ORIGINAL ARTICLE

Awareness about Workplace Harassment among Female Nursing

Students and Nursing Staff of a Teaching Hospital in Lahore
Tahseen Kazmi 1, Jamal Abdul Nasir 2, Umaila Qayyum 3, Tehreem Tahir 4

Professor, Department of Community Medicine, Central Park Medical College, Lahore1

Senior Demonstrator, Department of Community Medicine, Shalamar Medical & Dental College, Lahore 2
4th year MBBS Student, Department of Community Medicine, Shalamar Medical & Dental College, Lahore 3
4th year MBBS Student, Department of Community Medicine, Shalamar Medical & Dental College, Lahore 4

Doi: doi.org/10.53685/jshmdc.v2i2.6

ABSTRACT

Background: Harassment of working women is a common social and human rights problem and healthcare
settings are no exception. This unacceptable situation has many avoidable determinants that need preventive
measures to ensure, safe and secure working environment for nurses.
Objectives: To assess the knowledge and understanding among female nursing students and nursing staff
about workplace harassment in a tertiary healthcare facility.
Materials & Methods: It was a cross-sectional study conducted at Tertiary care hospital Lahore from July
to September 2018. Convenient sampling technique was used to collect data. Verbal informed consent
of voluntary participants was taken. Anonymity and confidentiality was assured. SPSS version 21 was
used for The
analysis. dataparticipants (n=80) comprised of senior female nurses students (62.5%) and senior nursing staff
(37.5%), aged 18 to 46 years.
Results: Awareness about common harassment forms was adequate (81.3%). Adverse effects included mental
health problems (83.8%) and low self-esteem (72.5%). A large percentage of nurses (62.5%) intended to report
such personal incident to institutional head and 72.5% were willing to accompany victims for such reporting.
77.5% desired arranging informative sessions and holding counseling for victims (78.8%) at workplace. Only
22.5% had vague idea about official protective legal frameworks.
Conclusion: Workplace harassment of female workers is quite prevalent but under-reported phenomena in
Pakistan. All organizations and institutions must have a harassment policy to protect the females.
Key Words: Harassment, Females nurses, Hospital
How to cite this article: Kazmi T, Nasir JA, Qayyum U, Tahir T.
Awareness about workplace harassment among female nursing Corresponding Author:
students and nursing staff of a teaching hospital in lahore. Prof. Dr Tahseen Kazmi
JSHMDC. 2021; 2(2): 64-71. doi: 10.53685/jshmdc.v2i2.6 Community Medicine Department
…………………………………………………………………… Central Park Medical College, Lahore
......................................................................................................... Email address: [email protected]
This is an Open Access article distributed under the terms of a Received 30.04.2021, Revised 04.06.2021,
Creative Commons Attribution-Noncommercial 4.0 Accepted 05.10.2021
International license.

Journal of Shalamar Medical and Dental College. 2021; Vol. 2 (2) 64

INTRODUCTION was ‘expected, encouraged, and for sure
The increasing participation of women in diverse demanded’. The sexual harassment resulted in
practical fields has led them to work side by side depression, anxiety and stress among 65.43% of
with male colleagues. Harassment is defined as an nurses.4 The drivers of such offensive behavior in
improper and unwelcomed gesture that invariably our healthcare system have to be identified to
fills the other person with a sense of indignation prevent such happenings at workplace.
and humiliation. Sexual harassment, a major type For people working in human resources, the threats
has become a global issue. and incidents of work-related violence has a
Other forms of harassment include verbal, physical, substantial number. This high exposure to recurring
psychological and sexual.1 In a workplace setting, acts of violence causes a negative change in the
women consider harassment to be an act that tends staff’s behavior towards the clients or patients.
to dishonor, oppress and embarrass the other person Bullying at workplace is not due to a small number
creating an intimidating work environment, of pathologically deranged individuals. Removing
adversely affecting their mental and social health as them from the institute cannot solve the problem.
well as their proficiency at work. It has been seen The solution lies beyond that. The organizations
that most cases of sexual harassment do not end up must play a central role.5
being reported to the authorities. The reason behind “The Protection against Harassment of Women at
is the fear of punishment or accusation of Workplace Act, 2010” (as amended in 2016)
whistleblowing which might ruin a woman’s defined workplace harassment as, “any unwelcome
career. Women have a firm belief that complaining sexual advance, request for sexual favors or other
about workplace abuse will not be taken seriously, verbal or written communication or physical
and might end up into victim-shaming. They also conduct of a sexual nature or sexually demeaning
fear that they might be told that harassment is a part attitudes, causing interference with work
of the process towards success. This leads to performance or creating an intimidating, hostile or
detrimental effects on their psychological and offensive work environment, or the attempt to
mental health as well as their careers and personal punish the complainant for refusal to comply to
life. Along with that, it is also seen that the official such a request or is made a condition for
proceedings to deal with complaints of harassment employment” .6
are more than merely a tokenistic effort and nothing “The Federal Ombudsperson for Protection against
substantial is done to deal with the problem.2 Harassment of Women at Workplace” has defined
In a study conducted in 2016 at Lahore, reported workplace harassment as; “Any unwelcome sexual
13.4% female house officers reported issues related advance, request for sexual favor or other verbal or
to sexual harassment, 65.3% faced gender-based written communication or physical conduct of a
cultural constraints and 38.3% had gender based sexual nature or sexually demeaning attitudes,
issues among female doctors.3 Our conservative causing interference with work performance or
societal mindset has yet not fully changed creating an intimidating, hostile or offensive work
according to the emerging reality of women environment, or the attempt to punish the
empowerment, the nursing profession still being complainant for refusal to comply to such a request
marginalized in our healthcare system. Historically or request is made a condition for employment”.7
nursing professionals, under Florence Nightingale, The same definition of harassment has been
formed a very hierarchical system where obedience adopted by all the provincial ombudspersons for

65 Journal of Shalamar Medical and Dental College. 2021; Vol. 2 (2)

protection against harassment of women at the survey were asked questions about common
workplace. Quite often, women are hesitant to modes of sexual harassment, frequency and type of
make genuine complaints at their workplace due to harassment, protective measures taken by the
many socio-cultural and religious constraints. victims and the impact of harassment on physical
The rationale of the study was an attempt to create and mental health. Frequencies and percentages
the basic awareness among local stakeholder were calculated for data reporting.
regarding a sensitive and less talked issue involving
RESULTS
safety of women at workplace in our traditional
male dominated society. Further, the study was Our study demonstrated that overall awareness
expected to enable the participants to identify their among the respondents about common forms of
information gaps about all the available official harassment was significantly high (81.3%).
forums and their legal privileges about their Participants described certain behaviors and acts of
protection against harassment at the workplace. males as common forms of harassment; obscene
The objective of the present study was to assess the gestures and uncomfortable sounds, sending
knowledge and understanding among the female inappropriate letters, text messages or voice mails,
nursing staff about workplace harassment in the unnecessary staring, and passing uncalled remarks
tertiary hospital. by male colleagues (Figure: 1). Majority of women
remain shy and hesitant to report such incidents due
MATERIALS AND METHODS to fear of being stigmatized by their colleagues.
A cross-sectional study was conducted from July Women also faced lot of difficulties in lodging such
2018 to September 2018 at a tertiary care hospital complaints, and lack of formal institutional
of Lahore. Convenient sampling technique was mechanisms to effectively handle such complaints
used for collection of data. Permission of the at workplaces (Figure: 3). Respondents considered
institutional review board was obtained for sexual harassment as the most common form of
conducting this small study. All the potential harassment at workplaces (Figure: 2). Regarding
participants were assured about their individual possible adverse effects of harassment on the
anonymity and the confidentiality of their given victims, respondents referred to developing mental
input while seeking their informed verbal consent. health problems, developing physical health
The participants had also been given the additional problems, deciding to quit the job, avoiding
choice to decline answering any of the asked employment wherever male colleagues work, low
questions. Total 80 female respondents voluntarily self-esteem, absenteeism, and decreased interest in
agreed to participate in the study. Among them 50 one’s job. More than half of all the respondents
(62.5%) were nursing students of third and final considered their own institution quite safe and
year of bachelor of nursing (BS) program, and the secure for women.
rest (37.5%) were nursing staff. However, sample Regarding improvement suggestions, 41.3%
size was influenced by the usual cultural sensitivity agreed to hold formal informative sessions about
and ‘less talked’ nature of the study topic. Ethical such matters at institution level. However, most of
and safety recommendations for intervention the females indicated willingness to help arrange
research on violence against women by WHO and participate in the seminars planned on the
(2016) were also considered for framing the study matter in the institution. More than two third
questions. Structured and pre-tested questionnaire respondents liked educating women at their
was developed for data collection. Participants of workplace about their own protection from

Journal of Shalamar Medical and Dental College. 2021; Vol. 2 (2) 66

harassment. Only one in five female nurses knew employment for serious offence (61.3%), giving
about ‘the protection against harassment of women the offender a warning in case of minor offence
at workplace act, 2010 (as amended in 2016), and (56.3%), culprit must formally apologize from
establishment of ‘the offices of federal and victim for minor offence (52.5%), and referral of
provincial ombudspersons for protection against the selected cases to office of the concerned federal
harassment of women at workplace’. Regarding or provincial ombudsperson for protection of
remedial measures arranged for victims at women against harassment at workplace (58.8%).
workplace included encouraging them to gain However, no significant responses were received to
confidence at workplace through counseling, three different open-ended parts of main questions
holding inquiry of the incident without which asked for participants’ own relevant
compromising victim’s fame and essentially suggestions. There was decreased interest in job
considering the available circumstantial evidence and deliberately skipping work in order to avoid
in inquiry (Figure: 3). contact with male harassers (Figure: 4).
For disposal of proven offender, the respondents
described that offender should be dismissed from

Purposefully brushing up of male against a female colleague 44 56

Passing uncalled for remarks at female colleague 50 50

Unnecessarily staring at women 75 25

Sending inappropriate letters, text messages, voice mails or

66 34
emails

Obscene gestures or sounds to making women feel

74 26
uncomfortable

0% 20% 40% 60% 80% 100%

Yes No

Figure 1: Common modes sexual harassment at workplace

67 Journal of Shalamar Medical and Dental College. 2021; Vol. 2 (2)

 Sexual harassment 39 61

Psychological harassment 58 43

Physical harassment 45 55

Verbal harassment 64 36

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Yes No

Figure 2: Frequency distribution of different types of harassment

Frequency of different type of harassment

Gradually decreasing interest in job 60 40

Absenteeism 50 50

Low self-esteem 73 27

Deliberately trying to skip workto avoid contact with male

67 33
harasser

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Yes No

Figure 3: Specific protective measures against harassment of women

Holding of formal sessions about such like matters in your

41 59
institution
Open display of the related information for inside the
38 63
institution
Information about composition of institutional inquiry
43 58
committee
Information about institutional complaint registration forum 36 64

Instructions about lodging complaints by victims or witness(es) 45 55

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Yes No

Figure 4: Impact of workplace harassment on job performance of effected female employee

Journal of Shalamar Medical and Dental College. 2021; Vol. 2 (2) 68

DISCUSSION harassment is significant predictor of low job
satisfaction and low self-esteem among in-training
In our society, women have increasingly been nurses.11 Our study results also showed 73% nurses
participating in diverse practical fields including suffered from low self-steam due to harassment. A
those traditionally labeled as ‘male-specific’. They significant positive correlation has been found
have assumed diverse hierarchical positions in between general workplace harassment and post-
public and private organizations on merit with a traumatic stress symptoms.12 Among women,
perceptible consciousness about their legal and sexual harassment has been associated with a vast
human rights. However, the necessary gender array of physical health problems e.g., elevated
sensitization of our conservative society is slow to systolic blood pressure.13
catch up with this newly emerging and positive
The findings of a study conducted in 2017 among
social reality.
nurses (309) of two tertiary care public hospitals of
A research conducted in 2015 showed that sexual Lahore showed that 73.1% of nurses reported
harassment among nurses is prevalent up to 10%. experiencing some sort of violence in the last 12
A survey done in Karachi showed equal incidences months; with 53.4% suffering from physical
of harassment in government and private set-ups. violence, 57.3% from verbal violence, and 26.9%
The 47.8% of the perpetrators were patients’ from sexual violence. The main perpetrators were
relatives and 32.6% were members of the staff. The reported to be male coworkers, patients, and
victims ranged from 19 to 29 years of age. Nurses attendants.14 These findings were similar to our
who had a work experience less than 5 years study where nurses faced verbal harassment as the
reported more incidents of harassment, along with most common form with 64% nurses experiencing
that, nurses whose duty timings varied, suffered it during duty. Sexual harassment was also
more from work-place harassment than those with experienced by 39% of the nurses.
fixed hours; it ranged from 80% to 85% in nurses
Present study findings showed that harassment of
who performed shift duties. 93.5% of nursing
females working in all-gender healthcare centers
participants had considered the incident of sexual
lead to adverse effects on their job performance,
abuse as a typical case of workplace violence.8
health and social bearing. These findings were
A study undertaken in three main teaching quite similar to workplace harassment study results
hospitals of Peshawar about sexual harassment of in China in which high percentage of nurses
staff and student nurses (n=150) showed that 80% suffered from stress, anxiety and other
had sexual harassment experience, 66% cases psychological problems after physical or sexual
occurred inside hospital. 65.3% of the respondents abuse.15-17 All the organizations and institutions of
reported the incidences to management, but 70.7% the country are legally bound to make policies and
were not satisfied from the measures taken. 50.7% procedures for handling such grievances and
had psychological effects, 40.7% had effects on preventing harassment experiences at workplaces.
their performance and 8% had health effects. They The amendment subsequently made in The Act,
were mostly victimized by patients and their male 2012 had further added ‘educational institutions’
visitors (55.3%), 25.3% by doctors, 4.7% by their and ‘students’ for implementation purpose as those
colleagues and 14.7% by administration.9 There is were missed in earlier passed legislation.
mounting evidence that abuse and mistreatment Nevertheless, the responsible and gender-
within the care team leads to worse outcomes for sensitized organizations maintain an effective
patients.10 A local study indicated that sexual remedial system through human resource

69 Journal of Shalamar Medical and Dental College. 2021; Vol. 2 (2)

management department, envisaging the official cautiously framed due to the possible restraining
guidelines for prompt redress of grievances. effect of the odd topic and the private healthcare
In our study, nurses mentioned verbal abuse as the setting. Hence, the veracity of input received from
most disturbing activity faced, and consequently our respondents is likely to be influenced
they had mental trauma making them emotionally accordingly so possibly being less categorical in
weak. A good percentage (72%) of our respondents nature.
is willing to participate in awareness seminars at CONCLUSION
college and university levels. It is a legal obligation
Workplace harassment of female workers is quite
of the policy makers in institutions and
prevalent but under reported phenomena in
organizations to prohibit gender discrimination and
Pakistan. All organizations and institutes must have
introduce practical measures that will raise general
a harassment policy to protect females. The
awareness among our nurses throughout the
harassment policy must be well known to the
country.
employees with an inbuilt system of reporting,
Our findings reflect the dire need to increase the follow-up and remedial measure for all incidences
awareness among all the female students and the of physical, psychological and sexual harassment.
working women about the relevant protective legal
Conflicts of interest
framework available to them officially. Moreover,
45% participants had the knowledge to some extent All authors declared no conflicts of interest.
about their own institutional instructions on the Source of funding
matter. The availability of purpose-specific online None
reporting system in organizations, addressed to a
Contributors
designated person, may ensure the arrangements
that complainants can safely lodge complaints TK: Conception, study design, drafted the
through giving a structured description along with manuscripts and final approval
circumstantial evidence. JAN: Statistical analysis and reviewed it critically
for important intellectual content
Workplace policy should deal with both primary
UQ: Data Collection, data Entry
prevention i.e., how to prevent offensive behavior
TT: data collection and data entry
and secondary prevention i.e. how to help workers
All authors approved the final version and signed
who have been offended and deal with the offender
the agreement to be accountable for all aspects of
or offenders of harassment. In case of violence or
work.
threat of violence it will often be appropriate to turn
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