Prevalence and Effect of Workplace Violence against Emergency Nurses at a Tertiary Hospital in Kenya: A Cross-Sectional Study

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.

The prevalence of physical and verbal violence among emergency medicine physicians in military hospitals vs non-military hospitals, Jeddah, Saudi Arabia: multi-center cross-sectional study

INTRODUCTION

In healthcare settings, physical and verbal attacks are commonly encountered in the workplace among healthcare providers. Patients and patients' relatives and friends have been reported to be the perpetrators of workplace violence. Among all healthcare settings, emergency department (ED) have been designated as high-risk settings for violence, where more than one-quarter of emergency physicians reported that they were victims of physical assault. This study aimed to report the prevalence of workplace violence against emergency medicine physicians in military and non-military hospitals in Jeddah city.

METHODOLOGY

A cross-sectional design has been used in this study. An electronic questionnaire was developed through the Google Form Platform and it included demographic data, the occurrence of verbal or physical violence in the workplace to participants, how many times they experienced this violence, the time of incidents, the location either inside or outside the hospital, whether the perpetrators were mostly patients, patient families, or friends, and whether they reported any violence or not. Categorical variables were used to describe frequencies and percentages, while descriptive statistics such as mean and 95% Confidence Interval (95% CI) were used to summarize the scale variables. P < 0.05 was considered for statistically significant differences.

RESULTS

Among the 100 participants, 76 experienced either physical or verbal violence, or both. The remaining 24 did not experience any sort of violence. 83% of the physicians who have been physically violated were working in non-military hospitals. Of the 72 participants who had experienced verbal violence, 51 (70.8%) were working in a non-military hospital, while 21 (29.2%) were in a military hospital. The most common reason for not reporting was that the participants felt that reporting the violence incidence was useless. Moreover, 92% of participants chose "Train healthcare workers to deal with violent attacks" as a suggested helpful factor in decreasing the number of work-related violence. In addition, "Education of the public" and "Raising awareness of healthcare workers" were chosen as helpful factors as well by 91% and 90% of participants, respectively.

CONCLUSION

This revealed that physicians in non-military hospitals experience higher levels of violence compared to their military counterparts. However, it is concerning that instances of violence are substantially under-reported across both military and non-military healthcare facilities.

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.

Prevalence and Determinants of Workplace Violence Against Pediatric Emergency Healthcare Workers and Its Effect on Their Psychological Resilience

The study aimed to determine the prevalence and risk factors of workplace violence (WPV) against pediatric emergency healthcare workers and evaluate the relationship between WPV and psychological resilience. This study is cross-sectional and correlational. According to the results, the prevalence of WPV was 69.8%, and its distribution was as follows: verbal abuse (56.9%), bullying/mobbing (37.6%), physical abuse (12.8%), and sexual abuse (2.2%). Being single/separated/divorced/widowed (odds ratio [OR]: 1.85, 95% confidence interval [CI]: 1.03-3.30), being a physician (OR: 4.74, 95% CI: 1.73-12.96), being a staff member (OR: 2.57, 95% CI: 1.10-5.99), routine direct physical contact with patients/clients (OR: 2.77, 95% CI: 1.40-5.48), and lack of encouragement to report WPV (OR: 3.76, 95% CI: 2.01-7.01) were independent predictors of WPV (P < .05), and WPV was found to be associated with low psychological resilience. Arrangements related to violence prevention, preparation, and intervention should be made and maintained in all pediatric emergency departments.

Discrimination and Abuse Among Healthcare Workers from Patients and their Relatives at a Tertiary Hospital in Kenya

Discrimination and abuse of healthcare workers (HCWs) by patients and their relatives remains a pressing and prevalent problem in various healthcare settings, negatively affecting professional outcomes. Despite this, little has been reported about discrimination and abuse in many low- and middle-income countries such as Kenya. We conducted a cross-sectional survey study between May - August 2021 among healthcare workers at a hospital in Kenya. Email invitations were sent, and the survey was in English, and the data was collected through and online survey. Discrimination based on gender was reported by 24.9% of all HCWs; 39.9% of doctors, 17.2% of nurses, and 10.9% of allied staff whereas racial discrimination was reported by 28.8% of all HCWs; 49.0% of doctors, 18.9% of nurses, and 8.9% of allied staff. Verbal or emotional abuse was the most common form of abuse and was reported by 56.8% of all HCWs while physical abuse was reported by 4.9% of all HCWs. For those that reported discrimination based on gender, 77.4% reported patient and their family members as the main source, whereas 81.2% of those that reported discrimination based on race reported the main source was from patient and their family members. Despite strict laws against discrimination and abuse, a significant portion of healthcare providers suffer from discrimination and abuse primarily from patients and their family members. In addition to education programs and policies to curb such behavior in the work environment, coping mechanisms should be actively sought to help healthcare providers deal with such actions.

The effects of an educational intervention based on the protection motivation theory on the protective behaviors of emergency ward nurses against occupational hazards: a quasi-experimental study

BACKGROUND

Emergency ward nurses face a variety of occupational hazards due to the nature of their occupational and professional duties, which can negatively affect their health. Therefore, this study aimed to evaluate the effects of an educational intervention based on the protection motivation theory on the protective behaviors of emergency ward nurses against occupational hazards in Tehran, Iran, in 2023.

METHODS

The present quasi-experimental study was conducted with two intervention and control groups, using a pretest-posttest design. A total of 124 nurses working in the emergency wards of four hospitals (two hospitals for the intervention group and two hospitals for the control group by random assignment) were selected by multistage sampling method. The educational intervention based on the protection motivation theory was implemented for the intervention group for three weeks. The nurses of both groups completed a demographic questionnaire and the scale of emergency ward nurses' protective behaviors against occupational hazards before, immediately, and one month after the intervention. Data analysis was performed using descriptive and inferential methods.

RESULTS

The two groups were similar in terms of demographic characteristics at the baseline (p > 0.05). Protective behaviors of emergency nurses against occupational hazards and their sub-scales (physical, chemical, biological, ergonomics, and psychosocial hazards) were higher in the intervention group than in the control group immediately and one month after the educational intervention. In addition, the measurement over time also showed the positive effect of time and educational intervention on the protective behaviors of emergency nurses against occupational hazards and their sub-scales in the intervention group.

CONCLUSION

These findings showed that the educational intervention based on the protection motivation theory can be effective and helpful in improving the protective behaviors of emergency ward nurses against occupational hazards and their sub-scales. Future studies can focus on a more specific design of this kind of intervention based on the type of occupational hazards and needs of nurses in different wards.

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.

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

AIM

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

DESIGN

Integrative review.

DATA SOURCES

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

REVIEW METHODS

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

RESULTS

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

CONCLUSION

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

IMPACT

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

NO PATIENT OR PUBLIC CONTRIBUTION

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

WHAT ALREADY IS KNOWN

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

WHAT THIS PAPER ADDS

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

IMPLICATIONS FOR PRACTICE/POLICY

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

Nurses' experiences of workplace violence in the emergency department

THE AIM

To describe nurses' perceptions about predisposing factors, nurses' roles and effective strategies to combat workplace violence (WPV) in the emergency department (ED).

BACKGROUND

Various forms of WPV against nurses is highly prevelent in EDs in Jordan and elsewhere. There is a dearth of information about predisposing factors for WPV and what strategies nurses use to counter this.

METHOD

A qualitative descriptive design was used to describe nurses' perceptions about their roles and effective strategies regarding WPV. A purposive sample of 24 nurses (12 male and 12 female) who were working in the ED at two Jordanian hospitals participated in this study. Semi-structured interviews were conducted for each participant. The data were analysed using Colaizzi's narrative analysis steps and the Lincoln and Guba's framework to ensure credibility and trustworthiness.

RESULTS

Three major themes emerged from the analysis of the data: (1) predisposing factors for WPV  in ED, (2) the roles adopted by nurses in WPV incidents and (3) beneficial strategies to counter WPV.

CONCLUSION

Participant nurses provided insights into the predisposing factors of WPV in Jordanian EDs. A range of strategies and roles used by nurses to counter WPV in health institutions and community contexts were identified. However, the effective strategies used by nurses confronted by WPV did not emerge from having been trained or educated for such crises and therefore WPV remains underestimated and underreported.

IMPLICATION FOR NURSING POLICYMAKERS

Violence of all types is a crime and laws need to be not only strong but also appropriately enforced. Employers have a legal responsibility to provide a safe workplace for staff. Their organizational policies about workplace safety must reflect national laws as well as the human rights of people who come to work in their organizations. Workplace policies need to emphasise safety measures, professional training and education for assuring a safe hospital environment. It is crucial to conduct culturally competent programmes for preventing and countering WPV, taking into consideration the nurses' Jordanian cultural backgrounds and context.

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

BACKGROUND

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

AIMS

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

DESIGN

A descriptive qualitative study.

METHODS

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

RESULTS

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

CONCLUSION

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

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.

Violence against health care workers in a crisis context: a mixed cross-sectional study in Eastern Democratic Republic of Congo

BACKGROUND

Health Care Workers (HCWs) in conflict zones face high levels of violence while also playing a crucial role in assisting the population in distress. For more than two decades, the eastern provinces of the Democratic Republic of the Congo (DRC), have been wracked by conflict. This study aims to describe the state of violence against HCWs and the potential prevention mechanisms in eastern DRC.

METHODS

In North and South Kivu, between February 5 and 21, 2021, we conducted a mixed cross-sectional convergent study in health facilities (health centers and hospitals). An anonymized self-administered questionnaire was sent to HCWs about their experience of violence in the 12 months prior to the study. In-depth individual interviews with HCWs, present on the day of the investigation, were also done to explore their experience of violence. A descriptive analysis of the quantitative data and a thematic analysis of the qualitative data was carried out.

RESULTS

Of a total of 590 participants, 276 (45.9%) reported having experienced violence in the 12 months before the study. In North Kivu, aggressors were more frequently the patients (43.7% vs. 26.5%) and armed group members (14.3% vs. 7.9%) than in South Kivu. Most respondents (93.5%) reported verbal aggression (insults, intimidation, death threats). Other forms of physical aggression including with bare hands (11.2%), firearm (1.81%), and stabbing (4.7%). Only nearly one-tenth of the attacks were officially reported, and among those reported a higher proportion of sanctions was observed in South Kivu (8.5%) than in North Kivu (2.4%). The mechanisms proposed to prevent violence against HCWs were community initiatives and actions to strength the health system.

CONCLUSIONS

In Eastern DRC, HCWs face multiple and severe forms of aggression from a variety of individuals. The effects of such levels violence on HCWs and the communities they served could be devastating on the already pressured health system. Policy framework that defines the roles and responsibilities for the protection of HCWs and for the development and implementation of preparedness measures such as training on management of violence are possible solutions to this problem.

Nursing and midwifery education, regulation and workforce in Kenya: A scoping review

AIM

To explore contextual literature on nursing and midwifery education, regulation and workforce in Kenya to develop an understanding of the current state and inform opportunities to strengthen the nursing and midwifery professions.

INTRODUCTION

Kenya has yet to achieve the minimum nursing and midwifery workforce threshold, despite the exponential increase in population and epidemiologic disease transitions.

BACKGROUND

There are glaring health gaps and inequities in sub-Saharan African countries. Health systems are evolving into complex and costly utilities, increasing the demand for nurses and midwives. It is, therefore, necessary to re-examine systems that educate, deploy and retain the nursing workforce, especially given the ongoing COVID-19 pandemic and increase in non-communicable diseases.

METHODS

This scoping review was guided and reported following the PRISMA-ScR guidelines. Four electronic databases (PubMed, Scopus, CINAHL and Web of Science) were probed for relevant studies conducted in Kenya between 1963 and 2020. The search was supplemented using Google Scholar. Findings from selected studies were extracted and analysed thematically.

RESULTS

Of the 238 retrieved studies, 37 were included in this review: 10 articles on nursing and midwifery education, 11 on regulation and 16 on the workforce.

DISCUSSION

There have been changes in regulation and an increase in nursing and midwifery enrolment and graduates. However, maldistribution and shortage of nurses and midwives persist.

CONCLUSIONS

Kenya's nursing and midwifery professions have undergone significant changes to meet the demand for a skilled workforce. However, the shortage of qualified and specialised nurses and midwives persists. Moreover, this shortage is exacerbated by underinvestment, outmigration and a need for more reforms to expand the nursing and midwifery workforce.

IMPLICATION FOR NURSING AND MIDWIFERY POLICY

Investment in nurse and midwifery education, mentorship and legislation is needed to build the capacity of the profession to provide quality health services. Several nursing and midwifery policy changes utilising a multipronged approach involving stakeholders' collaboration are suggested to address the bottlenecks from education to deployment.

Lived Experience of Violence Perpetrated by Treated Patients and Their Visitors in Intensive Care Units: A Qualitative Study of Nurses

BACKGROUND

Patient and visitor violence (PVV) is a widespread problem for health professionals. Nurses working in intensive care units (ICUs) face a relatively high risk of experiencing PVV, which significantly impacts both the health of nurses and the institution as a whole. The subjective perceptions of ICU nurses regarding PVV are inadequately explored in the literature.

PURPOSE

The purpose of this study was to explore the perspectives, experiences, and perceptions of PVV in ICU nurses and to better understand the precipitating factors of violence.

METHODS

A phenomenological qualitative design and purposive sampling were used. A semistructured interview guide was used to conduct in-depth interviews with 12 ICU nurses with PVV experiences. Giorgi's method of analysis was used to discover and identify the essential categories of experience.

RESULTS

Five main experience categories were identified: family and patient factors as flashpoints, managing suppressed emotions by weathering the emotional storm, spiritual awakening after violence, and strategies for surviving further violence. The participants' experiences with PVV included a range of caring and mental health difficulties. In ICU settings, patient progress is often unpredictable, resulting in discrepancies between patient/family expectations and reality. Because feelings of frustration and powerlessness can eventually cause exhaustion in ICU nurses, implementing effective emotional management, stress adjustment, psychological counseling, team support, and violence intervention programs are crucial.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

This study provides new information on the process by which nurses can progress from inner trauma to self-recovery, moving from a negative affectivity disposition to a better understanding of threat appraisals and coping response options. Nurses should increase their awareness of the complexity of the phenomenon and of the interplay among the factors underlying PVV. The results of this study suggest that routine confusion and delirium assessments to rule out patients with ICU delirium in ICUs are important to preventing PVV. This study considers some of the implications of the research findings for nursing managers. Interventions, training programs, and/or management action should be used to ensure psychological and mental support is extended to all witnesses of PVV events and not only to those targeted by violence.

Systemic relations among the variables involved in occupational accidents of the nursing team in a psychiatric hospital

BACKGROUND

The occupational activities carried out in hospital environments pose occupational risks to professionals. In psychiatric hospitals, due to the characteristics of the patients treated, professionals are also subjected to other risks, such as physical aggression.

OBJECTIVE

This research aimed to identify the systemic context, highlighting the cause-and-effect relationships that culminate in occupational accidents that occurred with the nursing staff in a psychiatric hospital in Brazil.

METHODS

The current study is an applied research and was divided into three stages. First, the collection of data related to the case study was made and accidents were analyzed and occupational hazards were identified. In the second stage, from the collected information, occupational safety indicators were defined. Lastly, in the third stage, the qualitative aspect of System Dynamics was applied to perform the systemic analysis and to identify how the different variables were related.

RESULTS

The results showed that physical aggression was the main cause of accidents. Regarding safety indicators, while both the level of use of Personal Protective Equipment (PPE) by professionals and the high level of PPE protection were positive aspects, the level of training of professionals to use PPE was a negative aspect. The Causal Link Diagram (CLD) showed that the perception of risk influenced the level of use of PPE and those organizational measures influenced the accident rate.

CONCLUSION

In conclusion, the systemic analysis of the system dynamics can optimize the diagnostic process of occupational accidents in psychiatric hospitals, and especially help to identify the cause and effect among the variables involved.

Workplace violence and its associated factors among health care workers of a tertiary hospital in Kathmandu, Nepal

Workplace violence (WPV) is a globally prevailing public health concerns among healthcare workers. Workplace violence includes occupational abuse (physical, sexual, verbal and psychological), threats or harm among health workers, and workplace harassment. It is important to identify the prevalence of workplace violence at the workplace. Therefore, this study aimed to assess workplace violence and its associated factors among healthcare workers at a tertiary hospital in Kathmandu, Nepal. A descriptive cross-sectional study was carried out among 369 health care workers in a tertiary hospital in Kathmandu. A semi-structured questionnaire was used for data collection. Data was entered and analyzed using SPSS v20. Descriptive statistics were used to assess workplace violence and other independent variables. Bivariate and multivariate logistic regression model was used to examine the factors associated with workplace violence. The prevalence of verbal violence was highest among doctors (34.3%) and nurses (52.8%) followed by bullied/mobbed among doctors (11.9%) and nurses (17%) any time in the past. Experience of any type of workplace violence in the past among doctor was 45.5% and among nurses was 54% while 35.8% doctors and 46.8% nurses had experienced it in the past 12 months. Patients and relatives of patient were major perpetrator for physical and verbal violence while management and staff members were major perpetrators for bullying/mobbing. Participants marital status, work experience, posted department, nature of work shift, frequency of night shift and working hours per week showed statistically significant association with the experience of workplace violence within past 12 months (p<0.05) in binary logistic regression analysis. There is a crucial need to establish evidence-based actions to prevent violence in the workplace and promote a healthy workplace setting. Placing adequate staffs at emergency and medical departments and providing training to cope with the stressful emergency situations would help in minimizing workplace violence among health workers.

Workplace Violence among Nurses at a Tertiary Hospital in Myanmar: A Cross-sectional Study

ABSTRACT

Among all types of health-care workers, nursing professionals are at the highest risk of violence since they have to deal with patients and their families directly and frequently. This study aimed to assess the magnitude of both physical and psychological workplace violence (WPV) among nurses at a public hospital in Myanmar and identify related factors. A cross-sectional study was carried out among 192 nurses with a minimum 1-year of working service at a large tertiary hospital using a standard self-administered questionnaire developed by the World Health Organization/International Labour Organization in 2003. The prevalence of overall WPV in the past 12 months was 29.2%. In particular, verbal abuse was the most frequent type (27.1%), followed by bullying/mobbing (7.8%) and physical violence (1.6%). Majority of perpetrators were patient's relatives (62.7%) for verbal abuse and staff members (64.3%) for bullying/mobbing. The reporting rate was very low for verbal abuse (13.5%) and bullying/mobbing were not reported. Logistic regression analysis showed that respondents who were older than 45 years' group (adjusted odds ratio [AOR]: 19.32; 95% confidence interval (CI): 1.99-186.95, P = 0.011), those who were staff nurses (AOR: 17.87; 95% CI: 1.05-33.20, P = 0.046), and those who 1-5 years and 5.1-10 years of working experiences (AOR: 18.68; 95% CI: 3.43-101.65, P = 0.001) (AOR: 15.74; 95% CI: 2.80-88.42, P = 0.002) were more likely to be exposed to WPV than their respective counterparts. Awareness generation about the importance of WPV, enforcing available legal instruments, and establishing management strategies for safe working environments should be emphasized.

Implementation of a Behavioral Emergency Response Team in the Emergency Department

INTRODUCTION

Emergency nurses, physicians, and patients experience occurrences of workplace violence. Having a team to respond to escalating behavioral events provides a consistent approach to reducing occurrences of workplace violence and increasing safety. The purpose of this quality improvement project was to design, implement, and evaluate the effectiveness of a behavioral emergency response team in an emergency department to reduce occurrences of workplace violence and increase the perception of safety.

METHODS

A quality improvement design was used. The behavioral emergency response team protocol was created using evidenced-based protocols that have been shown to be effective in reducing the number of occurrences of workplace violence. Emergency nurses, patient support technicians, security personnel, and a behavioral assessment and referral team were trained in the behavioral emergency response team protocol. Data on occurrences of workplace violence were collected from March 2022 to November 2022. Postbehavioral emergency response team debriefings were conducted, and real-time education was provided after implementation. Survey data were collected to evaluate the emergency team members' perceptions of safety and of the effectiveness of the behavioral emergency response team protocol. Descriptive statistics were calculated.

RESULTS

The number of reported occurrences of workplace violence decreased by to 0 postimplementation of the behavioral emergency response team protocol. The perception of safety increased 36.5% postimplementation (mean 2.2 preimplementation, mean 3.0 postimplementation). In addition, an increase in awareness about reporting occurrences of workplace violence resulted from education and implementation of the behavioral emergency response team protocol.

CONCLUSION

Postimplementation, participants reported an increase in the perception of safety. Implementation of a behavioral emergency response team was effective in reducing assaults toward emergency department team members and increasing the perception of safety.

Violence against Emergency Nurses in Kermanshah-Iran: Prevalence and Associated Factors

Background

Violence against emergency nurses is a global concern with undesirable physical and psychological consequences. This study was conducted to investigate the characteristics of physical and verbal violence against emergency nurses in Iran.

Methods

In this cross-sectional study, 150 nurses working in seven hospitals affiliated to Kermanshah University of Medical Sciences were included in the study using the stratified random sampling method. The data collection tools included a personal information form and a researcher-made questionnaire. Violence-related characteristics were assessed using descriptive statistics. Logistic regression was used to identify factors related to physical and verbal violence.

Results

The frequency rates of physical and verbal violence during the past 12 months were equal to 62% (n = 93) and 94.7% (n = 142), respectively. In both types of physical violence (49.5%, n = 46) and verbal violence (40.4%, n = 57), the nursing station was the most common place of violence. In both physical (n = 40, 43.0%) and verbal violence (n = 101, 71.1%), the most common perpetrator was the patient's family. Most physical violence (57.0%, n = 53) and verbal violence (35.2%, n = 50) occurred in the night shifts. No statistically significant relationship was found between physical and verbal violence and gender, age, marital status, type of employment, and work experience. Discussion. The results indicate the seriousness of workplace violence against nurses. It is necessary to adopt a global approach along with providing sufficient manpower and psychological empowerment of nurses. Further studies with a forward-looking approach are suggested.

Iranian nursing students' experiences of workplace violence: a qualitative study

BACKGROUND

Workplace violence against nursing students is a common phenomenon. This study aimed to investigate Iranian nursing students' experiences of workplace violence, including their reaction to violence and the consequences and the effects of such violence on the students.

METHODS

The study participants were undergraduate nursing students. The data were collected using semi-structured, in-depth face-to-face interviews. Data analysis was carried out with qualitative approach using conventional content analysis.

RESULTS

Four categories were extracted from the analysis of the interview transcriptions: vertical violence, horizontal violence, reaction to violence and consequences of violence. Nurses were the major imposers of violence against students and psychological and verbal violations were the most of used forms of violence. The students reacted to violence in the forms of counteracting, reporting, disregarding and considering as commonplace.

CONCLUSIONS

Workplace violence is a common phenomenon experienced by nursing students in this study, which causes devastating individual, educational, and professional impacts. Action plans including providing safe environment and appropriate support from nurses and educators should be developed in clinical settings to intervene and to prevent workplace violence.

Sexual Harassment and Associated Factors Among Female Nurses: The Case of Addis Ababa Public Hospitals

Background

Sexual harassment of female nurses at work is an issue that is receiving more attention globally and is progressively being acknowledged as a form of gender discrimination in the workplace. Africa’s situation is getting worse every day, especially in Sub-Saharan Africa. Determining the prevalence of workplace sexual harassment and associated factors among female nurses working in Addis Ababa public hospitals was the aim of this study.

Methods

A cross-sectional research design was conducted in August 2021 GC and 339 randomly selected female nurses working in an Addis Ababa public hospital were selected. The data were collected using a pre-tested, semi-structured questionnaire. EPI-Info 7 was used to enter the data, which was then exported to SPSS version 26 for further analysis.

Results

Forty six (46.6) percent of workplaces reported having experienced sexual harassment. One hundred sixty seven (49.3%) of all cases involved physical sexual harassment, while 79 (51.2%) involved verbal sexual harassment. Sexual harassment was 4.64 times more likely to happen to single female nurses than to married people (AOR= 4.64, 95% CI [2.6, 8.4]). Female nurses in the 20–25 age group were roughly 4.7 times more likely to suffer sexual harassment than those in the >40 age group (AOR=4.69, 95% CI [2.44, 9.03]). Alcohol consumers had a 4.5-fold higher chance of experiencing sexual harassment than non-consumers (AOR=4.50, 95% CI [2.40, 8.50]).

Conclusion

Violence among female nurses was demonstrated in this study. It demands a particular focus from the involved bodies. Age, marital status, and alcohol consumption were found to statistically significantly correlate with sexual harassment. Female nurses must get training that emphasizes behavior modification, and healthcare facilities must foster a pleasant atmosphere for nurses, patients, and other staff members.

Sexual harassment before and during the COVID-19 pandemic among adolescent girls and young women (AGYW) in Nairobi, Kenya: a cross-sectional study

OBJECTIVES

Sexual harassment among adolescent girls and young women (AGYW) is a prevalent and understudied form of gender-based violence (GBV) with negative impacts on health and well-being. The COVID-19 pandemic raised global concern about GBV within homes; less is known about how it affected GBV in public spaces.

METHODS

Present analyses use cross-sectional data from a cohort of adolescents and young adults residing in Nairobi, Kenya, restricted to female participants. Data were collected August-October 2020 via phone after implementation of COVID-19 restrictions. Prevalence of past-year sexual harassment and harassment relative to COVID-19 restrictions were calculated for overall sample, and by individual, household, and pandemic-related factors. Multivariate negative binomial regression models examine correlates of (1) past-year sexual harassment and (2) increases in sexual harassment relative to COVID-19 restrictions.

RESULTS

Overall, 18.1% of AGYW experienced past-year sexual harassment at the 2020 survey. Among this group, 14.6% experienced sexual harassment pre-COVID-19 only, 18.8% after only and 66.6% at both time points. Among the latter group, 34.9% reported more occurrences following COVID-19 restrictions, 20.5% reported less occurrences and 44.7% reported no change in occurrence. Overall, 42.0% of AGYW experienced an increase in sexual harassment while 58.0% experienced no increase since COVID-19. In adjusted models, past-year sexual harassment was associated with higher educational attainment (adjusted risk ratio, aRR 2.11; 95% CI 1.27 to 3.52) and inability to meet basic financial needs (aRR 1.67; 95% CI 1.05 to 2.66). Increased sexual harassment since COVID-19 was associated with having full control to leave the home (aRR 1.69; 95% CI 1.00 to 2.90).

CONCLUSIONS

Sexual harassment among AGYW in Nairobi, Kenya was prevalent before and during COVID-19 restrictions. Safety in public spaces remains a highly gendered issue that impacts women's safety and ability to participate in public life. Prevention and support services to address sexual harassment remain an important element in ensuring safe, sustainable public spaces.

Workplace violence against nurses working in the public hospitals in Giresun, Turkey: Prevalence, risk factors, and quality of life consequences

PURPOSE

The aim of this study is to determine the prevalence and risk factors of workplace violence (WPV) against nurses working in public hospitals and to evaluate for associations between WPV with the quality of life (QOL).

DESIGN AND METHODS

A cross-sectional study design was carried out from April to May 2021. The study population consisted of 890 nurses working in public hospitals in Giresun, Turkey.

FINDINGS

The prevalence of WPV was found to be 54.8%, consisting of verbal abuse (38.4%), followed by bullying/mobbing (37.5%), physical violence (6.2%), and sexual harassment (1.7%). Moreover, the WPV was found to be related to poor QOL among the nurses.

PRACTICE IMPLICATIONS

Violence prevention, preparedness, and response arrangements should be established and maintained in all hospitals.

Prevalence, influencing factors, and adverse consequences of workplace violence against nurses in China: A cross-sectional study

AIMS

The primary objective of this study was to determine the prevalence of workplace violence among nurses in China and its association with demographic characteristics, quality of work life, and coping styles. The secondary objective was to explore how nurses deal with workplace violence and the emotional/psychological impact of workplace violence on nurses.

BACKGROUND

Workplace violence is a common occupational hazard that causes physical and psychological harm to nurses.

METHODS

A cross-sectional study was conducted with 2769 nurses from China. A demographic information questionnaire, hospital workplace violence questionnaire, Chinese version of the work-related quality of life scale, and coping style scale were used in this study. The Chi-squared test, Mann-Whitney U test, and binary logistic regression analysis were used to investigate the effects of demographic characteristics, quality of work life, and coping styles on nurses' workplace violence.

RESULTS

Workplace violence toward emergency medicine physicians in the hospitals of Taif city, Saudi Arabia: a cross-sectional survey

BACKGROUND

Workplace violence against health care workers is an emerging concern in various global health settings and the documentation of physical and verbal attacks against physicians in tertiary hospitals in Saudi Arabia is uncommon. This study aimed to determine the incidence of workplace violence against physicians in the emergency department of selected tertiary hospitals in Taif City, Saudi Arabia from June to July 2021. Associations between the incidence of violence and interventions and type of physicians and years of experience were also investigated.

METHODOLOGY

Using a cross-sectional design, a total of 96 physicians were recruited to answer the World Health Organization Questionnaire on Violence against Health Care Workers last June to July 2021.

RESULTS

It was found out that 75 physicians (78.1%) experienced verbal violence while 14 physicians (14.6%) experienced physical violence. Most of the workplace violence happened within hospital premises (84.4%). Despite having an experience of verbal and physical violence, only 44.8% of the respondents reported the incidents. The most common instigators were patients (55.21%), their relatives (78.00%), external colleagues (9.37%) and staff members (6.25%). Most respondents took no action, or reported the incidence to the police or senior staff member. The incidence of workplace violence and type of physician showed significant association. The number of years of practice in emergency medicine also exhibited statistically significant association with the incidence of verbal attack, frequency of violence, and location of incident.

CONCLUSION

There is high incidence of workplace violence among physicians in tertiary hospitals, and younger physicians with less experience in emergency medicine were the most susceptible to both verbal and physical violence. There is a need to strengthen policies to protect physicians against workplace violence.

Nursing violent patients: Vulnerability and the limits of the duty to provide care

The duty to provide care is foundational to the nursing profession and the work of nurses. Unfortunately, violence against nurses at the hands of recipients of care is increasingly common. While employers, labor unions, and professional associations decry the phenomenon, the decision to withdraw care, even from someone who is violent or abusive, is never easy. The scant guidance that exists suggests that the duty to care continues until the risk of harm to the nurse is unreasonable, however, "reasonableness" remains undefined in the literature. In this paper, I suggest that reasonable risk, and the resulting strength of the duty to provide care in situations where violence is present, hinge on the vulnerability of both nurse and recipient of care. For the recipient, vulnerability increases with the level of dependency and incapacity. For the nurse, vulnerability is related to the risk and implications of injury. The complex interplay of contextual vulnerabilities determines whether the risk a nurse faces at the hands of a violent patient is reasonable or unreasonable. This examination will enhance our understanding of professional responsibilities and can help to clarify the strengths and limitations of the nurse's duty to care.

Formally reporting incidents of workplace violence among nurses: A scoping review

AIM

To describe and synthesise the scientific literature on nurses' formal reporting of workplace violence.

BACKGROUND

Research on reporting workplace violence among nurses is increasing annually, but the evidence from such reports has not been summarised or analysed.

EVALUATION

A scoping review was conducted using electronic databases including PubMed, Web of Science, Scopus, CINAHL and Ovid-Embase.

KEY ISSUES

Forty-nine studies were included in this review, and four significant issues pertinent to reporting of workplace violence was identified: (1) the reporting rate is generally low, and oral report is the most popular medium (2) nurses are often not satisfied with how the organisation handles their report, (3) the reasons affecting reporting are complex and diverse, (4) few studies have proposed countermeasures to promote reporting formally.

CONCLUSION

Scholars are paying increasing attention to workplace violence, however, the reporting of workplace violence in real world situations is not being facilitated to inform improvements in managing violence in the workplace. Therefore, more countermeasures conducive to reporting urgently need to be put forward.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers are in a pivotal position to encourage reporting by their staff, respond pro-actively and advocate for more streamlined and accessible processes. The findings of this review can provide a basis for nursing managers to better manage workplace violence and improve the reporting rate among nurses.

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

INTRODUCTION

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

METHOD

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

RESULTS

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

CONCLUSIONS

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