The impact of heavy nurse workload and patient/family complaints on workplace violence: An application of human factors framework

Mapping and Characterizing Instruments for Assessing Family Nurses' Workload: Scoping Review

BACKGROUND

The importance of knowing the workload of family nurses lies essentially in the possibility of improving health outcomes, care processes and the nurse's professional life. There is a lack of studies that fully describe the nursing workload in primary care, particularly, in the context of family health nursing, and the ideal metrics to be used remain unknown, making it impossible to characterize and therefore provide the necessary insight to acknowledge the different contributions of several aspects that embody the global workload of family nurses. The objective of this scoping review was to map the known evidence and characterize the instruments used to assess the workload of family nurses.

METHODS

Scoping review, according to the Joanna Briggs Institute, proposed a methodology for scoping reviews, consisting of three research stages: (1) an initial research in Medline and CINHAL; (2) an extended search, using keywords and search terms, in the following databases: JBI, CINAHL Complete, MEDLINE, Cochrane and Scopus; and (3) a search of the reference lists of the selected articles. No time limit was defined.

RESULTS

Fourteen studies referring to ten assessment instruments were included. Nine of them analyze workload as a dimension of a broader instrument, and two studies refer to an instrument that focuses exclusively on workload.

CONCLUSIONS

The diversity of professional competencies and contexts, the conceptual complexity of workload and the absence of a theoretical framework make it difficult to identify consensual instruments to assess the workload of family nurses. This study was prospectively registered with the Open Science Framework® on 6 September 2023, with the registration number: 3k6vr.

Workload of home care nurses: Italian adaptation, validity, and reliability of the National Aeronautics and Space Administration Task Load Index questionnaire

The aim of this study was to adapt the National Aeronautics and Space Administration Task Load Index (NASA-TLX) to the home care setting and translate and validate it in Italian. An online questionnaire containing the Italian version of the NASA-TLX adapted to the home care setting was administered to home care nurses to measure workload. Content Validity Index, Exploratory, and Confirmatory Factor Analyses were used to measure the psychometric characteristics of the modified NASA-TLX. The modified Italian version of NASA-TLX_HC-IT showed good psychometric characteristics in measuring the workload of home care nurses, with excellent fit indices. The reliability, calculated with Cronbach's alpha, was 0.73, indicating adequate reliability. A negative correlation between workload and job satisfaction among home care nurses, as well as a positive association between high workload and intention to leave the workplace, was verified. The modified Italian version of the NASA-TLX_HC-IT was confirmed to be a valid and reliable instrument to measure workload in home care nursing. Furthermore, the correlation between workload and the intention to leave the workplace among home care nurses was an important result that community nursing managers should consider preventing the shortage of home care nurses.

Journey toward Baby-Friendly Hospital Initiative designation: Healthcare professional's view on successful implementation process and maintenance of accreditation

PROBLEM

The Baby-Friendly Hospital Initiative has yet to achieve widespread global implementation.

BACKGROUND

The implementation of the Baby-Friendly Hospital Initiative has been recognised as complex. The challenge has been to maintain accreditation.

AIM

To explore and gain a deeper understanding of the healthcare professionals' perceptions of the implementation process and the maintenance of the Baby-Friendly Hospital Initiative.

METHODS

A qualitative descriptive study with focus groups (n = 10) of the nurses, midwives and unit leaders (n = 43) perceptions of the implementation process were analysed using inductive thematic analysis.

FINDINGS

Analysis of the data revealed five main themes: groundwork for the baby-focused breastfeeding context, management support throughout the process, promoting baby-friendly practices, effective communication ensuring the right track, and supporting the maintenance of BFHI designation. The main themes describe the implementation as a journey of climbing a hill and after reaching the top trying to maintain their position.

DISCUSSION

The starting point for implementation was an optimal environment supporting baby-friendly breastfeeding practices. The support of the management of the organisation was an important way of moving the implementation forward. Commitment to the common goal strengthened the baby-friendly approach and with concrete and immediate feedback the right pathway on a journey was ensured.

CONCLUSION

Practical ways to support the implementation journey include regular update education on breastfeeding and continuous monitoring, as well as providing statistics to health professionals. Global guidelines on how to sustain change are needed. This will ensure that the work done is not wasted.

Identifying communication barriers between nurses and patients from the perspective of Iranian nurses: a Q-methodology-based study

BACKGROUND

Effective communication is essential for high-quality healthcare, yet barriers often impede meaningful connection between nurses and patients. This study aimed to prioritize communication barriers between nurses and patients in Iranian hospitals, exploring nurses' perspectives.

METHODS

Thirty-one nurses participated in a six-step Q methodology study to identify different perspectives on communication barriers. Participants sorted a set of statements based on their own experiences and beliefs.

RESULTS

The average age of participants was 38.07 (SD = 6.49), with 70% being women. Four distinct factors emerged, explaining 47% of the total variance in perspectives: Organizational factors and work conditions (20%), Emotional distress and psychological barriers (11%), Lack of mutual understanding and awareness (7%), and declining professional motivation and engagement among nurses (9%).

CONCLUSION

These findings highlight the multi-faceted nature of communication barriers between nurses and patients in this context. Interventions should address organizational factors, emotional well-being of nurses, cultural awareness, and professional motivation to improve communication and ultimately, patient care. This study provides valuable insights for Iran and other developing countries that are facing similar challenges.

Working conditions, missed care and patient experience in home care nursing in Italy: An observational study

INTRODUCTION

The aging of the population requires an appropriate knowledge of the type of care that needs to be provided to inform healthcare policies. In Italy, neither home care nursing, nor the patient experiences have ever been described.

OBJECTIVES

To describe the characteristics of nurses and care recipients involved in home care.

METHODS

A descriptive cross-sectional study conducted in 18 Italian Regions. Between April and October 2023, data from nurses and patients involved in home care were collected through two surveys. Psychosocial conditions in workplaces, missed care, and care experiences were assessed using validated tools. Descriptive statistics and Pearson's correlations were performed.

RESULTS

A total of 46 local healthcare units were included in this study, with a total of 2549 nurses and 4709 care recipients. Nurses (mean age 46.60; 79.48% female; 44.68% regional nursing diploma as the highest qualification) reported good working conditions (42.37; SD = 12.25; range = 0-100) and a high mean number of missed care activities (5.11; SD = 3.19; range 0-9). Most nurses (83.41%) reported high levels of job satisfaction, while 20.28% intended to leave their job. Patients (mean age 75.18; 57.57% female; 36.95% primary school), on the other hand, rated positively the care they had received (8.23; range = 0-10).

CONCLUSIONS

Despite the perception of critical issues at work and some missed care, satisfaction in nurses and patients was high. These data constitute a preliminary snapshot of the studied phenomena, which will be investigated through more in-depth analyses.

Impact of Workplace Bullying on Nursing Care Quality: A Comprehensive Review

Workplace bullying, commonly known as mobbing, persists as a significant problem across various industries, including the healthcare sector. To establish effective interventions and protocols for enhancing the well-being of healthcare workers and patients, it is vital to fully grasp the link between workplace bullying and the quality of nursing care. The analysis highlights the complex link between workplace bullying and nursing care quality, stressing the urgency of addressing this issue due to its wide-reaching impact on individuals and healthcare organizations, ultimately affecting patient safety. Emphasizing the significance of addressing workplace bullying across different professional settings is crucial for protecting the mental health and well-being of employees. The research identifies various forms of aggression and emphasizes the need to understand how these behaviors affect patient outcomes. Further investigation is needed to clarify nurses' responses to workplace violence, particularly in specialized settings like mental health facilities. The studies underscore the numerous challenges nurses encounter when trying to report incidents of workplace bullying. This insight is vital for developing effective reporting mechanisms and targeted interventions to combat bullying behaviors in medical environments. Ultimately, establishing a safer working environment for nurses is paramount. This article aims to review the associations between workplace bullying and the quality of nursing care.

Medical and surgical nurses' experiences of modifying and implementing contextually suitable Safewards interventions into medical and surgical hospital wards

AIM

To explore general nurses' experiences of modifying and implementing contextually suitable Safewards interventions into medical and surgical hospital wards.

DESIGN

Qualitative action research was used working with nurses as co-researchers.

METHODS

Pre-implementation focus groups were conducted in April 2022 to understand and explore the current strategies nurses utilized to avert, respond to or decrease violence. Following this, two Safewards interventions were modified by the nurses on the wards. Post-implementation focus groups were conducted in October 2022, to explore the nurses' experience of implementing Safewards interventions and the effect on their nursing practice. Data were analysed using Braun and Clarke's framework for thematic analysis.

RESULTS

Three themes emerged from the analysis of the pre-implementation focus groups that reflected the type of violence experienced by these nurses and the context within which they occurred: 'the space is hectic'; 'it can feel like a battlefield'; and 'the aftermath'. These themes encompass the nurses' experience of violence from patients and their visitors. Following the implementation of two modified Safewards interventions, the analysis of the focus groups reflected a change in nursing skills to avert or respond to violence: 'Safewards in action'; 'empathy and self-reflection'; and 'moving forward'.

CONCLUSION

Safewards interventions can be successfully modified and used in general hospital wards and influence nursing practice to manage patient and visitor violence.

IMPLICATIONS FOR THE PROFESSION

In the interests of safety, successful interventions to reduce violence towards general hospital nurses should be a priority for managers and healthcare organizations. Averting, mitigating and managing violence can decrease the negative professional and personal effect on nurses and ultimately improve well-being, job satisfaction and retention rates. Furthermore, decreasing violence or aggressive incidents leads to a safer patient experience and decreased number of nursing errors ultimately improving patient experiences and outcomes. Understanding nurses' experiences of violence and working with them to explore and develop contextually relevant solutions increases their capacity to respond to and avert violent incidents. Contextually modified Safewards interventions offer one such solution and potentially has wider implications for healthcare settings beyond the specific wards studied.

IMPACT

This study addressed the implementation of modified Safewards strategies in medical and surgical wards to prevent violence. Three themes emerged from the analysis of the pre-implementation focus groups that reflected the type of violence experienced by these nurses and the context within which they occurred. Following the implementation of two modified Safewards interventions, the post-implementation focus groups reported positive changes to their practices using the modified resources to prevent violence from patients and their visitors. Mental health interventions, such as those used in the Safewards model can be modified and provide a tool kit of interventions that can be used by medical and surgical nurses.

REPORTING METHOD

This paper has adhered to the COREQ guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: This paper outlines and discusses the action research approach undertaken to work with general hospital nurses to modify mental health nurses' Safewards interventions into their clinical practice. This paper provides evidence of the 'real world' application of Safewards interventions by medical and surgical nurses in general hospital wards. This paper presents qualitative findings based on focus group methods to highlight the narratives of general nurses and their experiences of violence.

The impact of pandemics on healthcare providers' workloads: A scoping review

AIMS

To review and synthesize available evidence exploring the impact of pandemics on direct healthcare providers' workloads in the acute care setting.

DESIGN

Scoping review.

DATA SOURCES

A review of English research articles published up to August 2022 that examined the impact of pandemics on healthcare providers' workloads was undertaken. Studies were identified by searching four electronic databases: Medline (EBSCO), CINAHL (EBSCO), Web of Science and PsychInfo (EBSCO). Fifty-five studies met the inclusion criteria.

REVIEW METHODS

The review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses Scoping Review checklist.

RESULTS

Healthcare workers experience an increase in workload pressures during a pandemic. This included patients requiring more care, undertaking non-normal work activities, increase in work content including changes to documentation, increase in demand and skills required, an increase in overtime and hours of work per week and higher patient-to-nurse ratios. The review also highlighted changes to the work environment and worsened work environments, including staffing shortages.

CONCLUSION

Focused efforts from health organizations to prioritize supportive conditions, policies focused on improved work environments, staffing adequacy and fair and reasonable workloads will enhance retention of the current workforce and future planning for pandemics.

IMPACT

Understanding workload challenges faced by frontline health professionals during the pandemic can improve planning, including policies and procedures, and resource allocation for future pandemic or emergency situations. In addition, extended periods of high workloads can impact staff retention. As many countries return to life after COVID-19, it is important that healthcare organizations examine staff pressures and identify ways to support staff moving forward. This will be vital for the future sustainability of the workforce.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

What are the key factors influencing newly graduated nurses' preference for choosing their workplace? A best-worst scaling approach

INTRODUCTION

The literature cites many factors that influence a nurse's decision when choosing their workplace. However, it is unclear which attributes matter the most to newly graduated nurses. The study aimed to identify the relative importance of workplace preference attributes among newly graduated nurses.

DESIGN

A cross-sectional study.

METHODS

We conducted an online survey and data were collected in June 2022. A total of 1111 newly graduated nurses in South Korea participated. The study employed best-worst scaling to quantify the relative importance of nine workplace preferences and also included questions about participants' willingness to pay for each workplace preferences. The relationships between the relative importance of the workplace attribute and the willingness to pay were determined using a quadrant analysis.

RESULTS

The order according to the relative importance of workplace preferences is as follows: salary, working conditions, organizational climate, welfare program, hospital location, hospital level, hospital reputation, professional development, and the chance of promotion. The most important factor, salary, was 16.67 times more important than the least important factor, the chance of promotion, in terms of choosing workplace. In addition, working conditions and organizational climate were recognized as high economic value indicators.

CONCLUSION

Newly graduated nurses nominated better salaries, working conditions, and organizational climate as having a more important role in choosing their workplace.

CLINICAL RELEVANCE

The findings of this study have important implications for institutions and administrators in recruiting and retaining newly graduated nurses.

Nurses and nursing students as second victims: A scoping review

BACKGROUND

Second victim describes the impact on health care professionals after an error causing preventable patient harm. However, to date, the impact of making errors in practice by nurses and/or nursing students is unclear.

PURPOSE

To describe and understand what is known about nurses and nursing students as second victims.

METHODS

A scoping review was completed using three databases: CINAHL, Medline, and Proquest for the period between 2010 and 2022. A total of 23 papers underwent thematic analysis.

DISCUSSION

Three themes were identified: (a) Psychological distress and symptomatology, (b) Coping-response/reactions to errors, and (c) Seeking support and understanding.

CONCLUSION

Nurses and nursing students' well-being and productivity levels can be negatively affected by inadequate team and organisational support. To improve team functioning, appropriate support mechanisms must be implemented to assist nurses who experience significant distress after making errors. Nursing leadership should prioritise improving support programs, assessing workload allocation, and increasing awareness amongst leaders of the potential benefits of providing support to second victims.

Caring Knowledge as a Strategy to Mitigate Violence against Nurses: A Discussion Paper

Violence against nurses is a disturbing trend in healthcare that has reached epidemic proportions globally. These violent incidents can result in physical and psychological injury, exacerbating already elevated levels of stress and burnout among nurses, further contributing to absenteeism, turnover, and intent to leave the profession. To ensure the physical and mental well-being of nurses and patients, attention to the development of strategies to reduce violence against nurses must be a priority. Caring knowledge-rooted in the philosophy of care-is a potential strategy for mitigating violence against nurses in healthcare settings. We present what caring knowledge is, analyze its barriers to implementation at the health system and education levels and explore potential solutions to navigate those barriers. We conclude how the application of models of caring knowledge to the nurse-patient relationship has the potential to generate improved patient safety and increased satisfaction for both nurses and patients.

Workplace Predictors of Violence against Nurses Using Machine Learning Techniques: A Cross-Sectional Study Utilizing the National Standard of Psychological Workplace Health and Safety

Background: Nurses experience an alarming rate of violence in the workplace. While previous work has indicated that working conditions play an important role in workplace violence outcomes, these studies have not used comprehensive and systematically operationalized variables. Methods: Through cross-sectional survey responses from 4066 British Columbian nurses, we identified which of the 13 psychosocial factors, as outlined in the National Standard of Psychological Workplace Health and Safety, are most predictive of workplace violence perpetrated against nurses by patients and their visitors (Type II violence) and organizational employees (Type III violence). Results: Eighty-seven percent of respondents indicated that they had experienced Type II violence, whereas 48% indicated they had experienced Type III violence over the last year. Lack of physical safety, workload management, and psychological protection were the top three psychosocial factors in the workplace predictive of Type II violence, whereas lack of civility and respect, organizational culture, and psychological support were the top three factors associated with Type III violence. Conclusions: The findings in this study shed light on the distinct psychosocial factors in the workplace in need of investment and intervention to address Type II and III violence.

Perceptions of nurses on TB with HIV adherence counselling skills in a health sub-district, Cape Town: A qualitative study

Background: People living with HIV (PLHIV) co-infected with Tuberculosis (TB) account for one in three HIV-related deaths. Retention in care and adherence to medication remain key behaviours that PLHIV co-infected with TB must adopt to achieve better health outcomes. Nevertheless, TB with HIV adherence-counselling services provided by nurses designed to enhance these behaviours remain inadequate. Additionally, limited information is found in the literature on the perceptions of nurses regarding their TB with HIV adherence counselling skills pertaining to PLHIV co-infected with TB.Aim: To explore and describe the perceptions of nurses regarding their TB with HIV adherence counselling skills of PLHIV co-infected with TB.Setting: The study was conducted in a health sub-district of Cape Town.Method: An exploratory, descriptive qualitative design was followed. A total of 14 purposively sampled nurses were interviewed individually. Nurses caring for PLHIV co-infected with TB were included and nurses not offering care to PLHIV co-infected with TB were excluded. All interviews were audio recorded with the participants’ permission followed by verbatim transcriptions. Thematic analysis was done using ATLASti.8 electronic software.Results: It was established that the varied roles of these nurses increased their workload. Nonetheless, despite the gap in their counselling skills, the majority still maintained work expertise, professionalism and empathy towards the patients. Additionally, there were perceived barriers impacting patients’ attendance of their follow up appointments.Conclusion: Based on the findings of this study, there is a need to equip nurses caring for PLHIV co-infected with TB with adherence counselling skills to improve practice.Contribution: The findings were synthesised with results from an in-depth literature review to stand as the backbone for the development of a training programme for nurses to improve adherence counselling.

Comparing workplace violence among nurses and other professionals using online articles: A social network analysis

AIM

To investigate workplace violence in online articles and compare workplace violence-related words characteristics of nurses and other professionals using social network analysis.

BACKGROUND

Workplace violence is a widespread problem across nursing practice. Online articles are useful for the timely identification and management of nurse violence problems.

METHODS

This descriptive exploratory study involved data extraction focused around the search term workplace violence from sources published during January 1990-December 2020 listed in the BIGKinds database, a Korean integrated news database system. The connections between the extracted terms were determined through social network analysis using the programs UCINET and NetDraw.

RESULTS

Our search found 675 articles for nurses and 5,797 articles for other professionals related to workplace violence. Work burden was found to be the primary cause of violence among both nurses and other professionals. Specifically, being a woman was closely related to violence among nurses, and abuse of power was closely related to violence among other professionals.

CONCLUSION

Nurses and other professionals have different vulnerabilities to violence, which require a different approach to addressing violence.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers should provide a healthy work environment, sufficient workforce, and flexible work schedules to protect nurses from workplace violence.

Do type A personality and neuroticism moderate the relationships of occupational stressors, job satisfaction and burnout among Chinese older nurses? A cross-sectional survey

Background

The high prevalence of burnout among nurses produces huge health service losses. Existing literature found that occupational stressors and low levels of job satisfaction were related to burnout, whilst personality traits such as type A personality and neuroticism influenced occupational stressors, job satisfaction, and burnout. The purpose of this study was to investigate the mediating effect of job satisfaction on the relationship between occupational stressors and burnout among Chinese older nurses, and explore the moderating effects of type A personality and neuroticism on the relationships among occupational stressors, job satisfaction and burnout.

Methods

A cross-sectional study was conducted in five provinces and municipalities (mainly in Shandong) in China. A total of 527 female older nurses (age≧40) were included in this study. Structural equation modelling (SEM) approach was employed to investigate the mediating effect of job satisfaction on the relationship between occupational stressors and burnout. Multi-group analysis was conducted to explore the moderating effects of type A personality and neuroticism on the relationships among occupational stressors, job satisfaction and burnout.

Results

Both nurses with high type A personality and high neuroticism had higher occupational stressors, higher burnout and lower job satisfaction. Occupational stressors had direct effect (β = 0.29, P = 0.001) and indirect effect mediated by low levels of job satisfaction (β = 0.25, P = 0.001) on burnout. Type A personality had significant moderated effect (P = 0.007) on the relationships among occupational stressors, job satisfaction and burnout, whereas the moderated effect of neuroticism was not significant.

Conclusions

Low levels of job satisfaction mediated the relationship between occupational stressors and burnout among Chinese older nurses, and both the direct and indirect effect of occupational stressors on burnout were moderated by type A personality. Hospital administrators should take specific measures such as transferring older nurses to easier positions to reduce their occupational stress, thereby increasing their job satisfaction and reducing their burnout, which is especially important for the older nurses with high type A personality.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-022-00865-7.

Exploring Experiences of Workplace Violence and Attempts to Address Violence Among Mental Health Nurses in the Kingdom of Saudi Arabia

INTRODUCTION

Workplace violence has emerged as a global phenomenon requiring immediate attention. The nursing profession is primarily affected, and the unique vulnerability of nurses to workplace violence is particularly evident in the field of mental health nursing.

AIMS

This study explores the experiences of mental health nurses with work-related violence and attempts to combat this violence in the context of inpatient mental health facilities in Saudi Arabia.

METHODS

This research comprises a qualitative exploratory study consisting of semistructured interviews with 16 participants using open-ended questions. The participants are psychiatric/mental health nurses with experience in the field, so this methodological approach facilitates a detailed investigation of their encounters with workplace violence.

RESULTS

This study reveals that nurses experience violence in accordance with two main themes and subthemes: experiences of workplace violence, the influence of violence on work settings, and efforts required to combat violence. Data show that these participants consider of prime importance access to training to increase safety through knowledge, improved communication, and protective skills, along with adequate staffing and a safe built environment.

CONCLUSION

The research findings confirm the urgency of addressing the needs of mental health nurses in inpatient psychiatric hospitals. Policymakers in the healthcare field must be aware of the inpatient psychiatric care climate and the need for support from those who staff these areas of practice. Training in specialized knowledge and skills is required to ensure a safe work environment as well as appropriate staffing levels, and a safe built environment. These conditions may be required to recruit and retain mental health nurses capable of providing best-practice care.

Causes of workplace violence against nurses from patients and their relatives: A qualitative study

BACKGROUND

Nurses are frequently exposed to violence in workplaces. Although the causes of workplace violence have been widely analyzed, there are only a limited number of qualitative studies dealing with violence against nurses from patient and their relatives with a comprehensive and multi-directional approach.

AIM

This study aimed to explore the causes of violence against nurses exercised by patients and/or their relatives in different departments of Turkish hospitals.

METHODS

This study utilized a qualitative descriptive design. Participants were chosen with purposive sampling and maximum variation sampling method from five different hospitals. Semi-structured in-depth interviews were conducted with 34 nurses working in different positions and departments. The interviews were recorded with audio recorders and the data were analyzed with a content analysis.

RESULTS

Four major themes emerged from the nurses' perspective concerning causes of workplace violence including the followings: (1) health care system, (2) health institutions, (3) health professionals, and (4) patients and their relatives. The themes "health care system" and "health institutions" include four subthemes, "health professionals" include five subthemes and "patients and their relatives" include twelve subthemes.

CONCLUSION

There are various causes why nurses are exposed to violence in the workplace by patients and/or their relatives. Since the causes of violence are a multifaceted issue, prevention strategies of violence against nurses should be planned and implemented accordingly.

Identifying the most important workplace factors in predicting nurse mental health using machine learning techniques

OBJECTIVES

Nurses are at a high risk of developing mental health problems due to exposure to work environment risk factors. Previous research in this area has only examined a few factors within nurses' work environments, and those factors were not conceptualized with the goal of improving workplace mental health. The purpose of this study is to identify the most important work environment predictors of nurse mental health using a comprehensive and theoretically grounded measure based on the National Standard of Psychological Health and Safety in the Workplace.

METHODS

This is an exploratory cross-sectional survey study of nurses in British Columbia, Canada. For this study, responses from a convenience sample of 4029 actively working direct care nurses were analyzed using random forest regression methods. Key predictors include 13 work environment factors. Study outcomes include depression, anxiety, post-traumatic stress disorder (PTSD), burnout and life satisfaction.

RESULTS

Overall, healthier reports of work environment conditions were associated with better nurse mental health. More specifically balance, psychological protection and workload management were the most important predictors of depression, anxiety, PTSD and emotional exhaustion. While engagement, workload management, psychological protection and balance were the most important predictors of depersonalization, engagement was the most important predictor of personal accomplishment. Balance, psychological protection and engagement were the most important predictors of life satisfaction.

CONCLUSIONS

Routine assessment with standardized tools of nurses' work environment conditions and mental health is an important, evidence-based organizational intervention. This study suggests nurses' mental health is particularly influenced by worklife balance, psychological protection and workload management.

Describing the Mental Health State of Nurses in British Columbia: A Province-Wide Survey Study

A cross-sectional province-wide survey study of 3,978 British Columbia (BC) nurses was conducted to explore the mental health state of the nursing workforce in BC. About one third of nurses reported depression and anxiety; about half reported symptoms of post-traumatic stress disorder and at least one third reported high levels of one or more dimensions of burnout. Mental health problems were about 1.5 to 3 times more prevalent among BC nurses compared to their peers nationally. Improving nurses' mental health requires multi-factorial and multi-level efforts. Evidence-based and workplace-specific policies and interventions that better support nurses at risk are recommended.

The National Standard of Psychological Health and Safety in the Workplace: A Psychometric and Descriptive Study of the Nursing Workforce in British Columbia Hospitals

BACKGROUND

In 2013, the Mental Health Commission of Canada created a National Standard that includes 13 workplace factors associated with employee mental health.

PURPOSE

This study (a) examined the psychometric properties of Guarding Minds at Work (GMW), the instrument used to measure the Standard's 13 workplace factors and (b) assessed BC nurses' workplace risk factors.

METHODS

A province-wide survey study of 3,077 direct care nurses working in acute care settings was conducted.

RESULTS

Subscale internal consistencies were acceptable. For most items, the original alphas were greater than the alpha-if-item-deleted. All corrected item-subtotal correlations were moderate to high. The 13-factor structure showed an adequate model fit based on absolute fit indices (SRMR = 0.057 and RMSEA = 0.054) but the relative fit indices were lower than the recommended cutoff (CFI = 0.827 and TLI = 0.815). Nurses identified nine of the 13 GMW factors as serious or significant concern in their workplace.

CONCLUSIONS

The findings were consistent with a plethora of evidence pointing to shortcomings in nurses' work environments. This was the first study partially supporting the reliability and validity of the GMW. More work is required to refine the GMW and gain a better understanding of its psychometric properties.

Does the Type of Exposure to Workplace Violence Matter to Nurses' Mental Health?

Workplace violence is a prevalent phenomenon in healthcare, particularly among nursing professionals. Exposure to workplace violence may be direct through firsthand involvement, indirect through secondhand witnessing, or both. Even though implications for victims of workplace violence have been well-studied, less is known about the various types of exposure and their effects on nurse mental health. The purpose of this study is to examine the impact of workplace-violence exposure types on the mental health of nurses, while accounting for the intensity of the incident/s. This study employs an exploratory correlational design with survey methods. Nurses from British Columbia (BC), Canada, were invited by the provincial nurses' union to complete an electronic survey in Fall 2019. A total of 2958 responses from direct-care nurses in acute-care settings were analyzed using logistic regression. The results showed that mental-health problems increased with cumulative exposure; even though nurses with solely indirect exposure to workplace violence did not report greater mental-health problems, those experiencing solely direct exposure, or both direct and indirect exposure, were two to four times more likely to report high levels of post-traumatic stress disorder (PTSD), anxiety, depression and burnout compared to their counterparts with no exposure. There is an urgent need for better mental-health support, prevention policies and practices that take into account the type of workplace-violence exposure.

Workplace Violence among British Columbia Nurses Across Different Roles and Contexts

Workplace violence in healthcare settings is on the rise, particularly against nurses. Most healthcare violence research is in acute care settings. The purpose of this paper is to present descriptive findings on the prevalence of types and sources of workplace violence among nurses in different roles (i.e., direct care, leader, educator), specialties, care sectors (i.e., acute, community, long-term care) and geographic contexts (i.e., urban, suburban, rural) within the province of British Columbia (BC), Canada. This is a province-wide survey study using a cross-sectional descriptive, correlational design. An electronic survey was emailed by the provincial union to members across the province in Fall 2019. A total of 4462 responses were analyzed using descriptive and chi-square statistics. The most common types of workplace violence were emotional abuse, threats of assault and physical assault for all nursing roles and contexts. Findings were similar to previous BC research from two decades ago except for two to ten times higher proportions of all types of violence, including verbal and physical sexual assault. Patients were the most common source of violence towards nurses. Nurses should be involved in developing workplace violence interventions that are tailored to work environment contexts and populations.