Journal of Clinical and Medical Reviews

Abstract

Background: Workplace violence (WPV) is a critical occupational hazard that threatens the well-being of healthcare workers (HCWs) and the quality of patient care. In resource-constrained settings like Nigeria, the determinants of physical versus verbal abuse often vary across professional cadres. This study aimed to identify the demographic and occupational predictors of physical and verbal WPV at Enugu State University of Science and Technology (ESUT) Teaching Hospital Parklane, Enugu.

Methods: A cross-sectional descriptive study was conducted among 388 clinical and non-clinical staff selected via stratified proportionate random sampling. Data were collected using a structured questionnaire adapted from the ILO/ICN/WHO/PSI. Analysis involved chi-square tests and multinomial logistic regression to identify independent predictors of violence, with significance set at p < 0.05.

Results: Bivariate analysis showed that males reported significantly higher rates of physical (24.7%) and verbal (87.5%) violence than females (p < 0.05). Nurses experienced the highest frequency of physical violence (20.3%), while verbal abuse peaked among those aged 50–54 years (20.8%). Multinomial regression (Nagelkerke R² = 0.593 for physical; 0.586 for verbal) identified age, marital status, and ethnicity as significant independent predictors for both forms of violence. Occupationally, being a nurse, pharmacist, or radiographer significantly predicted physical WPV, while physicians, pharmacists, and radiographers were the primary predictors of verbal abuse (p < 0.05).

Conclusion: WPV at ESUT Teaching Hospital is pervasive and influenced by a complex interplay of age, professional role, and marital status. While nurses remain vulnerable to physical assault, diagnostic staff face a high risk of verbal abuse. The findings underscore the need for targeted de-escalation training, enhanced security in adult care units, and a zero-tolerance policy to protect HCWs in tertiary health settings.

Introduction

Workplace violence (WPV) has become a significant occupational health and safety concern worldwide, especially among healthcare workers (HCWs), as the World Health Organization has noted that the group is most exposed many times due to their frontline roles in patient care, a high-stress work environment, and close interactions with patients and their relatives. Workplace violence encompasses both physical violence (for example, hitting, pushing, or other assaults) and verbal violence (for example, insults, threats, or harassment) [1].
It has been shown globally that the majority of healthcare workers report at least one episode of workplace violence during their careers, and verbal abuse is almost the most consistently reported. Verbal abuse from global reports commonly affects well over half of healthcare workers more than physical assault, which was reported less but causes far more significant damage. These global patterns were mostly reflected in low- and middle-income countries (LMICs) like Nigeria, where constrained resources, overcrowded facilities and weak reporting or prevention systems often magnify the risk [2].
The healthcare environment in Nigeria has not been spared, as reviews conducted in different geopolitical zones of Nigeria reported high prevalence of verbal abuse among doctors, nurses and other cadres, with physical abuse causing more harm. Emergency departments, outpatient clinics, and other high-throughput service points have been repeatedly put as hotspots for many incidences of verbal abuse, with common triggers such as long waiting hours, unmet expectations, poor communication and perceived poor quality of care. Patients and patients’ relatives were the most culprits perpetrating these acts as compared to co-workers, supervisors and other workers from the hospital environment [3]. Determinants of physical and verbal workplace violence identified can be patient-and visitor-related factors, staff and workforce characteristics, organizational and health-system drivers, and environmental, cultural and policy contexts, with each contributing distinct risk pathways [4].
It is therefore of great importance to study the determinants of physical and verbal workplace violence in Enugu State University of Science and Technology (ESUT) Teaching Hospital Parklane Enugu, being a tertiary healthcare and referral center in Enugu metropolis.

Materials and Methods

Study design
A cross-sectional descriptive study on determinants of physical and workplace violence experienced by healthcare workers at ESUT Teaching Hospital, Parklane, Enugu. ESUT Teaching Hospital is a tertiary hospital serving urban and peri-urban populations in Enugu State and neighbouring areas. The hospital provides emergency, surgical, medical, obstetrics/gynaecology, pediatric, and outpatient services and employs a multidisciplinary workforce. This variety of clinical areas and high patient throughput make ESUT Teaching Hospital an appropriate setting to study workplace violence in Nigerian tertiary healthcare.

Study Population
The study population were clinical and non-clinical staff of ESUT Teaching Hospital who have direct and indirect interactions in the work environment and have spent at least 6 months working at the facility before data collection. These staff include, but are not limited to, doctors, nurses, laboratory scientists/technicians, radiographers, pharmacists, physiotherapists, administrative staff, security personnel, orderlies, and the like. Students, visitors, staff on long leave greater than 1 year recently and workers who declined consent were excluded from the study.

Ethical clearance
Before the study started, approval from the ESUT Teaching Hospital Health Research and Ethics Committee was acquired. Every participant signed a written informed consent form after being instructed on the study's goals and given assurances regarding the questionnaire's anonymity, confidentiality, and voluntary nature.

Sample size, data collection and analysis
Sample size was determined using n = z²pq/ d², where n is the sample size [5]. The prevalence rate (p) of 64.4 per cent from a Nigerian tertiary hospital study was used [6]. A sample size of 388 was calculated after adding 10% attrition in ESUT Teaching Hospital, Parklane, Enugu. A stratified proportionate random sampling technique was used for data collected. Data was collected using structured, self-administered questionnaire adapted from ILO/ICN/WHO/PSI [7] divided into different sections: sociodemographic characteristics, work characteristics, exposure to violence, incident details, reporting, management response, and consequences, and perceptions of causes and preventive measures. Approval was gotten from the ESUT Teaching Hospital Health Research and Ethics Committee before commencement of the research.
Data was analyzed with Statistical Package for Social Sciences (version 26). Frequencies and proportions were used for categorical variables and mean ± standard deviation for continuous or discrete variables (median ± IQR for non-parametric data). Level of significance was set at p < 0.05.

Results

The findings of this research work are presented on tables 1 to 5. The analysis of demographic and job-related characteristics in relation to physical workplace violence (WPV) is presented in Table 1. Sex was significantly associated with physical violence (χ² = 11.2, p = 0.001), with 24.7% of male workers reporting incidents compared to only 1.1% of females. Profession also showed a strong significant association (χ² = 20.8, p < 0.001), identifying nurses as the most vulnerable group, with 20.3% experiencing physical violence compared to 3.1% of physicians and 2.6% of other staff. Conversely, age group (p = 0.55), marital status ( p = 0.42), educational level (p = 0.89), and years of experience (p = 0.84). did not show statistically significant relationships with physical violence in the bivariate analysis. 
Multinomial logistic regression (Table 2) explained 59.3% of the variance in physical WPV (Nagelkerke R² = 0.593). Significant independent predictors included age (p < 0.001), marital status (p = 0.001), and ethnicity (p = 0.010). Occupational roles, specifically nurses (p = 0.001), pharmacists (p < 0.001), radiographers (p < 0.001), and administrative staff (p < 0.001), were also significant predictors. Sex was not a significant predictor in the multivariate model.
As shown in Table 3, verbal abuse was significantly associated with age (p < 0.001), with the highest reports in the 50–54 age group (20.8%). Males reported significantly more verbal abuse (87.5%) than females (12.5%). Significant associations were also found for marital status (p = 0.009) and professional roles, specifically physicians (p = 0.003), pharmacists (p < 0.001), and radiographers (p < 0.001).
The nominal regression model (Table 4) for verbal abuse explained 58.6% of the variance (Nagelkerke R² = 0.586). Age (p = 0.001), sex (p = 0.013), marital status (p = 0.006), and ethnicity (p = 0.006) were identified as significant predictors. Occupationally, physicians (p = 0.038), pharmacists (p = 0.003), and radiographers (p < 0.001) remained significant. Religion did not significantly influence verbal abuse.
Descriptive data (Table 5) indicated that the majority of respondents had 1–10 years of experience and 44.8% were full-time employees. While 73.5% do not work shifts, 45.6% have direct interaction with patients. Patient care was primarily focused on adults (38.1%) and the elderly (27.8%). Involvement in specialized care, such as psychiatric (3.6%) or terminally ill care (6.2%), was relatively low.

Table 1: Factors Associated with Physical Workplace Violence

Likelihood Ratio Chi-square = 183.896, df = 54, p < .001; Pseudo R² (Nagelkerke) = 0.593
Table 2: Factors Influencing Physical Workplace Violence (Multinomial Logistic Regression)

Table 3: Association Between Factors and Verbal Abuse

Table 4: Factors influencing verbal violence

Table 5: Percentage distribution of workplace characteristics of workers in ESUT Hospital Parklane, Enugu

Discussion

Workplace violence (WPV) is increasingly recognized as a critical global concern within healthcare settings, manifesting predominantly in physical and verbal abuse. Healthcare workers (HCWs) remain one of the most vulnerable occupational groups due to high-stress environments, intense workloads, and frequent, high-stakes patient interactions [1]. This study at ESUT Teaching Hospital Parklane, Enugu, provides insights into the demographic, occupational, and workplace-related factors influencing these forms of violence.
Bivariate analysis revealed that male workers experienced significantly more physical violence than their female counterparts (Table 1). However, the multinomial regression (Table 2) indicated that gender was not an independent predictor. This suggests that the initial gender disparity is confounded by other variables; specifically, the higher exposure of males may stem from their frequent deployment in high-risk wards or roles requiring physical intervention. In contrast, female staff are often more frequently involved in verbal rather than physical confrontations [6].
Although bivariate analysis showed no significant association between age and physical violence, regression analysis identified age as a strong predictor, with workers under 30 reporting the highest rates. This susceptibility among younger staff aligns with previous findings attributing the risk to limited experience and insufficient conflict de-escalation skills [8]. Furthermore, marital status was a significant predictor, possibly because single HCWs are disproportionately stationed in high-risk departments, whereas married staff may benefit from stronger institutional support networks.
Occupational role was a major determinant, with nurses experiencing more physical violence than physicians. Regression analysis confirmed that being a nurse, pharmacist, radiographer, or administrative staff member significantly predicts physical abuse. This aligns with global literature stating that nurses face the greatest exposure due to their central role in direct caregiving and the enforcement of hospital policies [3]. Interestingly, while physical violence correlated with ethnicity (p=0.010), the lack of ethnic diversity in the sample (over 95% Igbo) limits wider comparisons. However, existing research suggests that cultural misunderstandings often exacerbate conflict in patient-staff interactions [2].
Verbal abuse exhibited a strong association with age, particularly among those aged 50–54 years. This contrasts with the trend for physical violence, where younger workers were more vulnerable. Older HCWs may perceive aggressive communication more acutely as abuse, or they may face higher patient-driven expectations [9]. There was also a significant relationship between gender and verbal abuse, with males reporting higher incidence rates. This diverges from global trends where females frequently report higher rates of psychological harassment [10], suggesting a unique cultural dynamic within the Nigerian healthcare context.
Marital status played a significant role, as single staff reported higher levels of verbal abuse compared to married or divorced individuals. This mirrors patterns reported by Aderinto et al. [8], suggesting that marital status may modulate both the exposure to and the likelihood of reporting abuse. While ethnicity was not significant in the chi-square test, it emerged as a predictor in the regression model (p=0.006), though religion remained non-significant (p=0.576).
In a departure from global trends where nurses report the most verbal abuse [10], this study found that verbal abuse was strongly associated with physicians, pharmacists, and radiographers. This likely reflects local hospital dynamics where diagnostic delays or prescription-related misunderstandings lead to patient frustration and subsequent verbal confrontation.
The data indicate that a significant proportion of HCWs provide care for adults (38.1%) and the elderly (27.8%). These patient groups often involve emotionally charged situations, increasing the risk of aggressive interactions. Consistent with literature on geriatric and terminal care, family members and relatives of these patients are frequent contributors to WPV incidents, particularly in high-pressure clinical environments [11].

Conclusion

This study highlights that workplace violence (WPV) at ESUT Teaching Hospital Parklane is a significant occupational hazard driven by a complex interplay of demographic and professional factors. While physical violence is strongly associated with nursing roles and male gender in bivariate analysis, multivariate modelling reveals that age, marital status, and ethnicity are the primary independent predictors of risk. Verbal abuse is even more pervasive, with older staff and those in diagnostic roles such as pharmacists and radiographers showing unexpected levels of vulnerability.
The findings suggest that the risk of WPV is not uniform; it is concentrated among frontline staff who handle high volumes of adult and geriatric patients. The high explanatory power of the regression models (R2 > 58%) indicates that the identified determinants are critical for understanding the landscape of violence within the facility. Addressing these factors is essential to preserving the mental and physical well-being of the healthcare workforce.

Financial support and sponsorship: None.

Conflicts of interest: There are no conflicts of interest.

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