Violence and its effects on the job satisfaction of healthcare staff in paediatric emergency departments

Abstract

Background

Workplace violence in healthcare settings poses significant challenges to staff safety and the quality of patient care, particularly in Paediatric Emergency Departments (PEDs), where its impact extends to psychological strain and diminished care standards. This study aimed to determine the prevalence and characteristics of workplace violence experienced by PED staff, and to examine its association with their job satisfaction.

Methods

This study was a descriptive cross-sectional study. Participants were PED physicians and nurses. Data collection tools were “socio-demographic and work-related questions form”, “Workplace Violence Scale” and “Minnesota Job Satisfaction Short Scale”. The population of the study consisted of a total of 476 PED healthcare staff who had at least 1 year working experience in two tertiary hospitals and one public hospital located in the southeast Anatolia region of Turkey. A total of 434 healthcare staff participated in this study. Data were collected face-to-face using a survey method between January 3, 2024 and May 12, 2024. The data were analysed using the statistical program SPSS 26.

Results

In this study, the prevalence of violence exposure was 84.33%. Major perpetrators were patients’ relatives (n = 394, 53.2%), main cause of violence was waiting time (n = 302, 17.3%), and violence often occurred in the waiting room (n = 263, 24%). The most frequently reported types of verbal and physical violence were shouting (n = 395, 38.9%), and scratching-pinching (n = 268, 34.5%), respectively. The most violence occurred between 17:00–24:00 (n = 224, 51.6%). Reactions to violence included decrease in motivation-performance (n = 375, 56.7%), thinking of quitting the job (n = 127, 19.7%), and experiencing psychological problems (n = 91, 13.7%). Workplace Violence (WPV) Scale score was 14.25 ± 4.66 and Minnesota Job Satisfaction score was 2.83 ± 0.87. A statistically significant but weak negative correlation was found between workplace violence and job satisfaction (r:-0.125, p = 0.009).

Conclusion

Exposure to violence was frequent among PED staff. The level of job satisfaction among PED staff was low. This study suggests that taking measures to prevent violence in healthcare settings may contribute to fostering a safer work environment and potentially increasing job satisfaction.

Clinical trial number

Not applicable.

Introduction

Violence against healthcare staff has emerged as a critical global concern, particularly in the high-stress environment of Paediatric Emergency Departments (PED). Workplace violence in healthcare settings poses significant challenges to staff safety and the quality of patient care. PEDs have been identified as high-risk environments for such violence, with healthcare staff facing increased vulnerability compared to other clinical units [1–4]. Staff frequently encounter a range of aggressive behaviours, from verbal abuse and threats to physical assaults, perpetrated by patients or their relatives in the PED [5].

In addition, studies have reported high rates of violence exposure among PED staff, with prevalence varying across countries and contexts [6, 7]. Studies across diverse settings report that 70–92% of ED healthcare staff have experienced some form of violence during their careers, with PEDs often representing a high-risk setting [8]. The prevalence of workplace violence in healthcare setting in Turkey was 44.7% in [9], 69.8% in [8], 78.1% in [10], 85.9% in [11]. These results highlight the unique challenges faced by frontline staff in these settings.

Workplace violence in healthcare settings has been associated with serious physical and psychological consequences, including decreased job satisfaction and burnout, which negatively impact care quality [12, 13]. Prior research has examined the relationship between workplace violence and mental health conditions such as depression and burnout, especially among PED staff [14–16]. These negative outcomes not only harm individual staff but also compromise the functioning and quality of healthcare systems. Exposure to violence correlates with emotional exhaustion, diminished engagement at work, and a heightened intention to leave the profession [17].

While numerous studies have examined workplace violence in adult emergency settings, limited attention has been paid to PED staff, especially in low- and middle-income countries such as Turkey. This study aims to address this gap by investigating the prevalence and characteristics of workplace violence experienced by PED staff and exploring its impact on their job satisfaction.

Methods

Design

This study was a descriptive cross-sectional study.

Participants, settings, and sampling

Participants were physicians and nurses working in PEDs at two tertiary and one public hospital in the Southeastern Anatolia region of Turkey. These hospitals were selected because they have PED and serving the highest patient volumes. Remaining hospitals were not included in the study as they did not have PED.

Participants had to meet the following inclusion criteria were included in the study: (1) being employed in the PED, (2) have at least one year of work experience in the PED, and (3) voluntarily agree to participate by providing written informed consent.

A total of 476 eligible PED healthcare professionals were approached in person during their shifts. Among them, 434 participants (91.17%) completed the survey in full. Forty-two individuals declined participation due to time constraints or unavailability. No sample selection was applied; instead, the entire accessible population was targeted. Since all returned questionnaires were complete, no participants were excluded from the study. To minimise social desirability bias, participants completed the self-administered surveys independently, with assurances of anonymity and without the involvement of supervisors during the data collection process.

Data collection

Data were collected face-to-face using a survey method between January 3, 2024 and May 12, 2024 by the research team.

Data collection tools

Data collection tools were “socio-demographic and work-related questions form”, “Workplace Violence (WPV) Scale” and “Minnesota Job Satisfaction Short Scale”.

Sociodemographic and work-related questions form

This form was developed by the researchers (A.B. and M.Ö.) based on the current literature. This form included 17 questions regarding age, gender, education status, occupation, the hospital they work in, years of working experience, and various questions in relation to violence. This form was piloted with 5 participants and amended based on the feedback received before the actual data collection process.

Workplace violence (WPV) scale

The WPV Scale developed by Chen et al. [18], translated into English by Duan et al. [12], and its validity and reliability into Turkish was conducted by Tutan and Kökalan [19]. The scale consists of 9 questions and 3 sub-dimensions. The verbal violence dimension of the scale consists of 2 questions and includes scolding, abusing, humiliating, or discrediting words and threats. The physical violence dimension of the scale consists of 4 questions and includes questions on minor injuries, severe injuries, and physical violence that does not cause injury. In the last dimension of the scale, the sexual harassment dimension consists of 3 questions and includes verbal sexual harassment, sexual assault, rape, and attempted rape. In the evaluation of the scale, a 4-point Likert type (1: no, 2: 1 time, 3: 2–3 times, 4: more than 3 times) was used. The total score varies between 0 and 36 points. Higher scores indicate a more frequent exposure to workplace violence. In the Turkish version of the scale, Tutan and Kökalan [19] calculated Cronbach’s alpha value as 0.76 and 0.84 for 2 different groups, while in this study, it was calculated as 0.80, indicating high reliability.

Minnesota job satisfaction short scale (MSQ-SS)

Minnesota Job Satisfaction Questionnaire Short Scale (MSQ-SS) was developed by Weiss et al. [20] in 1967. Its validity and reliability into Turkish was conducted by Baycan [21] in 1985 (Cronbach alpha = 0.857). The Minnesota Job Satisfaction Short Scale is a five-point Likert-type scale scored in five levels (1 = strongly unsatisfied, 2 = unsatisfied, 3 = uncertain, 4 = satisfied, and 5 = strongly satisfied) for each item. The scores for each respondent’s intrinsic, extrinsic, and general satisfaction scores were calculated by summing the scores for the associated questions. There are no reverse questions in the scale. The general satisfaction score was obtained by dividing the sum of the scores obtained from the 20 items by 20. A mean above 3 indicates high job satisfaction, whereas a mean below 3 indicates low job satisfaction. The intrinsic satisfaction score is obtained by dividing the sum of the scores obtained from items 1, 2, 3, 4, 7, 8, 9, 10, 11, 15, 16, and 20 by 12, and the extrinsic satisfaction score is obtained by dividing the sum of the scores obtained from items 5, 6, 12, 13, 14, 17, 18, and 19 by 8. The Cronbach’s alpha value in this study was 0.96, indicating high reliability.

Data analysis

The data were analysed using the statistical program SPSS 26 (Statistical Package for Social Science). Percentage, mean, and standard deviation were used to describe sociodemographic variables. Because the data did not follow a normal distribution, Mann–Whitney U test and Kruskal–Wallis H test were used to compare quantitative data. The relationship between workplace violence and job satisfaction was tested using Spearman’s correlation analysis. A p-value < 0.05 was considered significant.

Ethical considerations

Ethical approval was obtained from the Mardin Artuklu University Non-Invasive Clinical Research Ethics Committee (Date: 06/11/2023, REF: 2023/11 − 7). In addition, necessary permissions were obtained from the Mardin Directorate of Health (Date: 27/12/2023, REF: E-68051626-770-232730112). Informed consent was obtained in writing before participation. This study was carried out in accordance with the principles of the Declaration of Helsinki.

Results

Table 1 presents the general information and univariate analysis of workplace violence scores of PED staff. A total of 434 PED staff were surveyed. Of these, 55.5% were male, 53.7% were aged between 20 and 29 years, 75.8% had a bachelor’s degree, 87.3% were nurses, and the most working years group was 1–5 years. The results revealed statistically significant differences in the workplace violence scores of PED staff in terms of reporting after violence, receiving support after violence, and finding methods to prevent violence (p < 0.05).

Table 1.

General information and univariate analysis of PED staff’s workplace violence scores

Variables	n	%	Median Score	U/X2	P value
Gender				20,777	0.055
Female	193	45.5	13
Male	241	55.5	14
Age group				0.431	0.806
20–29	233	53.7	13
30–39	155	35.7	13
40 and over	46	10.6	13
Educational status				8.437	0.077
High school	32	7.4	15
Associate degree	32	7.4	13
Bachelor’s degree	329	75.8	13
Master’s degree	32	7.4	13
PhD degree	9	2.1	18
Profession				8880.50	0.075
Nurse	379	87.3	13
Physician	55	12.7	14
Working years				0.084	0.919
1–5 years	227	52.3	13
6–10 years	128	29.5	13
11–15 years	49	11.3	13
16–20 years	15	3.5	13
21 years or more	15	3.5	13
Time interval during which the violence occurred				0.223	0.89
08:00–17:00	150	34.6	14
17:00–24:00	224	51.6	13
24:00–08:00	60	13.8	13
Reporting after violence				18,050	< 0.001
I did not report it	258	59.4	13
I reported it	176	40.6	14
Receiving support after violence				5617.50	0.005
I did not receive any support	395	91.0	13
I received support	39	9.0	16
Finding the methods to prevent violence adequate				3590.5	0.025
Inadequate	410	94.5	13
Adequate	24	5.5	16

U: Mann Whitney U, X²: Kruskal-Wallis H

The results show that who reported violence had higher violence scores than those who did not report. Furthermore, PED staff who received support after violence reported higher violence scores than those who did not receive support. The violence scores of those who found the violence prevention methods adequate were higher than those who did not find them sufficient (p < 0.05). There were no statistically significant differences in the violence scores among the variables of gender, age group, educational status, profession, working years, and time interval of violence (Table 1). The results showed that most violence incidents (n = 224, 51.6%) occurred between the time interval of 17:00–24:00. The majority of PED staff did not report the violent incident (n = 258, 59.4%), 395 of participants (91.0%) did not receive support after the violence, and the vast majority of participants (n = 410, 94.5%) did not find adequate methods of preventing violence.

Table 2 provides information about violence. In this study, the prevalence of violence exposure was 84.33%, with patients’ relatives being the most common perpetrators (53.2%). Most of the violence was perpetrated by patients’ relatives (n = 394, 53.2%) and patients (n = 250, 33.7%). The most frequently reported incident causing violence were waiting time (n = 302, 17.3%), excessive demands of patients’ relatives (n = 294, 16.9%), communication problems (n = 279, 16%). Among the reported causes of violence, 15.4% of participants attributed incidents to perceived communication barriers or misunderstandings, which they associated with differing educational backgrounds between healthcare staff and patients or their families. It is important to note that this assessment was based on the perceptions of healthcare staff and not on direct measurement of patients’ or families’ education levels.

Table 2.

Participant’s responses regarding violence

Variables	n	%
Exposure to violence
Yes	366	84.33
No	68	15,67
Total	434	100
Persons who perpetrate violence*
Patient	250	33.7
Patient relatives	394	53.2
Hospital staff	60	8.1
Physician	37	5.0
Total	741*	100
Causes of the violence experienced*
Long waiting time	302	17.3
Excessive demands of patient relatives	294	16.9
Communication problems	279	16.0
Low level of education of patients and their relatives	268	15.4
Insufficient security	225	12.9
Staff shortage	220	12.6
News about media-triggered violence	150	8.6
Total	1738*	100.0
Places where violence occurs*
Waiting room	263	24.0
Observation area	230	21.0
Nurse station	224	20.0
Examination room	202	18.4
Triage area	174	15.9
Total	1093*	100
Types of verbal violence*
Shout	395	38.9
Verbal threat	339	33.3
Blasphemy	281	27.7
Total	1015*	100
The type of physical violence*
Scratching-Pinching	268	34.5
Hitting	244	31.4
Punching	148	19.1
Kicking	115	14.8
Total	775*	100
Time interval during which the violence occurred*
08:00–17:00	150	34.6
17:00–24:00	224	51.6
24:00–08:00	60	13.8
Total	443*	100
Reporting after violence*
I did not report it	258	59.4
I reported it	176	40.6
Total	443*	100
Your reactions to the violence you have experienced*
Decrease in my motivation and performance	375	56.7
I was thinking about quitting my job.	127	19.2
I have had psychological problems.	91	13.7
I saw the attack as part of a job	68	10.2
Total	661*	100
Receiving support after violence*
I did not receive any support	395	91.0
I received support	39	9.0
Total	443*	100
Finding the methods to prevent violence adequate*
Inadequate	410	94.5
Adequate	24	5.5
Total	443*	100

*As there are multiple responses, the number ‘n’ exceeds the number of participants. All items in this table were presented to participants as separate and independent questions. Therefore, the total number of responses in specific categories (e.g., types of violence, perpetrators, reporting behaviour, and consequences) may exceed the number of participants who reported exposure to violence in general

In addition, the waiting room (n = 263, 24%), observation area (n = 230, 21%), and examination room (n = 202, 18.4%) were reported as places where violence occurred the most. The most frequently reported types of verbal violence were shouting (n = 395, 38.9%) and verbal threats (n = 339, 33.3%), while the most frequently reported types of physical violence were scratching-pinching (n = 268, 34.5%), and hitting (n = 244, 31.4%). The most reported violence occurred between 17:00–24:00 (n = 224, 51.6%). The reactions to the violence experienced were as follows: decrease in motivation-performance (n = 375, 56.7%), thinking of quitting the job (n = 127, 19.7%), experiencing psychological problems (n = 91, 13.7%), and considering the attack as a part of the job (n = 68, 10.2%). The majority of the participants did not report the violence to the management (n = 258, 59.4%), did not receive support after the violence (n = 395, 91%), and did not find adequate violence prevention methods adequate (n = 410, 94.5%). The results showed that experience violence decreased healthcare staff motivation and their performance (n = 375, 56.7%).

Table 3 presents the general information and univariate analysis of Minnesota Job Satisfaction scores of PED staff. The results showed that there were statistically significant differences in the Minnesota Job Satisfaction scores of PED staff in terms of educational status, time interval of the violence, reporting after violence, and receiving support after violence (p < 0.05).

Table 3.

General information and univariate analysis of Minnesota job satisfaction scores of PED staff

Variables	n	%	Median Score	U/X2	P value	Post hoc
Gender				21,403	0.153
Female	193	45.5	2.8
Male	241	55.5	3
Age group  20–29  30–39  40 and over	233 155 46	53.7 35.7 10.6	2.9 3 2.75	2.650	0.266
Educational status				14.811	0.005
High school	32	7.4	3.25
Associate degree	32	7.4	2.57			2,5 < 1;
Bachelor	329	75.8	2.90			2,5 < 3
Master’s degree	32	7.4	2.97
PhD degree	9	2.1	1.90
Profession				9483	0.280
Nurse	379	87.3	2.90
Physician	55	12.7	3
Working years				5.330	0.255
1–5 years	227	52.3	3
6–10 years	128	29.5	3
11–15 years	49	11.3	2.8
16–20 years	15	3.5	2.55
21 years or more	15	3.5	2.2
Time interval during which the violence occurred				15.700	0.000
08:00–17:00	150	34.6	3.1
17:00–24:00	224	51.6	2.75			2 < 1,3
24:00–08:00	60	13.8	3.2
Reporting after violence				18478.5	0.001
I did not report it	258	59.4	3
I reported it	176	40.6	2.62
Receiving support after violence				4322.0	0.000
I did not receive any support	395	91.0	3
I received support	39	9.0	1.9
Finding the methods to prevent violence adequate				4517.0	0.500
Inadequate	410	94.5	2.95
Adequate	24	5.5	2.75

U: Mann Whitney U, X²: Kruskal-Wallis H. Post Hoc: Bonferroni

High school and bachelor’s degree graduates have higher job satisfaction than associate and master’s degree graduates. Furthermore, participants working between the hours of 08:00–17:00 and 24:00–08:00 had higher levels of job satisfaction than those working in the 17:00–24:00 shift. Additionally, those who did not report incidents of violence demonstrated higher job satisfaction than those who did. Furthermore, participants who received support following incidents of violence had lower levels of job satisfaction than those who did not receive such support. (p < 0.05). There was no statistically significant difference in the job satisfaction score among the variables of gender, age group, profession, working years, and finding the methods to prevent violence adequate (Table 3).

Table 4 presents the mean scores, standard deviations, and Cronbach’s alpha values of the Workplace Violence (WPV) and Minnesota Satisfaction Short Scales, including their subdimensions. The overall workplace violence score was 14.25 ± 4.66 (range: 9–36), indicating a moderate level of perceived violence. Among the subdimensions, the mean scores were 4.79 for verbal violence, 5.60 for physical violence, and 3.85 for sexual harassment. In terms of job satisfaction, the mean total score was 2.83 ± 0.87, suggesting low-to-moderate satisfaction. The mean scores for intrinsic and extrinsic satisfaction were 2.93 and 2.70, respectively. The Cronbach’s alpha values ranged from 0.74 to 0.96, demonstrating acceptable to excellent internal consistency.

Table 4.

PED staff’s violence and job satisfaction scores in different dimensions

Scales and dimensions	n	x̅	Sd	Median	Min.	Max.	α
Workplace Violence (WPV) Scale	434	14.25	4.66	13	9	36	0.80
Verbal violence	434	4.79	1.93	5	2	8	0.82
Physical violence	434	5.60	2.47	4	4	16	0.86
Sexual harassment	434	3.85	1.63	3	3	12	0.74
Minnesota Satisfaction Short Scale	434	2.83	0.87	2.95	1	5	0.96
Intrinsic satisfaction	434	2.93	0.90	3	1	5	0.94
Extrinsic satisfaction	434	2.70	0.90	2.63	1	5	0.90

x̅: Mean, Sd: Standard deviation, Min.: Minimum, Max.: Maximum, α: Cronbach’s alpha

Table 5 presents the relationship between Minnesota job satisfaction and workplace violence. Accordingly, a very weak and negative relationship was found between workplace violence and job satisfaction. It is concluded that as the incidence of workplace violence increases, job satisfaction decreases, but the strength of this relationship is very weak.

Table 5.

Relationship between Minnesota job satisfaction and workplace violence

	Workplace Violence
Minnesota Job Satisfaction	r: − 0.125 p: 0.009* n: 434

*p < 0,01; r: Spearman correlation

Discussion

The results of this study highlighted the prevalence and nature of violence in PED settings, including their underlying causes, common forms, and the impact on job satisfaction among healthcare staff. This study found that PED healthcare staff experienced high levels of exposure to various forms of violence, including verbal and physical violence, which aligns with recent literature on paediatric emergency settings [8]. Of the total participants, 258 individuals (59.4%) stated that they had not reported any incidents of violence they experienced in the workplace. In line with this study, half of the participants in Huang et al. [22], and %44.8 (n = 43) of participants in Ferri et al. [23] never reported violence. Furthermore, this study revealed that the waiting room was the place where violent incidents occur most frequently (24%). Overcrowded and poorly designed waiting rooms may increase patient and family frustration due to long waiting times, lack of privacy, or discomfort, which can escalate tension and potentially trigger aggressive behaviours toward healthcare staff. Therefore, improving waiting rooms could help patients and their relatives wait patiently and thus alleviate violence. Effective communication strategies in waiting room, such as providing regular updates and explanations for delays could reduce patient frustration and improve satisfaction.

A notable observation in the present research was that most PED staff did not receive support (n = 395, 91.0%) after experiencing violence, which may have contributed to reduced job satisfaction. Interestingly, participants who did receive support after violence reported lower levels of job satisfaction than those who did not. This result may reflect that individuals who sought support were exposed to more frequent or severe incidents of violence. Moreover, the support mechanisms in place might have been perceived as inadequate or merely formalities, falling short of meeting staff’s emotional and psychological needs. Huang and Li [15] reported that ED nurses’ perception of organizational support was negatively associated with workplace violence. Thus, improving the quality and effectiveness of organizational support remains essential for mitigating the impact of workplace violence and supporting staff morale in PED settings.

Study results indicated that violence decreased PED staff’s motivation and performance, leading to psychological problems and quitting their job. These results are consistent with existing studies [24, 25]. Therefore, supporting healthcare staff after violence is crucial to maintaining staff morale and increasing job satisfaction.

In the present study, no statistically significant difference in the violence score was observed among gender, age group, educational status, profession, and working years. While this contradicts several previous studies reporting that younger, female healthcare staff with less experience are more prone to workplace violence [23, 25]. This inconsistency may be attributed to contextual differences such as organisational culture, regional or institutional practices, sample characteristics, or differing perceptions and reporting behaviours among participants.

Similar to other studies, this study found that most of the violence cases were perpetrated by patients, patients’ relatives, and co-workers [23, 26–28]. The results of this study revealed that the reasons for violence included long waiting times, excessive demands of the patient’s relatives, low level of education for patients and their relatives, communication problems, staff shortage, insufficient security, and media coverage about violence. In line with these results, some studies also found that the most common causes of violence were impatience, high expectations, communication problems between patients and healthcare staff, long waiting times, and insufficient number of staff [1, 29, 30]. Therefore, reducing the length of stay, improving communication skills and providing educational interventions for healthcare staff, patients and their relatives could help to alleviate violence in PED settings.

The job satisfaction level was low for healthcare staff who were exposed to violence compared to those who were not. This result is consistent with the current literature [13, 31]. In addition, similar to the existing literature, this study showed that nearly all participants did not find violence prevention methods sufficient. The current studies have suggested some recommendations to prevent workplace violence, including security measures and training (violence-coping strategies, communication skills, conflict resolution, self-defences) [28, 32], implementing workplace violence response [33]. This study emphasizes the need for taking necessary actions and measures to prevent workplace violence in healthcare settings.

Implications and recommendations

The existing literature showed that supporting fair working conditions could help to alleviate violence [34]. Healthcare providers should build a culture of safety that reduces the risk of violence and creates a safe work environment by supporting staff and policy enhancements. Studies have emphasized the importance of creating supportive and safe work environments to improve the safety and job satisfaction of PED staff.

Based on the results of this study, several recommendations can be made to address factors contributing to workplace violence. For instance, waiting times were identified by 17.3% of participants as a contributing factor to incidents of violence. Although our study did not evaluate causality, this result suggests that operational issues, such as prolonged waiting times, may lead to increased patient frustration. Efforts to streamline workflows and improve service efficiency could potentially reduce such risks. Similarly, communication problems (16.0%) were noted as another contributor, indicating a need for training programs focused on communication and conflict resolution strategies.

In addition, educating PED healthcare staff through training programs on de-escalation techniques and management of aggressive behaviour, as well as emphasising the importance of seeking assistance, could help to alleviate violence and improve job satisfaction in healthcare settings [27, 30].

Efforts to address workplace violence in the PED include assessing the risk of violence among healthcare staff, examining the causes of violent behaviours, and implementing prevention programs to alleviate the physical and psychological complications associated with violence exposure.

Strengths and limitations

One of the strengths of this study is to collect data from three different settings and includes a large sample of 434 healthcare staff. However, this study has several limitations. First, the study was conducted in a specific region of Turkey, which may limit the generalizability of the results to other settings. Second, the face-to-face data collection method, while beneficial for ensuring high response rates, may have introduced social desirability bias, as participants may have provided answers they believed were expected or desirable rather than truthful responses. To mitigate this, participants were assured of the confidentiality of their responses and encouraged to answer honestly. Third, this study relied on participants’ recall of past incidents of violence, which may have introduced recall bias. Participants may have underreported or overreported incidents due to memory inaccuracies or the emotional impact of the events.

Conclusion

The results of the present study indicate that workplace violence is highly prevalent among PED staff and has a significant negative impact on job satisfaction. The low job satisfaction levels observed highlight the urgent need to address this issue through targeted and comprehensive interventions. These should include reducing root causes such as long waiting times and communication breakdowns, as well as strengthening organisational support systems to mitigate the long-term psychological burden on staff. This study suggests that implementing measures to prevent violence and enhance institutional support may contribute to fostering a safer work environment and improving staff satisfaction. Future research should evaluate the effectiveness of these strategies to inform sustainable policy and practice.

Abbreviations

PED

Paediatric Emergency Department

Author contributions

A.B.: Conceptualization, Resources, Data curation, Software, Visualization, Methodology, Project administration, Formal analysis, Writing – original draft, Writing – review & editing. M.O.: Data curation, Software, Visualization, Methodology, Formal analysis, Writing – original draft, Writing – review & editing.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Data availability

The datasets used and/or analysed during the current study are available from the corresponding author upon reasonable request.

Declarations

Ethics approval and consent to participate

Ethical approval was obtained from Mardin Artuklu University Non-Interventional Clinical Research Ethics Committee (Date: 06/11/2023, REF: 2023/11 − 7). In addition, the necessary permissions were obtained from the Mardin Directorate of Health (Date: 27/12/2023, REF: E-68051626-770-232730112). Also, informed consent was obtained from all participants. This study was carried out in accordance with the principles of the Declaration of Helsinki.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.