Investigation of Workplace Violence Against Midwives: A Systematic Review

Document Type : Review Article


1 PhD candidate of reproductive health, Student Research Committee, Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, IR Iran

2 Master student of Midwifery, Student Research Committee, Faculty of Medicine, Gonabad University of Medical Sciences, Iran


Introduction:Workplace violence is defined as an aggressive behavior toward the staff performing their duties at the workplace. This violence occurs in various forms, such as verbal abuse, physical abuse, assault, rape, harassment, bullying, threats, as well as ugly and unpleasant behaviors. Workplace violence can occur in any occupational environments or positions. Several studies have shown that violence takes place in midwifery workplaces. Regarding this, the present review was conducted to investigate the evidence on violence against midwives.
Materials and Methods:The articles related to the subject of interest and published until Dec 2018 were searched in several databases, including SID, Irandoc, Scopus, Pubmed, and ISI Web of Science, with no time limitation using the following medical subject headings: “Workplace aggression”, “Bullying”, “Workplace violence”, “Verbal violence”, “Physical violence”, and “Midwife”. For reviewing the articles, a "data extraction form" was designed based on the research objective. The results were reported qualitatively.
Results: Among 214 articles retrieved in the initial search, seven articles met the inclusion criteria, including 1, 2, and 4 studies withcross-sectional, descriptive-exploratory, and descriptive-analytic designs, respectively. Verbal violence had the highest prevalence rate (83.3%), 60% of which was committed by patients’ companions.
Conclusion:Despite the high level of violence in midwifery and according to the percentages stated in the articles, it is necessary to investigate this issue in Iran in order to identify the factors influencing violence, source of violence, midwife's experiences of violence, and its consequences. It is suggested that authorities at each hospital identify violence and sources of violence in the midwifery department with a standard questionnaire. They should also help resolve workplace violence because it can affect their job performance and productivity, which in turn negatively affect the quality of care and health of their patients.


1.     Samir N, Mohamed R, Moustafa E, Abou Saif H. Nurses' attitudes and reactions to workplace violence in obstetrics and gynaecology departments in Cairo hospitals. East Mediterr Health J. 2012; 18(3):198-204.
2.     Fallahi Khoshknab M, Oskouie F, Najafi F, Ghazanfari N, Tamizi Z, Ahmadvand H. Psychological violence in the health care settings in iran: a cross-sectional study. Nurs Midwifery Stud. 2015; 4(1):e24320.
3.     Gillen PA. The nature and manifestations of bullying in midwifery. [Doctoral Dissertation]. Coleraine: University of Ulster; 2007.
4.     Paryad E, Jahani Sayad Noveiry M, Kazemnejad Leili E, Akbari A, Ghanbari Khanghah A, Bouraki S. Incidence of violence against nurses in the educational-medical centers in Rasht. J Holistic Nurs Midwifery. 2015; 25(2):16-23.
5.     Fallahi-Khoshknab M, Oskouie F, Najafi F, Ghazanfari N, Tamizi Z, Afshani S. Physical violence against health care workers: a nationwide study from Iran. Iran J Nurs Midwifery Res. 2016; 21(3):232-8.
6.     Ramezani T, Fasihi T, Mangali M. Nurses' experiences of occupational aggression in the psychiatric wards: Phenomenology approach. J Fundamen Mental Health. 2012; 13(4):314-27.
7.     Fallahi Khoshknab M, Oskouie F, Najafi F, Ghazanfari N, Tamizi Z, Ahmadvand H. Psychological violence in the health care settings in Iran: a cross-sectional study. Nurs Midwifery Stud. 2015; 4(1):e24320.
8.     Babaei N, Rahmani A, Mohajjel AA, Zamanzadeh V, Dadashzadeh A, Avazeh M. Workplace violence against nurses from the viewpoint of patients. Iran J Psychiatric Nurs. 2014; 2(1):43-54.
9.     Abbas MA, Fiala LA, Abdel Rahman AG, Fahim AE. Epidemiology of workplace violence against nursing staff in Ismailia Governorate, Egypt. J Egypt Public Health Assoc. 2010; 85(1-2):29-43.
10.  Sohrabzadeh M, Menati R, Tavan H, Mozafari M, Menati W. Patients' aggressive behavior towards female nurses and lack of reporting event in Ilam hospitals at 2012. Iran Occupat Health. 2015; 12(1):47-55.
11.  McKenna L, Boyle M. Midwifery student exposure to workplace violence in clinical settings: an exploratory study. Nurse Educ Pract. 2016; 17:123-7.
12.  Farrell GA, Shafiei T. Workplace aggression, including bullying in nursing and midwifery: a descriptive survey (the SWAB study). Int J Nurs Stud. 2012; 49(11):1423-31.
13.  El Ghaziri M, Zhu S, Lipscomb J, Smith BA. Work schedule and client characteristics associated with workplace violence experience among nurses and midwives in sub-Saharan Africa. J Assoc Nurs AIDS Care. 2014; 25(1):S79-89.
14.  Nourani Saadoldin S, Hadizadeh Talasaz Z, Shakeri MT, Modares Gharavi M. The relationship between occupational stress and happiness of midwives who work in the hospitals and health centers of Mashhad, Iran, 2013. Iran J Obstet Gynecol Infertil. 2013; 16(74):1-9.
15.  El Ghaziri M, Zhu S, Lipscomb J, Smith BA. Work schedule and client characteristics associated with workplace violence experience among nurses and midwives in sub-Saharan Africa. J Assoc Nurses AIDS Care. 2014; 25(1 Suppl):S79-89.
16.  Sorensen AA, Wojahn RD, Manske MC, Calfee RP. Using the strengthening the reporting of observational studies in epidemiology (STROBE) statement to assess reporting of observational trials in hand surgery. J Hand Surg Am. 2013; 38(8):1584-9.e2.
17.  Papathanasiou AA, Zintzaras E. Assessing the quality of reporting of observational studies in cancer. Ann Epidemiol. 2010; 20(1):67-73.
18.  Boyle M, McKenna L. Paramedic and midwifery student exposure to workplace violence during clinical placements in Australia - a pilot study. Int J Med Educ. 2016; 7:393-9.
19.  Najar S, Alipour MM, Afshary P, Hagigie E. Review the amount of verbal violence against midwives and its related factors in midwife of Khuzestan province. Int J Bioassays. 2015; 4(7):4134-8.
20.  Khalil D. Violence against midwives in Cape Town. Afr J Midwifery Womens Health. 2009; 3(1):37-40.
21.  Gaffney DA, DeMarco RF, Hofmeyer A, Vessey JA, Budin WC. Making things right: nurses' experiences with workplace bullying-a grounded theory. Nurs Res Pract. 2012; 2012:243210.
22.  Noorana Zahra A, Feng JY. Workplace violence against nurses in Indonesian emergency departments. Enferm Clin. 2018; 28(Suppl 1):184-90.
23.  Beattie J, Innes K, Griffiths D, Morphet J. Healthcare providers' neurobiological response to workplace violence perpetrated by consumers: informing directions for staff well-being. Appl Nurs Res. 2018; 43:42-8.
24.  Eslamian J, Akbarpoor AA, Hoseini SA. Quality of work life and its association with workplace violence of the nurses in emergency departments. Iran J Nurs Midwifery Res. 2015; 20(1):56-62.
25.  Hadizadeh Talasaz Z, Nourani Saadoldin S, Shakeri MT. Relationship between components of quality of work life with job satisfaction among midwives in mashhad, 2014. J Hayat. 2015; 21(1):56-67.
26.  Liu W, Zhao S, Shi L, Zhang Z, Liu X, Li L, et al. Workplace violence, job satisfaction, burnout, perceived organisational support and their effects on turnover intention among Chinese nurses in tertiary hospitals: a cross-sectional study. BMJ Open. 2018; 8(6):e019525.
27.  Lin WQ, Wu J, Yuan LX, Zhang SC, Jing MJ, Zhang HS, et al. Workplace violence and job performance among community healthcare workers in China: the mediator role of quality of life. Int J Environ Res Public Health. 2015; 12(11):14872-86.
28.  Sun T, Gao L, Li F, Shi Y, Xie F, Wang J, et al. Workplace violence, psychological stress, sleep quality and subjective health in Chinese doctors: a large cross-sectional study. BMJ Open. 2017; 7(12):e017182.