International Council of Nurses [Fact Sheet - Violence: A World-wide epidemic]

Nursing Matters fact sheets provide quick reference information and international perspectives from the nursing profession on current health and social issues.

Violence: A World-wide epidemic

Violence in all its forms has increased dramatically worldwide in recent decades¹. Apart from civil conflict and war, violence - being destructive towards another person - can be interpersonal, self-directed, physical, sexual and mental. It is a generic term that incorporates all types of abuse - behaviour that humiliates, degrades or injures the well-being, dignity and worth of an individual.

Violence crosses all boundaries, including age, race, socio-economic status, education, religion, sexual orientation and workplace. A recent report concludes that workplace violence has also gone global, crossing borders, work settings and occupational groups². Violence has become a public health concern of epidemic proportion with extensive health care ramifications. During 1993, at least 4 million deaths (8% of the total) resulted from injury due to aggression. Of these violent deaths, some 3 million were in the developing world.

In many countries, violence is endemic and the leading cause of death among males aged 15 - 34. The burden of violence however is disproportionately borne by young people and women. Gender violence is considered a universal plague even though it continues to be grossly underreported.

Gender Violence

Women are targets of violence more often than men. They are subjected to domestic and workplace violence, manifested through physical and verbal abuse, sexual harassment and bullying. Certain culturally condoned practices, such as female genital mutilation and son preference, are also considered violent acts against women. Recently, special attention has highlighted the plight of women in times of social disorder - victims of organised rape in armed conflict situations or sexual violence in refugee camps.

Societal tolerance of such abuses has contributed to the existence of such behaviours. In many societies, wife abuse is acceptable behaviour and justified as a routine part of married life. The absence of credible support systems for women victims helps perpetuate an escalation of violence.

Nurses and Nursing

Nurses have a particular interest in eliminating violence. As health care professionals, nurses often have first line contact with the increasing numbers of the victims of violence. Regrettably, a small number of nurses have also been known to be perpetrators of violence, patient or colleague abuse in violation of nursing's code of conduct. Nurses also suffer from societal tolerance of violence. The legal system has on several occasions refused to grant compensation to nurse victims. This was justified on the principle that to practise nursing was to accept the risk of personal violence. Nurses themselves often feel that they are "legitimate targets" and that violence is "part of the job".

Ninety-five percent of nurses around the world are women. Attitudes towards women are often reflected in interactions with the profession. What are some of the relevant statistics?

Health care workers are more likely to be attacked at work than prison guards or police officers.

Nurses are the health care workers most at risk, with female nurses considered the most vulnerable.

General patient rooms have replaced psychiatric units at the second most frequent area for assaults.

Physical assault is almost exclusively perpetrated by patients.

97% of nurse respondents to a UK survey knew a nurse who had been physically assaulted during the past year.

72% of nurses don't feel safe from assault in their workplace.

Up to 95% of nurses reported having been bullied at work.

Up to 75% of nurses reported having been subjected to sexual harassment at work.

A campaign for zero-tolerance of violence at the workplace needs to address the contributing factors, namely: working in isolation, inadequate staff coverage, lack of staff training, poor inter-relationships within the work environment such as managers' disinterest, difficulty dealing with people who have been drinking or taking drugs, and with people under stress, frustrated, violent or grief-struck.

What are the statistics?

In the US, a woman is beaten every 18 minutes and every six minutes a woman is raped. Between 22 and 35 per cent of women who visit emergency rooms are there as a result of domestic violence³.
In the developing countries, one-third to over one-half of women report being beaten by their partner⁴. In Peru, 70 per cent of all crimes reported to the police involve women beaten by their husbands. In the 400 cases of domestic violence reported in 1993 in the province of Punjab, nearly half ended with the death of the wife⁵.
In the Caribbean, one in three women has been sexually abused as a child⁶.
According to the World Health Organization, 85 - 115 million girls in the world's population have undergone some form of female genital mutilation and suffer from its adverse health effects⁷.
In a large Bombay hospital, 95.5 per cent of foetuses identified as female were then aborted, compared with a far smaller percentage of male foetuses⁸.
Thousands of women held in police custody world-wide are routinely raped.
World-wide, the vast majority of sexual harassment victims are women⁹.

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References

WHO (1997) The World Health Report 1997, Geneva: WHO.

ILO (1998) When Working Becomes Hazardous. World of Work, 26

UN (1996) Human Rights: Women and Violence.

Jejeebhoy, S.J. (1998) Implications of domestic violence for women's reproductive health: what we know and what we need to know. Biennial Report 1996-1997.

UN (1996) Human Rights: Women and Violence.

Contact (1993) Why Women's Health? No 131, p3.

UN (1996) Human Rights: Women and Violence.

ICN (1994) Coping with Violence in the Workplace