**7. Psychosocial factors**

Job satisfaction explains the harmony between the expectations of the employee from the institution and the profession and the opportunities offered to employee. The job satisfaction is one of the factors, which affects the burnout which has severe outcomes particularly in professions which provide the service directly to human. An intense burnout state can lead to problems such as resigning, incompatibility in marriage and family, decreased in self‐esteem, a difficulty to concentrate and social isolation [12]. One of the factors that adversely influence the job satisfaction and lead to burnout in the workplace is violence. A violence, which has affected the health of health professionals recently, can be observed as a problem in every health institution and health professional [8]. The violence in a health institution is defined as a verbal or behavioral threat, physical or sexual assault [36]. It has been increasingly more accepted that the health professionals, who must contact directly with individuals in difficult situations due to their deteriorated health status, are the most important target and victim of the occupational violence among all professions [37, 38]. For instance, in Turkey, totally five doctors were killed in the past 10 years due to the violence in hospitals. The names of the doc‐ tors were as follows: Prof. Dr. Göksel Kalayci (11th of November, 2005), Dr. Ali Menekse (15th of January, 2008), Dr. Ersin Arslan (17th of April, 2012), Dr. Melike Erdem (30th of November, 2012), Dr. Kamil Furtun (29th of May, 2015) and Aynur Dagdemir (19th of November, 2015) [2]. It has been estimated in some studies that the risk of exposure to violence of particularly health professionals by patients, families of patients or others is 4–16 times more compared to other employees in various sectors (such as guards, police officers, bank employees, retail workers, those working in the transport sector) [39].

Resistant bacteria and skin parasites such as scabies are examples of microorganisms which

These biological agents can transmit through the skin due to its impaired integrity and mucous membranes (mouth, eye and urogenital mucosa) as a result of the exposure to blood and/or bloody body fluids and some sterile body fluids. Even though there are almost 30 microorganisms which can be transmitted in this way, the most important ones are hepa‐ titis B virus (HBV), hepatitis C virus (HCV), hepatitis D virus (HDV) and human immu‐ nodeficiency virus (HIV) since they can lead to systemic infections because of their current importance. The diversity of the clinical outcomes of these agents varies from asymptomatic infections to severe and even fatal infections [3, 4, 12, 13, 24, 27, 28]. The transmission of the infections via blood occurs mostly by the penetration of the needles used in patients, injury with contaminated sharp instruments or mucosal splashes infected blood or body fluids [29, 30]. It has been specified that the two‐third of the health professionals stated that they were exposed to blood and/or body fluids at least once, the HIV infection was related to the profes‐ sion in the 57% of the HIV‐positive health professionals, and the risk of developing hepatitis B infection in health professionals is 10 times more compared to the general population [12, 13]. For example, in Turkey, you can see the Crimean‐Congo Hemorrhagic Fever (CCHF) and

can lead to severe infections in inpatients [24].

48 Occupational Health

**6. Ergonomic factors**

**7. Psychosocial factors**

**5.3. Biological agents transmitted by blood and bloody body fluids**

Margburg which make hemorrhagic fever and which are infected with blood.

1 year was 58.3% in nurses and health officers and 33.0% in the sick nurses [35].

The more the harmonization is ensured between employer and work environment, the better the safety and efficiency can be provided to employees [31]. In case there is an inconsistency between the physical capacity of the laborer and the physical requirements, occupational dis‐ eases may occur [32]. Particularly, nurses are in the third row after heavy industry workers and the heavy vehicle drivers who can experience the musculoskeletal system problems [8, 33]. According to the study performed in Turkey in which the prevalence of low back pain in the last 12 months and related factors were examined, it has been shown that the prevalence of low back pain in the last 12 months was at a high level that affects the working life (73.3%) [34]. In another study, we have indicated that the frequency of the low back pain in the past

Job satisfaction explains the harmony between the expectations of the employee from the institution and the profession and the opportunities offered to employee. The job satisfaction is one of the factors, which affects the burnout which has severe outcomes particularly in professions which provide the service directly to human. An intense burnout state can lead to problems such as resigning, incompatibility in marriage and family, decreased in self‐esteem, According to the 2002 report of the World Health Organization (WHO) entitled "Workplace violence in the health sector," the International Labor Organization (ILO) and the International Union of Nurses (ICN), it has been reported that more than 50% of the health professionals are exposed to violence [40]. In this report, generally 3–17% of the health professionals were exposed to physical, 27–67% of them were exposed to verbal, 10–23% of them were exposed to psychological, 0.78% of them were exposed to sexual and 0.8–2.7% of them were exposed to ethnical violence [41]. The violence has long‐term impacts on health professionals such as despondency, job loss, discontentedness, decreased job satisfaction, anxiety, life‐threatening injury, restlessness, anger, stress disorder, nightmares and sleep problems. The violence in the workplace not only affects the employee but also influences the colleagues, family and friends of the individual [42–47].

The studies performed on the workplace violence have shown that the psychological violence has reached to more dangerous levels compared to physical violence. Psychological violence in the workplace (mobbing) is defined as systematic and hostile attitudes of one or several people toward one individual with unethical communication. Mobbing is performed gener‐ ally by management team, but it can be directed also by colleagues, subordinates or a group of employees. It has been specified that health professionals particularly nurses are seriously a risk group exposed to mobbing in workplace [48, 49]. Mobbing leads to excessive stress, exclusion, anxiety, digestive system problems, sleep disorders, depression, anxiety, job dis‐ satisfaction and burnout [48–52].
