradicted by data reported by Turkish nurses (Ergun & Karadakovan, 2005). However,
this finding could be related to Jordanian Arabic culture in which individuals show more respect to older
individuals; experienced nurses also may have less contact with patients than less experienced nurses due to task
distribution. Therefore, younger, less experienced nurses should be the primary focus of continuing education
programs about violence management. Also, continuous assessment of the psychological status of ED nurses could
be beneficial in this regard.
Study Limitations
This study asked Jordanian nurses to recall incidents of violence within the past 5 years. Therefore, results may
be affected by recall bias, and generalizability is limited due to the study’s descriptive exploratory design. The
limited number of participants constitutes another limitation, for which future studies with larger national samples
are recommended. However, the results of this study, along with other similar studies, increase occupational health
nurses’ understanding of
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vol. 63 ■ no. 1 Workplace HealtH & Safety
Table 4. Nurses’ Thoughts About Violence and Legal Procedure
Self-Related Disagree Neutral Agree
Self-related
If I were physically assaulted by a patient/relative, I would take legal action 66.1 20.1 13.8
Nurses can expect to be physically assaulted sometime during
their careers
this phenomenon of violence in Jordanian EDs so that better solutions can be developed to limit violence and its
effects.
60.3 24.7 14.9
Nurses who are physically violated by a patient/relative cannot do their
job properly afterward
58.6 29.9 11.5
Being physically assaulted by patients/relatives affects nurses
psychologically
68.4 27 4.6
Prediction of patient/client assault is within the competence and ability
of qualified nurses
37.9 42.5 29.6
Nurses who are assaulted and have only minor injuries should not
report the assault
23.6 28.7 47.7
Nurses who are physically violated are less competent clinically than
staff who are not assaulted
35.6 35.6 28.7
It is unacceptable for nurses to respond similarly when being
physically assaulted by patient/client
43.1 35.1 21.8
Patient/relative related
Patients/relatives are responsible for all their behaviors although patients/ relatives tend to display assaulting
behavior, they should still be admitted to EDs
17.2 36.2 46.6
Patients/relatives have the right to take legal actions against nurses who
have physically assaulted them
16.7 32.8 50.6
Procedure related
Nurses should be educated about the prevention and management
of assault as part of their in-service education
13.2 22.4 64.4
It is ethically appropriate for a nurse to take legal action against a
patient/client who has physically assaulted him or her
9.2 27 63.8
My unit does not accept patients/relatives if it is not equipped or staffed
to treat them safely
24.7 33.9 41.4
Nurses who take legal action against a patient/relative are in jeopardy
of losing their jobs
28.7 37.9 33.3
The employment pattern and physical environment of this unit are adequate and so will prevent assaults by
patients/clients
25.9 36.8 37.4
Nurses have the right to take legal action against patients/relatives who
have physically assaulted them
16.7 29.9 53.4
Using a self-reported questionnaire could not describe all the issues contributing to violence in EDs. Future studies
are
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January Workplace HealtH & Safety
2015 Table 5. Comparisons Between Violence Experience and Dichotomous Demographics
Violence Chi-square test
Variable Yes No χ2 df p value
Study setting
Educational 41 1 8.519 2 .014*
Governmental 70 4
Private 48 10
Gender
Male 93 9 .013 1 .910
Female 66 6
Marital status
Single 97 13 3.92 2 .141
Married 59 2
Others 3 0
Educational level
Diploma 33 1 2.253 2 .324
Bachelor 122 14
Master 4 0
Title
RN 126 14 1.730 1 .188
LPN 33 1
Note. RN = registered nurse; LPN = licensed practical nurse. *p < .05.
recommended using actual rates and consequences of violence
adequate safety measures, efficient administrative
procedures, documented in formal registries, interviewing victims of
and sincere efforts to overcome the causes of this
phenomenon. violence, and conducting qualitative studies that explore nurses’ actual experience with violence.

Acknowledgments Conclusion
This study explored the prevalence of violence toward Jordanian ED nurses, which was common and comparable to
The authors acknowledge The University of Jordan for funding this study. Also, sincere thanks to the participants
and to the directors of nursing within the participating hospitals.
the literature. Verbal violence was more common than physical violence; younger and less experienced nurses were
more likely

Conflict of Interest
to experience violence than older, more seasoned nurses; and
 The author(s) declared no potential conflicts of
interest with respect nurses in private hospitals reported less violence than nurses in
to the research, authorship, and/or publication of this
article. university and government hospitals. Violence against nurses had many consequences, including sick leaves
and affected
Funding physical and emotional health. Health care
administrators have
The author(s) received no financial support for the
research, an obligation to prevent violence against nurses by providing
authorship, and/or publication of this article.
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vol. 63 ■ no. 1 Workplace HealtH & Safety

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Author Biographies Dr. Muhammad W. Darawad is an associate professor at Faculty of Nursing-The University of
Jordan, with an advanced degree in critical care and clinical nursing. Dr. Darawad is a member of many nursing
associations including Sigma Theta-Jordan Charter, California Board of Nursing. He has many publications in
different peer-reviewed nursing journals and has participated in many local and international professional events.
Dr. Mahmoud Al-Hussami is an associate professor at Faculty of Nursing-The University of Jordan, with advanced
degrees in nursing administration and public health. Dr. Al-Hussami was the head of the Community Health
Nursing Department and was recognized for the Research Achievement Prize in his institution. He has many
publications in different peer-reviewed nursing journals and has participated in many local and international
professional events.
Dr. Ali M. Saleh is an assistant professor at Faculty of Nursing- The University of Jordan, with advanced degrees in
nursing administration and quality assurance. Currently, Dr. Saleh is appointed as the dean assistant for quality
development in his institution. He is a member of many nursing associations including Jordan Nurses and Midwives
Council and Jordan Society of Scientific Research.
Dr. Waddah Mohammad Mustafa is an assistant professor at Al Farabi College, with an advanced degree in
nursing administration. Dr. Mustafa has participated in many local and international professional events. He is a
member of many nursing associations including Jordan Nurses and Midwives Council.
Mrs. Haifa Odeh is a part-time clinical instructor at Faculty of Nursing-The University of Jordan, with a master’s
degree in clinical nursing. Mrs. Odeh is a clinical nurse specialist in the intensive care unit. She is a member of the
Jordan Nurses and Midwives Council.
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