orkplace violence, a term used in the scientific literature to
define acts of aggression and/or violence that occur in the work context, began
to be studied in the 1980s (Turpin et al., 2021). The conceptualisation is a complex task because of the
multidimensionality, the number of factors and the agents involved as well as
for the diversity of contexts in which this violence may arise (Cannavò
& Fioravanti, 2018; Shier et al., 2018).
OSHA (1996) was
the first organization to define this concept as “psychological assault,
threatening behaviour, or verbal abuse that occurs in the workplace” (p. 4). However, this article makes use of the conceptualization by
Chappell and Di Martino (2006).
These authors introduce into the definition who performs the violent action;
that is, who is the causative agent. Workplace violence is understood as “any
incident in which a worker is abused, threatened or assaulted by a member of
the public: patient, client and/or co-worker” (Chappell & Di Martino, 2006, p. 12).
The study of the incidence of violence in the workplace presents
differences in countries and territories. In those countries that “it is a
matter of public debate, the registered data is higher than in others” (Merecz
et al., 2006, p. 442). Workplace violence affects
practically all sectors and professional categories, although there are
occupations with greater risk than others (Scaramuzzino, 2020). Specifically, professionals who work with vulnerable groups and
with high levels of stress have higher incidence rates (Robelski
et al., 2020; Vidal-Marti, 2020).
Workplace violence is a phenomenon with high incidence rates among
health and social service workers (NASW, 2013; OSHA, 2016). The
National Association of Social Workers (NASW, 2020) of the United States found that health and social workers were
five times more likely to suffer serious injuries from workplace violence than
those in other sectors. Specifically, between 2011 and 2013, 23,000 acts of
workplace violence were reported, 75% of them aimed at health and social
service workers (NASW, 2020).
This article focuses on workplace violence towards social workers,
more specifically when the client perpetrates the violent action. The first
study of this phenomenon was published in 1978 (Crane, 1986), and since then research has highlighted the problem and its
scope, although study of the subject has been uneven and irregular, and
significant differences are observed between countries (Jayaratne
et al., 2004; Padyab et al., 2012; Zelnick et al., 2013).
In 2014, the National Library of Medicine of the United States
established “workplace violence” as a Mesh term (Medical Subject Headings). The
establishment of this search descriptor makes it easier to use this as a
keyword in specialized databases in health sciences. In contrast, no keyword
was found in the partner work and consequently different terms are used, such
as: violence, aggression, injury, threat, assault, intimidation, harassment and
victimizing. The word violence is the most used as a keyword or word in the
title of an article. It is customary to combine it with the client concept, as
a causal agent of violence towards the professional (Sicora et al., 2021; Sousa et al., 2014; Virkki,
2008).
Client violence towards social workers has multiple consequences,
both for the workers themselves and the organization. Among workers affected,
high levels of stress are observed (Enosh &
Tzafrir, 2015; Koritsas et al., 2010; Lee et al., 2021; Shier
et al., 2018), as well as fear (Kagan
& Itzick, 2019; Lamothe et al., 2018), anxiety (Zychlinski et al., 2022), difficulty in thinking and acting (Enosh et al., 2013), demotivation (Lamothe et al., 2018) and depression (Lee et al., 2021).
At organization level, the effects include increased absenteeism (Malesa
& Pillay, 2020), lower performance levels (Robson
et al., 2014) and increased emotional
distancing from the client (Lamothe et al., 2018; Tzafrir et al., 2015).
In Spain, workplace violence towards healthcare workers has been
the subject of both descriptive and analytical studies (Babiarczyk
et al., 2020; Serrano et al., 2019; Vidal-Martí & Pérez, 2015). Its study has revealed its incidence and risk factors; and
consequently, there are review studies that make it possible to access the
current knowledge. However, no review studies are found in which violence
towards social workers is analyzed. This omission means that knowledge of
client violence towards social workers in Spain is scattered. Therefore, a
review article that collects and analyses the studies carried out is necessary
to know what the current situation is, to better understand the phenomenon and
is of great interest for the profession of social work.
Materials and Methods
This research has a main aim to identify the studies on client
violence towards the social worker in Spain. This aim has four specific
objectives to understand the phenomenon: (1) to identify those investigations
that study the violence of clients against social workers; (2) to analyze the
descriptive characteristics of the selected studies; (3) to analyze the
methodological characteristics of the selected studies; (4) to identify the
variables associated to client violence towards the social worker.
In order to achieve these objectives, the method was based on a
review of the literature on studies of violence towards social workers in
Spain. In it, the PRISMA-S guidelines [literature search extension for the
Preferred Reporting Items for Systematic Reviews and Meta-Analyses] for
descriptive and systematic reviews and meta-analyses were followed (Rethlefsen
et al., 2021).
Search Strategy
An exhaustive search of the databases APA PsycNET, ÍnDICE CSIC,
Educational Resource Information Center-ERIC and Scopus was conducted in the first
quarter of 2022. A free search was also conducted of Scholar Google to identify
studies not published in databases.
The search strategy was based on the following combination of
search terms: cliente [client], trabajador social [social worker], aggression,
violence, workplace violence, Spain, violencia ocupacional [workplace
violence], agresión [aggression], violencia [violence] and type II.
Inclusion and Exclusion Criteria
The criteria for inclusion were published a) in scientific
journals, doctoral theses and academic papers; b) until March 2022; c) in
English or Spanish.
Articles of an informative nature and letters to the editor were
excluded.
Selection of Studies
Figure 1 reflects the articles selection process. Initially 115
documents were found. Duplicated documents and those not related to the object
of study were eliminated. Next, a new screening of the 25 selected documents
was carried out, which consisted of reading each abstract. 9 documents were
rejected. The next step was a complete reading of the 16 documents to confirm
their suitability. The final selection is composed of 7 studies.
Figure 1.
Search strategy
Results
Analysis of the Descriptive Characteristics of the Review
Table 1 summarizes the principal descriptive characteristics,
results and implications of the selected studies.
Violence towards social workers was studied in seven documents.
The first research dates to 2008, and takes the form of a book and an article
(see Table 1). In both documents, the authors present the results of
the same research (Berasaluze & Berrio-Otxoa, 2008; Berrio-Otxoa & Berasaluze, 2008).
The time period with the most research was from 2015 to 2020, with
5 documents.
Four out of the seven documents are articles, two are books and
one is an academic paper. Spanish was the language most used with six studies.
As regards services, there is variability: three studies analyzed
social services in a broad context; two studied social work in health services;
one focused on community care; and one on nursing homes. The aims of the
reviewed studies are different. While they have in common the focus on and
knowledge of violence against social workers, some reviewed studies focus on
determining the occurrence, others on identifying the reasons, and still others
focus on risk factors. Specifically, four studies focus on knowing the occurrence
and variables involved in client violence against social workers, two studies
identify violence as a risk factor and evaluate what measures should be taken
to eradicate the phenomenon and one analyzes the causes that explain why the
phenomenon occurs.
Regarding the results, the seven studies reviewed state that
social workers have experienced client violence.
Regarding
the involvement, it should be noted that the four articles reviewed establish
the need to make visible the violence of clients towards social workers. The
other three studies focus on the need to design prevention or treatment
programmes when violence has already occurred.
Table
1.
Descriptive
characteristics of the studies
|
Reference, Language, Service
|
Purpose
|
Main Results
|
Implication
|
|
Berrio-Otxoa
& Berasaluze, 2008, Spanish, Social services
|
(1)
To describe and characterize the group of social workers.
(2)
To identify the professional needs of social workers.
|
(1)
Collecting information is the social worker’s most frequent task.
(2)
The social worker performs both direct and indirect intervention, but direct
takes more time than indirect.
(3)
61.8% of social workers describe the situation of the profession as
satisfactory.
(4) 7
out of 10 social workers said they had experienced a risk situation in their
professional practice.
|
(1)
Make visible the professional situation of social workers.
|
|
Herrero,
2018, Spanish, Health services
|
To
analyze the aggressions carried out by patients, relatives or companions
against the health centre professionals during a period of four years.
|
(1)
254 attacks were reported.
(2)
Verbal aggressions were the most frequent (76%).
(3)
Dissatisfaction with the care received (33.5%) is the main cause of
aggression.
(4)
The patients (67.3%) carried out the aggressions.
(5)
10.2% of the personnel who suffered an aggression (physical or verbal)
required medical leave.
(6)
7.4% of the professionals attacked filed a legal complaint.
|
(1)
Design programmes aimed at the prevention and treatment of aggression. Its
design must take into account the job category, the type of service and the
professional field.
|
|
Rincón-del
Toro et al., 2016, Spanish, Health services
|
Characterize
violence in primary care in the Community of Madrid.
|
(1)
1,157 attacks were reported.
(2)
Non-health personnel showed less risk of being physically attacked than
health personnel.
(3)
5.9% of the professionals reported the attacks.
|
(1)
Develop training plans aimed at all professionals related to the prevention
and management of aggression.
(2)
Provide support and advice to professionals to avoid violence by users.
|
|
Reference, Language, Service
|
Purpose
|
Main Results
|
Implication
|
|
Vidal-Martí
& Pérez-Testor, 2015, English, Nursing homes
|
Analyze
aggressions towards professionals who work in health centres carried out by
patients, families or companions during four years.
|
(1)
61.2% of the professionals were attacked by the elderly people they attend to
in the last year.
(2)
There is a significant relationship between stress and aggression.
(3)
Verbal aggression is the most frequent type of aggression. Specifically,
demands are the subtype of aggression most often expressed by professionals
and occur on a daily basis.
(4)
Men attack professionals more than women users.
|
(1)
Make visible the violent action carried out by the user towards the professionals
of the residences for the elderly in the city of Barcelona. Visibility as a
first step to address a problem that is not treated in residences.
|
|
Ureña
et al., 2017, Spanish, Social services
|
Analyze
and identify the aggressions of users towards community social services.
|
(1)
12 attacks were reported during the period from 2010 to 2017.
(2)
Primary care social workers are at greater risk.
(3)
Only physical attacks are reported.
|
(1)
Make visible the risk of aggression towards social workers.
(2)
Adapt care to prevent the attacks and implement protection measures.
|
|
|
|
|
|
|
|
Analysis of the Methodological Characteristics of the
Review
Table 2 summarizes the principal methodological characteristics of
the selected studies. Specifically, the kind of research, instruments used, the
size of the sample, the type of design and the dimensions were analyzed. All
studies agree on the type of research and design: quantitative research and
type of descriptive design. Five out of seven documents use the questionnaire
as an instrument and two use the form.
There is variability in the sample and six out of seven documents
make explicit the number of participants. However, only two out of the seven
articles reviewed in the sample are related to social workers. The other
articles involve other professionals (educators, doctors ...).
Table 2.
Methodological characteristics of the
studies
|
Reference
|
Method
|
Instrument
|
Sample
|
Type of design
|
Dimensions
|
|
Berasaluze &
Berrio-Otxoa, 2008
Berrio-Otxoa &
Berasaluze, 2008
|
Quantitative study
|
Questionnaire
|
370
|
Descriptive
|
Socio-demographic characteristics
Occupational-professional
Professional association
|
|
Rincón-del Toro et
al., 2016
|
Quantitative study
|
Online forms
|
11,525
|
Descriptive
|
Socio-demographic characteristics
Occupational-professional
|
|
Vidal-Martí
& Pérez-Testor, 2015
|
Quantitative study
|
Ad hoc questionnaire
|
67
|
Descriptive
|
Socio-demographic characteristics Occupational-professional
|
|
Ureña et al., 2019
|
Quantitative study
|
Questionnaire
|
--
|
Descriptive
|
Socio-demographic characteristics Occupational-professional
Professional association
|
|
Herrero, 2018
|
Quantitative study
|
Online forms
|
6,739
|
Descriptive
|
Socio-demographic characteristics Occupational-professional
Professional association
|
|
Cobos, 2019
|
Quantitative study
|
Self-administered questionnaire
|
172
|
Descriptive
|
Socio-demographic characteristics Occupational-professional
|
Table 3.
Identified elements of the studies
|
Emergent categories
|
Variables
|
Reference
|
|
Acts of violence towards the professional
|
Number of incidents
|
Berasaluze & Berrio-Otxoa (2008)
Berrio-Otxoa & Berasaluze (2008)
Vidal-Martí & Pérez-Testor (2015)
Rincón-del Toro et al. (2016)
Ureña et al. (2017)
Herrero (2018)
Cobos (2019)
|
|
Types (physical, verbal, threats, insults...
|
Vidal-Martí & Pérez-Testor (2015)
Ureña et al. (2017)
Herrero (2018)
Cobos (2019)
|
|
Authors
|
Authors (client, family and companions)
|
Berasaluze & Berrio-Otxoa (2008)
Berrio-Otxoa & Berasaluze (2008)
Vidal-Martí & Pérez-Testor (2015)
Rincón-del Toro et al. (2016)
Ureña et al. (2017)
Herrero (2018)
Cobos (2019)
|
|
Risk factor
|
Characteristics of the author: (1) aggressive profile, (2)
gender.
|
(1) Herrero (2018)
(1) Cobos (2019)
(2) Ureña et al. (2017)
|
|
Characteristics of the professionals
|
Ureña et al. (2017)
Herrero (2018)
|
|
Service: (1) public/private, (2) type of service
|
(1) (2) Berasaluze & Berrio-Otxoa (2008)
Berrio-Otxoa & Berasaluze (2008)
|
|
Following the acts of violence
|
Consequences
|
Cobos (2019)
|
|
Number of complaints
|
Herrero (2018)
Cobos (2019)
|
|
Extent of support received
|
Ureña et al. (2017)
|
In relation to the dimensions,
similar themes are observed. Four out of the seven studies focus on elements
related to the professional association and all documents studied focus on the
work area.
Identification of the Variables Associated to Violence of
the Client Towards Social Workers to Improve Awareness of the Phenomenon
In this review, the different variables were divided into four
main groups: (1) acts of violence, (2) the authors of the violent action, (3)
risk factors and (4) subsequent consequences of the violent action. Table 3
summarizes the items identified in these categories.
The number of incidents and the agent who commits the act of
violence are the variables studied in all documents. There are differences
between the studies as regards the number of acts of violence. Two studies
present similar values in this regard (70% and 75%) (Berasaluze &
Berrio-Otxoa, 2008; Berrio-Otxoa &
Berasaluze, 2008; Ureña et al., 2017), but differ in the average time, although both focus on social
services. In health services, the number is a value below 1: 0.4% (Herrero,
2018) and 0.17% (Rincón-del Toro,
2016). In community services, 66.3% of social
workers reported having experienced violence, defining the phenomenon as a
“natural occurrence”.
Clients are the authors of the violence in all research from 67.2%
(Herrero, 2018) to
92% (Berasaluze & Berrio-Otxoa, 2008; Berrio-Otxoa & Berasaluze, 2008). The client’s family was identified as the author of the
violence in two
out of seven studies at lower percentages, from 20.7% (Cobos,
2019) to 14% (Ureña et al., 2017).
The type of violence is another variable analyzed. It has been
categorized as acts of violence. Physical and verbal violence is the
category most frequently analyzed in four out of seven studies, with values
ranging from 1.63% (Herrero, 2018) to 50% (Ureña et al., 2017) for physical violence and from 3.1% (Herrero, 2018) to 71% (Cobos, 2019) for verbal violence. Verbal violence is divided into two
categories (threats and insults) and analyzed in two out of seven documents,
with values ranging from 42% (Ureña et al., 2017) to 18.4% (Cobos, 2019) for threats and 15.7% (Cobos, 2019) to 8% (Ureña et al., 2017) for insults.
The characteristics of the worker was one of the variables
analyzed in three out of seven studies, with gender (Herrero, 2018; Vidal-Martí & Pérez-Testor, 2015) and professional category (Cobos, 2019; Vidal-Martí & Pérez-Testor, 2015) being established as risk factors. Client characteristics was
another variable analyzed by three out of seven studies, and focusing on gender
(Ureña et al., 2017) and
aggressive profile (Cobos, 2019; Herrero, 2018).
However, the research studies differ as regards the variables
analyzed and therefore do not present results that can be compared one with
another. The variables type of service (Berasaluze &
Berrio-Otxoa, 2008; Berrio-Otxoa &
Berasaluze, 2008), consequences (Cobos,
2019), reporting (Herrero, 2018) and degree of support received (Ureña et al., 2017) were analyzed in one out of the seven studies.
Discussion
The results of the reviewed articles show that client violence
towards social workers is a common phenomenon. The data show a low number of
studies, a variability of variables studied and knowledge that is difficult to
compare between studies. However, the review is a good tool to identify this
variability and emphasizes the need for further research.
The low number of studies found to carry out the review is a first
consideration. We found three possible explanations. The first is that the
shortage is not typical of this country, but of the object of study. Few
countries have investigated client violence towards social workers and this
review contributes to those made by Australia (Koritsas et al., 2010), Canada (Kosny & Eakin, 2008; Lamothe et al., 2018; Macdonald
& Sirotich, 2005), Finland (Virkki,
2008), United States (Jayaratne et al.,
2004; Newhill, 1996; Newhill & Wexler, 1997; Shields & Kiser, 2003), UK (Harris & Leather, 2012; Littlechild, 2005; Robson et al., 2014),
Israel (Enosh & Tzafir, 2015; Enosh et al., 2013, 2015; Zychlinski
et al., 2022), Iran (Padyab
et al., 2012; Padyab,
Ghazinour et al., 2013; Padyab, Richter et
al., 2013) and Chile (Calderón-Orellana
et al., 2022). Therefore, the reduced
number of studies reviewed is not exclusive to Spain, but it is in accordance
with the study of the phenomenon.
A second explanation is the complexity of the object of study. The
lack of a consensual definition of workplace violence, of standardized
instruments and the lack of culture for addressing violence in the workplace
would be some of the elements that would explain this complexity and the
difficulty of studying the phenomenon (Robson et al., 2014; Vidal-Martí & Pérez-Testor, 2017).
In addition to this complexity of the object of study, there
is the variability of services where the social work professional works.
Working in social, health and community services and intervening with
vulnerable groups such as the elderly, people with functional diversity, high
levels of functional dependency, mental health or in child protection systems
are some of the professional services where social workers work.
At the same time, it is accentuated in the case of social work,
because it contradicts the professional mission; that is, the task of the
social worker is to intervene and help people with vulnerability and, the
violence that the professional can experience might be interpreted as a risk to
the labour force, but hardly as a violation of rights (Enosh & Tzafir,
2015; Zelnick et al., 2013). Therefore, studying an uncomfortable phenomenon, even if it has
serious consequences for the health of the professionals, could explain the low
number of investigations about the study of the phenomenon.
The third explanation is not exclusive to this research, but the
result obtained reinforces all the conceptual, methodological and axiological
difficulties previously mentioned.
A second consideration to note is that the results show that the
studies reviewed have focused on the description of the phenomenon, from a
cross-sectional design, to know the occurrence and facilitate the visibility of
the problem that affects the health of social workers.
However, addressing the clients’ violence towards social workers
requires complex responses (Kagan & Itzick, 2019). Therefore, studying the risk factors in depth will be basic and
necessary in the future to know the phenomenon more accurately and consequently
will facilitate the design of prevention and protection measures (Enosh
& Tzafir, 2015; Zelnick et al., 2013).
The characteristics of the client, the professional, the tasks
that professionals perform, the culture of the organization, prevention
policies, and the environment where the professional task is carried out are
some of the risk factors to be studied (Brown, 1986; Munobwa et al., 2021; Robson
et al., 2014; Tesi et al., 2019).
A third consideration to highlight is the study of the investigated
dimensions. Specifically, four out of the seven studies reviewed analyze
violence from a professional association perspective. This means that
collegiate organizations are concerned about the effects and consequences of
workplace violence.
Therefore, these organizations, aware that clients violence
against social workers is a health problem, have been promoters of studies to
make visible a hidden reality and, based on the results obtained, establish
legal and material measures such as books and guides on prevention and action (Alvarez,
2008, 2009; Santás,
2010).
Johnson (1998)
affirms that traditionally the prevention measures of the governments have been
guides and documents of good practices. The review shows that in the Spanish
case, this function has been performed by professional associations. In Spain,
each collegiate organization acts in a specific area. In the analysis of the
seven studies reviewed, two organizations that have been promoters of the
research are identified. This means that the knowledge is not homogeneous
throughout Spain, but focused on two specific areas: Euskadi and Madrid.
The study
period is a fourth consideration to analyze. The review shows that workplace
violence towards social workers began to be the subject of study in 2008,
intensifying from 2015 to the present. This progression over time is also
observed in the literature. Although there are studies from 1990 to 2008 (Balloch et al., 1998; McPhaul et al., 2008; Winstanley
& Hales, 2008), the
research intensifies from 2010 onwards (Enosh
& Tzafrir, 2015; Lamothe et al., 2018; Sousa et al., 2014; Truter & Fouché,
2019).
One of the
surprising aspects of the analysis of the reviewed studies is the delay in
studying the phenomenon. The first studies reviewed date from 2008, which means
that before that date client violence against social workers had not been
studied, which contrasts with the study of other countries such as the United
States (Newhill, 1996; Newhill & Wexler,
1997) or the UK (Balloch et al., 1998; Littlechild, 1995).
A fifth
consideration to ponder is who the author of violence against social workers
is. The results establish that the client is not the only agent and show that
the family or other companions can also be agents (Harris & Leather,
2012; Koritsas et al., 2010; Padyab et al., 2012; Padyab, Gazhinour et al., 2013). This aspect differs from other studies and
can be explained by two facts. The first fact is that the studies reviewed
analyze different services; in particular, four different types are examined
(social, health, community and nursing homes). And the second is because five
reviewed studies help to know the reality.
Finally, one
aspect was not found in the reviewed articles: frequency. In the seven
documents, the variable number of incidents is studied, but in none of them is
this data related to time.
Different
authors (Enosh & Tzafir, 2015; Enosh et al., 2013; Munobwa et al., 2021) affirm that the violence of clients towards
social workers is mild, but continuous over time (weekly/monthly). This
persistence of violence causes harmful consequences in the health of the
professionals.
Mild acts
of violence are actions such as threats, insults, verbal abuse, disavowals,
intimidation and actions of verbal and nonverbal coercion (Enosh & Tzafir, 2013; Lamothe, 2018).
In summary,
this review is a first step in finding out what research has been done, what
methodology has been used, and the variables studied. This knowledge allows a
better understanding of the phenomenon, to identify future lines of research in
order to address and as far as possible eradicate client violence towards
social workers.
Conclusions
This study shows that there is client violence
against social workers. It also shows that there is client violence towards
social workers, generating consequences for the professional and the
professional environment.
Nevertheless,
the results obtained in the review are neither significant nor sufficiently
representative because the number of studies is low, different services are
studied and the variables analyzed also vary, making them difficult to
understand and analyze. Even so, and while aware of these limitations, we can
highlight three elements that the studies which were analyzed in the review
share in common.
Firstly,
they are exploratory studies, descriptive in design, providing an insight into
the situation. This knowledge is a picture of the situation, which allows us to
approach a diagnosis, and begin to study the problem in greater detail.
Secondly,
they use ad hoc instruments that enable exploration and understanding of the
phenomenon. These instruments are good tools to begin study. However, the
subjectivity of the violence construct and the need to review the validity of
the instruments, require the number of instruments to be revised or expanded.
And a
third element is that the language used is Spanish. Almost no studies were
found in English, which means that the results serve to raise the profile of
the problem in the territory itself.
In summary,
the main objective of this manuscript is to present a systematic review of
client violence towards social workers in Spain and, to a large extent, it is
fulfilled. The four specific objectives are also met, because the manuscript
provides insight into the descriptive and methodological characteristics of the
studies and the variables analysed.
However,
the limited number of studies, the variability of variables studied and their
descriptive nature allow an approximation of the phenomenon, but further
research is needed to understand the incidence, risk factors, consequences of
the phenomenon and other characteristics that help to describe and explain the
phenomenon in greater detail.
The manuscript shines a light on the problem of
violence experienced by social workers and expressed through their collegiate
organizations, which are responsible for providing coping tools when violence
has occurred (Alvarez, 2008; 2009; Santás, 2010). Accordingly, this review is a first step,
but it is necessary to continue this research in order to minimize this
occupational risk.
Any review
study involves making decisions that may have affected the results presented.
Aware of these limitations, we present two possible constraints. The first is
that errors or biases may have been made when the bibliographic search was
performed, leading to some studies not being considered. A second is that the
languages used in the databases were Spanish and English, and other languages
were omitted.
In summary,
this research highlights the problem of workplace violence of social workers in
Spain, identifies the studies carried out and the variables studied, but it is
essential to continue this research in order to answer three questions: 1) to
determine the real scope of the problem at a global level, 2) to understand the
risk factors and 3) establish protection and prevention measures to improve the
health of professionals and their environment.
Conflicts of interest: The author declares no conflict of
interest.
Finance: The author declares that they have received no funding.
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