Moral harassment among Brazilian primary health care and hospital workers

This is a cross-sectional study with 647 health professionals working in primary health care and hospital services in southern Brazil. A socio-occupational questionnaire and the Workplace Violence in the Health Sector Questionnaire were used. The Poisson regression model identified factors related to the phenomenon in the workplace.

Results

Of the professionals, 22.41% reported having been incident victims in the last 12 months. Factors related to bullying were: being a nurse (Prevalence Ratio (PR)=2.77; 95%CI 1.63 to 4.70) or nursing assistant (PR=2.73; 95%CI 1.61 to 4.61); having a chronic disease (PR=1.43; 95% CI 1.07 to 1.93); negative perceptions regarding recognition at work (PR=1.52; 95% CI 1.07 to 2.17); interpersonal relationships at work assessed as indifferent (PR=2.16; 95% CI 1.55 to 3.01); sleeping hours (PR=0.89; 95%CI 0.80 to 0.99); and demonstrating greater concern with violence (PR=1.76; 95%CI 1.10 to 2.82).

Conclusion

Workplace moral harassment was influenced by work factors, health issues and individual perceptions about work and violence.

Bullying; Workplace violence; Health personnel; Primary health care; Hospitals

Variables	n(%)
Age (years)	39.3* ± 9.0†
Sex
Male	62(9.58)
Female	583(90.10)
Did not answer	2(0.30)
Skin color
Black	14(2.16)
Brown	70(10.81)
White	557(86.08)
Other	5(0.77)
Did not answer	1(0.15)
Education (years)	14.2* ± 2.7†
Marital status
Single/widow/no partner	166(25.65)
Married/with partner	478(73.87)
Did not answer	3(0.46)
Number of children – median, minimum and maximum	1(0 – 2)
Years of experience in the health field - mean	10(4 – 15)
Time working at the institution (years) - median	7(4 – 13)
Work sector
Hospital care	198(30.60)
Primary Health Care	449(69.40)
Role
Nurse	135(20.87)
Nursing technician	186(28.75)
Nursing assistant	123(19.01)
Doctor	25(3.86)
Dental surgeon	20(3.09)
Oral health technician	5(0.77)
Oral health assistant	16(2.47)
Community health worker	137(21.17)
Holds a managerial/supervisory position	90(13.91)
Weekly workload (hours)	40.4* ± 3.8†
Works at another institution	52(8.04)
Work shift
Morning	48(7.41)
Afternoon	43(6.64)
Night	75(11.59)
Weekend	4(0.61)
Weekday	472(72.95)
More than one type	4(0.61)
Did not answer	1(0.15)

Variables	n(%)
Do you consider this a typical situation in your workplace?
Yes	77(53.10)
No	68(46.90)
Who assaulted you the last time you were harassed?
Others (unidentified, patients and family members)	70(48.27)
Co-workers	41(28.27)
Head/supervisor	31(21.37)
Did not answer	3(2.06)
If co-worker
Doctor	38(92.68)
Nursing team	2(4.88)
Other	1(2.44)
Where the incident occurred
Inside the institution	137(94.48)
Out of institution	6(4.13)
Did not answer	2(1.37)
Do you think the incident could have been avoided?
Yes	107(73.79)
No	38(26.21)
Was any action taken before the event?
Yes	36(24.82)
No	107(73.79)
Did not answer	2(1.37)
By whom was any action taken in front of the event?
Head	25(69.44)
Co-worker	4(11.11)
Other	3(8.33)
Did not answer	4(11.11)
Consequences for the aggressor*
None	115(79.31)
Verbal warning	17(11.72)
Other	5(3.45)
Do not know	4(2.76)
Interrupted treatment/was transferred to another sector	3(2.07)
Police registration	1(0.69)
Lawsuit against the aggressor	0(0.00)
Did your employer or supervisor offer help?*
Offered opportunity to speak	64(44.14)
Did not offer	52(35.86)
Offered advice	22(15.17)
Other support	11(7.59)
Degree of satisfaction about how the incident was handled
Totally dissatisfied/dissatisfied	98(67.59)
Satisfied/totally satisfied	23(15.86)
Unresponsive	22(15.17)
Did not answer	2(1.38)
If you did NOT report or talk about the incident with others, why didn’t you do it?*
Considered that no action would be taken anyway	25(17.24)
Fear of negative consequences	21(14.48)
Other	14(9.65)
It was not important	8(5.51)
Did not know who to report to	8(5.51)
Felt ashamed	3(2.06)
Felt guilty	0(0.0)

Variables	PR *	Confidence interval (95%)	p-value
Role^†
Nurse	2.77	1.63 - 4.70	0.001
Nursing technician	1.61	0.96 - 2.69	0.069
Nursing assistant	2.73	1.61 - 4.61	0.001
Doctor	1.75	0.80 - 3.80	0.160
Dental surgeon	1.60	0.56 - 4.59	0.378
Community health worker (reference)	1
Have chronic non-communicable diseases
Yes	1.43	1.07 – 1.93	0.017
No	1
Sleeping hours	0.89	0.80 - 0.99	0.034
You feel recognized at work
Not at all/a little	1.52	1.07 – 2.17	0.020
Unresponsive	1.19	0.84 - 1.68	0.332
Recognized/highly recognized (reference)	1
How you assess the interpersonal relationship at work
Not at all satisfied/little satisfied	1.57	0.83 - 2.94	0.164
Unresponsive	2.16	1.55 - 3.01	0.001
Satisfied/very satisfied (reference)	1
How worried you are about workplace violence
Not at all/little worried (reference)	1
Unresponsive	1.31	0.77 – 2.23	0.312
Worried/very worried	1.76	1.10 - 2.82	0.018

Escola Paulista de Enfermagem, Universidade Federal de São Paulo R. Napoleão de Barros, 754, 04024-002 São Paulo - SP/Brasil, Tel./Fax: (55 11) 5576 4430 - São Paulo - SP - Brazil
E-mail: actapaulista@unifesp.br

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[1] Corresponding author Maiara Daís Schoeninger E-mail: maia_schoeninger@hotmail.com