Psychometric properties of the Management of Aggression and Violence Attitude Scale in Hong Kong's emergency care setting

Interns' and Junior Nurses' Workplace-Violence Perceptions, Coping Confidence and Attitudes Towards Violence Management: A Structural Equation Model Analysis

AIM

To investigate interns' and junior nurses' perceptions, coping confidence and attitudes towards workplace violence in China.

DESIGN

Cross-sectional survey study involving 622 interns or nurses with < 5 years of hospital experience.

METHODS

Data were gathered from the largest tertiary hospital in southwestern mainland China using a general information questionnaire, the Perception of Aggression Scale, the Confidence in Coping with Patient Aggression Instrument and the Management of Aggressive and Violence Attitude Scale. Structural equation modelling was used to understand relationships and pathways between the nurses' perceptions of, confidence in dealing with and attitudes towards managing workplace violence.

RESULTS

The average scores for the perception of workplace violence, confidence in coping with workplace violence and attitudes towards violence management were 37.44 (±11.60), 29.84 (±8.23) and 81.87 (±23.72), respectively. Perceptions of workplace violence, confidence in coping with workplace violence and attitudes towards violence management show low to moderate correlations; confidence in coping with workplace violence was the mediating variable in the interactions among the three variables.

CONCLUSIONS

Interns and junior nurses have weaker perceptions of workplace violence, lower confidence in their ability to cope with violence and more negative attitudes towards violence management. Perceptions of workplace violence affected attitudes towards violence management through the intermediary role of confidence in coping with workplace violence.

IMPLICATIONS

Nursing managers should increase education and training to improve interns' and junior nurses' awareness and confidence in dealing with workplace violence. Healthcare organisations should prevent and manage workplace violence to develop nurses' positive attitudes towards violence management.

REPORTING METHOD

The study adhered to the STROBE checklist of cross-sectional studies.

PATIENT OR PUBLIC CONTRIBUTION

Interns and nurses with < 5 years of experience participated by voluntarily completing a paper questionnaire.

Measuring Emergency Department Staff Perceptions of Causes and Management of Violence

BACKGROUND

Half of all reported violent incidents in health care settings occur in the emergency department (ED) placing all staff members at risk. However, research typically does not include all ED work groups or validated measures beyond nurses and physicians.

OBJECTIVE

The aims of this study were to (a) validate an established instrument measuring perceptions of causes of violence and attitudes toward managing violence within an inclusive workforce sample; and (b) explore variation in perceptions, attitudes, and incidence of violence and safety to inform a violence prevention program.

METHODS

This is an investigator-initiated single-site cross-sectional survey design assessing the psychometric properties of the Management of Aggression and Violence Attitude Scale (MAVAS) within a convenience sample (n = 134). Construct validity was assessed using exploratory factor analysis and reliability was evaluated by the Cronbach's α estimation. Descriptive, correlational, and inferential estimates explored differences in perceptions, attitudes, and incidence of violence and safety.

RESULTS

Exploratory factor analysis indicated validity of the MAVAS with a seven-factor model. Its internal consistency was satisfactory overall (Cronbach's α= 0.87) and across all subscales (Cronbach's α values = 0.52-0.80). Significant variation in incidence of physical assault, perceptions of safety, and causes of violence was found between work groups.

CONCLUSIONS

The MAVAS is a valid and reliable tool to measure ED staff members' perceptions of causes of violence and attitudes toward managing violence. In addition, it can inform training according to differences in work group learner needs.

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.

A combined behavioural economics- and simulation-based medical education to promote effectiveness among medical residents in coping with workplace violence in Northern China: a quasi-experimental study

BACKGROUND

Workplace violence is internationally recognised as a major concern for the workforce, which entails serious consequences, and research shows that medical residents are more likely than other doctors to experience violence in the workplace. This study first examines the effectiveness of simulation-based medical education, and then simulation-based medical education combined with behavioural economics as interventions in medical residents' perception of, attitude toward, and self-efficacy in coping with violence in the workplace.

METHODS

A quasi-experimental design was used, 190 participants were randomised into three study groups to respectively test the effect of simulation-based medical education only and simulation-based medical education plus behavioural economics interventions, compared with a control group. Data were obtained from structured questionnaires, including (1) a perception of aggression scale, a management of aggression and violence attitude scale, a general self-efficacy scale, and (2) socio-demographic characteristics.

RESULTS

The results show that the scores attained by simulation-based medical education (SBME) and simulation-based medical education combined with behavioural economics (SBME + BE) interventions for perception, attitude, and self-efficacy were significantly higher than those in the control group (p < .01). The SBME + BE group recorded a greater improvement in perception, which could be ascribed to the behavioural economics effect. Furthermore, the higher perception of workplace violence is correlated with single residents and those with more work experience, prior experiences of violence in the workplace, and training related to workplace violence. A higher positive correlation of workplace violence was recorded by female and widowed residents,and a higher level of self-efficacy related to violence in the workplace correlated with male, widowed,and senior (third-year) residents.

CONCLUSIONS

This study contributes important evidence regarding changes in the perception, attitude, and self-efficacy of subjects following both the SBME + BE and SBME interventions among medical residents in coping with workplace violence, the biggest perception change having been recorded after the SBME + BE intervention, which can be explained by the inclusion of behavioural economics.

Cross-cultural adaptation of the Management of Aggression and Violence Attitude Scale for nurse in emergency department

Objective

To follow the guidelines of intercultural adaptation provided by the American Academy of Orthopedic Surgeons’ (AAOS) Evidence-Based Medicine Committee, translating the original scale and evaluating the reliability and validity, and then to compile the Chinese version of the Management of Aggression and Violence Attitude Scale (MAVAS) for nurses in emergency room in the mainland of China.

Methods

This study consists of two phases of testing: (1) translation: forward translation, synthesis, back translation, expert committee review, and pretesting; (2) psychometric properties: content and construct validity, internal consistency, and test–retest reliability.

Results

The Chinese version of MAVAS and the original version showed excellent similarities and equivalence. The average Scale-level Content Validity Index was 0.904, and the Item-level Content Validity Index ranged from 0.80 to 1.00. The construct validity was tested using confirmatory factor analysis by LISREL 8.7; χ2/df of the scale was 4.781<5, NFI, NNFI, CFI, IFI>0.90, indicating that the scale’s factor structure model fitted better. The internal consistency was satisfactory (scale, Cronbach’s α=0.94; subscales, Cronbach’s α=0.74–0.90), and the test–retest reliability over 2 weeks was good (scale, Pearson’s coefficient=0.996; subscales, Pearson’s coefficient=0.801–0.963).

Conclusions

The Chinese version of MAVAS had an excellent feasibility. It was found to be a valid and reliable tool to assess nurses’ attitude toward patients’ violence in emergency department.

Aggression in Acute Inpatient Psychiatric Care: A Survey of Staff Attitudes

Introduction

Inpatient aggression poses consistent complications for psychiatric hospitals. It can affect patient and staff safety, morale, and quality of care. Research on staff attitudes toward patient aggression is sparse.

Purpose

The study explored staff attitudes toward patient aggression by hospital position types and years of experience in a psychiatric hospital. We predicted that staff experiencing patient aggression would be related to working in less trained positions, having less psychiatric work experience, and demonstrating attitudes that were consistent with attributes internal to the patient and not external.

Methods

Fifty-one percent completed online survey using Management of Aggression and Violence Attitude Scale, along with demographics, years of work experience, and number of times staff experienced aggressive event.

Results

Management of Aggression and Violence Attitude Scale scores, staff position types, and years of experience were related to the number of aggressive interactions. Nurses and psychiatric technicians reported highest number of exposures to patient aggression, followed by physicians; however, support staff reported less patient aggression. More years worked in a psychiatric hospital was associated with more aggressive experience.

Conclusion

Nurses, psychiatric technicians, and physicians reported greater exposure to patients’ aggression than support staff. Training programs, developed specifically to individual position types, focusing on recognition of sources of aggression, integrated into staff training, might reduce patient on staff aggression in psychiatric hospitals.

A Scale for the Management of Aggressive and Violent Behaviour (C_MAVAS): Psychometric Properties Testing in Mental Health Nurses

Background: This study set out to examine the psychometric properties of C_MAVAS, a newly Chinese-translated version of MAVAS, a 27-item scale assessing healthcare professionals' attitudes to the management of patient violence. Method: The English version of the MAVAS was translated and back-translated to come up with C_MAVAS. A convenience sample of 262 qualified mental health nurses working in a local psychiatric hospital was recruited. Exploratory factor analysis tested C_MAVAS's construct validity. Results: Content validity of the C_MAVAS was very satisfactory with validity indices of 97.4% for the overall scale and 90% to 100% for individual items. Exploratory factor analysis yielded a four-factor solution: 'interactional perspectives on patient violence', 'best ways perceived for violence management', 'internal or biomedical perspectives on patient violence', and 'external perspectives on patient aggression and violence', were important in shaping their attitudes towards managing violence and patient disruptiveness. Internal consistency of the Chinese version was barely satisfactory (Cronbach's alpha = 0.51⁻0.67) for the four factors/subscales and its test-retest reliability was good (Pearson's coefficient = 0.84). Conclusion: The findings suggest the C_MAVAS is a valid and reliable tool to measure mental health nurses' attitudes towards patient violence/aggression in a mental hospital setting.