Violence towards emergency nurses: A narrative review of theories and frameworks

Incident of violence escalation of patients with psychiatric emergencies boarding in the emergency department in the central region of Thailand and its association: a prospective observational study

BACKGROUND

This study investigates the incidence of violence escalation among psychiatric emergency patients admitted to general emergency departments in hospitals in central Thailand. In addition, patient and service delivery system factors associated with the survival time of violence escalation in 16 emergency departments in the central region of Thailand are determined. This is a prospective observational study, and the study sample includes 507 psychiatric emergency patients who are ≥ 18 years old. The patients are selected through stratified random and purposive sampling.

METHODS

Patient data-including demographic data, emergency services used, and clinical characteristics-are analyzed using descriptive statistics. The Kaplan-Meier method estimates the violence escalation curve, and the log-rank test compares the violence escalation-free time between the levels of the violent behavior group. In addition, univariable and multivariable Cox proportional hazard analyses are performed to investigate the factors affecting violence escalation.

RESULTS

The incidence of violence escalation in psychiatric emergency patients in the emergency department is 7.3%, whereas the incidence rate of violence escalation is 3 per 100 psychiatric emergency patient visit hours. Factors affecting violence escalation include the violent behavior score at triage (aHR = 2.004; 95% CI: 1.051-3.823) and the nurse competency score (aHR = 0.147; 95% CI: 0.032-0.680).

CONCLUSIONS

Assessing the violent behavior of psychiatric emergency patients at triage may assist emergency providers in monitoring patient behavior and providing early intervention to prevent the escalation of violent behavior. Furthermore, training emergency nurses in psychiatric emergency care is necessary.

Healthcare Workers: Heroes or Victims? Context of the Western World and Proposals to Prevent Violence

Episodes of direct violence against healthcare workers and social workers represent a worrying and widespread phenomenon in Western countries. These violent attacks, whether verbal or physical, occur in various work environments, targeting professionals working in private facilities, medical practices, or those employed within the National Health System facilities. We conducted a search using a single search engine (PubMed) using the terms "violence against healthcare workers AND Western" for the period 2003-2023, identifying 45 results to which we added to the literature through hand searching. Our review thus analyzed the sector literature to highlight the phenomenon of violence against healthcare workers, particularly in Western countries. We began with an analysis of the problem and then focused on the true purpose of the study, which is to propose new solutions to protect healthcare workers in all work settings. Consequently, we aim to improve both the working environment for healthcare professionals and to enhance the overall healthcare and public health outcomes.

Relationship between transition shock in novice emergency room nurses, quality of nursing care, and adverse patient events: The mediating role of emotional exhaustion

BACKGROUND

Transition shock, experienced during the first two years of employment, has been attributed to decreased clinical performance and an overall decrease in work productivity among newly graduated nurses, as well as compromised patient safety outcomes. This study tested the intermediary effect of emotional exhaustion on the association between transition shock in novice emergency room (ER) nurses, adverse patient events, and nursing care quality.

METHODS

A descriptive study was carried out involving 303 novice ER nurses from various emergency units in five different hospitals in Central Philippines, utilizing four standardized scales. Mediation testing was performed using Hayes' PROCESS macro in SPSS (Model 4).

RESULTS

Transition shock in novice ER nurses was associated with an increased incidence of adverse patient events (β = 0.3897, p = 0.0005) and poorer nursing care quality (β = -0.2146, p = 0.0021). Furthermore, emotional exhaustion partially mediated the association between transition shock and the two patient-related outcomes: adverse patient events (β = 0.0477, 95 % CI = 0.0078-0.0997) and nursing care quality (β = -0.0142, 95 % CI = -0.0412 to -0.0095).

CONCLUSIONS

Transition shock in novice ER nurses contributed to heightened emotional exhaustion, which subsequently led to an increased incidence of adverse patient events and a decline in the quality of nursing care.

Violence against nurses by patients and visitors in the emergency department: An integrative review

AIM

This integrative review explored violence against emergency nurses by patients/visitors, examining its nature, contributing factors and consequences.

DESIGN

Integrative review.

DATA SOURCES

Articles were obtained from PubMed, CINAHL, EMBASE, Web of Science and PsycInfo databases, up until December 2021.

REVIEW METHODS

26 articles were reviewed, evaluating study quality with the Crowe Critical Appraisal Tool and synthesizing conclusions through theme development and coding.

RESULTS

This review delves into the issue of violence perpetrated against emergency nurses by patients and visitors. It elucidates three overarching themes: the nature of violence, the contributing factors and the consequences of such acts.

CONCLUSION

The findings inform healthcare policy for the development of prevention approaches while identifying research gaps and emphasizing the need for alternative study designs and methodologies.

IMPACT

This review has implications for nursing practice, policymaking and research, emphasizing the need for stakeholder engagement and tailored interventions for at-risk emergency nurses.

NO PATIENT OR PUBLIC CONTRIBUTION

This project was an integrative review of the literature therefore no patient or public contribution was necessary.

WHAT ALREADY IS KNOWN

Violence by patients and visitors in healthcare settings, especially in emergency departments, has garnered considerable attention.

WHAT THIS PAPER ADDS

This review specifically examines violence-targeting emergency department nurses from patients and visitors, assessing its characteristics, contributing factors and consequences.

IMPLICATIONS FOR PRACTICE/POLICY

The findings will guide stakeholder engagement in developing interventions to support vulnerable emergency nurses.

Occupational violence in a tertiary emergency department: A retrospective descriptive study

OBJECTIVE

Occupational violence in emergency departments (EDs) impacts staff and patients. Most hospitals have a response mechanism called a 'Code Black' or similar. We aimed to determine the incidence of Code Black activations in a tertiary ED and describe contributory factors, management strategies and adverse events.

METHODS

Descriptive study in a tertiary ED in South-East Queensland in 2021. Adult patients for who a Code Black had been activated were eligible. Data were obtained from a prospectively collected Code Black database, supplemented with retrospective electronic medical records.

RESULTS

There were 386 Code Black events. The incidence of Code Black activation was 11.0 per 1000 adult ED presentations. Individuals requiring Code Black activation were 59.6 % male with a mean age of 40.9 years. The primary diagnosis was mental illness related in 55.1 %. Alcohol was a suspected factor in 30.9 %. When Code Black activation occurred, median length of stay increased. Restraint including physical, chemical or both were used in 54.1 % of Code Blacks.

CONCLUSION

Occupational violence occurs at a three-fold greater incidence within this ED than reported elsewhere. This study reinforces other literature suggesting an increase in occupational violence, demonstrating the need for dedicated preventative strategies for patients at risk of agitation.

The effectiveness of a workplace violence prevention strategy based on situational prevention theory for nurses in managing violent situations: a quasi-experimental study

BACKGROUND

Workplace violence (WPV) poses a significant occupational hazard for nurses. The efficacy of current education and training programs in mitigating WPV incidence among nurses remains uncertain, possibly due to insufficient consideration of clinical contexts and nurses' specific needs. Therefore, this study developed a WPV prevention strategy based on the actual requirements of clinical nurses and situational prevention theory and aimed to explore its application effects.

METHODS

Under the guidance of situational prevention theory, a WPV prevention strategy for nurses was constructed through literature review, semi-structured interviews and focus group discussion. This study adopted a self-controlled research design, and trained 130 nurses selected from a comprehensive tertiary grade A hospital in Suzhou in this WPV prevention strategy. Data were collected through structured questionnaires, including the revised WPV questionnaire, WPV severity grading scale, and hospital WPV coping resources scale. The WPV incidence, severity, and WPV coping resource scores of nurses were collected before the intervention, as well as at 3 months, 6 months, and 9 months after training.

RESULTS

The WPV prevention strategy comprised 11 prevention plans based on 11 high-risk situational elements of WPV. Each prevention plan included the WPV prevention flowchart, treatment principle, and communication strategy. The strategy demonstrated excellent feasibility and practicality. Following the intervention, the overall incidence of WPV among nurses significantly decreased from 63.85% (baseline) to 46.15% (9 months after training) (P < 0.05). After the training, the severity of psychological violence (Wald χ² = 20.066, P < 0.001) and physical violence (Wald χ² = 9.100, P = 0.028) reported by nurses decreased compared to the baseline (P < 0.05). Moreover, the overall WPV coping resource score significantly increased from [66.50 (57.00, 77.25) points] (baseline) to [80.00 (68.00, 97.25) points] (9 months after training) (P < 0.05).

CONCLUSIONS

The described WPV prevention strategy, grounded in situational prevention theory and tailored to the needs of clinical nurses, effectively reduced WPV incidence, mitigated its severity, and enhanced nurses' WPV coping resources. This approach offered new avenues for nurses in the prevention of WPV.

Implementation of an Assault Prevention Quality Improvement Initiative in an Urban Emergency Department

BACKGROUND

Emergency department (ED) health care workers experience high rates of workplace violence (WPV).

LOCAL PROBLEM

Patient-to-staff physical assaults at an urban, academic adult ED ranged between 1 and 5 per month, with a rate of 0.265 per 1000 patient visits.

METHODS

A quality improvement initiative, guided by the Social Ecological Model framework that contextualized WPV in the ED setting, informed the development of a Risk for Violence Screening Tool (RVST) to screen adult patients presenting to the ED.

INTERVENTIONS

Plan-Do-Study-Act cycles were utilized to implement a violence prevention bundle that incorporated the RVST, an alert system, and focused assault reduction strategies.

RESULTS

Patient-to-staff physical assaults decreased to a rate of 0.146 per 1000 patient visits.

CONCLUSIONS

Risk for violence screening, an alert system, and assault prevention strategies provide opportunities for nurse leaders to promote ED workplace safety.

Development and Validation of Questionnaires to Assess Workplace Violence Risk Factors (QAWRF): A Tripartite Perspective of Worksite-Specific Determinants in Healthcare Settings

Introduction

Workplace violence (WPV) incidences are prevalent in healthcare, and existing WPV interventions have only moderate evidence for effectiveness. This study aimed to develop and validate an instrument to assess worksite-specific WPV risk factors in healthcare settings based on a tripartite perspective of key stakeholders to facilitate improved interventions.

Methods

Three questionnaires were developed to get the responses from healthcare administrators, workers, and clients, representing the three components of Questionnaires to Assess Workplace Violence Risk Factors (QAWRF). The domains of the questionnaires were developed based on The Chappell and Di Martino's Interactive Model of Workplace Violence, and the items were generated from 28 studies identified from a systematic review of the literature. Six experts, 36 raters, and 90 respondents were recruited to assess the content validity, face validity, and usability and reliability of the QAWRF respectively. Item and Scale Level Content Validity Index, Item and Scale Level Face Validity Index, and Cronbach's alpha values were determined for QAWRF-administrator, QAWRF-worker, and QAWRF-client.

Results

The psychometric indices for QAWRF are satisfactory.

Conclusion

QAWRF holds good content validity, face validity, and reliability, and findings from QAWRF can contribute towards worksite-specific interventions that are expected to be resource efficient and more effective than general WPV interventions.

Nursing management of emergency department violence-Can we do more?

BACKGROUND

Emergency departments are the services with the highest risk of violence for nurses. Reports of violence in health care have increased exponentially in the last decade. Front line hospital services are more at risk, and worldwide there are attempts to quantify, manage and prevent episodes of violence, but no consistent solutions have yet been identified.

AIMS

To stimulate reflection on causal factors of violence against nurses in emergency departments and discuss potential solutions and strategies for aspects that largely remain unresolved.

DESIGN

A position paper underpinned by experiences and evidence reported in the literature.

METHODS

A search of Scopus and CINAHL using the term 'violence' provided information concerning the prevalence of the term 'violence' in contemporary literature and enabled to capture a general overview of contributing factors of violence and current approaches to its management and prevention.

CONCLUSIONS

However, while risk factors have been identified, there is a tendency to over accentuate the extent of their contribution. The main risk factors present conditions related to or accompanied by mental illness and the impact of overcrowding and long waiting times.

RELEVANCE TO CLINICAL PRACTICE

More is needed in terms of implementation of more far-reaching, holistic, practical and effective management solutions to promote nurses' safety and adequately support vulnerable patients.

The impact of COVID-19 pandemic on temporal trends of workplace violence against healthcare workers in the emergency department

Background

It is known that there has been an increase over the years in attacks by patients admitted to the emergency department (ED) on healthcare workers; it is unclear what effect the COVID-19 pandemic has on these attacks.

Aim

to verify through a long-term time analysis the effect of COVID-19 on ED attacks on healthcare workers.

Mothods

a quasi-experimental interrupted time-series analysis on attacks on healthcare workers was performed from January 2017 to August 2021. The main outcome was the monthly rate of attacks on healthcare workers per 1000 general accesses. The pandemic outbreak was used as an intervention point.

Results

1002 attacks on healthcare workers in the ED were recorded. The rate of monthly attacks on total accesses increased from an average of 13.5 (SD 6.6) in the pre-COVID-19 era to 27.2 (SD 9.8) in the pandemic months, p < 0.001. The pandemic outbreak led to a significant increase in attacks on healthcare workers from 0.05/1000 attacks per month (p = 0.018), to 4.3/1000 attacks per month (p = 0.005).

Conclusions

The COVID-19 pandemic has led to a significant increase in attacks on healthcare workers in the ED. Trends compared to pre-pandemic months do not seem to indicate a return to normality. Health institutions and policymakers should develop strategies to improve the safety of the working environment in hospitals and EDs.

Effectiveness of anger-focused emotional management training in reducing aggression among nurses

AIM

The aim of this study was to conduct a 5-h training programme on anger-focused emotional management for nurses and verify its effectiveness.

DESIGN

The study used a one-group pretest-posttest design.

METHODS

Participants (N = 283) attended a programme comprising lectures and exercises. The Japanese version of the Buss-Perry Aggression Questionnaire was administered pre-, post- and 3-month posttraining. Regression analyses were used to assess the effects of the programme by gender.

RESULTS

For the total aggression score, the difference between the pre- and posttraining scores was -2.827 points and remained at -1.602 points 3-month posttraining. Physical aggression scores decreased posttraining, but the scores increased after 3 months. There were statistically significant gender differences in hostility scores; pre-training scores were slightly higher for men than for women and lower for men after 3 months. Total and physical aggression scores were higher for men than for women. The training programme decreased aggression, and the effect persisted after 3 months.

Violence against nurses by patients and visitors in the emergency department: A concept analysis

AIM

This analysis investigates the concept of violence against nurses by patients and visitors in the emergency department. It aims to differentiate, clarify, and clearly identify this specific concept, which will facilitate more apt measurement and reporting, ultimately to contribute violence reduction measures.

BACKGROUND

Due to contextual factors, occupational risk and patient characteristics, violence against nurses by patients and visitors in the emergency department varies from other types of violence against other health care staff.

METHODS

This study employed Walker and Avant's concept analysis technique.

RESULTS

The analysis found that violence against nurses by patients and visitors in the emergency department is primarily an occurrence of interpersonal violence based on the working relationship, whereby the patient and/or visitor becomes an assailant, and a nurse becomes a target in the absence of capable guardianship. There is also an intentional use of physical force or power, which results in or has a high chance of causing harm.

CONCLUSION

A clearer understanding of the antecedents, attributes, and consequences of violence against nurses by patients and visitors arising from this concept analysis provides a framework that will assist in the understanding, measurement, reporting, and prevention of violence and inform future research.

IMPLICATIONS FOR NURSING MANAGEMENT

Nursing managers are encouraged to adopt strategies that act on the factors related to attributes and antecedents that will serve to reduce the occurrence of intentional violent acts.

The Permeating Effects of Violence on Health Services and Health in Mexico

Mexico's violence related to organized crime activity has grown to epidemic levels in the last 12 years. We interviewed 22 Mexican health care providers from five states to examine how violence impacts health care services and health. We transcribed and analyzed semi-structured interviews using framework analysis. Our findings describe the ways in which community violence in Mexico permeates health care services, impacting health care providers, and the health of patients. We developed a model to reflect our main themes that illustrate how violence permeates health care services over geographic space and time. We identified three thematic categories: (a) the impact of violence on health care facilities and service provision, (b) the impact of violence on providers, and (c) the impact of violence on the health of the community. Our model articulates a dynamic process of the spread and permeation of violence. Prior literature focuses on the impact of violence as an occupational hazard and the effect of war or civil conflict on health care services. We extend this literature by documenting the impacts of widespread violence on Mexican health care services and providers. We discuss how violence impacts services, providers, and health in a country that is not officially at war. We compare our findings to previous literature on occupational violence in health professions and the impacts on health services in official war zones. Finally, we highlight the implications for health care practice and policy. We suggest that violence should be considered throughout the care continuum in Mexico and make the case for violence as a structural contributor to health and health disparities in Mexico. We suggest additional research on this under-investigated topic.

Prazer e sofrimento no trabalho de Enfermagem em urgência e emergência

Objetivo: Conhecer as vivências de prazer e sofrimento de trabalhadores de Enfermagem de serviços de urgência e emergência. Metodologia: Pesquisa qualitativa descritiva. Foram entrevistados trabalhadores de Enfermagem de uma unidade de urgência e emergência de um hospital filantrópico e do Serviço de Atendimento Móvel de Urgência de uma cidade do Sul do Brasil. O material foi submetido à análise temática de conteúdo. Resultados: As vivências de prazer se relacionaram à identificação com o trabalho, à satisfação frente aos resultados exitosos, ao reconhecimento, ao trabalho em equipe e ao fortalecimento do sentido do trabalho. Já as vivências de sofrimento foram atribuídas ao contato com a morbimortalidade da população, aos conflitos e à precarização do trabalho. Conclusão: As vivências de prazer coexistem com as de sofrimento no cotidiano do trabalho de Enfermagem em urgência e emergência, sendo importantes espaços de fala e escuta para a ressignificação dos sentimentos e proteção à saúde mental no trabalho.

Workplace violence against emergency health care workers: What Strategies do Workers use?

Background

Workplace violence by patients and bystanders against health care workers, is a major problem, for workers, organizations, patients, and society. It is estimated to affect up to 95% of health care workers. Emergency health care workers experience very high levels of workplace violence, with one study finding that paramedics had nearly triple the odds of experiencing physical and verbal violence.

Many interventions have been developed, ranging from zero-tolerance approaches to engaging with the violent perpetrator. Unfortunately, as a recent Cochrane review showed, there is no evidence that any of these interventions work in reducing or minimizing violence.

To design better interventions to prevent and minimize workplace violence, more information is needed on those strategies emergency health care workers currently use to prevent or minimize violence.

The objective of the study was to identify and discuss strategies used by prehospital emergency health care workers, in response to violence and aggression from patients and bystanders. Mapping the strategies used and their perceived usefulness will inform the development of tailored interventions to reduce the risk of serious harm to health care workers.

In this study the following research questions were addressed: (1) What strategies do prehospital emergency health care workers utilize against workplace violence from patients or bystanders? (2) What is their experience with these strategies?

Methods

Five focus groups with paramedics and dispatchers were held at different urban and rural locations in Canada. The focus group responses were transcribed verbatim and analyzed using thematic analysis.

Results

It became apparent that emergency healthcare workers use a variety of strategies when dealing with violent patients or bystanders. Most strategies, other than generic de-escalation techniques, reflect a reliance on the systems the workers work with and within.

Conclusion

The study results support the move away from focusing on the individual worker, who is the victim, to a systems-based approach to help reduce and minimize violence against health care workers. For this to be effective, system-based strategies need to be implemented and supported in healthcare organizations and legitimized through professional bodies, unions, public policies, and regulations.

Pediatric emergency nurses' workplace violence experiences: A qualitative study

INTRODUCTION

Workplace violence is a crucial problem experienced by health workers who serve at the emergency service. The identification of emergency nurses' workplace experiences is of importance to the prevention of violence and the development of solutions.

PURPOSE

This study was performed to identify the workplace violence experiences of the nurses working for the pediatric emergency units.

METHOD

A total of 20 nurses who experienced violence at the emergency service participated in the study that was conducted as qualitative research. The data were collected with the semi-structured interview form and were evaluated by using thematic analysis.

RESULTS

Five themes, namely, "the characteristics of violence", "the causes of violence", "the approach during/after the violence", "the consequences of the violence for the person", and the "consequences of the violence for the profession", were identified. Nurses stated that they often experienced verbal violence due to patient relatives' unmet expectations, the failure of patient relatives to understand treatments and practices, and the heavy workload, they endeavored to eliminate violence by trying to communicate with perpetrators of the violence, calling the security staff, and reporting the violence to their managers, and they were individually and professionally affected by the violence.

CONCLUSION

Nurses are negatively affected by workplace violence. Pediatric emergency nurses should be supported with training programs and policies to be developed for the prevention and solution of violence.

Analysis of latent profiles and affected factors according to the implementation of a protection system against customer bullying in Korea

Background

Instances of customers bullying employees at the workplace are increasing with the development of the service industry. Korea has established a worker protection system to prevent negative effects of customer bullying on workers’ health. This study identified the latent profile types of protection against customer bullying in workplaces, and determined their predictors.

Methods

Data were collected over 28 days, from March 2 to 30, 2020. This study identified whether protection against customer bullying is implemented for workers in person-to-person services, the change effected by this protection, and worker monitoring scope. Data from 1,537 out of 1,550 participants were analyzed, excluding the missing values. Latent profile types were identified using Mplus 8.5 for data analysis, and the multinomial logistic regression analysis was performed to review the predictors.

Results

The results are as follows. There were four types of latent profile types: lagging, medium, relative preventive type, and excellent type. Variables predicting these types included age, gender, service period, position, occupational category, worker monitoring scope, decrease in the number of customers causing problems, decrease in disputes with customers, and worker satisfaction.

Conclusions

First, a system to prevent customer bullying must be adopted in the service industry. Second, there must be a way to improve trust between customers and workers when protective measures are being adopted. Third, managers must establish a system that can both protect workers against bullying and provide customer satisfaction.

Prevalence and predictors of depression among emergency physicians: a national cross-sectional study

BACKGROUND

Physicians' depression can damage their physical and mental health and can also lead to prescribing errors and reduced quality of health care. Emergency physicians are a potentially high-risk community, but there have been no large-sample studies on the prevalence and predictors of depression among this population.

METHODS

A nationally representative cross-sectional survey of 15,243 emergency physicians was conducted in 31 provinces across China between July and September 2019. Multivariable logistic regression analysis was performed to identify predictors of depression.

RESULTS

A total of 35.59% of emergency physicians suffered from depression. Emergency physicians who were male (OR=0.91) and older [>37 and ≤43 (OR=0.83) or >43 (OR=0.71)], had high (OR=0.63) or middle (OR=0.70) level income, and participated in physical inactivity (OR=0.85) were not more likely to suffer depression. Meanwhile, those who were unmarried (OR=1.13) and smokers (OR=1.12) had higher education levels [Bachelor's degree (OR=1.57) or Master's degree or higher (OR=1.82)], long work tenure [>6 and ≤11 (OR=1.15) or >11;11 (OR=1.19)], poorer health status [fair (OR=1.67) or poor (OR=3.79)] and sleep quality [fair (OR=2.23) or poor (OR=4.94)], a history of hypertension (OR=1.13) and coronary heart disease (OR=1.57) and experienced shift work (OR=1.91) and violence (OR=4.94)].

CONCLUSION

Nearly one third of emergency physicians in China suffered from depression. Targeted measures should be taken to reduce the prevalence of depression to avoid a decline in health care quality and adversely impact the supply of emergency medical services.

The prevalence of turnover intention and influencing factors among emergency physicians: a national observation

BACKGROUND

Adverse consequences of physician turnover include financial losses, reduced patient satisfaction, and organizational instability. However, no study has reported the prevalence among emergency physicians. This study explore the rate and influencing factors of this community, which could provide a reference for preventing the loss of emergency physicians.

METHODS

A nationally representative cross-sectional survey of 15,243 emergency physicians was conducted in 31 provinces across China between July and September 2019. Multivariable logistic regression analysis was performed to identify predictors of turnover intention.

RESULTS

There were 49.75% of emergency physicians having turnover intention. Logistic regression analysis model showed that emergency physicians who were male (OR = 0.87) and older [> 37 and ≤ 43 (OR = 0.78) or > 43 (OR = 0.64)], worked in eastern China (OR = 0.88) and higher level of hospital [two-grade level (OR = 0.71) or three-grade level (OR = 0.56)], and had high (OR = 0.75) or middle (OR = 0.81) level income were not more likely to have less turnover intention, while those who had higher education level [bachelor degree (OR = 1.55) or master degree or higher (OR = 1.63)], long work tenure [> 3 and ≤ 6 (OR = 1.29) or > 6 and ≤ 11 (OR = 1.41) or > 11 (OR = 1.25)], poorer health status [fair (OR = 1.55) or poor (OR = 2.12)] and sleep quality [fair (OR = 1.16) or poor (OR = 1.43)], history of coronary heart disease (OR = 1.29), depression (OR = 2.77) and experienced the shift work (OR = 1.37) and workplace violence (OR = 1.78) were more likely to intend to leave.

CONCLUSION

Nearly half of emergency physicians in China have turnover intention. Targeted intervening measures should be taken to reduce the turnover intention, so as to avoid the shortage of physicians and thus hinder the supply of emergency medical services.

Judicial judgment and media sensation of violence against medical staff in China: A fuzzy set qualitative comparative analysis (fsQCA)

INTRODUCTION

Violence against medical staff has been prevalent in China over the past two decades. Although Chinese authorities have released many laws and regulations to protect medical staff from violence since 2011, the legal approach alone is unlikely to resolve this complex issue. In particular, several cases of violence against medical staff in China have caused great media sensation.

METHOD

This paper proposes an integrated model that combines the environmental stimuli theory, broken windows theory, and rational choice theory. It adopts the fuzzy set qualitative comparative analysis (fsQCA) to untangle the causal relationship between violence against medical staff, media sensation, and judicial judgment. We examined reports of medical violence on media and news websites from January 1, 2010, to January 31, 2020, and selected 50 cases with detailed information for this study.

RESULTS

The results show that each condition is not sufficient for the absence of judicial judgment, but when combined, they are conducive to the outcome. The conditions of hospital level, medical cost, and media sensation play important roles. The providers, patients, and environmental factors are indicators of inadequate or lack of judicial judgment, which corresponds to previous expectations.

CONCLUSIONS

The integrated model greatly enriches the extant theories and literature, and also yields implications for preventing violence against medical staff in China. We suggest that sustainable and innovative healthcare reform should be initiated. For example, public hospitals should remain the cornerstone of national public health security. Medical staff in public hospitals must be regarded as "civil servants". Therefore, the current legal system should be improved. The media should objectively report events concerning medical staff and improve public healthcare knowledge.

Development and effectiveness of tabletop exercises in preparing health practitioners in violence prevention management: A sequential explanatory mixed methods study

BACKGROUND

Workplace violence in healthcare remains a significant issue for healthcare professional, in terms of risk to patients and staff. One part of a workplace violence prevention and management programme is to educate staff in their response to critical events. Drawn from the disaster management literature, tabletop exercises were used in this study to simulate workplace violence and educate staff on the appropriate emergency response during a violent event. The use of tabletop exercise in this context is a novel approach to workplace violence prevention management.

AIM AND OBJECTIVE

This study describes the development and effectiveness of tabletop exercises in preparing health practitioners in violence prevention and management emergency response systems.

METHODS

Using a sequential explanatory mixed method design. The study comprised of two phases 1) quasi-experimental (quantitative) and 2) focus group (qualitative) to evaluate the effectiveness of the violence prevention management tabletop exercises. COREQ guidelines were followed the qualitative arm of the study and the TREND statement for the quantitative part of the study.

RESULTS

Statistically significant improvements in healthcare professional confidence levels were found two weeks post the tabletop exercises. A post focus group revealed three categories concerning the participant's experiences of the tabletop exercises, (role clarity, adult learning and organisational support).

CONCLUSION

Tabletop exercise may provide a, low cost, context specific novel approach to educating staff in emergency violence response systems at a tertiary referral hospital. Educators and policy makers may consider the use of tabletop exercises in the ongoing work in preparing health care staff for workplace violence.

RELEVANCE TO CLINICAL PRACTICE

Successful tabletop exercises should consider a local ward level context, the use of adult learning principles, have high level organisational support and cover role clarity as a key learning area.

Hospital-Based Healthcare Workers Victims of Workplace Violence in Italy: A Scoping Review

The aim of this scoping review is to synthesize the available evidence on the prevalence rates of healthcare workers being victims of violence perpetrated by patients and visitors in Italy. PubMed, Scopus, Web of Science and CINAHL were systematically searched from their inception to April 2021. Two authors independently assessed 1182 studies. All the scientific papers written in English or in Italian reporting primary quantitative and/or qualitative data on the prevalence of aggression or sexual harassment perpetrated by patients or visitors toward healthcare workers in Italy were included. Thirty-two papers were included in the review. The data extracted were summarized in a narrative synthesis organized in the following six thematic domains: (1). Methodology and study design; (2). Description of violent behavior; (3). Characteristics of health care staff involved in workplace violence (WPV); (4). Prevalence and form of WPV; (5). Context of WPV; and (6). Characteristics of violent patients and their relatives and/or visitors. The proportion of studies on WPV differed greatly across Italian regions, wards and professional roles of the healthcare workers. In general, the prevalence of WPV against healthcare workers in Italy is high, especially in psychiatric and emergency departments and among nurses and physicians, but further studies are needed in order to gather systematic evidence of this phenomenon. In Italy, and worldwide, there is an urgent need for governments, policy-makers and health institutions to prevent, monitor and manage WPV towards healthcare professionals.

Violence against nurses: A serious issue in Indonesia

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The Effects of Emergency Room Violence toward Nurse's Intention to Leave-Resilience as a Mediator

(1) Background: Healthcare workplace violence has been a focused issue in the whole world. The rate of the occurrence is pretty high in every country. The emergency room is a high risk and high frequency place for violence to occur. Under the medical service demands from people, it is quite easy to bring about conflicts. This leads to serious physical and mental harm to nurses. When suffering from physical and mental injuries, resilience is a protective factor away from negative influence. It is rare to explore and study how the nurses' resilience ability, workplace violence and turnover intention are related. Thus, the aim of this study is to understand resilience as a mediator effect in emergency nurses toward the workplace violence. (2) Methods: A cross-sectional survey study was used to collect information from emergency room nurses of a medical center in northern Taiwan. There were 132 samples in total. Three research instruments were included as follows: Hospital Workplace Violence Prevention Questionnaire, Connor-Davidson Resilience Scale, and Turnover Intention Scale. Statistical analysis using t-test, ANOVA, Correlation, as well as Sobel test were used in this study. (3) Results: The results revealed that the average age was 29.5 ± 5.6. Almost 58% of nurses experienced workplace violence. Twelve percent of nurse had experienced physical violence and 53.8% had experienced mental violence. There was significant relationship between shift personnel and religious believers. To the people who suffered physical violence, there was a significant relationship between emergency room working years and the total working years. There was significant difference between those who had suffered mental violence and religious believers. Female nurses suffered mental violence to a much higher extent than male nurses. There was a significant relationship between nurses' working years, the total working years, resilience, and turnover intention. Resilience was not the mediator for workplace violence toward turnover intention in this study. (4) Conclusions: The outcome of this study suggested that on an individual level, nurses can enhance self-protection and communication skills to decrease workplace violence. For emergency environment settings, designing a good working environment, visitors' restriction, avoiding working alone, and enhancing supervising alarm system are recommended. As for hospital administrators, fitness for work and to set up a project team is necessary. These can be references in planning prevention on workplace violence and promoting quality of workplace and patient safety in the future.

Examining the utility of the Violence Prevention Climate scale: In a metropolitan Australian general hospital

AIM AND OBJECTIVES

To evaluate and examine the utility of the Violence Prevention Climate scale by generalist healthcare professionals.

BACKGROUND

Workplace violence in general hospital settings remains a challenge for healthcare organisations. High rates of violence are still being reported towards healthcare workers, despite organisational violence prevention strategies being implemented. There is a major challenge to healthcare organisation in the measurement of the effectiveness of these interventions, traditionally completed via the reporting and monitoring of workplace violent incidents. A novel approach to measuring workplace violence is by studying hospital atmosphere or climate.

DESIGN

A cross-sectional survey using the STARD guidelines was used.

METHODS

The Violence Prevention Climate scale was completed by 194 healthcare staff working in the emergency department, medical/surgical wards, respiratory/infectious disease, spinal care, renal unit, corrections health, and rehabilitation and community services of a major Australian tertiary referral hospital. The Violence Prevention Climate scale has previously been validated and used in mental health settings, but not general hospital settings. A content analysis of an open-ended question on violence prevention management strategies was also conducted.

RESULTS

Comprising of 14 items with two factors (patients and staff), the study revealed a 9-item staff factor scale that can be used in the general hospital setting, the patient factor did not show adequate reliability. The content analysis revealed seven categories of staff identified violence prevention and management strategies.

CONCLUSIONS

The use of the 9-item scale across an organisation annually, or added to existing organisational workforce surveys, could prove to be practical way of measuring the social climate of violence in a general hospital setting.

RELEVANCE TO CLINICAL PRACTICE

The results of which could guide clinical practice, workplace safety, policy and educational initiatives for the prevention and management of workplace violence.

User-friendly system (a smartphone app) for reporting violent incidents in the Emergency Department: an Italian multicenter study

BACKGROUND

Nurses, particularly emergency nurses, are among the health workers most exposed to workplace violence. Although reporting systems are increasingly used, under-reporting remains high. Recent studies suggest that the use of easy registration systems could facilitate violence reporting.

OBJECTIVES

To verify if a friendly reporting system based on a Mobile-app can facilitate the reporting of violent episodes and reduce under-reporting.

METHODS

Twenty emergency departments of five North and Central Italian regions participated in an interventional, multicentric, pre-post study to verify if a user-friendly reporting system based on a mobile app can facilitate the reporting of violent episodes and reduce under-reporting.

RESULTS

Three hundred and eighty-four out of 754 potentially eligible nurses answered the short questionnaire at time T0, and 318 registered for the use of the app. One hundred and eighty-nine answered the questionnaire at time T1. The t-Test for Paired Samples, although with a low mean difference, shows a significant difference in the change in the frequency of the reporting of violent episodes. The correlational tests showed no significant differences in the subgroups divided by demographic and professional characteristics. The usability of the app was considered very high.

CONCLUSIONS

The simplification of the reporting system and the preliminary acquisition of data on the characteristics of the ED and each nurse, can save time and facilitate the reporting, but technology alone is not enough to solve the under-reporting.

High strain and low social support at work as risk factors for being the target of third-party workplace violence among healthcare sector workers

INTRODUCTION

Healthcare workers are particularly vulnerable to third-party workplace violence. The experience of work-related stress, by threatening the psychological balance of healthcare workers, making them less effective in managing the relationship with patients and their family members, may significantly contribute to third-party violence.

OBJECTIVE

To investigate whether stress-related psychosocial situations at work as defined by the widely known Demand-Control model, and the level of work-related social support, act as risk factors for third-party violence among healthcare workers. Specifically, we explored whether the risk of violence is higher in situations associated with higher levels of work-related stress (i.e., active or passive situations, and especially the high strain situation) when compared to a work situation related to lower levels of stress (i.e., low strain situation). We also explored whether the risk of violence is lower at higher levels of social support.

METHOD

Cross-sectional study on 633 healthcare workers. Psychosocial work situations and third-party workplace violence have been operationalized by using well validated scales.

RESULTS

Logistic regressions including a number of relevant covariates (e.g., gender, job role, night shift work) revealed that, compared to a low strain situation, an active or passive situation had an increased risk for workplace violence. However, the highest risk was observed for a high strain situation (i.e., the situation associated with the highest level of work-related stress). High social support acted as a protective factor.

CONCLUSION

Healthcare workers' experience of stress at work may make them more vulnerable to third-party violence. Ensuring better psychosocial working conditions may contribute to the prevention of workplace violence and its consequences.

A cross-sectional survey on workplace psychological violence among operating room nurses in Mainland China

AIM

To investigate the status of workplace psychological violence (WPV) from managers, coworkers, or subordinates against operating room (OR) nurses in mainland China and identify risk factors.

BACKGROUND

WPV is a serious problem for nurses. However, limited information is available regarding the prevalence and risk factors of WPV against OR nurses in mainland China.

METHODS

A multi-center, cross-sectional study was conducted. OR nurses (n = 1557) from 26 hospitals, located in 13 cities of China, participated in this study.

RESULTS

Of the participants, 92.1% experienced WPV (30.9% from surgeons and 18.1% from senior nurses). Only 30.1% of the sufferers would report WPV. A logistic regression analysis revealed that nurses who had been in service longer and with senior professional titles were more likely to experience WPV.

CONCLUSION

Nursing managers should identify and resolve issues in a timely manner. Measures that promote effective team communication and facilitate teamwork, as well as inter-disciplinary educational workshops may be effective.

The Development and Effectiveness of a Clinical Training Violence Prevention Program for Nursing Students

The study aimed to develop and evaluate a violence prevention program for nursing students to improve communication self-efficacy, problem-focused coping style, emotion-focused coping style, and the ability to cope with violence. Using an eight-session violence prevention program, the study was designed as quasi experimental, with a pretest, posttest, and follow-up assessment with a nonequivalent control group. Nursing students from the fourth year of a university were selected as participants; 22 students were assigned to the experimental group and 23 to the control group. Data analysis included Chi-square, Fisher's exact test, Levene's Test, Mann-Whitney U-test, and repeated measures ANOVA. Results showed that the experimental group showed significantly higher posttest scores for the problem-focused coping style (F = 20.77, p < 0.001), intra-individual and interaction effects for the emotion-focused coping style (F = 12.03, p < 0.001), and the ability to cope with violence (U = 70, p < 0.001) than the control group. Thus, the workplace violence prevention program was effective for nursing students.

Determinants of aggression against all health care workers in a large-sized university hospital

BACKGROUND

The paper aims to describe the 3-year incidence (2015/17) of aggressive acts against all healthcare workers to identify risk factors associated to violence among a variety of demographic and professional determinants of assaulted, and risk factors related to the circumstances surrounding these events.

METHODS

A retrospective observational study of all 10,970 health workers in a large-sized Italian university hospital was performed. The data, obtained from the "Aggression Reporting Form", which must be completed by assaulted workers within 72 h of aggression, were collected for the following domains: worker assaulted (sex, age class, years worked); profession (nurses, medical doctors, non-medical support staff, administrative staff, midwives); aggressive acts (activity type during aggressive acts, season, time and location of aggressive acts); and type of aggressive acts (verbal, non-verbal, consequences, aggressors).

RESULTS

Three hundred sixty-four (3.3%) workers experienced almost one aggression. The majority of the assaulted workers were female (77.5%), had worked for 6/15 years and were Nurses (64.3%). The majority of aggressive acts occurred during assistance and patient care (38.2%), in the spring and during the afternoon/morning shifts and took place in locations where patients were present (47.3%). The most prevalent aggression type was verbal (76.9%). The patient was the most common aggressor (46.7%). 56% of those assaulted experienced interruptions in their work. Being female, being < 50 years of age, having worked for 6-15 years were significant risk factors for aggression. Midwives suffered the highest risk of experiencing aggression (RR = 12.95). The risk analysis showed that non-verbally aggressive acts were related to assistance and patient care with respect to activity type, to the presence of patients and during the spring and afternoon/evening.

CONCLUSIONS

The findings suggest the parallel use of future qualitative studies to clarify the motivation behind aggression. These suggestions are needed for the implementation of additional adequate prevention strategies on either an organizational or a personal level.

Cross-sectional study of aggression against Spanish nursing personnel and effects on somatisation of physical symptoms

INTRODUCTION

Violence against nursing personnel in their place of work is a severe problem generating important consequences for these workers. Even though there is a large body of research on the subject, the emotional impact of aggression against healthcare workers continues to be debated.

OBJECTIVES

The objective of this quantitative, observational cross-sectional study was to analyse the effects of aggression against nursing personnel and the mediating role of anxiety in somaticising physical symptoms.

METHOD

The sample was made up of 1357 nursing professionals who answered questionnaires evaluating their sensitivity to anxiety and the presence of somatic symptoms.

RESULTS

Of the professionals who indicated that they had been the victims of aggression by family members or patients in the previous year, 52.8% said it had happened to them on one occasion, 25.2% had experienced two episodes, while 6.9% and 15.1% said they had undergone three or more aggressions, respectively. Although 89.3% of the professionals affected by acts of indicated that they had not undergone physical or psychological consequences, there was a higher prevalence of somatic alteration among workers who had been victims of violence in the workplace. Furthermore, aggression at work had a direct effect on physical somatisation, which in turn acted as a mediator in the level of anxiety of nursing professionals. Thus, aggression increased the level of anxiety of nurses through the appearance of somatic symptoms.

CONCLUSIONS

The results are discussed based on some of the consequences that appeared after episodes of aggression in the healthcare sector and their relationship.

Management of the aggressive emergency department patient: non-pharmacological perspectives and evidence base

INTRODUCTION

Aggression in the Emergency Department (ED) remains an ongoing issue, described as reaching epidemic proportions, with an impact on staff recruitment, retention, and ability to provide quality care. Most literature has focused on the definition (or lack of) core concepts, efforts to quantify the phenomenon or provide an epidemiological profile. Relatively little offers evidence-based interventions or evaluations of the same.

AIM

To identify the range of suggested practices and the evidence base for currently recommended actions relating to the management of the aggressive Emergency Department patient.

METHODS

A meta-synthesis of existing reviews of violence and aggression in the acute health-care setting, including management of the aggressive patient, was undertaken. This provided the context for critical consideration of the management of this patient group in the ED and implications for clinical practice.

RESULTS

An initial outline of issues was followed by a systematic search and 15 reviews were further assessed. Commonly identified interventions are grouped around educational, interpersonal, environmental, and physical responses. These actions can be focused in terms of overall responses to the wider issues of violence and aggression, targeted at the pre-event, event, or post-event phase in terms of strategies; however, there is a very limited evidence base to show the effectiveness of strategies suggested.

CLINICAL IMPLICATIONS

The lack of evidence-based intervention strategies leaves clinicians in a difficult situation, often enacting practices based on anecdote rather than evidence. Local solutions to local problems are occurring in a pragmatic manner, but there needs to be clarification and integration of workable processes for evaluating and disseminating best practice.

CONCLUSION

There is limited evidence reporting on interventional studies, in addition to identification of the need for high quality longitudinal and evaluation studies to determine the efficacy of those responses that have been identified.

Violence and burnout in health care emergency workers in Santiago, Chile: A survey-based cross-sectional study

Shortage of quantitative studies regarding health risks for emergency services workers is a concern for Chilean's occupational health organizations.

OBJECTIVE

To explore the incidence of violence and burnout in emergency services of the Metropolitan Region of Chile, and associations with workers' characteristics and workplace conditions.

METHODS

A cross-sectional study was carried out from January to August 2016. A self-reported questionnaire explored about frequency and seriousness of violence episodes and about symptoms of burnout with the Maslach Burnout Inventory.

RESULTS

Of the 565 workers participating, 71% (95% CI 66.7-74.5) said violence episodes occurred at least once a week; 71.3% (95% CI 67.3-75.0) were victims of some aggression in the previous 12 months. Patients companions, relatives or friends arose as the main aggressors and the severity of the episodes was considered slight or moderate by more than 50% of participants. Fifty-seven respondents (10.5%, CI 95% 8.1-13.5) classified as having a burnout syndrome. Having been a victim of violence was associated to high emotional exhaustion (OR_adj = 1.7, 95% CI: 1.1-2.8) and depersonalization (OR_adj = 2.0, 95% CI 1.3-3.3).

CONCLUSIONS

Violence is a problem in the emergency departments of Chile's Metropolitan Region. Burnout is also present and independently associated to violence.

Psychopathology in Violent Offenders Against Healthcare Workers

Workplace violence in healthcare is gradually becoming a major concern in many countries around the world and research has usually been focused on the victims of violence. The aim of this study was to investigate the psychopathology of individuals who commit violence against healthcare workers. The study included 50 subjects (patient or relative of patient) aged 18-65 years who had committed violence against a healthcare worker (study group) and a control group of 55 subjects with no history of violence. A Sociodemographic Questionnaire, Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Barratt Impulsiveness Scale (BIS-11), State-Trait Anger Expression Inventory (STAXI), and Eysenck Personality Questionnaire-Revised Short Form (EPQ-RSF) were administered to both the study group and the control group. A psychiatric disorder was diagnosed in 50% of the violent offenders group and in 16.4% of the control group. It was determined that 54.8% of the patient relatives and 44.4% of the patients themselves who committed a violent act against healthcare workers had at least one psychiatric diagnosis and these rates did not differ between the patients and their relatives (χ² = 0.492, p = 0.483). Comparisons of the scale scores between the groups revealed that the STAXI scores (p < .001), BIS-11 total scores (p < .001), BDI, and BAI scores were statistically significantly higher in the violent offenders group. Considering the higher rates of psychiatric disorders and higher levels of anger and impulsivity among people who commit violent acts against healthcare workers, psychotherapeutic interventions such as stress and anger management interventions, improvement of interaction and communication between patients, their relatives and healthcare workers, and the implementation of rehabilitating punitive programs for violent offenders may be beneficial to reduce the rates of violent behavior against healthcare workers.

Using Simulation Training to Promote Nurses' Effective Handling of Workplace Violence: A Quasi-Experimental Study

Background: Workplace violence in the health care sector has become a growing global problem. Research has shown that although caregivers comprise a high-risk group exposed to workplace violence, most of them lacked the skills and countermeasures against workplace violence. Therefore, through a quasi-experimental design, this study aimed to investigate the effectiveness of situational simulation training on the nursing staffs’ concept and self-confidence in coping with workplace violence. Methods: Workplace violence simulation trainings were applied based on the systematic literature review and the conclusions from focus group interviews with nursing staff. Data were obtained from structured questionnaires including: (1) baseline characteristics; (2) perception of aggression scale (POAS); and (3) confidence in coping with patient aggression. Results: The results revealed that training course intervention significantly improved the nursing staffs’ self-perception and confidence against workplace violence (p < 0.001). Conclusions: The “simulation education on workplace violence training” as the intervention significantly improved the workplace violence perception and confidence among nursing staffs in coping with aggression events.

Impact of a comprehensive prevention programme aimed at reducing incivility and verbal violence against healthcare workers in a French ophthalmic emergency department: an interrupted time-series study

OBJECTIVE AND SETTING

Primary prevention, comprising patient-oriented and environmental interventions, is considered to be one of the best ways to reduce violence in the emergency department (ED). We assessed the impact of a comprehensive prevention programme aimed at preventing incivility and verbal violence against healthcare professionals working in the ophthalmology ED (OED) of a university hospital.

INTERVENTION

The programme was designed to address long waiting times and lack of information. It combined a computerised triage algorithm linked to a waiting room patient call system, signage to assist patients to navigate in the OED, educational messages broadcast in the waiting room, presence of a mediator and video surveillance.

PARTICIPANTS

All patients admitted to the OED and those accompanying them.

DESIGN

Single-centre prospective interrupted time-series study conducted over 18 months.

PRIMARY OUTCOME

Violent acts self-reported by healthcare workers committed by patients or those accompanying them against healthcare workers.

SECONDARY OUTCOMES

Waiting time and length of stay.

RESULTS

There were a total of 22 107 admissions, including 272 (1.4%) with at least one act of violence reported by the healthcare workers. Almost all acts of violence were incivility or verbal harassment. The rate of violence significantly decreased from the pre-intervention to the intervention period (24.8, 95% CI 20.0 to 29.5, to 9.5, 95% CI 8.0 to 10.9, acts per 1000 admissions, p<0.001). An immediate 53% decrease in the violence rate (incidence rate ratio=0.47, 95% CI 0.27 to 0.82, p=0.0121) was observed in the first month of the intervention period, after implementation of the triage algorithm.

CONCLUSION

A comprehensive prevention programme targeting patients and environment can reduce self-reported incivility and verbal violence against healthcare workers in an OED.

TRIAL REGISTRATION NUMBER

NCT02015884.

Violence towards Emergency Nurses: The 2016 Italian National Survey-A cross-sectional study

AIM

To analyse the dimensions and characteristics of violence towards Emergency nurses in a national context (Italy).

BACKGROUND

Nurses are the most exposed to workplace violence, especially in Emergency Department contexts.

METHODS

A cross-sectional study was conducted in all Italian regions. Descriptive analyses were used to examine violence from patients and relatives (Type II violence) concerning personal characteristics of the Emergency nurses and perpetrators, environmental and organisational factors. Multinomial logistic regression analysis was used to investigate risk factors.

RESULTS

About 76.0% of Emergency nurses experienced verbal violence, 15.5% both verbal and physical violence and only 8.5% denied having experienced either. Older age and more experience in Emergency settings are protective factors. Working in the South of Italy significantly increases the probability of being exposed.

DISCUSSION

There are many factors explaining violence, but some correlations are not clear.

CONCLUSION

Factors that have a positive effect on this problem include: specific training for younger nurses, a strong alliance between users and health personnel to restore a relationship of trust between parties, physical barriers and appropriate architectural measures.

IMPLICATIONS FOR NURSING MANAGEMENT

Comprehensive approaches can represent an effective strategy to counteract workplace violence.

Violence in the workplace: some critical issues looking at the health sector

BACKGROUND

The literature on occupational violence and even more the literature on violence against nurses in health settings have evidenced inconsistencies regarding how workplace violence has been conceptualized.

PURPOSE

To review and discuss some inconsistencies regarding how workplace violence against nurses in health settings has been conceptualized paying special attention to the challenges posed to the health of nurses stemming from patients, visitors or co-workers.

METHOD

Review of data of the European Working Conditions Surveys, and National Surveys on Working Conditions in Spain.

DISCUSSION

It is necessary to overcome these conceptual inconsistencies on violence in order to carry out intervention programmes based on solid theoretical grounds.

CONCLUSIONS

Violence against nurses takes place within an organisational climate defined by role relationships. The organizational climate can either reduce the likelihood of violence or, on the contrary, instigate violent behaviors.