Study on Verbal abuse Experience of Dental Personnel in Dental Clinics and Hospitals

 

Jung-Hui Son1, Chang-Hee Kim2*, Do-Seon Lim3

1 Dept. of Dental Hygiene, Daewon University College, Jecheonsi, Korea

2Dept. of Dental Hygiene, Chungcheong University, Cheongjusi, Korea

3Dept. of Dental Hygiene, Eulji University, Seongnamsi, Korea

*Corresponding author E-mail: jadoreya@naver.com, chst6619@hanmail.net, idsun@eulji.ac.kr

 

ABSTRACT:

Background/Objectives: This study was conducted to investigate the degree of verbal abuse experienced by dental personnel and to identify the associations among verbal abuse, coping response, turnover intention and emotional response.

Methods/Statistical analysis: Data were collected from 410 dental personnel from September 1 to 15, 2015.

Findings: Results of the analysis are as follows: 1) Among the verbal abuse items, the most frequently experienced cases were ‘talking roughly to me’ ‘ignoring my career’ and ‘speaking in a coercive tone’ Experiences from patients and caregivers were the most frequent. 2) There were correlations among the verbal abuse experience, coping response, turnover intention, and emotional response (p<0.001).

Improvements/Applications: Based on the above results, efforts to create a safe working environment must be made in order to reduce verbal abuse suffered by dental personnel. The administrative system must also be prepared.

 

KEYWORDS: dental clinic, dental hygienist, dental personnel, dentist, verbal abuse.

 

 

 


1. INTRODUCTION:

Dental hospitals and clinics are complex organizations involving interactions between the different people involved, a hierarchical leadership structure, and specialization of work. Although mutual cooperation within the organization is acknowledged as essential, there are countless obstacles to achieving cooperation1. In particular, because dental workers administer oral healthcare and treatment to patients through direct, they come to experience verbal and physical abuse for various reasons.

 

The rights and demands of medical users are increasing, as is the responsibility of dentists, and even though the professionalism of dental hygienists is emphasized, they sometimes suffer verbal abuse from patients and caregivers who have not experienced high-quality medical services. In addition, there is also conflict and abuse between dental care providers. Repeated verbal abuse is a major factor threatening the self-esteem, productivity, and mental health of dental workers, thereby reducing their work capacity, and even elevating the turnover rate by inducing the desire to quit2,3. It also affects personal lives, resulting in a passive lifestyle, including aspects of low self-confidence, psychological withdrawal, and shame4.

 

Verbal abuse produces various negative responses in dental hygienists, such as embarrassment, anger, withdrawal, and anxiety5. This affects their job satisfaction, which is thought to lower the quality of dental services provided to patients. Although some research has been conducted on dental hygienists’ experiences of verbal abuse, there have been no studies on the association between verbal abuse experiences and turnover intention in dental personnel. Therefore, the present study conducted a survey on the types of verbal abuse experienced by dental personnel in clinical practice, and examined the correlation with turnover intention. In this way, we aimed to provide data to support the development of efficient strategies to prevent verbal abuse and reduce the turnover rate.

 

2. MATERIALS AND METHODS:

2.1. Study design:

This was a descriptive correlation study aiming to identify the correlation between turnover intention and experience of verbal abuse in dental personnel. The study was approved by the Eulji University IRB (IRB no. EU15-46).

 

2.2. Research instruments:

The instrument to measure verbal abuse was adapted from a 17-question instrument developed by Nam et al6.It included questions on general characteristics, experiences of verbal abuse, coping response after verbal abuse, emotional response to verbal abuse, long-term impact of verbal abuse, and turnover intention.

 

 

 

2.3. Subjects and methods:

The data collection period was from 1stto 15thSeptember, 2015. The researchers visited dental hospitals directly, obtained the subjects’ consent to the study objectives and data collection procedure, and administered the questionnaire to 432 consenting dental personnel. Of the returned questionnaires, 22 were excluded for missing or insufficient responses and a total of 410 subjects were included in the final data analysis.

 

2.4. Statistical analysis:

The subjects’ general characteristics were displayed as the frequencies and percentiles. The extent of verbal abuse experiences was displayed as the mean and standard deviation. A hierarchical multiple regression was performed to verify the effects of verbal abuse experiences on turnover intention in dental personnel. PASW statistics 23.0 (SPSS Inc, Chicago, USA) was used for all statistical analysis, and statistical significance was defined as p<0.05.

 

3. RESULTS AND DISCUSSION:

3.1. Result:

3.1.1. General Characteristics of Subjects:

The general characteristics of subjects as shown in table 1.The general characteristics of the 410 total subjects are participated in the study.


Table 1. General Characteristics of Subjects

Characteristics

Category

Frequency (n)

Percentage (%)

M±SD

Sex

Male

51

12.4

 

Female

359

87.6

 

Age

20–29 years

242

59.0

29.24±6.89

30–39 years

132

32.2

40–49 years

31

7.6

≥50 years

5

1.2

Occupation

Dentist

45

11

 

Dental hygienist

286

69.8

 

Nurse assistant

26

6.3

 

Dental coordinator

23

5.6

 

Dental technician

14

3.4

 

Other

16

3.9

 

Highest education level attained

High school

23

5.6

 

Associate degree

196

47.8

 

Bachelor degree

134

32.7

 

Master’s degree or higher

57

13.9

 

Total clinical experience (months)

12–36 months

152

37.1

74.88±67.35

36–60 months

73

17.8

60–120 months

87

21.2

120–240 months

87

21.2

≥240 months

11

2.7

Experience at current workplace (months)

1–36 months

242

59.0

46.73±54.78

36–60 months

57

13.9

60–120 months

65

15.9

120–240 months

40

9.8

≥240 months

6

1.5

Total

 

410

100.0

 

 


 

3.1.2. Verbal Abuse Experience of Dental Personnel:

The verbal abuse experiences of dental personnel were as shown in table 2.Among experiences of verbal abuse by dentists, “have ever talked to me roughly” was the most frequent response at approximately 73%, while “have ever spoken to me in a commanding coercive tone” was also reported highly at 60%. Among experiences of verbal abuse by dental hygienists, “have ever talked to me roughly” was the most frequent response at 63%, while “have ever spoken ill of others and made me feel uncomfortable” was also high at 47%. Among experiences of verbal abuse by other dental personnel, “have ever talked to me roughly” was the most frequent response at 46%, while “have ever spoken ill of others and made me feel uncomfortable” was also high at 33%. As for experiences of verbal abuse by patients and caregivers, “have ever talked to me roughly” was the most frequent response at 87%, while “have ever been angry and called me names” was also high at 71%.


 

 

Table 2. Verbal Abuse Experience of Dental Personnel. Mean±SD

Item

Verbal Abuse by Dentist

Verbal Abuse by Dental Hygienist

Verbal Abuse by Other Dental Personnel

Verbal Abuse by Patient & Caregiver

Have ever been angry and call me names.

113(27.5)

102(24.9)

91(22.2)

291(71.0)

Have ever talked to me roughly.

300(73.2)

259(63.1)

189(46.1)

355(86.6)

Have ever verbally ignored my career.

196(47.8)

127(31.0)

117(28.5)

254(62.0)

Have ever spoken to me in a coercive commanding tone

245(59.7)

187(45.6)

124(30.2)

279(68.0)

Have ever verbally threatened me.

113(27.5)

101(24.6)

81(19.8)

209(51.0)

Have ever sexually insulted me verbally.

87(21.3)

70(17.1)

65(15.9)

124(30.2)

Have ever verbally criticized my appearance or body image.

121(29.5)

104(25.4)

73(17.8)

106(25.9)

Have ever verbally criticized my personality.

127(31.0)

124(30.2)

81(19.8)

121(29.5)

Have ever verbally ignored my capability.

179(43.6)

140(34.1)

91(22.2)

208(50.7)

Have ever verbally belittled my educational background and origin.

102(24.7)

87(21.2)

73(17.8)

106(25.9)

Have ever verbally cursed me.

74(18.6)

70(17.1)

59(14.4)

100(24.4)

Have ever verbally created a warlike atmosphere to me.

142(34.7)

123(30.0)

82(20.0)

215(52.4)

Have ever spoken ill of others and made me feel uncomfortable.

176(43.0)

193(47.1)

136(33.2)

220(53.7)

Have ever spoken roughly to another person or verbally abuse him or her in front of me.

197(48.0)

172(42.0)

126(30.7)

234(57.1)

 

 


3.1.3. The impact of experiences of verbal abuse on dental personnel’s turnover intention:

The impact of experiences of verbal abuse on dental personnel’s turnover intention was shown in table 3.We performed a multiple hierarchical regression analysis on 2 models in order to investigate the coping response and the emotional response of dental personnel after experiencing verbal abuse, as well as the long-term impact on turnover intention.

 

In Model 1, being a dentist was included as the independent variable. In Model 2, in addition to the variable in Model 1, coping response after verbal abuse, emotional response after verbal abuse, and the long-term impact of abuse were added. The explanatory power and the variance of each model were verified.

 

The analysis showed that there was a statistically significant effect on turnover intention in dental hygienists and dentists (p<0.05). The fit of both models was statistically significant. The variance inflation factor (VIF), which was calculated to test for multicollinearity between the independent variables, was found to be below 10 in both models, and the tolerance limit was higher than 0.1, meaning that there were no issues due to multicollinearity. In Model 1, experience of verbal abuse by dentists was found to have a significant effect on turnover intention (p=0.013). Model 1, containing a single variable, was able to explain 1.5% of variance in turnover intention.

 

In Model 2, after adding coping response and emotional response after verbal abuse to Model 1, these were also found to have a significant association with turnover intention. By including three variables, Model 2 increased explanatory power for turnover intention by 20.6%, and was able to explain 22.1% of total variance in turnover intention. Based on the results of Model 2, we evaluated the relative contribution of each independent variable. The largest effect was for emotional response after verbal abuse (t=6.466), followed by coping response after verbal abuse (t=3.311), long-term impact of verbal abuse (t=1.977), and being a dentist (t=-2.494).


 

Table 3. The effects on turnover intention of dental personnel. (N=410)

 

Model 1

Model 2

B

β

t

p

B

β

t

p

Being a dentist

-.331

-.123

-2.494

.013

-.241

-.089

-1.988

.047

 

Coping response after verbal abuse

 

 

 

 

.207

.159

3.311

.001

Emotional response after verbal abuse

 

 

 

 

.032

.322

6.466

p<0.0001

Long-term impact of verbal abuse

 

 

 

 

.068

.096

1.977

.049

Constant

2.776

1.164

F-value

6.220

28.677

Adjusted R2

.015

.221

hierarchical multiple regression *p<0.05 (0: dentist, 1: dental hygienist)

 


3.2. DISCUSSION:

Although verbal abuse does not cause visible trauma like physical abuse, it leaves mental trauma that can be even more severe7. A large number of studies have shown that sufferers of verbal abuse exhibit various negative responses, including embarrassment, shame, and fear, and also experience feelings of stress and burden with regard to their work. In such circumstances, verbal communication problems and verbal abuse have a multiplicative effect on these negative attitudes, and can ultimately lead to job turnover8.

 

The present study was a descriptive study to ascertain the impact of verbal abuse on turnover intention in dental personnel. We aim to provide information that can help reduce the turnover rate among dental personnel by preventing verbal abuse in dental hospitals, and forming a safer working environment.

 

Looking at the main verbal abusers of dental personnel, abuse was most frequently experienced from the external source of patients and caregivers, while among internal sources, abuse was most commonly experienced from dentists. This is consistent with previous studies in nurses9-11. The fact that dental personnel most often experience verbal abuse from patients and caregivers is thought to be an expression of the internal pain and discomfort of patients visiting the dental hospital, as well as any dissatisfaction they experience during the course of treatment. Rather than direct issues with dental treatment, patients experience dissatisfaction in medical service and project this onto dental personnel in the form of verbal abuse. This reflects the changes in the relationship between patients/caregivers and medical personnel towards one of medical service providers and consumers, as well as an increase in the demand for high-quality medical services that is not yet being met. In order to reduce verbal abuse and protect dental personnel, systematic devices need to be prepared, such as training programs in self-assertion and communication as they relate to prevention of and coping with verbal abuse, in addition to education programs for patients and caregivers, and crisis intervention programs. The present study found no dental personnel who had been educated in coping methods after verbal abuse, suggesting that there is an urgent need to prepare education programs and systematic devices for the prevention of abuse within dental hospitals.

 

Looking in detail at types of verbal abuse, the most common form of verbal abuse by dentists, dental hygienists, other dental personnel, and patients and caregivers was “talking roughly”. This was highest among patients and caregivers at 86.6%, following by dentists at 73.2%, dental hygienists at 63.1%, and other dental personnel at 46.1%. These results are similar to studies in nurses12,13. This is an effort by the abuser to demonstrate their own self-worth and superiority, and can damage the self-concept of the victim. However, in dental hospitals, although talking roughly is common among both dental personnel and patients and caregivers, the speaker himself is often not aware of their own register. Therefore, measures need to be developed to establish a mature working culture of mutual respect and recognition as colleagues.

 

In the present study, among medical personnel, dentists were the most frequent verbal abusers, and this is thought to be because of a lack of awareness for mutual respect between dental personnel. Dentists need to recognize that their position as collaborators in the cooperative effort to reduce verbal abuse among personnel, and should make efforts to establish mutual trust and improve their own image. At the level of the dental hospital, an organizational culture of respect and cooperation is required between dentists, dental hygienists, and other dental personnel.

 

We performed a hierarchical multiple regression analysis to ascertain the factors affecting turnover intention in dental personnel, and we found that the emotional response after verbal abuse had the greatest impact. ‘Anger’ was the most common type of emotional response after verbal abuse. This is consistent with the results of Kwon4, who also reported ‘anger’ as the most common response. Therefore, following an experience of verbal abuse, it is essential for dental personnel to control their ‘anger’. Dental personnel who experience verbal abuse show emotional responses including anger, frustration, depression, and decreased self-esteem, in addition to long-term reduction in job satisfaction, low self-esteem, and negative interpersonal relationships. This can lead to serious outcomes, causing impairments at work and even harming the individual’s self-concept10. Therefore, in order to reduce turnover and increased job satisfaction, dental personnel need to be protected from verbal abuse, and specific follow-up measures need to be prepared in cases of verbal abuse, to help personnel better control their emotional response.

 

4. CONCLUSION:

Since this study only investigated dental personnel at some dental hospitals, in order to generalize the results, replication studies need to be performed on more dental personnel at different sized hospitals. The results of our study showed that patients/caregivers and dentists were the most frequent verbal abusers, while the most common type of verbal abuse was “talking roughly”. The emotional response after verbal abuse had the greatest impact on turnover intention. Therefore, in order to prevent verbal abuse and alleviate the emotional response in dental personnel, there is a need to develop and enact preventative education programs and programs to effectively respond to verbal abuse.

 

REFERENCES:

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10.     HJ Jung, YS Lee, Nurses`s Experiences of Verbal Abuse in Hospital Setting. Korean J Health Commun, 2011, 6(2), pp. 118-126.

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Received on 20.06.2017           Modified on 19.07.2017

Accepted on 28.07.2017          © RJPT All right reserved

Research J. Pharm. and Tech. 2017; 10(7): 2335-2339.

DOI: 10.5958/0974-360X.2017.00413.9