Nurse exposure to physical and nonphysical violence, bullying, and sexual harassment: A quantitative review

Safeguarding healthcare professionals from sexual harassment in the workplace: urgent need for effective training and education

Sexual harassment (SH) is a particularly harmful type of harassment that can inflict lasting psychological harm on victims. Within the healthcare sector, it negatively impacts teamwork, communication, and potentially compromises patient care. While concerns about workplace SH, including in healthcare, are long-standing, the #MeToo movement has brought renewed scrutiny to this issue since late 2017. Despite increased awareness, evidence suggests that SH remains prevalent in healthcare settings and shows no signs of decline over time. Therefore, there is an urgent need for effective training and intervention measures to enhance the identification of potential sexually offensive behaviors, thus fostering a work environment characterized by respect and inclusivity.

Prevalence and predictors of workplace sexual harassment of nurses in the Central Region of Ghana: a cross-sectional online survey

OBJECTIVE

We investigated the prevalence and predictors of workplace sexual harassment against nurses in the Central Region of Ghana.

DESIGN

A cross-sectional online survey.

SETTING

Central Region of Ghana.

PARTICIPANTS

A total of 1494 male and female nurses from various healthcare facilities in the Central Region participated in this survey from August to September 2021.

MAIN OUTCOME MEASURES

The prevalence of sexual harassment was determined using the Sexual Experiences Questionnaires and the Workplace Violence in the Health Sector Questionnaires. We used descriptive statistics to analyse participants' characteristics and the occurrence of sexual harassment. Binary logistic regression was used to determine the predictors of sexual harassment. The survey instrument yielded a reliability value of 0.82.

RESULTS

The prevalence of sexual harassment was 43.6% when behaviour-based questions were applied and 22.6% when a direct question was used. The main perpetrators of sexual harassment were male physicians (20.2%), male nurses (15.4%), male relatives of patients (15.1%) and male patients (11.6%). Unfortunately, only a few victims lodged complaints of harassment. Compared with males, female nurses were more likely to be sexually harassed (adjusted OR, aOR 1.59, 95% CI 1.23 to 2.07). Moreover, nurses with higher work experience (aOR 0.86, 95% CI 0.80 to 0.93), those married (aOR 0.54, 95% CI 0.41 to 0.72) and those working in private or mission/Christian Health Association of Ghana health facilities (aOR 0.49, 95% CI 0.36 to 0.68) were less likely to be sexually harassed.

CONCLUSIONS

The prevalence of workplace sexual harassment against nurses in the Central Region of Ghana is high and may compromise quality healthcare delivery in the region. Therefore, managers of healthcare facilities and the Ghana Health Service need to institute antisexual harassment interventions, including education, training and policy, with a focus on females in general, but especially those who are not married, less experienced and those working in public health facilities.

Implementing Trauma-Informed Care-Settings, Definitions, Interventions, Measures, and Implementation across Settings: A Scoping Review

Traumatic experiences can have long-lasting negative effects on individuals, organizations, and societies. If trauma is not addressed, it can create unsafe cultures with constant arousal, untrusting relationships, and the use of coercive measures. Trauma-informed care (TIC) can play a central role in mitigating these negative consequences, but it is unknown how and in which way(s) TIC should be implemented. Our objective was to conduct a scoping review that systematically explored and mapped research conducted in this area and to identify existing knowledge about the implementation of TIC. The search was conducted on the CINAHL, Cochrane, Embase, ERIC, Medline, PsycINFO, and Web of Science databases, and more than 3000 empirical papers, published between 2000 and 2022, were identified. Following further screening, we included 157 papers in our review, which were mainly from the USA, Australia, New Zealand, and Canada, focusing on study settings, methodologies, and definitions of TIC, as well as the types of interventions and measures used. This review shows that TIC is a complex and multifaceted framework, with no overarching structure or clear theoretical underpinnings that can guide practical implementations. TIC has been defined and adapted in varied ways across different settings and populations, making it difficult to synthesize knowledge. A higher level of agreement on how to operationalize and implement TIC in international research could be important in order to better examine its impact and broaden the approach.

Sexual Harassment at Work: Scoping Review of Reviews

Background

This article presents a scoping review of reviews on the topic of Sexual Harassment (SH) in the workplace, a subject that has garnered significant global attention. The phenomenon of SH poses a critical challenge to equal opportunity and gender equity in the workplace.

Aim

The review aims to synthesize existing research, focusing on the antecedents, consequences, and interventions related to SH.

Methods

The inclusion and exclusion criteria were established based on the research question, which was adapted from the PICO strategy. A protocol was devised following the "DS-CPC" format, which encompasses considerations related to Documents, Studies, Construct, Participants, and Contexts. The search was carried utilizing several automated databases, specifically focusing on the fields of Psychology, Behavioral Sciences, and Health. Preliminary search yielded a total of 468 articles, and the review ultimately encompassed a total of 22 articles.

Results

This review critically examines the complexity of SH, including the role of bystanders, the perpetuation of myths and misconceptions, and the exploitation of power imbalances by harassers. It also explores the manifestation of SH in male-dominated workplaces and the varying levels of organizational awareness and response to such incidents. The review highlights the importance of fostering an organizational culture that not only acknowledges and protects victims but also implements effective measures to penalize perpetrators.

Implications

It aims to elucidate the intricacies of SH and advocate for a workplace environment characterized by respect and accountability. Through this comprehensive analysis, the article seeks to inform and guide future research, policy development, and organizational practices concerning SH.

A participatory and comprehensive intervention to improve violence prevention in two high-risk occupations: effect and process evaluation of a stepped wedge cluster randomised trial

BACKGROUND

Work-related violence committed by clients, patients, and customers represents a major occupational health risk for employees that needs to be reduced.

METHODS

We tested a comprehensive violence prevention intervention involving active participation of both employees and managers in the Prison and Probation Service (PPS) and on psychiatric wards in Denmark. We used a stepped wedge cluster randomised controlled trial design. We measured the degree of implementation of the intervention by registration of fidelity, reach, and dose and used a mixed-effects regression analysis to estimate the effects of the intervention.

RESULTS

We recruited 16 work units for the intervention, but three work units dropped out. The average implementation rate was 73%. In the psychiatric wards, the intervention led to statistically significant improvements in the primary outcome (an increase in the degree to which managers and employees continuously work on violence prevention practices based on their registration and experiences), but none statistically significant improvements in any of the secondary outcomes. In the PPS units, the intervention did not lead to a statistically significant improvement in the primary outcome, but to statistically significant improvements in three secondary outcomes.

CONCLUSION

Most work units were able to carry out the intervention as planned. The intervention showed mixed results regarding the primary outcome. Nevertheless, the results indicate improvements also in the sector where a change in the primary outcome was not achieved. The results point at that a participatory and comprehensive approach could be a viable way of working with violence prevention in high-risk workplaces.

TRIAL REGISTRATION

ISRCTN86993466: 20/12/2017.

Classifying Studies on Workplace Violence for Visiting Nurses Using the Social-Ecological Model: A Scoping Review

PURPOSE

To prevent workplace violence (WV) against visiting nurses (VNs), understanding the influencing factors is crucial. To better comprehend potential violence prevention strategies, the U.S. Centers for Disease Control and Prevention has presented the four-level social-ecological model (SEM) at the 1) individual, 2) relationship, 3) community, and 4) societal levels. This study aims to quantify WV studies against VNs, examine the influencing factors, identify gaps based on SEM levels, and propose future research and policy directions.

DESIGN

A scoping review was conducted following the five-stage protocol proposed by Arksey and O'Malley in 2005.

METHODS

Systematic searches, including manual searches, were performed using English and Korean databases. Published journal articles including editorials on WV against VNs were included, irrespective of the publication date.

FINDINGS

Sixty journal articles were finally selected. Until the 1990s, most of the literature comprised editorials, with empirical research emerging after the 2000s. Classifying studies by SEM level, many studies have focused on individual (86.7%) and community (66.7%) factors, but fewer have addressed relationship (21.7%) and societal (16.7%) factors.

CONCLUSIONS

The study revealed that much research has focused on individual-centered training, with gaps in risk assessment tool development, training incorporating relational aspects, standardized protocols, and understanding of the impact of legal rights and policies. This article advocates a comprehensive approach that considers all SEM levels to address WV against VNs.

CLINICAL EVIDENCE

The findings confirm a research gap, which suggests the direction for future research and policies. Stakeholders should be urged to implement evidence-based strategies that contribute to safer work environments for VNs.

Prevalence and predictors of workplace violence against nurses in Africa: A systematic review and meta-analysis

Background and Aims

Workplace violence (WPV) against nurses is a pervasive global issue, yet the extent of this phenomenon in the African context remains insufficiently explored. This review aimed to synthesize the available literature to identify the prevalence and predictors of WPV against nurses in Africa.

Methods

A systematic search was conducted across MEDLINE, CINAHL, PsycINFO, and Scopus, to identify studies published from 2000 to October 2023. The pooled prevalence of WPV and it subtypes were estimated using random-effect meta-analysis. Heterogeneity between studies was quantified with I 2 statistics. Subgroup analysis and meta-regression were performed to identify sources of heterogeneity.

Results

This review included 27 studies, involving 9831 nurses. The pooled prevalence of WPV was 62.3% (95% confidence interval [CI]: 51.6-72.0). Verbal abuse emerged as the most common form of WPV, with a prevalence rate of 51.2% (95% CI: 41.3-61.1), followed by threat 23.3% (95% CI: 6.5-57.2), bullying 22.9% (95% CI: 14.0-35.2), physical abuse 15.1% (95% CI: 11.0-20.4), and sexual harassment 10.3% (95% CI: 5.9-17. 5). The proportion of WPV varied across geographical areas in Africa; however, the differences were not significant. The predictors of WPV encompassed demographic factors, personal habits, workplace characteristics, and nurses' past experience.

Conclusion

WPV against nurses is prevalent in Africa and transcends geographical boundaries in this region. This underscores the urgent need for targeted interventions and policy changes to address this issue in Africa.

Fear of violence and working department influences physical aggression level among nurses in northwest Ethiopia government health facilities

Purpose

Violence is recognized as an extreme expression of aggressive behavior and physical violence is most recognized type among victims. Patients always come to the hospitals looking for a cure, remedy, or assurance; however, incompatibility of demand and service often results in violent incidents that become statuesque in health facilities. This study aims to investigate physical violence and associated factors among nurses in health facilities in Gondar town, Ethiopia.

Method

The study was an institutional-based cross-sectional study among nurses in Gondar town from April to May 2017. Data were collected using a pretested modified version of the standard [ILO/ICN/WHO/PSI] questionnaire by trained data collectors among 339 nurses across health facilities. Multivariable logistic regression analysis with 95% confidence interval (CI) was used to identify the factors significantly associated with physical violence at p-value ≤0.05.

Result

Over one fourth (28.9%) [95% CI: (24.8, 33.9)] of nurses were victims of violence in the past 12 months. Level of verbal abuse (AOR = 2.35; 95%CI, 1.26-4.40), working in emergency (AOR = 4.58; 95%CI, 1.47-14.30) and inpatient (AOR = 3.33; 95%CI, 1.15-9.66)departments; having moderate (AOR = 0.41; 95%CI, 0.18-0.90),high (AOR = 0.41; 95%CI, 0.18-0.90), optimal (AOR = 0.41; 95%CI, 0.18-0.90) level of concern of violence were significantly associated with physical violence.

Conclusion

This study underlines findings nurses are at high-risk of physical violence and it is ranked second highest only to psychiatric and trauma facilities in Gondar town. Exposure to verbal abuse, working in emergency and inpatient departments and perceived level of concern are the precursors of experiencing physical violence. Therefore, investing time and capital in training like restraining and de-escalation, structural measures that deter the assailants are important.

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.

PTSD prevalence and factors in intern nursing students after COVID-19 full liberalization in China: a cross-sectional study

Objective

This study aimed to assess the prevalence of post-traumatic stress disorder (PTSD) and its influencing factors among intern nursing students after the full liberalization of the COVID-19 prevention and control policy in China.

Methods

Participants completed the online survey from January 14 to January 19, 2023. A demographic questionnaire, COVID-19 and internship-related questionnaire, the Fear of COVID-19 scale, the Primary Care PTSD Screen, and the Connor-Davidson Resilience Scale were used to conduct the online survey.

Results

Of 438 participants, 88.4% tested positive for COVID-19 in the last 6 months. The prevalence of fear, resilience, and PTSD was 16.9, 15.5, and 11.2%, respectively. Direct care of COVID patients in hospital (OR = 2.084, 95%CI 1.034 ~ 4.202), the experience of occupational exposure (OR = 2.856, 95%CI 1.436 ~ 5.681), working with an experienced team (OR = 2.120, 95%CI 1.070 ~ 4.198), and fear COVID-19 (OR = 8.269, 95%CI 4.150 ~ 16.479) were significantly and positively associated with PTSD in nursing internship students.

Conclusion

After COVID-19 full liberalization in China, intern nursing students still experienced pandemic-related mental distress, which can bring PTSD. Adequate support and counseling should be provided, as needed, to intern nursing students who are about to enter the workforce and have experienced severe PTSD symptoms related to COVID-19. Our findings indicated that should understand the importance of screening, formulate intervention strategies and preventive measures to address psychosocial problems, and provide coping skills training to intern nursing students.

A latent profile analysis of resilience and the associations with flourishing in emergency nurses exposed to workplace violence in China

Workplace violence (WPV) exposure has been particularly prevalent in emergency nurses, coupled with negative mental health outcomes. Few explored resilience after WPV exposure using the perspective of positive mental health. We aimed to identify latent profiles of resilience and examine associations with flourishing in emergency nurses with WPV exposure. A total of 1241 Chinese emergency nurses were surveyed on the frequency of WPV exposure, resilience, and flourishing. Eight hundred and twenty five participants (90.1% female, 86.6% aged 20-39) reported WPV exposure at least once in the past 3 months. Latent profile analysis identified profiles of resilience as low resilience (15.0%), moderate decision respond and interpersonal link with low rational thought and flexible adaption (18.0%), moderate resilience (31.0%), high decision respond, interpersonal link, and rational thought with moderate flexible adaption (16.0%), and high resilience (20.0%). Higher flourishing was observed in profiles of moderate resilience, high decision respond, interpersonal link, and rational thought with moderate flexible adaption, and high resilience. We differentiated profiles of resilience and the associations with flourishing in emergency nurses with WPV exposure, which informed targeted interventions for promoting positive mental health.

Development and validation of the nurses sexual harassment scale in Iran

INTRODUCTION

In recent years, the prevalence of sexual harassment has become a global problem, and nursing, like other professions, has not been immune to this issue. By having a valid and reliable instrument, healthcare personnel can be helped in preventing and managing this problem and reduce its negative consequences on mental health and well-being. The aim of this study was developing and psychometrically measuring the Nurses Sexual Harassment Scale.

MATERIALS AND METHODS

This study is the second phase of a mixed method study. Initially in the first phase, a qualitative approach with conventional content analysis was used to explain nurses' experiences of sexual harassment in the workplace. To design the Nurses Sexual Harassment Scale, qualitative data and literature were reviewed. In the quantitative phase (second phase), the target scale was psychometrically evaluated using content validity (14 experts), face validity (12 nurses with being sexually harassed), construct validity (316 nurses working in hospitals affiliated to Kerman University of Medical Sciences), and reliability (internal consistency and repeatability).

RESULTS

A 15-item scale with two components: "latent sexual harassment" (9 items) and "manifest sexual harassment" (6 items), which explained 68.4% of the total variance was developed. Also, due to the strong correlation between the Nurses Sexual Harassment Scale and the Impact of Event Scale-Revised (r = 0.67), convergent validity was confirmed. Also, the scale of the present study had good reliability (Cronbach's alpha coefficient = 0.94, Omega coefficient = 0.94, and ICC = 0.92).

CONCLUSION

Given the importance of sexual harassment among nurses, measuring the dimensions of this problem may allow professionals to plan interventions to prevent it. Overall, the results of the present study showed that the psychometric properties of the " Nurses Sexual Harassment Scale" with 15 items are acceptable and this scale can be used in the clinical environment. A further study within the nursing community is recommended to confirm the findings.

A cross-sectional survey on the relationship between workplace psychological violence and empathy among Chinese nurses: the mediation role of resilience

BACKGROUND

Workplace violence is one of the most serious public health issues worldwide in healthcare occupations, nurse is a profession which faces the greatest risk of exposure to workplace violence among healthcare occupations.

OBJECTIVE

The present study aimed to explore the relationship between workplace psychological violence and empathy among Chinese nurses, and further examine the mediation role of resilience in this relationship.

METHOD

A cross-sectional survey was conducted among a convenience sample of clinical registered nurses in Xinjiang China from 29 September 2023 to 19 October 2023.The online questionnaire, contained the general information form, the Workplace Psychologically Violent Behaviors Instrument, the Jefferson Scale of Empathy-Healthcare Professionals Version, and the Connor-Davidson Resilience Scale, was used to collect data. The IBM SPSS statistics software version 22.0 was used to perform data analyses in forms of descriptive statistics, correlation analysis, and mediation analysis.

RESULT

This survey recruited a convenience sample of 1613 clinical registered nurses aged 22 to 55 years who come from diverse ethnicities and worked in different departments. A total of 534 nurse experienced psychological violent, which yielded a positive rate of 33.1% for psychological violent among nurses. Pearson analysis reported a negative correlation between psychological violences and empathy (r=-0.724, P < 0.01) as well as a negative correlation between psychological violences and resilience (r=-0.681, P < 0.01). Mediation analysis reported that resilience mediated the negative relationship between psychological violence and empathy, the mediation effect accounted for ab/(ab + c') = 23.40% of the total effect.

CONCLUSION

This study supported an inverse ralationship between psychological violence and empathy among Chinese nurses where resilience acted as a protective factor to mediated the negative impacts of psychological violences on empathy These results directed health policies and clinical interventions to equip nurses with resilience to copy with and recover from workplace psychological violence.

Medical Students' Self-Perceptions of Harassment During Clinical Placement

Objectives

Exploring workplace dynamics during clinical placement is crucial to determine whether medical students are encountering safe and meaningful learning experiences. The aim of this original article is to describe medical students' reported harassment experiences whilst on clinical placement.

Design

Medical students in years 4 to 6 were invited to participate in the survey. In this mixed-methods study, data collection included demographic information, responses to the Generalized Workplace Harassment Questionnaire, and qualitative commentaries.

Results

Two hundred and five students completed the questionnaire. Medical students experienced harassment in areas of verbal aggression, disrespect, isolation/exclusion, threats/bribes, and physical aggression. Concerning levels of occurrence were noted for disrespect, isolation/exclusion, and verbal aggression.

Conclusions

Many medical students in this study reported experiencing harassment during their clinical placements indicating that harassment during clinical placement continues to be of concern in medical education. The findings indicate that further initiatives need to be designed to identify and respond to these cases of workplace harassment and that power imbalance and safe reporting appear to be further issues of concern. It was evident that students need to feel safe enough to be able to report harassment experiences to allow managers and educators to address the full extent of the problem.

The reality of occupational harm incurred by Japanese home health care nurses, the hazardous situations they face, and protective measures: a cross-sectional study

Objectives: To gain a comprehensive understanding of the occupational hazards encountered by home health care nurses in Japan and to elucidate the reality of harm they incur, the hazardous situations, and the protective measures taken.

Methods:A questionnaire survey of managers of home health care nursing agencies in Japan was conducted, and 355 valid responses were obtained. The survey questions concerned the occupational hazards experienced by home health care nursing staff. The occupational hazards were classified into 6 categories, and responses were obtained regarding harm, hazardous situations, and protective measures in each category.

Results: The types of harm that occurred at highest rates during the previous 3 years were emotional abuse by the patient or their family members, lower back pain resulting from improper posture while providing care, sexual harassment by the patients and their family members, automobile accidents while traveling to home care sites, and allergic reactions to the environment at home care sites. Some hazardous situations were caused by the unique environments of home care sites.

Conclusions: In order to prevent the occurrence of harm, the development of risk assessment tools, educational initiatives to increase awareness of occupational hazards, and consideration of the financial and technical support that will enable the use of assistive devices in the practice of nursing techniques were considered necessary. The development of effective guidelines and manuals specific to the occupational hazards encountered by home health care nurses is an important challenge.

Prevalence and associated factors of sexual, psychological, and physical violence among physical therapists in their clinical role in Spain: a national web-based cross-sectional survey

OBJECTIVES

To determine the extent of career-long and 12-month exposure to sexual, physical, and psychological/verbal violence committed by patients or their companions among physical therapists in Spain. Additionally, to identify the factors associated with such exposure.

METHODS

This study employed an observational cross-sectional approach. Initially, a questionnaire was developed and validated using a convenience sample. Subsequently, it was distributed via email to all physical therapists registered in Spain in the first quarter of 2022. Individual risk models were created for each type of violence experienced within the past 12 months.

RESULTS

The prevalence of violence encountered by physical therapists throughout their careers was 47.9% for sexual violence, 42.7% for psychological/verbal abuse, and 17.6% for physical abuse. Lower values were observed within the last 12 months (13.4%, 15.8%, and 5.2%, respectively). Statistical risk modeling for each type of violence experienced in the past 12 months indicated that the common precipitating factor for all forms of violence was working with patients with cognitive impairment. Working part-time appeared to be a protective factor. Other factors, such as the practitioners' gender, practice setting, or clinic location showed variations among the diverse types of violence.

CONCLUSIONS

The exposure to type II workplace violence within the last 12 months among physical therapists in Spain (Europe) is not so high as in some other world regions. Various individual, clinical, and professional/organizational risk factors have been identified in connection with type II workplace violence. Further research is warranted to compare the violence experienced once the COVID pandemic has subsided.

Workplace bullying in pharmacy - a study on prevalence, impacts and barriers to reporting

PURPOSE

The study aims to estimate the prevalence of workplace bullying, personal and work-related impacts, reporting practices for bullying, and the reasons for not reporting bullying incidents in the New Zealand pharmacy sector.

DESIGN/METHODOLOGY/APPROACH

An online survey was conducted among registered pharmacists and pharmacist interns in New Zealand from June to August 2020. The questionnaire comprises both close-ended and semi-structured free-text questions. Goldberg's 12-item General Health Questionnaire (GHQ-12) assessed the respondents' general psychological health status, and a 22-item Negative Acts Questionnaire-Revised (NAQ-R) was used to estimate bullying prevalence together with the self-rated/self-labeled questions. The qualitative information obtained from the free-text responses was used to support and elaborate on the quantitative results.

FINDINGS

The self-labeled prevalence of workplace bullying was 36.9%, with almost 10% reporting it occurring almost daily to several times per week. The 54.7% prevalence based on the NAQ-R assessment compares well with the prevalence of witnessing the incidents (58.5%). Psychological distress symptoms were experienced by 37.1% in pre-COVID and 45.3% during COVID-year 1. Supervisors or direct managers were the commonest perpetrators (32.7%). Only 28.8% of those who experienced bullying had reported the incidents formally.

RESEARCH LIMITATIONS/IMPLICATIONS

This study is cross-sectional, and the relationships indicated are bi-directional. The consistency of the results is reassuring, however inferring causality of effect is challenging. Future studies and analyses should focus on this. This study suggests that in the pharmacy environment bullying from the top is reasonably prevalent, is not commonly reported and requires the design and implementation of prevention and management strategies that take into account and mitigate these bullying factors. Professional pharmacy leadership organizations, National Health Authority and Pharmacy regulators could play a significant role in awareness and training to reduce bullying with the development and promotion of strategies to curb it and improve reporting.

ORIGINALITY/VALUE

This is the first paper to describe the prevalence and impact of workplace bullying, and the practices of reporting bullying incidents in the New Zealand pharmacy sector. Based on empirical evidence, pharmacists represent a small share of total healthcare workforce, yet the overall prevalence of bullying is consistent with professions with much larger numbers such as medicine and nursing.

Quitting one's job or leaving one's profession: unexplored consequences of workplace violence and discrimination against health professionals

BACKGROUND

Although workplace violence and discrimination against healthcare workers are global and universal phenomena, and violence at work is recognized as a serious and growing problem, in Switzerland, hardly anything is known about the related consequences on job changes and career endings, which are two major staffing challenges present in the notoriously understaffed healthcare sector.

METHOD

Data collected from a written survey conducted among 1,840 hospital employees, of which 1,441 were health professionals, were used to evaluate and estimate the prevalence and impact of specific and cumulated forms of workplace violence and discrimination on the work climate and particularly on subsequent turnover intentions and career endings. Established multi- and single-item measures were used as predicting, intervening and outcome variables. Relative frequencies stratified for nurses, physicians and therapists were calculated to estimate and differentiate the size of the phenomena under study. Furthermore, crosstabulations, as well as multivariate regression analyses, were performed to explore the associations of interest.

RESULTS

Every fifth to sixth nurse and every seventh to eighth physician reported having had intentions to change jobs or leave the profession within the past year. These intentions become much more prevalent across all health professions when one or even two or more different forms of violence and/or discrimination at work are experienced and reported. Accordingly, the relative risks for intending to quit one's job or leave one's profession increase significantly and steadily with a growing number (1, 2 +) of different experienced forms of violence and/or discrimination at work compared to the reference group of those who are nonaffected (aOR from 2.5 up to 5.4). This fairly strong association was only slightly reduced (aOR from 2.1 to 4.0) when work climate was additionally taken into account as a potential intervening variable. Although work climate only partly accounted for the association under study, a poor work climate was an additional strong predictor and independent risk factor for intentions to turnover (aOR = 6.4) or leave the profession (aOR = 4.2).

CONCLUSIONS

Experiences of workplace violence and discrimination and the resulting poor work climate both together and independent of each other seem to be important causes of job changes and career endings among healthcare workers in Switzerland.

Visualization and bibliometric analysis of occupational exposure among nurses in Asia

Background

Occupational exposure is of increasing concern, posing a serious threat to nurses, especially in the event of a public health emergency. Bibliometrics sheds novel light on the current state of research and factors influencing nurses' occupational exposures, illuminating hot topics and trends in the literature. Bibliometrics is essential to analyze the potential harm to nurses in Asia.

Methods

Data were extracted from the Web of Science Core Collection on August 6, 2022 with the following search terms: TS= (nurses) AND (TS= (occupational exposure OR occupational health)). CiteSpace and VOSviewer were used to analyze national and institutional collaborations, reference clustering, citations and co-citations of journals and keyword bursts, and HistCite was used to analyze the citation historiography map. To analyze the data and generate statistical charts, Origin and Microsoft Excel were utilized.

Results

A total of 1448 studies on nurses' occupational exposure in Asia were identified. China Medical University had the most publications among Asian institutions, and China had the largest share among Asian countries. Most articles on nurses' occupational exposure in Asia were in the Journal of Occupational Health, and the journal with the highest impact factor was the Journal of Nursing Management. The COVID-19 outbreak caused a substantial shift in the direction of studies on nurses' occupational exposure in Asia. Mental health is a current hot topic, while sharps injuries and bodily fluid exposure are long-term priorities for attention.

Conclusions

The hotspots of research on nurses' occupational exposure in Asia focus on mental health, burnout, blood exposure, infection, and sharps injury. Due to the COVID-19 pandemic, recent research has concentrated on personalized mental health care and the development of protective equipment, and cross-disciplinary collaboration may be a new trend in the future.

Competence in managing workplace violence among nursing interns: Application of latent class analysis

AIM

To identify subtypes of competence in managing workplace violence (WPV) among nursing interns and to assess between-group differences.

BACKGROUND

Nursing interns are reported to be a vulnerable population for experiencing workplace violence during their clinical placement. Although WPV could have a negative impact on nursing interns' health and attitudes towards the nursing profession, little is known about nursing interns' competence in workplace violence management or its influencing factors.

DESIGN

A cross-sectional study.

METHODS

Between March to April 2023, nursing interns at three tertiary general hospitals in Anhui Province, China, completed questionnaires including a general information questionnaire, the Management of Workplace Violence Competence Scale (MWVCS), the Utrecht Work Engagement Scale (UWES-9), the Emotional Labour Scale for Nurses (ELSN) and were classified into subtypes by latent class analysis. Subsequently, univariate analysis and multivariate logistic regression were performed to identify the influencing factors by subtypes.

RESULTS

A total of 264 questionnaires were valid and the overall mean age of the participants was 21.06 ±1.41 years. Four classes were identified: low competency group (15.5%), low cognition-low coping competency group (18.2%), low cognition-medium to high competency group (21.6%) and high competency group (44.7%). The results of multinomial logistic regression analysis showed that placement hospitals with a WPV management department, emotional control effort in profession dimension and emotional pretense by norms dimension in the Emotional Labour Scale for Nurses, pursuing further education and vigour dimension in the Utrecht Work Engagement Scale were influencing factors of the potential categories of WPV management competence.

CONCLUSIONS

Four classes were identified and there was competence variability among nursing interns. More attention should be given to nursing interns who did not receive WPV-related training in their school or placement hospital.

Workplace Violence Against Nurses in Canada: A Legal Analysis

Workplace violence against nurses is a significant global occupational health problem, with incidents of violence increasing in frequency since the COVID-19 pandemic began. In this article, we provide a review of recent legislative amendments meant to bolster workplace safety in health care in Canada, analyze legal cases where nurses were the victims of violence, and discuss what these legal reforms and decisions reveal about how nurses' work is treated within the Canadian legal system. Under criminal law, the limited number of cases we could find with oral or written sentencing decisions show that, historically, the fact a victim was a nurse was not always considered an aggravating factor on sentencing. Recent legislative amendments make this a specified aggravating factor and it is important to track the impact of these amendments when judges exercise their discretion in sentencing. Under employment law, it appears that, despite the government's efforts to increase the deterrence factor under legislation with significantly increased fines for employers who fail to protect their employees from injury, courts remain reluctant to impose such sanctions. In these cases, it is also important to track the impact of harsher penalties. We conclude that combating the widespread normalization of workplace violence in health care, and specifically against nurses, is acutely needed to help ensure that these ongoing legal reforms aimed at improving the safety of health workers are effective.

Application of the theory of planned behaviour for predicting the determinants of workplace violence reporting behaviour among public hospital healthcare workers in Malaysia: A cross-sectional study

Introduction

Reporting workplace violence (WPV) is a crucial preventive measure. Given the great impact of WPV on mental health and well-being, this study aimed to determine the prevalence and determinants of WPV reporting among healthcare workers (HCWs).

Method

A total of 557 public hospital HCWs in Melaka were recruited via probability sampling. A questionnaire guided by the theory of planned behaviour was developed, pre-tested and distributed. Malaysians with a minimum employment period of 12 months who experienced WPV within the same period in the selected public hospitals were eligible for inclusion. Multiple logistic regression analysis was conducted to determine the association between the independent variables and WPV reporting.

Results

Psychological violence was the most common WPV (80.3%), with only 177 (31.8%) respondents reporting such. The respondents who had high subjective norm (adjusted odds ratio [AOR]=2.160, 95% confidence interval [CI]=1.32-3.53) and perceived behavioural control scores (AOR=3.976, 95% CI=2.41-6.55); were clinical (AOR=2.679, 95% CI=1.43-5.02) and non-clinical (AOR=4.271, 95% CI=2.23-8.18) support staff; experienced physical WPV (AOR=13.157, 95% CI=3.83-45.24) and both physical and psychological WPV (AOR=2.029, 95% CI= 1.13-3.65); and perceived that WPV was intentional (AOR=11.111, 95% CI=6.50-19.00) were more likely to report WPV.

Conclusion

HCWs who experience physical WPV have the highest likelihood to report, followed by those who perceive WPV as intentional. The prevalence of reported WPV among public hospital HCWs is low, potentially underestimating its true occurrence owing to underreporting. Ensuring readily available reporting mechanisms for WPV, especially the psychological type, is crucial for HCWs.

Sexual workplace violence in the health sector in Saudi Arabia: a cross sectional study

BACKGROUND

Sexual workplace violence occurs worldwide with increasing prevalence, causing psychological and physical injuries. However, only few reports from the Kingdom of Saudi Arabia have investigated the most involved health specialty and its association with other factors, such as working and sociodemographic conditions. The aim of this study was to determine the prevalence of workplace sexual violence over 12 months, from May 2018 to May 2019, circumstances related to the event, and consequences for the perpetrator and survivor and to identify associated factors among all healthcare workers (HCWs) in Saudi Arabia.

METHODS

This cross-sectional study included all HCWs registered with the Saudi Commission for Health Specialties who worked for > 1 year in the health sector (government or private) in Saudi Arabia until May 2019. A non-probability convenient sampling technique was used. A modified self-administered questionnaire sent via email was utilized to assess workplace violence. Descriptive statistics were used to report percentages and frequencies, while advanced statistics, such as bivariate analysis, were used to determine associations. Multivariate logistic binary regression analysis was used to assess the combined and individual associations between relevant predictors of exposure of HCWs to recent sexual violence at the workplace.

RESULTS

In total, 7,398 (male, 51.3%; female, 48.7%) HCWs were electively enrolled in the study (mean age 40 ± 8.62 years). Most were non-Saudi (60%). Overall, 3.9% were sexual violence survivors. Approximately 60.7%, 51.4%, 48.3%, and 65.9% of female workers, nurses, Saudi natives, and night shift workers (18:00 to 07:00), respectively, were significantly exposed to sexual violence. Furthermore, approximately 54.8% of those with direct physical contact with patients had a higher rate of exposure to sexual harassment (p = 0.001).

CONCLUSIONS

The prevalence of sexual violence is low but remains a risk to HCWs, especially those working night shifts and having direct physical contact with patients. Thus, more support, specific strategies, and policies are needed to reduce the rate of occurrence, protect HCWs, and prevent such events. The underreporting of cases may be skewing the magnitude of the problem; thus, more education and additional research in Saudi Arabia are needed regarding sexual violence experienced by HCWs.

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.

Female patient violence experienced by female qualified nurses working in an inpatient psychiatric department

Whilst there is an increasing prevalence of healthcare staff facing aggression, psychiatric nurses are thought to be most at risk; with such events being a hazard to their physical, emotional and psychological health. This study explored how patient violence is experienced by qualified nurses employed in an in-patient psychiatric facility in the Kingdom of Saudi Arabia (KSA). As male and female patients and nurses are segregated in Saudi healthcare settings, this study focused on female patient violence against female psychiatric nurses. Both the immediate and more long-term impacts were explored, together with approaches that could potentially facilitate avoiding, reducing and managing aggression within the work setting. The study adopted a qualitative descriptive design and used purposive sampling to recruit nine psychiatric nurses working in an in-patient setting, from a single KSA medical facility. Inclusion criteria required participants to be licensed, registered nurses, who, during the last 10 years, had worked in an acute in-patient psychiatric ward for adult females, and to have experienced some form of patient aggression. Semi-structured, one-to-one interviews were used to gather data, which was then subjected to thematic analysis. Two dominant themes were identified: (i) occurrence of violence and (ii) determination of violence. It was concluded that female psychiatric nurses were adversely affected by aggression towards them from female patients. Although the nurses considered this behaviour to be part of their nursing role, they reported minimal support from institutional managers, peers and their relatives.

Exploring the experience of undergraduate nursing students following placement at psychiatric units in China: A phenomenological study

AIM

To explore undergraduate nursing students' experiences of psychiatric placements.

BACKGROUND

Placement is an important learning phase for undergraduate nursing students and the placement experiences may affect their career choices. However, nursing students' experiences of psychiatric placements have not been fully explored in China.

DESIGN

This study adopted a descriptive, phenomenological design.

METHODS

After psychiatric placement, a semi-structured interview was conducted in June 2022 among 22 final-year undergraduate nursing students using purposive sampling. The data were analysed using Colaizzi's seven-step analysis method.

RESULTS

Five themes were identified: i) destigmatising mental illness; ⅱ) beneficial communication; ⅲ) gaining confidence; iv) disappointment and sadness; and v) fear and discomfort.

CONCLUSION

Nursing students experienced various positive experiences and negative emotions during their psychiatric placement. Further research should explore and validate appropriate educational strategies to optimise students' placement experiences to increase their career interest in psychiatric nursing.

Association of workplace bullying and burnout with nurses' suicidal ideation in Bangladesh

Suicidal ideation is a complex phenomenon influenced by several predisposing, contextual, and mediating factors that seem more common among healthcare workers, especially nurses. We investigated the association of bullying and burnout with suicidal ideation among Bangladeshi nurses and identified the associated factors. We conducted a cross-sectional study among 1264 nurses in Bangladesh between February 2021 and July 2021. We applied a modified Poisson regression model with robust error variance to determine the association of bullying and burnout with suicidal ideation. Among 1264 nurses, the female was 882 (70.02%), and the mean age was 28.41 (SD = 5.54) years. The prevalence of high levels of suicidal ideation was 13.26%. In the Poison regression model, high risk bullying (RR = 6.22, 95% CI 3.13-12.38), targeted to bullying (RR = 7.61, 95% CI 3.53-16.38), and burnout (RR = 8.95, 95% CI 2.84-28.20) were found to be significantly associated with suicidal ideation. Furthermore, we found significant interaction between workplace bullying and burnout with suicidal ideation (p < 0.05). The high prevalence of bullying, burnout, suicidal ideation, and their association indicate an unsafe workplace for the nurses. Initiatives are needed to make a favorable work environment to improve nurses' overall mental health and reduce suicide ideation.

Workplace bullying and violence in health sector in Saudi Arabia

Workplace bullying violence (BV), with psychological and physical impacts, is increasing globally. However, studies from Saudi Arabia investigating which specialties are most exposed, and linking them with other factors, such as sociodemographic conditions, are scarce. This study aimed to estimate the prevalence of workplace BV over a 12-month period and determine the circumstances related to the event, consequences for the attacker, and targeted personnel among all healthcare providers in the Kingdom of Saudi Arabia (KSA). This analytical cross-sectional study included all health providers registered with the Saudi Commission for Health Specialties who worked for more than 1 year in the healthcare sector (governmental or private) in the KSA until May 2019. In total, 7398 healthcare workers were electively enrolled in the study; 51.3% were men, and 48.7% were women, with a mean age of 40 ± 8.62 years. They were mostly (60%) non-Saudi. Overall, 26.6% encountered BV. Those who worked in the private sector, in shifts, especially evening shifts, were significantly more exposed. Furthermore, pharmacists had the highest prevalence of workplace violence. The prevalence of BV is moderately high; however, it is a serious issue faced by healthcare workers, especially those working night shifts. Pharmacists were more likely to experience bullying. This demonstrates that more support, specific strategies, and policies are required to reduce the occurrence of workplace BV, protect healthcare providers, and prevent attacks. Underreporting these situations may give an incorrect indication of the magnitude of the problem; thus, more education and further studies in the KSA are needed.

Impact of workplace violence against psychological health among nurse staff from Yunnan-Myanmar Chinese border region: propensity score matching analysis

BACKGROUND

Owing to different social background factor in Yunnan-Myanmar Chinese border region, stressful working environment may lead to extra psychological burden among nurse staff in China. However, the prevalence of workplace violence and its effect on psychological characteristics among nurse staff are still unclear. This study aims to explore the effect of workplace violence against psychological health among nurse staff from Yunnan-Myanmar Chinese border region.

METHODS

A cross-sectional survey was conducted among 18 local governmental hospitals in Dehong districts. Participants were 1,774 nurses. Psychosocial characteristics were screened by sleep quality, the 9-item Patient Health Questionnaire for depressive symptoms, the generalized anxiety disorder-7 for anxiety symptoms, the Connor Davidson Resilience Scale - 10 item for resilience, the multidimensional scale of perceived social support for social support, the Chinese version of Work place Violence Scale for workplace violence. Propensity score matching and multivariate linear regression were applied to analyze the data.

RESULTS

The nurse staff with workplace violence have a higher risk of bad sleep quality (b = -0.883, 95%CI = [-1.171, -0.595]), anxiety symptoms (b = 2.531, 95%CI = [2.031, 3.031]) and depressive symptoms (b = 3.227, 95%CI = [2.635, 3.819]), loneliness (b = 0.683, 95%CI = [0.503, 0.863]), perceived cognitive deficits (b = 1.629, 95%CI = [1.131, 2.127]), poor resilience (b = -2.012, 95%CI = [-2.963, -1.061]), and poor social support (b = -5.659, 95%CI = [-7.307, -4.011]).

CONCLUSIONS

Preventing workplace violence can improve mental health outcomes significantly among nurse staff, including loneliness, perceived cognitive deficits, anxiety symptoms, depressive symptoms, sleep quality, resilience and social support.

Collective Violence against Health Workers in the Context of the COVID-19 Pandemic

Concerns about violence against nurses and other medical personnel have increased during the COVID-19 pandemic. However, as of yet, limited systematic knowledge of such violence is available. Addressing this gap, we analyse the geographical distribution of, motivations behind, and contexts of collective attacks against health workers in the context of the COVID-19 pandemic. To do so, we systematically recorded and coded attack events worldwide from 1 March 2020 to 31 December 2021. We identify high-risk countries, attack characteristics, and the socio-economic contexts in which attacks tend to occur. Our results show that opposition against public health measures (28.5%), fears of infection (22.3%), and supposed lack of care (20.6%) were the most common reasons for attacks. Most attacks occurred in facilities (often related to a supposed lack of care) or while health workers were on duty in a public place (often due to opposition to public health measures). However, 17.9% of all attacks took place in off-duty settings. Democratic countries with high vaccination rates and strong health systems were relatively safe for nurses and doctors. Distrust in the skills of health workers and the science underlying health interventions is a major driver of collective attack risks and should be addressed before it turns violent. This study was not registered.

Student nurses' experiences of workplace violence: A mixed methods systematic review and meta-analysis

OBJECTIVES

To identify the prevalence of student-directed violence on clinical placement and description of their related experience during clinical placements.

DESIGN

Mixed methods systematic review and meta-analysis conducted following Joanna Briggs Institute guidelines and reported according to Preferred Reporting of Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

DATA SOURCES

CINAHL, Embase, Medline, Proquest, PsycINFO and Google Scholar.

REVIEW METHODS

Included studies were peer reviewed, published primary studies where pre-registration nursing students were surveyed about their experiences of physical, verbal, or sexual aggression, bullying or racism during clinical placement. Studies were quality assessed but not excluded based on the result. A convergent segregated approach to synthesis and integration was undertaken. Prevalence data were extracted and pooled using both random and quality effects models; separate analyses were conducted by violence type, source, and region. Qualitative data were thematically analysed.

RESULTS

14,894 student nurses from 42 studies were included across the meta-analyses. There was substantial heterogeneity in the included data. Pooled prevalence rates ranged from racism 12.2 % to bullying 58.2 %. Bullying (38.8 %) and physical aggression (10.2 %) were most perpetrated by nurses whereas sexual aggression was perpetrated mostly by patients (64.2 %) and physicians (18.6 %). Qualitative findings identified students' descriptions of reasons for, effects of, strategies for dealing with and higher education establishments' responsibilities with regards to workplace violence.

CONCLUSIONS

Student nurses commonly experience violence during their clinical placements. Given the potential debilitating physical and psychological sequelae of all forms of violence then this study further emphasises the need to use multiple strategies to prevent violence and to better equip student nurses to manage potentially violent incidents, their responses to violence, and to whistle blow or report when they are subject to violence.

Workplace Bullying among Healthcare Professionals: A Quanti-Qualitative Survey in a Sample of Women Working in an Italian Healthcare Setting

The main objective of this study was to analyze, in a sample of female healthcare workers in Italy, the training needs to improve positive relationships in the healthcare organization. To better understand these needs, perceived workplace bullying and its consequences in terms of professional commitment and well-being were analyzed from a descriptive and quantitative perspective (or mixed-methods analysis). A questionnaire was completed online in a healthcare facility in northwestern Italy. The participants were 231 female employees. The quantitative data showed that, on average, the sampled population perceived a low burden of WPB. The majority of the sample expressed moderate engagement at work and moderate perception of psychological well-being. It is interesting to note that one element seemed to be overarching in the responses to the open-ended questions: communication, which emerged as a problematic element that affects the entire organization. The research data provide useful evidence for intervention in favor of an environment that helps to recognize the phenomenon and intervene in time, offering the possibility of accepting the discomfort and fatigue of healthcare workers and offering useful interventions to the individual and the team.

Experiences of Sexual Harassment by Patients among Nurses at the Mental Hospital of West Java Province: A Qualitative Study

Sexual harassment is behavior related to forced sex without the consent of the victim. Incidents of sexual harassment on nurses can be in the form of physical behavior and verbal behavior. The factor of power relations between men and women and the patriarchal culture in Indonesia are the causes of the sexual harassment of mental health nurses, so many incidents of the sexual harassment of women occur. The forms of sexual harassment that occur include kissing, hugging from behind, and verbal abuse related to sex. The purpose of this study was to explore the experience of sexual harassment of psychiatric nurses at the Mental Hospital of West Java Province. This study implemented a qualitative descriptive approach using the NVIVO 12 software application. The sample in this study was 40 psychiatric nurses at the Mental Hospital of West Java Province. The sampling technique in this study was focus group discussions with semi-structured and in-depth interviews. The data analysis in this study used a thematic analysis. This study shows that sexual harassment behavior is carried out by patients in physical and verbal forms. Sexual harassment is mostly carried out by male patients towards female nurses. Meanwhile, sexual harassment took the form of hugging from behind, kissing, naked patients in front of nurses, and disturbing nurses with verbal abuse related to sex. Nurses feel disturbed, afraid, anxious, and shocked by the incidents of sexual harassment committed by patients. Sexual harassment by patients towards nurses causes psychological problems for nurses and causes nurses to want to leave their jobs. Gender adjustment between nurses and patients is a preventive effort to prevent the sexual harassment of nurses. Sexual harassment by patients causes a decrease in the quality of work of nurses in providing nursing care, creating a work environment that is less safe and comfortable.

Sexual harassment as experienced by nurses from selected healthcare facilities in Ghana

BACKGROUND

Workplace Sexual Harassment (WSH) remains a major occupational health hazard to many nurses globally. Despite the negative impact of WSH on health and safety of nurses, there are limited studies exploring sexual harassment experiences of nurses in the line of duty in Low- and middle-income countries (LMICs) including Ghana.

AIM

This study aimed at exploring the lived sexual harassment experiences among nurses working in healthcare facilities in the Central Region of Ghana.

METHOD

This study used a qualitative interpretive phenomenological approach (IPA). Data from 24 participants, 13 participants' written descriptive narratives of sexual harassment experiences (via online) and 11 telephone interviews were analysed concurrently using the IPA.

RESULTS

Participants experienced verbal, non-verbal and physical forms of sexual harassment, often perpetrated by physicians, colleague workers, and patients. Most victims reacted passively to the acts sexual harassment and cases are often not reported despite the negative impact on victims' health. While some participants dealt with sexual harassment by accepting the behaviour as an inevitable part of their job, others either quit or intend to quit the job to avoid the harassers. Most participants are unaware of any workplace measure such as policy that addresses sexual harassment in the health sector in Ghana.

CONCLUSION

This study highlights the problems of sexual harassment against nurses in the healthcare sector in Ghana, and calls for urgent development of measures such as a sexual harassment policy to prevent occurrence and promote effective resolution of sexual harassment within the healthcare sector in the country. Sexual harassment against nurses could be hampering quality healthcare delivery in the region.

Prevalence and correlates of workplace violence against medical assistants in Germany: a cross-sectional study

BACKGROUND

Workplace violence is widespread, but studies on workplace violence against health professions in outpatient settings are sparse. We aimed to examine, for the first time, the prevalence of workplace violence against medical assistants as well as potential sociodemographic, occupational and health-related correlates of the exposure to workplace violence.

METHODS

We used data from a survey (03-05/2021) among medical assistants in Germany (n = 424). We assessed the 12-month prevalence (yes/no) of verbal violence, physical violence, and sexual harassment as well as the types of perpetrators of workplace violence. Further, information was gathered on sociodemographic (e.g., age, educational level), occupational (e.g., years in job), and mental health-related factors (i.e., anxiety, depression). The 12-month prevalences of the different types of workplace violence were merged into a single variable ("any workplace violence" vs. none) for association analysis. We ran multivariable Poisson regression models to examine potential associations between sociodemographic and occupational correlates (i.e., independent variables) with any workplace violence as dependent variable and in addition between any workplace violence (independent variable) and dichotomized mental health as dependent variable.

RESULTS

Overall, 59.4% of the medical assistants reported verbal violence, 5.9% reported physical violence, 3.8% reported sexual harassment, and 60.1% reported any workplace violence in the previous 12 months. Patients were reported to be the main perpetrators, followed by patients' relatives. Younger age, being single, and working in a medical care center were sociodemographic and occupational correlates of workplace violence (PRs ≥ 1.27). Workplace violence was significantly associated with mental health variables (PRs ≥ 1.72).

CONCLUSION

Medical assistants experience workplace violence, in particular verbal violence. To devise preventive measures, prospective studies are needed to confirm the potential risk groups for workplace violence and the potential mental health sequels of workplace violence observed in our study.

Exploring workplace violence on surgical wards in Sweden: a cross-sectional study

BACKGROUND

Workplace violence is a global threat to healthcare professionals' occupational health and safety and the situation has worsened during the COVID-19 pandemic. This study aimed to explore workplace violence directed against assistant and registered nurses working on surgical wards in Sweden.

METHODS

This cross-sectional study was conducted in April 2022. Using a convenience sampling procedure, 198 assistant and registered nurses responded to an online questionnaire developed for this specific study. The questionnaire comprised 52 items and included, among other items, subscales from validated and previously used instruments. Data analysis included descriptive statistics, the chi-square test, and independent-samples t-test.

RESULTS

The most frequently reported type of workplace violence was humiliation (28.8%), followed by physical violence (24.2%), threats (17.7%), and unwanted sexual attention (12.1%). Patients and patients' visitors were reported as the main perpetrators of all kinds of exposure. Additionally, one third of the respondents had experienced humiliation from colleagues. Both threats and humiliation showed negative associations with work motivation and health (p < 0.05). Respondents classified as working in a high- or moderate-risk environment were more frequently exposed to threats (p = 0.025) and humiliation (p = 0.003). Meanwhile, half of the respondents were unaware of any action plans or training regarding workplace violence. However, of those who indicated that they had been exposed to workplace violence, the majority had received quite a lot or a lot of support, mainly from colleagues (range 70.8-80.8%).

CONCLUSION

Despite a high prevalence of workplace violence, and especially of humiliating acts, there appeared to be low preparedness within the hospital organizations to prevent and/or handle such incidents. To improve these conditions, hospital organizations should place more emphasis on preventive measures as part of their systematic work environment management. To help inform such initiatives, it is suggested that future research should focus on the identification of suitable measures regarding different types of incidents, perpetrators, and settings.

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

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

Violence on the front line: a qualitative comparative analysis of the causes of patient violence towards medical staff in China during the COVID-19 pandemic

COVID-19, reduced funding and a shortage of healthcare workers has led to growing international concern about patient violence towards medical staff in medical settings. As the number of reported physical and verbal assaults increases, many medical staff are considering leaving their positions due to the resulting impact on their mental and physical wellbeing, creating a critical need to understand the causes for violence towards medical staff working on the front line. This study aims to examine the causes for patient violence towards medical staff in China during the COVID-19 pandemic. A case library was created containing twenty reported incidents of patient violence towards medical staff during the pandemic in China. Based on the Triadic Reciprocal Determinism (TRD) theory, we identify the personal, environmental, and behavioral factors, that cause incidents of violence towards medical staff. The outcome was set as 'Medical Staff Casualties', referring to whether, due to the violence experienced, the medical staff member was injured or died, or only experienced threatening or insulting behavior. Data was analyzed using Qualitative Comparative Analysis (QCA) to clarify the relationship between the different conditions and their relationship with the outcome. The study's results reveal that Relationship Closeness is a necessary condition for patient violence in the presence of outcome. Secondly, four distinct types of causes for patient violence towards medical staff were identified: Strong Relationship Oriented Violence, Healthcare Resources and Services Mismatched Violence, Violence caused by Ineffective Patient-Physician Communication, and Ineffective Communication Superimposed Low Patient Compliance Violence. Scientific guidance is provided for the creation of measures to prevent future violence towards medical staff from occurring. Strict precautions should be taken for preventing violence to protect a healthy society and harmonious medical environment, emphasizing the need for joint governance of multiple participants.

A peek behind the curtain: An integrative review of sexual harassment of nursing students on clinical placement

AIMS AND OBJECTIVES

This integrative review aimed at systematically searching, analysing and synthesising multiple sources of evidence, to build a temporal understanding of nursing students' experiences of sexual harassment whilst on clinical placement, and to discuss the social context which enables this.

BACKGROUND

Sexual harassment is highly prevalent in workplaces globally. Contemporary social understandings contextualise sexual harassment as a significant form of interpersonal violence. This is the first literature review to go beyond prevalence to synthesise the experience, implications and responses to sexual harassment encountered by student nurses on clinical placement.

DESIGN

Whittemore and Knafl's (2005) integrative review methodology is used to structure a rigorous analysis and synthesis of evidence.

METHODS

The PRISMA checklist supported sound reporting of the search strategy. Three databases (CINAHL, Scopus and Medline) were searched using a Boolean strategy. Papers with a significant focus on sexual harassment of nursing students in the clinical setting were included with no limitation on publication date. Papers were excluded if they were not published in English or were only published as abstracts.

RESULTS

A synthesis of 26 papers demonstrated that sexual harassment has significant impacts on student nurses and the nursing profession. The intimacy of close body care, dominant social perceptions of nursing as women's work and the sexualisation of nurses increase student vulnerability to sexual harassment. Workplace power imbalances further exacerbate sexual harassment and shape responses to incidents.

CONCLUSIONS

Sexual harassment of nursing students is widespread and impacts student well-being and learning.

RELEVANCE TO CLINICAL PRACTICE

Education is a strong protective factor and should target students, clinicians, clinical facilitators and academics. Attention to workplace culture, and processes that support disclosure and reporting, is also required to meaningfully address the sexual harassment of nursing students.

Crisis social support after work-related violence and threats and risk for depressive symptoms: a 3-months follow-up study

INTRODUCTION

Employees working at psychiatric wards are at risk for work-related threats and violence that may impact their physical and mental health. Studies have found that crisis social support may mitigate these adverse health effects.

PURPOSE

To examine the effects crisis social support on depressive symptoms 3 months after a violent or threating work incident and furthermore, to examine the effect of variations in prolonged social support on depressive symptoms during 3 months after a violent or threating incident.

METHODOLOGY

After exposure to work-related violence and threats at work, the employees received a questionnaire within the first month and after 3 months. Right after the incident, 374 employees answered both the depression and crisis support items and were included in the analyses. 3 months later 276 employees answered both the depression and social support items. Prospective associations between crisis social support and depression were calculated using stepwise regressions and linear mixed models.

RESULTS

Crisis social support at T1 was significantly and inversely associated with a lower level of depressive symptoms at T2, Std. Beta =  - 012, t (3) =  - 2.1, p = .040. Employees experiencing either a stable or increasing level of support from T1 to T2 had significantly lower levels of depressive symptoms compared to employees who experienced a decrease in support in the same period, mean difference_{Stable-Decreasing} = 4.0 t (190) = 5.2, p = 0.006 and mean difference_{Increasing-Decreasing} = 7.6, t (189) = 5.3, p < .001.

CONCLUSION

The study results indicate that depressive symptoms following work-related violence or threats can be mitigated by prolonged social support. We recommend that organizations continue to offer crisis social support in the subsequent months, and not just immediately after a violent or threating incident.

Frequency and Impacts of Verbal Abuse on Healthcare Workers in a Secondary Healthcare Structure in Greece

BACKGROUND

Threatening and aggressive behaviors in healthcare settings constitute a significant problem that can affect not only the physical and mental integrity of staff but also patient safety and the quality of healthcare. Literature highlights verbal abuse as the most common form of non-physical violence and is estimated from 51.8% to 63.4% worldwide.

PURPOSE

The purpose of the study was the investigation of verbal abuse incidence toward physicians and nurses and the differences noted between them in a regional hospital.

METHODS

The study took place in a public regional hospital in southern Greece. A number of 185 nurses and 60 physicians completed the verbal abuse scale (VAS) for assessing verbal violence in the work environment; selected socio-demographic and occupational characteristics were also recorded.

RESULTS

Physicians have undergone verbal abuse once a week at a percentage of 38.3%, while at the same frequency; nurses record a percentage of 12.4%. Regarding the relationship between the victim of verbal abuse and the abuser, 26.7% of the physicians answered that the abuser was another senior member of the staff, while the percentage for nurses is higher and reaches 31.9%. According to VAS items, accusing and blaming (mean±SD=3.00±0.96) is noted as the most common form of verbal abuse for physicians, judging and criticizing stands out as the most frequent (3.17±1.11) and the most stressful action (3.25±1.11) form for nurses. The most frequent behavior by the physicians is to put the verbal abuse situation in a humorous context (2.78±1.14). In contrast, nurses are trying to clarify any misunderstanding that may occur (3.10±1.00).

CONCLUSIONS

Verbal abuse incidents are experienced by both physicians and nurses. They are stressful for the victims and can significantly affect work relationships and job satisfaction.

The burden in palliative care assistance: A comparison of psychosocial risks and burnout between inpatient hospice and home care services workers

OBJECTIVE

Literature suggests that home care professionals could be at higher risk of burnout than their colleagues in hospital settings, but research on home-based palliative care is still limited. Our study investigates psychosocial risk factors and burnout among workers involved in palliative care, comparing inpatient hospice, and home care settings.

METHOD

A cross-sectional study was carried out in a single palliative care organization providing inpatient hospice-based and home care-based assistance in a large urban area of Northern Italy. Participants completed a self-administered questionnaire collecting socio-demographic and occupational data, psychosocial risk factors, and burnout scales (Psychosocial Safety Climate 4; Conflict and Offensive Behavior - COPSOQ II; Work Life Boundaries; Work-home Interaction; Peer Support - HSE; Copenhagen Burnout Inventory).

RESULTS

The study sample included 106 subjects (95% of the overall eligible working population) who were predominantly female (68%) and nurses (57%), with a mean age of 41 years. Compared to inpatient hospice staff, home care workers reported more frequent communications with colleagues (p = 0.03) and patients/caregivers (p = 0.01), while there were no differences in the perception of work intrusiveness. Inpatient hospice workers showed lower peer support (p = 0.08) and lower psychosocial safety climate (p = 0.001) than home care colleagues. The experience of aggressive behaviors was rare, and it was relatively more frequent among inpatient hospice workers, female workers, and health assistants. Average scores of burnout scales were similar for both groups except for caregiver-related burnout, which was higher among inpatient hospice workers compared to home care colleagues (p = 0.008). The number of subjects at risk for work-related burnout was similar for both groups.

SIGNIFICANCE OF RESULTS

Our study confirms the presence of psychological and physical fatigue in both home-based and inpatient hospice palliative care. Results suggest that home care assistance may not be characterized by higher psychological burden compared to inpatient hospice setting. Given the general tendency to increase home-based care in our aging population, it is essential to broaden the knowledge of psychosocial risks in this specific context to properly protect workers' health.

Aggression in mental health care: Opportunities for the future-A qualitative study on the challenges when defining and managing aggression across inpatient disciplines

WHAT IS KNOWN ON THE SUBJECT?: Aggression towards caregivers is a global phenomenon in mental health care. Although attempts have been made to define aggression, there is no globally accepted definition. Discrepancies in defining aggression can lead to differences in judgement and a sub-par management of aggression. The fact that different disciplines work together in mental health care makes it an even more pressing matter as no research was found regarding a multidisciplinary definition of aggression. Currently, coercive measures, such as isolation, sedation or restraints, are the most common ways of managing aggression. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Mental healthcare nurses and psychologists defined aggression by previous experiences, and they also agree that there are no alternatives in managing aggression when non-coercive techniques do not work. Several opportunities and examples of best practice were given by the participants, but the consensus was that caregivers are in need of alternatives when they are face to face with acute aggression. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: It is vital for residential units to agree on a definition of aggression and acute aggression. It is our belief that this can aid them in preventing and de-escalating aggression as well as diminishing the use of coercive measures. Further primary research exploring the opportunities of non-coercive techniques, a multidisciplinary approach and the relationship between a workplace culture normalizing aggression and the mental well-being of healthcare workers is also needed.

ABSTRACT

INTRODUCTION: Aggression by patients against healthcare workers is a global recurring phenomenon in mental health care. Discrepancies in defining aggression can lead to differences in judgement, which in turn causes difficulties in managing aggression. The multidisciplinary nature of mental healthcare makes a standardized definition an even more pressing matter. No studies, however, were found exploring the way different disciplines approach the definition of aggression. Although traditional methods of managing aggression rely on coercive methods, current research favours the use of non-coercive measures.

AIM

The aim of this study was to explore the different ways mental healthcare nurses and psychologists define and manage aggression in a residential unit.

METHOD

A qualitative research design was used, consisting of interviews and focus groups. Transcripts were analysed using a reflexive thematic approach.

RESULTS

Three major themes were found: (1) approaches towards defining aggression, (2) experiencing aggression and (3) managing aggression: the need for alternatives.

DISCUSSION

In this study, aggression is defined by how aggression has been experienced, both mental health nurses and psychologists agree that there are no alternatives in managing aggression when non-coercive techniques do not work. Aggression is considered an integral part of the job indicating an "aggression-tolerating" workplace.

IMPLICATIONS FOR PRACTICE

Three implications for practice were identified: (1) It is vital for residential units to agree on a broad-based definition of aggression, (2) further primary research exploring the opportunities of non-coercive techniques and a multidisciplinary approach is crucial and (3) the relationship between a workplace culture normalizing aggression and the mental well-being of healthcare workers also needs further study.

Impact of workplace bullying and burnout on job satisfaction among Bangladeshi nurses: A cross-sectional study

Background

Job satisfaction is one of the most important but least researched issues in the nursing profession in Bangladesh. This study aimed to investigate how workplace bullying and burnout are related to job satisfaction, as well as determine the factors that are associated with job satisfaction among Bangladeshi nurses.

Methods

Data were collected from Bangladeshi registered nurses between February 26, 2021, and July 10, 2021, in this cross-sectional study. Bullying, burnout, and job satisfaction were measured with the Short Negative Acts Questionnaire [S-NAQ], the Burnout Measure-Short version (BMS), and the Short Index of Job Satisfaction (SIJS-5), respectively. The correlations between age, bullying, burnout, and job satisfaction were assessed using a Pearson's correlation test. In order to investigate the adjusted association of demographic characteristics, occupational variables, bullying, and burnout with job satisfaction, multiple linear regression models were fitted.

Results

The study included 1,264 nurses (70.02% were female) with a mean age of 28.41 (±5.54) years. Job satisfaction was significantly negatively correlated with bullying and burnout (p < 0.001). According to the multiple linear regression models, the private-employed nurses had lower job satisfaction than the government-employed nurses (β = -0.901, CI: -1.640 to -0.162). Compared to the nurses in the Dhaka division, the nurses in the Chattogram division (β = 0.854, CI: 0.099 to 1.609) and other divisions (β = 0.993, CI: 0.273 to 1.713) had higher job satisfaction. Nurses without sufficient equipment to manage patients (β = -1.230, CI: -1.696 to -0.763), and nurses not paid on time (β = -1.475, CI: -2.221 to -0.729) were predicted to have significantly lower job satisfaction. Nurses' job satisfaction levels were decreased with higher levels of workplace bullying (β = -0.086, CI: -0.120 to -0.053), and burnout (β = -1.040, CI: -1.242 to -0.838).

Conclusions

Nurses' job satisfaction was correlated with workplace bullying and burnout. Moreover, insufficient professional support from the authorities predicted nurses' job satisfaction. Reducing the instances of bullying and burnout among nurses, as well as improving their working environment, are essential to increase job satisfaction. This is possible with the support of hospital management, policymakers, and government authorities.

Psychological Reactions of Lebanese Nurses to Workplace Violence in Critical Care Units

Introduction

Workplace violence (WPV) is a growing concern that constitutes a major threat to occupational health and safety, thereby comprising a priority issue for policymakers. Given the increasing prevalence of chronic diseases and comorbidities among the Lebanese population, nurses working in critical care settings encounter intense workloads and high-risk interactions, potentially increasing the risk of WPV.

Objectives

This study aimed to investigate the traumatic and psychological reactions of Lebanese critical nurses who have been exposed to WPV, and the risk factors for depression and anxiety.

Methods

The study utilized a cross-sectional descriptive correlational design; 112 critical care nurses from diverse departments took part in this study during the period of June to July 2021.

Results

A positive, significant correlation between WPV exposure and self-reported anxiety was observed, p = .03 with high levels of WPV, especially among patients and their families. Although verbal abuse was found to be more prevalent among critical care nurses in Lebanon compared to physical and sexual violence, the severity of the situation and its impact on the nurses' mental health and well-being cannot be ignored.

Conclusions

WPV for critical care nurses is a serious issue that needs to be considered. Policy-makers should develop the politics of regulating the nursing profession, especially for critical care nurses in Lebanon.

A Systematic Review of Violence Risk Assessment Tools Currently Used in Emergency Care Settings

INTRODUCTION

Violence risk assessment is commonplace in mental health settings and is gradually being used in emergency care. The aim of this review was to explore the efficacy of undertaking violence risk assessment in reducing patient violence and to identify which tool(s), if any, are best placed to do so.

METHODS

CINAHL, Embase, Medline, and Web of Science database searches were supplemented with a search of Google Scholar. Risk of bias assessments were made for intervention studies, and the quality of tool development/testing studies was assessed against scale development criteria. Narrative synthesis was undertaken.

RESULTS

Eight studies were included. Three existing violence risk assessment tools featured across the studies, all of which were developed for use with mental health patients. Three newly developed tools were developed for emergency care, and 1 additional tool was an adaptation of an extant tool. Where tested, the tools demonstrated that they were able to predict patient violence, but did not reduce restraint use. The quality issues of the studies are a significant limitation and highlight the need for additional research in this area.

DISCUSSION

There is a paucity of high-quality evidence evaluating the psychometric properties of violence risk assessment tools currently used along the emergency care pathway. Multiple tools exist, and they could have a role in reducing violence in emergency care. However, the limited testing of their psychometric properties, acceptability, feasibility, and usability in emergency care means that it is not possible to favor one tool over another until further research is conducted.

The Lived Experience of Workplace Violence Among Emergency Nurses

INTRODUCTION

Workplace violence remains a significant threat to the United States health care workforce. With increasingly aggressive patients, emergency nurses reported that the increased prevalence of workplace violence impacted their professional and personal lives.

METHODS

This study employed a qualitative, descriptive phenomenological approach with purposive sampling. Participants were asked to describe their lived experience with workplace violence while working as emergency nurses and how this affected them personally and professionally.

RESULTS

Eleven experienced emergency registered nurses from 3 mid-Atlantic hospitals participated in the study. After reviewing, clustering, and validating significant statements, 4 major themes were identified: walking wounded to wounded healer, unexpected shock, betrayal, and resilient but changed.

DISCUSSION

Our findings were consistent with other studies exploring the effects of workplace violence in emergency departments. We validated that trauma has long-lasting effects. Organizations should ensure that programs and processes are in place to support the nurse or health care worker when workplace violence events occur.

Workplace sexual harassment toward male nurses in South Korea: a cross-sectional online survey

Background

Many studies have focused on sexual harassment of female nurses perpetrated by patients and coworkers. However, as males in a female-dominated occupation, male nurses are also at risk of being exposed to sexual harassment. The aim of this study was to examine the prevalence of workplace sexual harassment faced by male nurses in South Korea and to identify related factors.

Methods

A cross-sectional study was conducted using an online survey that recruited male nurses working in various general hospitals in South Korea. In total, 246 participants with at least 6 months of clinical experience enrolled in an online survey, and 155 male nurses were included in the final analysis. Data were collected from May 31, 2019 to July 26, 2020. Items on the questionnaire included sexual harassment experiences, nursing work environment, and general characteristics of the participants. Descriptive statistics were used to analyze participants’ general characteristics and a negative binomial regression model was used to analyze predictors of workplace sexual harassment.

Results

The mean number of sexual harassment incidents was 3.2 ± 5.5. The majority (65.2%) of male nurses had experienced sexual harassment at least once at work. The negative binomial regression model in the study was found to be acceptable (likelihood ratio chi-square = 30.03, df = 18, p = .037). The perceived nursing work environment was the only significant predictor of sexual harassment towards male nurses (p = .001; incidence rate ratio = 0.37; 95% CI, 0.20–0.66).

Conclusions

Nursing administrators must recognize that men in female-dominated occupation may experience sexual harassment in the workplace. Specific and realistic managerial policies and educational programs should be implemented to prevent workplace sexual harassment and improve the nursing work environment for male nurses.