Workplace violence: A qualitative study drawing on the perspectives of UK nursing students

Australian nursing students' experiences of workplace violence during clinical placement: A cross-sectional study

AIM

To identify the nature, degree and contributing factors of workplace violence (WPV) incidents experienced by Australian nursing students during clinical placement.

DESIGN

Descriptive cross-sectional study.

METHODS

Data were collected from 13 September to 25 November 2022. Eligible participants included all nursing students enrolled in nursing degrees at any Australian university who had completed at least one clinical placement. An adapted version of the WPV in the Health Sector Country Case Study survey was used.

RESULTS

A total of 381 nursing students across eight states of Australia completed the survey. More than half of the students had experienced an episode of WPV; patients were the most frequent perpetrators. Personal factors of patients, staff and students, organizational factors and cultural norms within the workplace supported acts of WPV.

CONCLUSION

Student nurses (SNs) most often experience violence from patients during direct care. Patient encounters are the core component of clinical placement. Education providers have a responsibility to effectively prepare students to be able to identify escalating situations and manage potentially violent situations. Registered nurses who supervise students during clinical placement require support to balance their clinical role with student supervision.

IMPLICATIONS FOR THE PROFESSION

Experiencing WPV can negatively impact relationships between students, healthcare professionals and care recipients. This results in personal distress, decreased job satisfaction and potentially the decision to leave the nursing profession.

IMPACT

What already is known: SNs are exposed to WPV during clinical placement.

WHAT THIS PAPER ADDS

More than half the SNs in this study experienced violence inclusive of physical, verbal, racial and sexual harassment. Patients were the predominant perpetrators. Implications for practice/policy: Interventions at individual and systemic levels are required to mitigate WPV.

REPORTING METHOD

This study is reported using the STROBE guidelines.

Why nursing students do not report workplace bullying during clinical practice: A mixed methods systematic review

BACKGROUND

Workplace bullying in clinical nurse education significantly threatens students' well-being and professional development. Despite its prevalence, many incidents go unreported, exacerbating the issue and compromising the quality of care. A significant gap exists in the literature regarding comprehensive mixed-methods systematic reviews on unreported bullying incidents among nursing students. This review aims to address this knowledge gap and propose effective strategies to tackle this pervasive problem.

AIM

This mixed-methods systematic review aimed to explore the factors influencing the non-reporting of workplace bullying incidents among nursing students during clinical practice.

DESIGN

Mixed-methods systematic review.

REVIEW METHODS AND DATA SOURCES

An extensive literature search was conducted across ten databases, including PubMed, Cochrane, Embase, Web of Science, CINAHL, PsycINFO, Scopus, Chinese Biomedical, China National Knowledge Internet, and WANFANG, from database inception to November 1, 2023. Google Scholar and reference lists of included studies were also searched. Studies were selected based on eligibility criteria regarding population, phenomena of interest, and context. Two researchers independently assessed study quality, with disagreements resolved by a third reviewer. Relevant data were extracted and synthesized using the Joanna Briggs Institute's convergent integrated approach, ensuring a comprehensive integration of qualitative and quantitative findings.

RESULTS

Twenty-one studies met the inclusion criteria, comprising six qualitative, twelve quantitative, and three mixed-methods studies. Four integrated themes emerged from nursing students' perspectives on reasons for not reporting workplace bullying during clinical practice: (i) fear and concerns related to reporting, (ii) concerns about professional image, (iii) barriers and challenges in reporting, and (iv) perceived ineffectiveness of reporting.

CONCLUSIONS

This systematic review provides valuable insights into nursing students' perspectives on the non-reporting of workplace bullying incidents during clinical practice. Understanding these reasons enables stakeholders to collaboratively develop interventions to create a safer and more supportive environment for nursing students, ultimately enhancing quality care and the well-being of healthcare professionals.

Clinical Facilitators' Perceptions of Factors Contributing to Nursing Students' Experience of Workplace Violence

BACKGROUND

Workplace violence (WPV) is experienced by Bachelor of Nursing (BN) students during clinical placements. Students in this vulnerable group are supervised in the practice environment by clinical facilitators. This study examined clinical facilitators' views on WPV.

METHOD

Eleven clinical facilitators were recruited for this study and participated in interviews. Transcribed data were probed, and thematic analysis was conducted.

RESULTS

Six major themes emerged that identified factors contributing to BN students' experience of WPV during clinical placements: (1) setting; (2) university; (3) nursing students; (4) site staff; (5) patients; and (6) other factors. Clinical facilitators perceived WPV toward students as being a common yet complex issue due to multiple contributing factors.

CONCLUSION

This study adds detailed knowledge regarding the factors that influence WPV directed toward BN students to inform the development of policies and procedures for reducing the incidence of WPV in the clinical setting. [J Nurs Educ. 2024;63(10):671-678.].

Effectiveness of interventions for the prevention or management of workplace violence in student nurses during clinical placement: A systematic review

AIM

To systematically investigate the effectiveness of interventions for managing workplace violence experienced by registered nursing students during clinical placement.

DESIGN

A systematic review of experimental studies.

METHODS

The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The key search concepts such as "Nursing students", "Education", "workplace violence", "clinical placement" and "clinical study" were inspected to identify relevant articles (Appendix A). Two independent reviewers completed screening, critical appraisal and data extraction. Due to heterogeneity among the included studies, results were synthesized narratively.

DATA SOURCES

MEDLINE (Ovid), CINAHL (EBSCOhost), Web of Science Core Collection (Clarivate Analytics), Scopus (Elsevier), Embase (Ovid), Cochrane CENTRAL, ERIC (ProQuest), ProQuest Central and ProQuest Social Science Premium Collection were searched from inception to 27th February 2023.

RESULTS

A total of 13 studies were included in this review. The predominant intervention for managing workplace violence experienced by registered nursing students during clinical placements was education. Approaches varied among studies and included didactic teaching, e-learning, role-playing and simulation practice. The included studies showed uncertain improvements in registered nursing students' confidence, coping skills, knowledge, competence and self-efficacy in dealing with workplace violence during clinical placements. Only one study assessed the incidence rate of workplace violence and found that a multi-faceted intervention involving both staff and students decreased the incidence.

CONCLUSION

Given the heterogeneity of educational interventions, the effect of interventions for managing workplace violence during students' clinical placement is uncertain. To address this gap, high-quality, proactive and combined interventions at both institutional and organizational levels are needed.

Interventions to prevent or manage workplace violence against student nurses during clinical placement: a systematic review protocol

OBJECTIVES

The objective of this review is to investigate the effectiveness of workplace violence management or prevention interventions, including strategies, protocols, and policies, to address violence against, and provide support to, registered nursing students (RNS) following incidents of violence during clinical placement.

INTRODUCTION

Workplace violence is a global issue that affects victims' physical and mental health. RNS are especially vulnerable to workplace violence because of their limited work experience and confidence. These students often feel shocked and unprepared when experiencing workplace violence due to limited education and support provided by educational institutions or clinical sites. Workplace violence can lead to anxiety, decreased confidence, and professional attrition. There is a need to systematically synthesize the evidence on workplace violence management and prevention to support nursing students during clinical placement.

INCLUSION CRITERIA

The review will consider studies assessing the effectiveness of interventions to address workplace violence or improve support for RNS. Studies that report on educational interventions or pre-clinical placement strategies and measure the preparedness of students will also be considered. Study designs will be limited to quantitative methods that evaluate intervention effectiveness.

METHODS

Databases to be searched include MEDLINE (Ovid), CINAHL (EBSCOhost), Web of Science Core Collection, Scopus, Embase (Ovid), Cochrane Central, ERIC (ProQuest), ProQuest Central, ProQuest Social Science Premium Collection, and ProQuest Dissertations and Theses Global. Two independent reviewers will screen, review, appraise, and extract data from eligible articles. For data synthesis, studies will be pooled using JBI SUMARI. The GRADE approach for grading the certainty of evidence will be followed and a Summary of Findings will be created.

REVIEW REGISTRATION

PROSPERO CRD42022377318.

Experience of verbal violence among Chinese nursing students in clinical practice: a qualitative study

BACKGROUND

Workplace violence is prevalent in the nursing profession, and as a relatively junior link of the professional hierarchy, nursing students are not immune to it. Among these, verbal violence may have more serious consequences for the victims than physical violence, but the literature on verbal violence among nursing students in Chinese clinical settings is limited.

AIMS

To explore the verbal violence experience among Chinese nursing students in clinical practice, and the strategies used by nursing students to cope with violence.

DESIGN

A descriptive qualitative study.

METHODS

From January 2022 to June 2022, semi-structured interviews were conducted with 21 nursing students in clinical practice by purposive snowball sampling. Nvivo12 software and inductive content analysis were used for data analysis. This paper followed the COREQ (Consolidated criteria for Reporting Qualitative Research) guidance.

RESULTS

Through data analysis, three themes were defined:(1) Multiform verbal violence; (2) Hurting and impacting and (3) Struggling or Coping. The findings indicated that nursing students were subjected to multiple forms of verbal violence in clinical practice, not only from patients and caregivers, but also from peers such as clinical tutors and doctors, which not only harmed students' personal health and well-being, but may also contribute to the nursing industry's future loss of human resources. Seeking emotional support from others and forcing themselves to grow up were the most commonly used coping strategies.

CONCLUSION

Nursing educators and nursing managers need to pay attention to verbal violence in the clinical environment, and actively develop the ability of nursing students to deal with uncivilized behavior. Establishing relevant courses and training such as communication, resilience, and violence prevention, establishing a stricter clinical mentor appointment system, and teaching assessment system may be strategies to help nursing students better perform clinical practice.

Nursing students' experience of workplace violence in clinical practice: A qualitative systematic review

AIMS

To systematically identify, appraise and synthesise qualitative studies investigating Registered Nurse students' (RNS) experiences of workplace violence (WPV) while on clinical placement. It is expected that the literature review findings will guide the development of targeted programs and policies to address WPV against RNS.

BACKGROUND

WPV affects RNS during clinical placements as they are vulnerable to violence due to their limited experience and skills to challenge abusive behaviour. In this review, RNS are students enrolled in a Bachelor of Nursing program to become registered nurses and exclude students who are enrolled in nursing program that does not lead to registration as a registered nurse. For example, enrolled in nursing programs and postgraduate nursing programs. RNS are chosen for their scope of practice and the training requirements. RNS reported experiencing WPV mainly from colleagues, staff, teachers, doctors and supervisors, which resulted in leaving nursing practice, impacting students' progression and healthcare systems. This review examines all types of violence RNS face irrespective of the abuser.

METHODS

A qualitative systematic review of existing literature was conducted through a comprehensive database search of eight databases MEDLINE, CINAHL, Web of Science, Scopus, Embase, Cochrane Central and ProQuest. Furthermore, reference lists of included studies were searched to identify further research. English language qualitative primary studies of any study design were searched from inception to 6th June 2022 and included if they met the inclusion criteria. Double review process utilised from screening until data synthesis reported according to PRISMA. JBI critical appraisal tools were used to assess the studies, and data extraction utilised JBI QARI tool and screened for credibility and confidence in findings.

RESULTS

A total of 18 studies met the inclusion criteria, and the studies were conducted in nine countries. Five main themes relating to RNS experiences of WPV while on clinical placement were identified, including: 'Types of workplace violence', 'Perpetrators', 'Causes', 'Consequences' and 'Management of workplace violence'.

CONCLUSIONS

This qualitative systematic review provides new and significant knowledge in understanding the phenomenon of WPV experienced by RNS while on clinical placement.

RELATIVE TO CLINICAL PRACTICE

This review highlights the unwillingness of RNS to reach out to instructors or clinical placement leaders in many situations and identifies avenues of support and awareness that are crucial to empower and enabling students to seek support.

Challenges perceived by nursing professionals in physician-centred organizations: An exploratory qualitative study

AIM

To explore and analyse contextual challenges in nursing that have affected nurses' perceptions and role performance.

BACKGROUND

Health system hierarchy and patient/family-centred care has led to a high demand for skilled nurses. However, patriarchal organizations create challenges for nursing clinicians in Pakistan and elsewhere.

METHODS

A qualitative exploratory research (phenomenology) design was used. Twenty-five participants identified through purposive sampling contributed to the study. The data analysis was conducted using NVivo 12 Plus. We generated six major themes. Reporting was accomplished according to the consolidated criteria for reporting qualitative research checklist.

RESULTS

Gendered division of labour places nurses in a submissive position in clinical practice. Decreases in nurse-to-patient ratio and increase in patient-focused care adversely affect evidence-based practice. The gap between theory and practice in delivering quality care is increasing due to existing communication barriers among health-related professionals and an inadequate work environment. Comparatively inactive nursing leadership and directorate roles are not improving the social image of nursing, and are promoting role conflict and poor nursing self-concepts among nurses. In fact, cultural shock experienced by young nurses has produced inherent disorientation in their professionalism and fostered displays of horizontal violence towards them by senior nurses.

CONCLUSION

These challenges are influencing nurses' decisions to remain in or to join nursing as a profession that is confronted by severe recruitment and retention shortages due to the social and cultural stigmatization of this female dominated profession.

IMPLICATIONS FOR NURSING, HEALTH AND SOCIAL POLICY

This study promotes the concept of evidence-based practice to deliver quality health services in public hospitals and to improve the social status of nursing in Pakistan. It provides influential evidence to policymakers who should urgently address nurses' workplace health and safety issues as a global right.

Workplace violence directed at nursing and medical students - What can students tell us about it?

BACKGROUND

Workplace violence (WPV) directed at healthcare teams is a widespread growing phenomenon that affects students as well. The negative consequences of WPV may impede patient care and future retention rates.

PURPOSE

To explore (a) the incidence and type of WPV experienced by nursing and medical students during their clinical rotations; (b) the associations between the emotional consequences of WPV events for students and their perceived professional performance; (c) students' preparedness and current training on WPV.

METHOD

One hundred and fifty-one Israeli nursing and medical students completed an online questionnaire that included closed and open-ended questions. Quantitative data and qualitative data were analyzed separately, before their integration.

RESULTS

More than half the students reported having experienced verbal violence during their clinical rotations. Experiencing WPV caused some students (14.6%) to consider leaving the profession and about one third (27.8%) reported that it had affected patients' care. The vast majority of students did not report experiencing incidents of physical violence.

CONCLUSIONS

There is an essential need to promote and implement multidisciplinary programs aimed at eliminating WPV, beginning at the students' level. Students need preparation and practical tools for coping with WPV. At the same time, health organizations must act to examine how cases of WPV against students are handled.

Decider Life Skills training as a method of promoting resilience with mental health student nurses on clinical placement

AIM

The aim of this study is to explore mental health student nurses' perceptions and application of a CBT-orientated training programme - the Decider Life Skills programme.

BACKGROUND

The undergraduate nursing degree programme is a challenging one and places high demands both professionally and personally on students. Mental health nursing students are faced with particular stressors including working with people in significant psychological distress, which can result in students feeling overwhelmed and emotionally burdened. There is a requirement for student nurses to be supported to cope with professional and personal difficulties while on practice placement. The Decider Life Skills is a one-day training programme that aims to build resilience and increase effective coping skills. This programme was offered to internship mental health nursing students with the aim of providing them with a toolbox of skills to maintain their wellbeing while on clinical placement.

METHODS

A qualitative descriptive design was used, and data were collected through two 45-min focus group interviews with mental health students (n = 10) on their internship placement. These students had received a one-day training in Decider Life Skills prior to their clinical placements. Full ethical approval was achieved for this study.

RESULTS

Participants reported that they found the skills imparted in the training easy to understand and apply in both their professional and their personal lives.

CONCLUSIONS

The findings from this study that the Decider Life Skills helped students cope in stressful situations and become more mindful of protecting their own mental health is important, as there is a need to safeguard the emotional well-being of mental health nursing students and support them to become resilient practitioners.