Workplace Violence in the Setting of Pain Management

Perpetrators of gender-based workplace violence amongst nurses and physicians-A scoping review of the literature

In healthcare settings worldwide, workplace violence (WPV) has been extensively studied. However, significantly less is known about gender-based WPV and the characteristics of perpetrators. We conducted a comprehensive scoping review on Type II (directed by consumers) and Type III (perpetuated by healthcare workers) gender based-WPV among nurses and physicians globally. For the review, we followed the Preferred Reporting Items for Systematic and Meta Analyses extension for Scoping Review (PRISMA-ScR). The protocol for the comprehensive review was registered on the Open Science Framework on January 14, 2022, at https://osf.io/t4pfb/. A systematic search in five health and social science databases yielded 178 relevant studies that indicated types of perpetrators, with only 34 providing descriptive data for perpetrators' gender. Across both types of WPV, men (65.1%) were more frequently responsible for perpetuating WPV compared to women (28.2%) and both genders (6.7%). Type II WPV, demonstrated a higher incidence of violence against women; linked to the gendered roles, stereotypes, and societal expectations that allocate specific responsibilities based on gender. Type III WPV was further categorized into Type III-A (horizontal) and Type III-B (vertical). With Type III WPV, gendered power structures and stereotypes contributed to a permissive environment for violence by men and women that victimized more women. These revelations emphasize the pressing need for gender-sensitive strategies for addressing WPV within the healthcare sector. Policymakers must prioritize the security of healthcare workers, especially women, through reforms and zero-tolerance policies. Promoting gender equality and empowerment within the workforce and leadership is pivotal. Additionally, creating a culture of inclusivity, support, and respect, led by senior leadership, acknowledging WPV as a structural issue and enabling an open dialogue across all levels are essential for combating this pervasive problem.

A gender-based review of workplace violence amongst the global health workforce-A scoping review of the literature

Workplace violence (WPV) impacts all levels of the health workforce, including the individual provider, organization, and society. While there is a substantial body of literature on various aspects of WPV against the health workforce, gender-based WPV (GB-WPV) has received less attention. Violence in both the workplace and broader society is rooted in gendered socio-economic, cultural, and institutional factors. Developing a robust understanding of GB-WPV is crucial to explore the differing experiences, responses, and outcomes of GB-WPV with respect to gender. We conducted a scoping review and report on the prevalence and risk factors of GB-WPV in healthcare settings globally. The review followed the Preferred Reporting Items for Systematic and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). We registered the scoping review protocol on the Open Science Framework on January 14, 2022, at https://osf.io/t4pfb/. A systematic search was conducted of empirical literature in five health and social science databases. Of 13667, 226 studies were included in the analysis. Across the studies, more women than men experienced non-physical violence, including verbal abuse, sexual harassment, and bullying. Men experienced more physical violence compared to women. Younger age, less experience, shifting duties, specific clinical settings, lower professional status, organizational hierarchy, and minority status were found to be sensitive to gender, reflecting women's structural disadvantages in the workplace. Given the high prevalence and impact of GB-WPV on women, we provided recommendations to address systemic issues in clinical practice, academia, policy, and research.

Pain Management and Sociology Implications: The Sociomedical Problem of Pain Clinic Staff Harassment Caused by Chronic Pain Patients

Background

Patients with chronic pain often experience psychological issues. They may also exhibit harassing behaviors toward healthcare staff. This complex sociomedical issue necessitates increased attention.

Objectives

This study analyzed incidents of staff harassment caused by chronic pain patients. It examined the characteristics of chronic pain patients who harassed clinic staff, as well as the causative or associated factors. The study also explored the management and outcomes of these harassment incidents.

Methods

This prospective observational study involved 1102 chronic pain patients who received treatment at a pain clinic. Data were prospectively collected on patients' gender, age, ethnicity, occupation, injury insurance claims, and incidents of staff harassment caused by patients.

Results

Pain clinic staff were harassed by 121 patients (11%). Among the harassers, females constituted 70.2% and males 29.8%. Additionally, 50.4% of the harassers were unemployed, with unemployed patients causing more staff harassments (P = 0.001). A significant portion, 86 %, of the harassers had injury insurance claims and were associated with a higher incidence of staff harassments (P = 0.002). Patients making disability insurance claims also caused more staff harassments (P = 0.001). Among the harassers, 50.4 % demanded higher drug doses, and 50% did not have regular primary healthcare providers. The types of harassment included insults (34.7%), threats (19.8%), retaliations (3.3%), and sexual harassment (42.2%). All cases of sexual harassment were addressed; the patients involved were counseled. Most harassment incidents were resolved through tactful communication. Of the harassers, 9.9 % were discharged from the clinic.

Conclusions

Harassment of pain clinic staff by chronic pain patients is significant. This sociomedical issue may be worsening due to factors such as opioid misuse, racism, the pandemic, and socioeconomic challenges. While most chronic pain patients are reasonable, some can be challenging. This study confirmed that the majority of patients who harassed staff were female, unemployed, had made injury insurance claims, and demanded higher drug doses. Abusive patients should receive anxiolytic therapy, behavioral boundaries, counseling, distraction therapy, and empathy. Pain clinics should implement staff training and support programs to protect staff from harassment. Additionally, pain clinicians should establish peer support networks to mitigate the psychological impacts of patient aggression and maintain professional well-being.

Violence in the pain clinic: the hidden pandemic

Workplace violence is any physical assault, threatening behavior or other verbal abuse directed toward persons at work or in the workplace. The incidence of workplace violence in healthcare settings in general and more specifically the pain clinic is thought to be underestimated due to hesitancy to report, lack of support from management and healthcare systems, and lack of institutional policies as it relates to violence from patients against healthcare workers. In the following article, we explore risk factors that place clinicians at risk of workplace violence, the cost and impact of workplace violence, how to build a violence prevention program and lastly how to recover from violence in the practice setting.

Psychological stress responses of medical staff after workplace violence: a longitudinal study

OBJECTIVE

To explore the occurrence and dynamic trends of psychological stress responses of medical staff experiencing workplace violence at different time points.

METHODS

A longitudinal study of 23 medical workers who experienced workplace violence was conducted. The perceived stress scale (PSS-4), posttraumatic stress disorder checklist for DSM-5 (PCL-5), and hospital anxiety and depression scale (HADS) were used to measure the medical workers' psychological perception of pressure, posttraumatic stress symptoms, anxiety, and depression at the time of exposure to violence, at 1 month, 2 months, and 4 months after exposure in the workplace, respectively. Repeated measures analysis of variance was applied to analyze psychological stress response and temporal effect. Factors influencing psychological stress responses were analyzed.

RESULTS

The scores of PSS-4, PCL-5, HADS-anxiety, and HADS-depression of medical staff exposed to violence began to increase at the time of exposure, peaked 1 month after exposure, and gradually decreased 2 months and 4 months after exposure (all P<0.05). The main influencing factors were being nurses, physical violence, working years ≤5, and being female.

CONCLUSION

Effective interventions for medical staff should be made up to 1 month after exposure to workplace violence when the psychological stress responses are the highest.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Facilitators and Barriers to Nurse Practitioners Prescribing Methadone for Opioid Use Disorder in Nova Scotia: A Qualitative Study

Background

Opioid use has escalated dramatically resulting in an increase in deaths. Access to treatment for opioid use disorder (OUD) is poor. The addition of nurse practitioners (NPs) as prescribers of methadone for OUD offers potential for improving access. Little is known about what support NPs will require as they prescribe methadone.

Purpose

This paper identifies facilitators and barriers to NPs prescribing methadone.

Methods

In this qualitative study, in-person and phone semi-structured interviews were conducted with 18 participants. Participants included NPs (n=5), physicians (n=5), and stakeholders including members of professional regulatory bodies and government, academics and other clinicians (n=8). Interviews were recorded, transcribed, and analyzed using thematic analysis and software (NVivo 12.4.0) for data management.

Results

Four themes emerged: 1) Pervasive Barrier of Stigma; 2) Perceived Complexity of Patients Living with OUD; 3) NP Education and Practice Supports and; 4) Health Care Context and NP Role Implementation.

Conclusions

Barriers and facilitators to NP prescribing are similar to those encountered by physicians. Factors unique to NPs include the identification of role clarity as a facilitator and navigation of physician networks as a barrier. Research conducted with current NP methadone prescribers is required to evaluate implementation of this service.