Masood Ali Shaikh ( Pakistan Medical Research Council, Islamabad. )
Objective: To assess the extent of Sexual harassment of female nurses by male physicians, patients or patient’s relatives.
Setting: A general hospital in islamabad.
Method: A cross sectional written study through a self administered brief questionnaire.
Results: Male physicians were identified as the major perpetrators of sexual harassment, followed by the patients and their relatives.
Conclusion: The nurses and hospital administration need to work together for fostering work environment conducive to healthy environment for effective health care delivery UPMA 50:130, 2000).
Sexual harassment may be defined as an unwelcome conduct based on sex, which affects the dignity of women, However, there is no universally agreed definition. As cultural context and subjective perception also strongly determine what constitutes sexual harassment. The intrinsic nature of nurses job transgresses socio-cultural norms regarding bodily contact, which perpetrators exploit.
In Pakistan, sexual harassment has not been addressed in the medical profession. One study1 of 68 nurses reported a 13.2 percent and 72 percent rate of physical harassment and verbal harassment respectively, of female nurses by the male physicians in Pakistan.
Nurses sexually harassed at work, experience adverse psychological consequences and are unable to render care effectively2-6.
Nurses responding to questionnaires in various surveys conducted in Europe, Australia and North America, reported having experienced sexual harassment at work, ranging from 9 percent to 75 percent5-9 . In these surveys, with sample sizes ranging from 120-345, nurses specifically identify male physicians as sexual harassers ranging from 22 percent to 50 percent5,8,9. While only one study 9 of 229 nurses, reported a detailed break-down of harassers in which male physicians were identified as sexual harassers by 50 percent of female nurses, while 34 percent and.14 percent nurses identified patients and patients relatives as sexual harassers, respectively. In a study of internal medicine female interns 24 out of 33 (73%) reported experiencing sexual harassrnent10.
Subjects, Methods and Results
This study was conducted by using an anonymous, self-administered, brief questionnaire in a cross-sectional written study of ninety nurses at a hospital in Islamabad. A discussion with few nurses of another hospital prior to finalization of questionnaire, suggested that response rate might be substantially low if open-ended questions were included. The open-ended questions require writing answers/opinions rather than simply marking given choices. And a given individual could be traced based on the hand writing in the questionnaire, hence all the questions in the questionnaire were close-ended.
The questionnaires were given to the Nursing Superintendent of the hospital to distribute among all the nurses working in the hospital. Nurses were instructed to deposit the filled questionnaires in a designated box, kept for this purpose in the office of the Nursing Superintendent.
The nurses were asked to report whether they had been sexually harassed during their job or while being a nursing student by either male physicians, male patients or patient’s male attendants/relatives.
No specific definition of sexual harassment could be included in the questionnaire, as such attempt was deemed culturally inappropriate by the hospital administration. And a request for the same was sternly denied. Hence every respondent ostensibly used her own definition of what constitutes sexual harassment, and responded accordingly.
Seventy-one questionnaires were returned, i.e., a response rate of 78.9%. The mean age of respondents was 35.4 years (range 25 - 41 years). Out of the available responses2’ (29.6%) nurses said that they think male physicians sexually harass nurses, while 15 (21.1%) reported having experienced verbal sexual harassment and 12 (16.9%) reported having experienced physical sexual harassment. Two (2.8%) and 8 (11 .27%) reported such harassment from male patients and patient’s male attendants respectively. While 10 (14.1%) reported sexual harassment from male physicians while being a nursing student. Sexual harassment was seen as an occupational hazard by 17 (23.9%) of respondents.
Sixteen (22.5%) nurses reported having known a nurse who has left nursing due to sexual harassment by male physicians. This question was asked to tap those nurses who either experienced gross abuse or were severely affected by this abuse to niake a career change.
Sexual harassment violates the sense of equality and personal autonomy. It is abuse of status and power, and needs to be seen in the context of institutionalized male power. Hence, effective interventions need to address both, individuals and institutions. The anonymous self-administered format of this study has definite advantages over personal interviews due to the sensitive nature of questions asked. Sexual harassment seriously affects productivity and performance of nurses leading to in some instances quitting the profession11. This was borne out in this study as 22.54% of nurses reported kno\\\\.ving a nurse who quit nursing due to sexual harassment. Major limitations of this study are firstly, the fact that the Nursing Superintendent, a hospital official, was requested to distribute and collect the questionnaires, albeit in an anonymous manner. Ostensibly sonic of the respondents might have had concerns about divulging the truth or the true extent of it. Hence, the figures reported in this study could be an understatement of reality, which may explain the low prevalence of reported sexual harassment in this study. Second, a definition of sexual harassment was not used. Hence respondents were left to interpret the term on their own. But this is a first study of its kind in Pakistan, and research on socially sensitive issues tends to address questions and improve only incrementally. Future studies on this issue need to find a way to incorporate clearly stated definition of sexual harassment in questionnaires or have open-ended questions about what constitutes sexual harassment.
There is no Pakistani-based empirical research to guide hospitals, the principal employers of nurses, for developing effective policies to address sexual harassment.
Nevertheless, this study suggests that sexual harassment of nurses by male physicians is a concern that needs to be studied in more detail and effectively addressed in our country by the professional associations.
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