Prevalence, characteristics, and consequences of verbal and physical violence against healthcare staff in Chinese hospitals during 2010-2020

Prevalence, associated factors, and nursing practice-related outcomes of workplace violence towards nursing students in clinical practice: A systematic review and meta-analysis

OBJECTIVES

To estimate the prevalence of Workplace violence (WPV) among nursing students in clinical practice, and examine the associated factors and nursing practice-related outcomes.

DESIGN

A systematic review and meta-analysis.

REVIEW METHODS AND DATA SOURCES

A comprehensive literature search was performed in nine databases from inception to Mar 2023. Two researchers independently screened studies, extracted data and assessed the quality of included studies. The random-effects model was used to estimate the pooled prevalence of WPV. Separate analyses were conducted by WPV type and source.

RESULTS

57 studies involving 23,451 nursing students were identified. The overall prevalence of WPV experienced and witnessed by nursing students was 45.37 % and 53.76 %, respectively, and 13.73 % were unsure if they had WPV. Psychological violence was the most prevalent form of WPV, but the prevalence of WPV also varied by setting and source, with obstetrics and gynaecology (41.25 %) being the most common settings and patients and their relatives (50.80 %) being the most common sources. When exposed to WPV, 65 % of nursing students did nothing except keep quiet, and 74 % did not report it. Concerning the associated factors of WPV, there were few reports on patient-related factors, and the selected studies focused primarily on nursing student- and occupational-related factors. Regarding nursing practice-related outcomes, WPV had a predominantly negative impact on nursing students' professional practice, but it also had a certain motivating effect.

CONCLUSIONS

This meta-analysis estimates the global prevalence, associated factors, and nursing practice-related outcomes of WPV among nursing students. The findings confirm the high prevalence of WPV; therefore, schools and institutions should prioritize WPV education and training. The hospital should then formulate WPV laws and regulations, enhance the WPV reporting procedure, and protect the rights and interests of nursing students. Finally, hospital administrators should employ individualized intervention strategies for nursing students based on the variables that affect them.

Post-traumatic responses to workplace violence among nursing professionals: a collaborative and comparative study in South Korea and Hong Kong

BACKGROUND

Workplace violence has had a significant and negative psychological impact on nursing professionals worldwide. Concerted worldwide efforts to improve work environments have not yet removed nursing professionals from the threat of violence. It is highly essential to conduct comparative research in various working environments where the nurses of each country have unique experiences of workplace violence. The aim of this study was to examine the differences in the rate, associated factors, and post-traumatic responses to workplace violence between South Korean and Chinese nurses in Hong Kong among East Asian countries.

METHODS

A cross-sectional, correlational study design recruited a total of 471 registered nurses (319 South Korean nurses and 152 Chinese nurses in Hong Kong; overall response rate = 78.5%) at online communities in South Korea and Hong Kong. The data were collected by conducting a Qualtrics survey from January 15, 2020, to July 24, 2021. A structured questionnaire was administered for data collection, including rate of workplace violence, perception of workplace violence, attitudes toward workplace violence, coping styles, post-traumatic cognitions, post-traumatic stress disorder, post-traumatic growth, and mental health indicators (depression, anxiety, and stress). T-test, chi-squared, and binary logistic regression analyses were conducted.

RESULTS

In our sample, 30.7% South Korean nurses and 31.6% Chinese nurses in Hong Kong had experienced workplace violence. South Korean and Chinese nurses in Hong Kong with experience of workplace violence had lower perceptions of it. Nurses with experience of workplace violence reported lower levels of mental health, and this trend was more prominent among South Korean nurses.

CONCLUSIONS

Our study findings showed a positive association between workplace violence and post-traumatic responses in both settings. We found that the close monitoring of post-traumatic responses associated with workplace violence could be improved by enhancing nurses' perception of workplace violence.

Prevalence and predictors of workplace violence against emergency physicians in China: a cross-sectional study

BACKGROUND

Workplace violence (WPV) is considered a global problem, particularly in the health sector; however, no studies have assessed the national prevalence of WPV against emergency physicians and the associated factors in China.

METHODS

A national cross-sectional survey was conducted in 31 provinces/autonomous regions/municipalities across China between July 2019 and September 2019. A total of 15 455 emergency physicians were selected using a multistage stratified random sampling method. A structured self-administered questionnaire was used to collect information on WPV and potential associated factors among emergency physicians. Descriptive and multivariable logistic regression analyses were used to identify the predictors of WPV.

RESULTS

A total of 14 848 emergency physicians responded effectively (effective response rate: 96.07%). Of the respondents, 90.40%, 51.45%, and 90.00% reported exposure to any type of WPV, physical or nonphysical violence in the preceding year, respectively. Verbal aggression (87.25%) was the most common form of violence, followed by threat (71.09%), physical assault (48.24%), verbal sexual harassment (38.13%), and sexual assault (19.37%). Patients' families were the main perpetrators of these incidents. Unmet patient needs, taking drugs or drinking, and long waiting times were the main contributors to WPV. Physicians who were from low-developed regions, female, and without shift work were less likely to have experienced any type of WPV. Chinese emergency physicians who were from medium-developed regions, had a bachelor's degree, worked in a higher level hospital, had a higher professional title, with lower incomes, had a history of hypertension or coronary heart disease, were smokers or drinkers, and worked in hospitals without preventive measures or training for WPV and not encouraging to report WPV were more likely to have experienced any type of WPV. The predictors of WPV varied in different types of WPV.

CONCLUSIONS

This study shows that the prevalence of WPV against emergency physicians is high in China. Measures should be taken at the physicians, patients, hospital, and national levels to protect GPs from WPV; for example, improving physicians' level of service and hospital' reporting procedures. Creating a prevention strategy and providing a safer workplace environment for emergency physicians should be prioritized.

Associations between work-related variables and workplace violence among Chinese medical staff: A comparison between physical and verbal violence

Background

Workplace violence (WPV) against medical staff has been an important public health and societal problem worldwide. Although numerous studies have implied the differences between physical violence (PV) and verbal violence (VV) against medical staff, few studies were conducted to analyze the different associations between work-related variables, PV, and VV, especially in China.

Methods

A cross-sectional study was conducted among Chinese medical staff in public hospitals, and 3,426 medical staff were interviewed and analyzed. WPV, including PV and VV, were evaluated by the self-report of the medical staff. Work-related variables, physical disease, depression, and social-demographic variables were also measured. The work-related variables included types of medical staff, professional titles, hospital levels, managers, working years, job changing, working hours/week, night duty times/week, monthly income, self-reported working environment, and social position. Logistic regressions were conducted to examine the factors associated with PV and VV.

Results

A total of 489 medical staff (23.0%) reported the experience of PV and 1,744 (50.9%) reported the experience of VV. Several work-related variables were associated with PV and VV, including nurse (OR = 0.56 for PV, p < 0.01; OR = 0.76 for VV, p < 0.05), manager (OR = 1.86 for PV, p < 0.01; OR = 1.56 for VV, p < 0.001), night duty frequency/week (OR = 1.06 for PV, p < 0.01; OR = 1.03 for VV, p < 0.01), bad working environment (OR = 2.73 for PV, p < 0.001; OR = 3.52 for VV, p < 0.001), averaged working environment (OR = 1.51 for PV, p < 0.05; OR = 1.55 for VV, p < 0.001), and bad social position (OR = 4.21 for PV, p < 0.001; OR = 3.32 for VV, p < 0.001). Working years (OR = 1.02, p < 0.05), job changing (OR = 1.33, p < 0.05), and L2 income level (OR = 1.33, p < 0.01) were positively associated with VV, but the associations were not supported for PV (all p>0.05). The other associated factors were male gender (OR = 1.97 for PV, p < 0.001; OR = 1.28 for VV, p < 0.05) and depression (OR = 1.05 for PV, p < 0.001; OR = 1.04 for VV, p < 0.001).

Conclusion

Both PV and VV were positively associated with work-related variables, such as doctor, manager, more night duty frequency, perceived bad working environment, or social position. Some variables were only associated with VV, such as working years, job changing, and monthly income. Some special strategies for the work-related variables should be applied for controlling PV and VV.

Workplace violence against Chinese health professionals 2013-2021: A study of national criminal judgment documents

Objectives

Patient-initiated hospital violence is a global problem which threatens the safety of health professionals and is indicative of doctor-patient tensions, impeding health system quality and access. The current study aimed to improve the understanding of medical workplace violence (WPV) in China, using authoritative and nationally representative judgment records, and to approach violence prevention strategies.

Methods

All litigation records relating to violence against health professionals between 2013 and 2021 were extracted from the China Judgment Online System. Basic case information, victim characteristics, perpetrator characteristics and the nature of the violence were collated. The relationship between different treatment outcomes and violence was also explored.

Results

Numbers of cases of hospital violence gradually increased from 2013 to a peak in 2016 before gradually decreasing in the following years. The most common perpetrators were patients' relatives (58.2%), followed by patients themselves (38.2%). Only 9 perpetrators had a confirmed history of mental illness and only two were intoxicated with alcohol. More than half of the cases (52.5%) occurred in rural areas and this percentage is even greater for primary health care institutions (71.4%) and secondary hospitals (73.5%). On a departmental level, the highest incidence of medical WPV was found in the emergency (18.9%), pediatrics (13.2%) and obstetrics (11.5%) departments. Violent behaviors, such as stalking, mass occupation of the ward and sharp instrument injury were significantly related to cases not involving patient death (p < 0.05). Disruptive behavior, such as hanging banners, blocking hospital passages, placing flower wreaths and burning paper money were significantly correlated with cases involving patient death (p < 0.01). The interval between a patient's death and the ensuing violence was short, happening on the same day in 54.8% of cases.

Conclusions

A comprehensive overview of medical WPV in China is presented and may have utility for the formulation of prevention strategies.

Sağlık Çalışanlarına Yönelik Şiddet; Yeni Bir Salgın mı?

Amaç: Şiddet, toplumda olduğu gibi işyerlerinde de bir halk sağlığı sorunu olmakla birlikte yaşanma sıklığı giderek artmaktadır. Sağlık çalışanlarının maruz kaldığı şiddete ilişkin yurt içi ve yurt dışında pek çok çalışma yapılmıştır, bu çalışmalardan birinde sağlık kurumunda çalışmanın diğer iş yerlerine göre şiddete uğrama açısından 16 kat daha riskli olduğu gösterilmiştir (1). Sağlık çalışanları her an şiddete maruz kalacağını düşünerek sürekli bir tehdidin varlığından endişe etmektedir. Şiddet ve maruz kalma korkusu, çalışanlardaki olumsuz etkileri sunulan sağlık hizmetinin de kalitesini düşürerek yeni şiddet olaylarını ortaya çıkarmaya zemin hazırlamaktadır. Gereç ve Yöntem: Birinci basamak, devlet hastanesi ve üniversite hastanesi çalışanlarının dâhil edildiği bir çalışmada sağlık çalışanlarının yaklaşık yarısının %50,8 (erkeklerde %48,4 ve kadınlarda %52,5) son bir yılda şiddete uğradığı belirtilmiştir (2). Sağlık çalışanlarına yönelik yaşanan şiddet olaylarının bildiriminin oldukça az oranda yapıldığı, sadece yaralanma ve ölüm gibi ciddi olayların şiddet olarak değerlendirilip diğerlerinin bildirilmediği yapılan bazı çalışmalarda öne çıkmaktadır (3). Bulgular: Beyaz Kod Uygulaması 6 Nisan 2011 tarih ve 27897 sayılı Hasta ve Çalışan Güvenliğinin Sağlanmasına Dair Yönetmelik ile tesis edilmiş olup (4), en son 16 Mart 2016 tarih ve 11045126-010.06 sayılı Türkiye Cumhuriyeti Sağlık Bakanlığı Hukuki Yardım ve Beyaz Kod Uygulaması Genelgesi ile düzenlenmiştir ve halen yürürlüktedir (5). Bu uygulama ile kamu ve özel tüm sağlık kurum ve kuruluşlarında gerçekleşen şiddet olaylarının izlenmesi, gereken müdahalenin yapılması ile olayın takip edilmesi, adli mercilere iletilmesi, beraberinde; gerçekleşen olayların analizinin yapılarak ilgili sağlık kurumuna özgü tedbirlerin alınması için çalışma yapılması amaçlanmaktadır. Beyaz kodun kapsamı, hastane personeli, hastalar, hasta yakınları ve ziyaretçilerden oluşmaktadır. Sonuç: Bu çalışmadaki amacımız artık neredeyse her gün gördüğümüz sağlıkçıya şiddet haberlerinin dışında bu şiddetin sıklığını, tipini ve sağlık çalışanları açısından demografik verileri bilmek, ölçülebilir hale getirmek, bu olayların sebebine ve alınacak önlemlerle bu olayları önlenebilir hale getirmektir.

Prevalence, characteristics, and consequences of verbal and physical violence against healthcare staff in Chinese hospitals during 2010-2020

OBJECTIVES

This study investigated the characteristics of workplace violence (WPV) against Chinese healthcare staff and their casualties after severe physical violence (PV).

METHODS

We scrutinized medical WPV incidents reported online and analyzed information on timing, location, violence, criminal incentives, and casualties following severe PV in China from 2010 to 2020.

RESULTS

WPVs were mostly committed by young and middle-aged male family members of the patients, especially in the emergency department (49.1%), and mostly associated with dissatisfaction with treatment effect (28.9%) in general. High medical costs (62.5%) were the leading cause of verbal violence (VV), whereas men predominantly committed PV (OR = 4.217, 95% CI: 1.439-12.359) owing to dissatisfaction with the healthcare staff's attitude (P < 0.001). The victims were security personnel in most cases (81.1%). Nurses were generally more likely to experience PV (P < 0.05), while doctors were more likely to experience lethal PV (OR = 4.732, 95% CI: 1.42-15.772), which mostly happened in oncology (P < 0.05) and committed by visitors (P < 0.001). Slight injuries and mortality were more likely to be inflicted by being rejected for unreasonable demands and disappointed with the treatment effect (P < 0.05).

CONCLUSIONS

Medical WPV has numerous reasons, locations, and diverse victims and offenders. Some severe WPVs have serious consequences. Therefore, it is recommended for the concerned authorities to adopt effective steps for appropriate legislative, security, and conflict-resolution measures.