Nurses' perceptions of the nature and frequency of aggression in general ward settings and high dependency areas

Workplace Violence Experienced by Personal Care Workers in a District in Seoul, Republic of Korea: A Comparison Study with Office and Service Workers

This study compared the level of workplace violence experienced by personal healthcare workers in a district in Seoul, Republic of Korea, with those experienced by workers in office or service jobs. We matched 150 personal care workers with 150 office workers and 150 service workers using a propensity score. Workplace violence was categorized into psychological violence and physical violence. Of the surveyed personal care workers, 53.3% reported experiencing psychological violence, and 42.0% reported experiencing physical violence. After adjusting for self-reported work-related symptoms, personal care workers had significantly higher odds of experiencing psychological violence than office workers (OR = 5.01; 95% CI: 2.80-8.97) or service workers (OR = 7.54; 95% CI: 3.93-14.47). The adjusted odds for physical violence were also significantly higher for personal care workers compared with those for office workers (OR = 5.83; 95% CI: 2.96-11.50) and service workers (OR = 6.00; 95% CI: 2.88-12.49). In terms of specific types of workplace violence, personal care workers were 7-10 times more likely to experience unwanted sexual attention, sexual harassment, and physical violence than office or service workers. We found that personal care workers were more prone to workplace violence than office or service workers, with gender-based or physical violence being the most common types. Considering the negative impact of workplace violence on workers' well-being and health services, policy updates and interventions focusing on personal care workers are needed to reduce workplace violence, safeguard workers' rights, and establish a secure working environment.

Professional Preparedness Implications of Workplace Violence against Medical Students in Hospitals: A Cross-Sectional Study

Workplace violence is an increasing public health concern around the world. In Vietnam, attacks on healthcare workers have become a huge issue in recent years. Our study aims to shed more light on the issue and look at what variables affect acts of violence toward healthcare workers. We conducted this cross-sectional study by surveying 550 medical students from 3 universities in Vietnam. Following this survey on SurveyMonkey's platform (surveymonkey.com), the participants were suggested to invite their associates who met the selection criteria to join in this online survey. The structured questionnaire included demographics and details on the violence. There were 90.5% of respondents were medical students, the mean age was 23.3, and verbal abuse had a prevalence rate of 29.3%. Women respondents are less likely to suffer from violent experiences than men (OR = 0.48, 95% CI = 0.28-0.84), and those specializing in nurse and technician also faced a lower rate of acts of aggression (physical violence: OR = 0.35; 95% CI = 0.19-0.63, sexual harassment: OR = 0.36; 95% CI = 0.15-0.87, and any type of violence: OR = 0.55, 95% CI = 0.37-0.82). Medical students working in Ho Chi Minh City (OR = 0.55; 95% CI = 0.34-0.89), and other regions (OR = 0.40; 95% CI = 0.19-0.85) were significantly less likely to face verbal abuse than those working in Hanoi. The workplace culture needs to be changed to make sure that people feel comfortable reporting, especially those who are younger. Protecting medical students also ensures patient safety since victims of assault in the workplace can have severe aftereffects affecting their ability to provide good patient care. Hence, policies need to be implemented at both the government and hospital administration levels to keep health workers safe.

Do nurses receive any support following incidents of workplace violence? A qualitative study

AIM

We aim to investigate nurses' perceptions of support after incidences of Workplace Violence.

BACKGROUND

Nurses experience workplace violence daily. Adequate support following incidents of violence can reduce adverse impacts. Current support systems for coping with workplace violence are lacking.

METHODS

Focus group interviews were conducted with 23 nurses working in a regional Queensland Hospital. Qualitative data was transcribed and thematically analyzed to determine themes. The consolidated criteria for reporting qualitative research checklist was followed.

RESULTS

The primary source of support after a violent incident was from other nurses. Support was needed immediately to empower nurses to be able to continue their caring role. Often the support was not provided nor were nurses aware of the support services available. Although personal family and friends were a valuable support, most nurses were reluctant to disclose their experiences to protect them.

CONCLUSIONS

This paper discusses nurses' experience of support following violence incidents at work as part of findings from a more extensive study that explored the perceptions of nurses regarding violence, strategies and support in a regional Queensland Hospital. Hospital support following a violent incident was perceived as inadequate and nurses felt unsupported immediately following an incident.

IMPLICATIONS FOR NURSING MANAGEMENT

After an incidence of workplace violence, appropriate effective support may mitigate the enduring impacts of experiencing violence. There is the need for hospital management to provide effective support services and improve staff awareness of available support services.

Association between workplace psychological violence and work engagement among emergency nurses: The mediating effect of organizational climate

Background

Given that increasing attention is being given to the burdens on medical systems, researchers have concentrated their attention on nurses’ work engagement, especially in emergency departments.

Purpose

To investigate the current situation of work engagement of nurses in emergency department, and to find out the impact of psychological violence on work engagement and its impact path.

Basic procedures

The research is a cross-sectional study. Questionnaires were distributed to 243 nurses from the emergency departments of ten tertiary hospitals from September to October 2019. SPSS was used to conducted ANOVA. The AMOS was used to conduct structural equation model to test the mediating effect of organizational climate on the association between psychological violence and dimensions of work engagement.

Main findings

Psychological violence was negatively correlated with organizational climate, vitality, dedication, and focus, and organizational climate was positively correlated with dimensions of work engagement. A negative relationship was found between psychological violence and three dimensions of work engagement, which was mediated by organizational climate.

Conclusion

In order to curb workplace psychological violence and improve the work engagement level of emergency nurses, organizational climate can be used as an intervention measure. The support of leaders, the care of colleagues and the mutual understanding and communication between doctors and patients can alleviate the job burnout of nurses in the face of heavy work, so that nurses can face their daily work with a better mental outlook.

The Effect of Abuse and Mistreatment on Healthcare Providers (TEAM): A Survey Assessing the Prevalence of Aggression From Patients and Their Families and Its Impact

OBJECTIVE

Aggression from patients and families on health care providers (HCP) is common yet understudied. We measured its prevalence and impact on HCPs in inpatient and outpatient settings.

METHODS

Four thousand six hundred seven HCPs employed by a community teaching hospital received an anonymous survey with results analyzed.

RESULTS

Of 1609 HCPs (35%) completing the survey, 88% of inpatient staff reported experiencing different types of aggression compared to 82% in outpatient setting. Almost half did not report it to their supervisor. Younger staff were more likely to report abuse. Negative impacts on productivity and patient care were reported. A third of all responders' indicated negative effects on mental health.

CONCLUSIONS

Despite negative impacts on staff wellbeing and productivity, patient/family aggression toward HCPs is highly prevalent and underreported. Our healthcare system needs measures to address staff security and wellness.

The public's mixed emotional responses to violence directed at nurses: A mixed methods study

AIMS AND OBJECTIVES

To understand whether exposure to an incident of violence directed at nurses, evoke among the public a sense of identification with the victim or with the perpetrator.

BACKGROUND

Worldwide, evidence regarding workplace violence (WPV) in healthcare systems, explored the characteristics of the perpetrator, the healthcare settings and staff. Nevertheless, no studies examine the emotions of the public towards WPV in the healthcare systems.

DESIGN

A convergent mixed method parallel design.

METHODS

A structured questionnaire was distributed among 925 adults. Two scenarios were presented, with verbal and physical violence towards nurses. The participants rated how intensely they felt positive and negative emotions regarding the nurse and the perpetrator (quantitative stage). Sixty participants were also interviewed concerning their emotions regarding violence committed towards nurses (qualitative stage). Paired samples t-test were used to compare the emotions that were aroused regarding the perpetrator and the nurse. The effect size and Bonferroni correction for multiple comparisons were calculated. Constant comparative analysis method was used to analyzed the qualitative data. The STROBE checklist for cross-sectional studies and the COREQ guidelines for qualitative studies were used for reporting.

RESULTS

Positive emotions were significantly higher towards the nurse than the perpetrator. Nevertheless, there were both positive and negative emotions towards the perpetrator and the nurse. The qualitative findings yielded two themes: (1) Mixed emotions towards the perpetrator, and (2) Mixed emotions towards the nurse.

CONCLUSIONS

The public may emotionally identify with both the nurse and the perpetrator while positive and negative emotions are intertwined. Likewise, positive emotions are more intensely felt for the victims in both verbally and physically violent scenarios.

RELEVANCE TO CLINICAL PRACTICE

These complemented findings highlight the need for campaigns promoting positive emotions toward healthcare professionals in an attempt to reduce and eliminate WPV in healthcare.

Solidarity in a Community of Nursing Colleagues

Introduction

Several concepts have been used to describe the qualities of communities of nursing colleagues. Nonetheless, few studies have shed light on nursing communities by drawing on the concept of solidarity.

Objective

To explore solidarity among a community of nursing colleagues.

Methods

A qualitative research design with a reflective life world approach was selected. This study reused data from a larger Norwegian empirical study. The data from the original study consisted of qualitative interviews and follow-up interviews with 13 nurses (RNs). The research context was municipality and specialist health services. A secondary data analysis was conducted. The study was based on the SRQR reporting guidelines.

Results

The results were formulated under two themes: 1) having indispensable relationships and 2) encountering a relative absence of sympathy.

Conclusion

A sense of community among nursing colleagues seems to rely on solidarity: whatever affects one nurse affects another. The solidarity that arose from the content of commonalities involved maintaining indispensable relationships with nursing colleagues by supporting and aiding them and simultaneously enduring a relative absence of sympathy. Solidarity among the community in this study was not a peripheral concept of the general notion of solidarity, implying that the commonalities within the collegial relationships were ambiguous and could shift from something good to something relatively good and vice versa. Such a shift was evidenced by nurses’ experiences of their community.

Simulation-based education for teaching aggression management skills to health care providers in the acute health care setting: a systematic review protocol

BACKGROUND

Clinical aggression episodes, that is aggression and externalising behaviours that create risk, in acute care hospitals are increasing. Acute care staff are often not confident or trained in the management of aggression. Various aggression management training formats have been described in practice including face to face training, written learning resources, web- and media-based training resources, and simulation training. The aim of this systematic review is to assess whether simulation-based training is effective in increasing de-escalation knowledge, skills, and behaviour of staff working in the acute care setting.

METHODS

We designed and registered a study protocol for a systematic review of studies evaluating simulation-based training for the management of patients with aggression. We will include randomised controlled trials, non-randomised controlled trials, quasi-experimental studies, and observational studies including health care professionals and trainees in acute health care settings. Comprehensive searches will be conducted in the following databases (from January 1980 onwards): PubMed, MEDLINE, PsycINFO, CINAHL, and the Cochrane Library. The reference lists of selected studies, trial registers, and leading journals will also be searched. Two reviewers will independently screen all citations, full-text articles, and abstract data. Potential discrepancies will be resolved through discussion. The primary outcomes will include patient outcomes (e.g. frequency of clinical aggression), quality of care (e.g. frequency of emergency situations, physical/chemical/mechanical restraint), and adverse effects (e.g. patient/family complaints, patient harms, staff harms). Secondary outcomes will include workplace resource use, health care provider-related outcomes, knowledge (de-escalation techniques), performance, attitudes, and satisfaction. The study methodological risk of bias will be appraised using appropriate tools. A narrative synthesis will be performed for included studies. If feasible, we will conduct random-effects meta-analysis of data. Additional analyses will be conducted to explore the potential sources of heterogeneity (e.g. participant characteristics, interventions, and follow-up).

DISCUSSION

This systematic review will identify, evaluate, and integrate the evidence on simulation-based training programmes for acute care health professionals on managing clinical aggression. The results of this study will inform the implementation of effective training strategies. Implications for future research will be discussed.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration number CRD42020151002.

When leader is morally corrupt: interplay of despotic leadership and self-concordance on moral emotions and bullying behavior

Purpose

This study investigates despotic leadership (DL) as an antecedent to bullying behavior with a mediating role of moral emotions at work. Another aim is to study the moderating role of self-concordance to buffer the relationship between DL and arousal of moral emotions.

Design/methodology/approach

The authors collected two-source (self-reported and supervisor reported) time-lagged data in the shape of a three-wave survey (i.e. one month time interval for each time) from 242 dyads in the health sector of Pakistan.

Findings

The results revealed that moral emotions mediated the relationship between DL and bullying behavior. Furthermore, self-concordance moderates the relationship between DL and moral emotions, such that the relationship will be stronger in the case of low self-concordance.

Research limitations/implications

Managers need to promote a culture that accommodates diversity of opinion at the organization so that everyone is able to express and share their views openly. Organizations should encourage supervisors to participate in leadership development programs aimed at eliminating DL.

Originality/value

This study establishes the role of self-concordance and moral emotions in the relationship between despotic leadership DL and bullying behavior.

Patient-on-Staff Assaults: Perspectives of Mental Health Staff at an Acute Inpatient Psychiatric Teaching Hospital in the United States

INTRODUCTION

Physical assaults perpetrated by patients in psychiatric hospitals against mental health staff (MHS) is a serious concern facing psychiatric hospitals. Assaulted staff reports physical and psychological trauma that affects their personal and professional lives. There is a dearth of literature exploring this phenomenon.

PURPOSE

To explore MHS perspectives of assault by psychiatric patients.

METHODS

A transcendental phenomenological qualitative design was used to explore and analyze the perspectives of a purposeful sample of 120 MHS perspectives at an acute inpatient psychiatric hospital. Participants' age ranged from 22 to 63 years (mean age = 32.4). Moustakas' theoretical underpinnings guided the study.

RESULTS

Two patterns, 8 themes, and 19 subthemes were identified: (a) Psychological impacts revealed four themes-increase of anxiety/fear level, helplessness and hopelessness, flashbacks/burnout, and doubting own competency. (b) Physiosocial impacts revealed four themes-unsupportive superiors, stigmatization of staff victim, failure to report the incident, and environmental safety.

DISCUSSION

Participants verbalized that assaults by patients have instilled fear and trauma in them. Most of the assaults occurred when staff were performing their routine job functions and setting limits to patient's behavior.

CONCLUSION

The study allowed MHS opportunities to narrate their lived experiences of being assaulted by patients and provided validation of their perspectives. Findings illuminated the phenomenon and may help to support policy changes in psychiatric hospitals.

Frequency, Characteristics and Risk Factors of Aggressive Incidents in a Paediatric Rehabilitation Setting: A Prospective Survey

Aim: Aggressive incidents (AI) are a serious concern in health care and can have negative effects on the physical and emotional well-being staff. This study aimed to determine frequency, characteristics and risk factors for aggressive behavior.Methods: AI were recorded during six months by the staff in a pediatric rehabilitation clinic using the evaluation form for AI (EVA). Patients were divided into the study group (patients who were involved in AI) and controls.Results: 14/105 (13%) of patients were involved in 79 AI. 0.44 AI per day occurred. Most often AI occurred on Mondays and 98% included physical, 22% verbal aggression. Most frequent target (43%) were nurses, followed by therapists (31.6%).Significant risk factors for AI were: previous aggressive behavior (p = .038), lower cognitive and higher mobility sub-scores in the WeeFIM. Conclusion: Findings emphasize the magnitude of AI in pediatric rehabilitation and thus the importance of implement preventive strategies.Abbreviations: ADL: Activity of daily living; AI: Aggressive Incidents; CFCS: Communication Function Classification System; EVA: Recording aggressive incidents (Erfassung von Aggressionsereignissen); GMFCS: Gross Motor Function Classification System; MACS: Manual Ability Classification System; SOAS-R: Staff Observation of Aggression Scale-Revised; WeeFIM: Functional Independence Measure for Children; WPV: Workplace violence.

Prevalence of aggression in patients with schizophrenia: A systematic review and meta-analysis of observational studies

OBJECTIVE

Aggression is common in patients with schizophrenia and is clinically significant, but its prevalence is inconsistent across studies. This is a meta-analysis of the prevalence of aggression and its associated factors in patients with schizophrenia.

METHODS

PubMed, EMBASE, PsycINFO, the Cochrane Library, Medline and Web of Science databases were systematically searched. Studies that reported the prevalence of aggression in patients with schizophrenia using the Modified Overt Aggression Scale (MOAS) were included and analyzed using the random-effects model.

RESULTS

Fifteen studies with 4855 patients were initially included; of these, 13 studies with 3929 patients were pooled in the final meta-analysis. The pooled prevalence of aggression was 33.3% (95%CI: 21.5%-47.7%); specifically, the estimated prevalence of verbal, property-oriented, auto and physical aggression were 42.6% (95%CI: 17.0%-72.9%), 23.8% (95%CI: 10.1%-46.4%), 23.5% (95%CI: 6.5%-57.7%), and 23.7% (95%CI: 10.4%-45.3%), respectively. Subgroup analyses revealed that different MOAS cut-off values (P < 0.001) and source of patients (inpatients vs. community-dwelling patients) significantly moderated the results (P < 0.001). Meta-regression analyses found that studies published recently reported higher aggression rate, while higher quality assessment score was associated with lower aggression rate (both P < 0.01).

CONCLUSIONS

This meta-analysis confirmed that aggression is common in schizophrenia patients. Considering the significant clinical risk issues, appropriate treatments and effective management of aggression in this population need to be developed.

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

BACKGROUND

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

PURPOSE

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

METHOD

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

DISCUSSION

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

CONCLUSIONS

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

Narrative Case Notes Have the Potential to Predict Seclusion 3 Days in Advance: A Mixed-Method Analysis

Objectives: Current risk assessment tools can predict problematic behavior and the need for coercive measures, but only with a moderate level of accuracy. The aim of this study was to assess antecedents and triggers of seclusion. Methods: Narrative notes of health care professionals on psychiatric inpatients were analyzed daily starting 3 days prior to seclusion in the case group (n = 26) and compared to a matched control group without seclusion (n = 26) by use of quantitative and qualitative research methods, based on qualitative content analysis. Results: Quantitative measures showed more aggression in the case group with highly significant differences between the groups (p < 0.001) at all measurement times. Seclusion was significantly associated with the total word count of the narrative notes. Subjective emotional expressions by staff were more apparent before seclusion (p = 0.003). Most frequently, subjective expressions regarding "arduous/provocative" (p < 0.001) and "anxious" (p = 0.010) sentiments could be identified in the case group. Description of patients' behavior in the case group included more negatively assessed terms (p = 0.001). Moreover, sleep loss, refusing medication, high contact frequency, demanding behavior and denied requests were present in a significantly higher frequency before seclusion. Expressions like "threatening" (p = 0.001) were found only before seclusion and appeared to have the function of personal risk assessment. The expression "manageable" (p = 0.035) appeared often in difficult situations that could still be handled. Conclusion: Several factors preceding seclusion could be identified. Narrative notes of staff already showed differences 3 days before the escalation. Particularly the word count, the analysis of terms describing patients' behavior, subjective expressions of staff, and terms used as a function of personal risk assessment could help to provide better predictions of aggressive incidents and to prevent coercive measures.

Postincident Support for Healthcare Workers Experiencing Occupational Violence and Aggression

PURPOSE

To investigate the relative contributions of workplace type, occupational violence and aggression (OVA) strategies and interventions along with perceptions of the occupational health and safety (OHS) environment on the likelihood of receiving postincident support following the experience of OVA.

DESIGN

We used a cross-sectional study design with an online survey to collect data from employees in nursing and midwifery in Victoria, Australia.

METHODS

Survey data collected from 3,072 members of the Australian Nursing and Midwifery Federation (Victorian branch) were analyzed using logistic regression.

FINDINGS

Of the 3,072 respondents who had experienced OVA in the preceding 12 months, 1,287 (42%) reported that they had received postincident support. Hierarchical logistic regression revealed that the OHS environment was the dominant factor that predicted the likelihood of workers receiving postincident support. Working in a positive OHS environment characterized by higher levels of leading indicators of OHS, prioritization of OHS, supervisor support for safety, and team psychological safety was the stronger predictor of postincident support. Being employed in a workplace that offered training in the management and prevention of OVA also increased the likelihood of receiving postincident support.

CONCLUSIONS

While training in the management and prevention of OVA contributed to the likelihood of receiving postincident support, a greater emphasis on the OHS environment was more important in predicting the likelihood that workers received support.

CLINICAL RELEVANCE

This study identifies workplace practices that facilitate the provision of postincident support for healthcare workers. Facilitating effective postincident support could improve outcomes for workers, their patients and workplaces, and society in general.

Aggression and violence in healthcare and its impact on nursing students: A narrative review of the literature

Aggression and violence is a significant social problem in many countries and an increasing problem in healthcare settings in which nurses are particularly vulnerable. The literature suggests that aggression and violence has a significant negative impact upon nurses and potentially upon nursing students and can result in these staff members experiencing stress as a direct result of these adverse events. The literature suggests that there is confusion over what constitutes aggression and violence in the workplace and therefore a true lack of understanding of the scale of the problem relating to nursing students. This review proposes that nursing students are indeed at significant risk of aggression and violence in the clinical setting which has the potential to significantly impact their role as a novice carer. Furthermore, aggression and violence can manifest negative stress responses in individuals, therefore, the potential for nursing students to cope with stressful situations shall be presented.

Health Care Workers' Experiences of Aggression

PRIMARY OBJECTIVE

To identify the prevalence of patient aggression against health care workers, the consequences and coping mechanisms.

DESIGN

Retrospective cross-sectional design.

SUBJECTS

50 participants comprised 37 nurses, 1 ward staff, 12 allied health staff employed in two brain injury wards with experience ranging from 3months to 34years.

SETTING

Neurosciences and Brain Injury Rehabilitation wards of a metropolitan tertiary hospital in Brisbane.

MAIN OUTCOME MEASURES

Researcher designed self-report questionnaire.

RESULTS

98% of respondents had experienced aggression during their health care careers with an average of 143.93 events. Physical injuries had been sustained by 40% of staff, psychological injury by 82%, but only 12% sought treatment. Verbal aggression related to receiving a psychological injury (r=0.305, p<0.05). Experiencing one type of aggression made it more likely the person would also experience the other types of aggression. Verbal aggression was correlated with physical aggression (r=0.429, p<0.01) and non-verbal aggression (r=0.286, p<0.05), and physical aggression was correlated with non-verbal aggression (r=0.333, p<0.05). The majority of staff used informal debriefing with others as their main coping strategy which was considered effective.

CONCLUSIONS

Patient aggression is prevalent and of serious concern for staff working in hospital settings.

Verbal abuse and physical assault in the emergency department: Rates of violence, perceptions of safety, and attitudes towards security

INTRODUCTION

Emergency Department (ED) workers are prone to occupational violence, however the extent and impact of this may not be evenly felt across all roles in the ED.

AIMS

Explore: 1) the rate of verbal abuse and physical assaults experienced by ED staff, 2) perceptions of safety, 3) attitudes towards security officers, and 4) formal reporting of incidents.

METHODS

330 ED workers were surveyed at four public hospitals in one metropolitan health service district in Queensland, Australia, including 179 nurses, 83 medical staff, 44 administration staff, 14 allied health, and 9 operational.

RESULTS

Nurses were more likely to have been physically assaulted in the last six months and were less likely to feel safe. Most ED staff across all roles experienced verbal abuse. Nurses were better than medical staff at reporting instances of occupational violence although overall reporting across all roles was low. Staff who thought that security officers respond to incidents quickly and are a visible presence in the ED were more likely to feel safe in the ED.

CONCLUSIONS

Workers in the ED, particularly nurses, experience high rates of verbal abuse and physical aggression and there may be a case for having designated security guards in the ED.

Workplace violence against women nurses working in two public sector hospitals of Lahore, Pakistan

BACKGROUND

Cultural and structural forces help sustain workplace violence (WPV) against feminized professions like nursing in Pakistan.

PURPOSE

The purpose of this study was to identify the prevalence and patterns of workplace violence (WPV) against women nurses (more than 95% of entire nursing population) in two hospitals of Pakistan.

METHODS

A standardized international survey developed by the World Health Organization was used to collect cross-sectional data. Descriptive statistics, chi-square tests, and multivariate regression were used for data analysis. A total of 309 nurse respondents were sampled from two public sector tertiary care hospitals of Lahore.

RESULTS

Findings show that 73.1% of nurses reported experiencing some sort of violence in the last 12 months; with 53.4% suffering from physical violence, 57.3% from verbal violence, and 26.9% from sexual violence. The main perpetrators were reported to be male coworkers, patients, and attendants. Higher risk for WPV includes single status, non-Punjabi provincial belonging, Islamic faith, staff and student nurse designations, temporary government contract, and working additional hours in the evening and night. The primary response to violence included not doing anything and remaining silent. It was also reported that nurse victims experienced moderate levels of emotional grievances after facing violence.

CONCLUSION

The results of this study suggest that public sector hospitals in the region need to improve their policy for the protection and monitoring of WPV against female nurses. Reporting and counseling bodies need to be installed to encourage both complaints and the seeking of medical attention after victimization.

Use of a Violence Risk Assessment Tool in an Acute Care Hospital

This study examined the use and effectiveness of the Alert assessment form. The form is part of the Alert system, used by one large acute care hospital to identify patients with a propensity for violence. All reported incidents of patient violence from August 1, 2003, through December 31, 2004, were included in patient charts. One hundred seventeen violent patient charts were reviewed and compared with 161 non-violent patient charts, randomly chosen from the same time period. Overall use of the Alert assessment form for violent and non-violent patients was 75.7% and 35.4%, respectively. The assessment form was found to have moderate sensitivity (71%) and high specificity (94%). It is reasonably effective in identifying potentially violent or aggressive patients when it is used according to protocol. Efforts to improve the tool are warranted, as is evaluation of its benefit in settings with low prevalence of violence. Also, greater effort must be taken to prevent violence once an aggressive patient has been identified.

Concern about Workplace Violence and Its Risk Factors in Chinese Township Hospitals: A Cross-Sectional Study

Workplace violence in Chinese township hospitals is a major public health problem. We identified the risk factors of healthcare workers’ worry about experiencing workplace violence in 90 Chinese township hospitals and determined specific measures for differing stages of violence (based on crisis management theory). Participants were 440 general practitioners and 398 general nurses from Heilongjiang Province, China (response rate 84.6%). One hundred and six (12.6%) respondents reported being physically attacked in their workplace in the previous 12 months. Regarding psychological violence, the most common type reported was verbal abuse (46.0%). While most (85.2%) respondents had some degree of worry about suffering violence, 22.1% were worried or very worried. Ordinal regression analysis revealed that being ≤35 years of age, having a lower educational level, having less work experience, and working night shifts were all associated with worry about workplace violence. Furthermore, those without experience of such violence were more likely to worry about it. Respondents’ suggested measures for controlling violence included “widening channels on medical dispute solutions,” “improving doctor-patient communication,” and “advocating for respect for medical workers via the media.” Results suggest the target factors for reducing healthcare workers’ worry by according to the type of education and training and possible measures for limiting workplace violence in township hospitals.

Assault experiences: Lessons learned from mental health nurses in Taiwan

Mental health nurse are frequently subjected to patients' violent and aggressive behaviour. These assault experiences have given rise to mental health nurses' physical and psychological trauma, and negatively impact the quality of patient care. The purpose of the present qualitative study was to understand mental health nurses' experiences of being assaulted, the influences on their patient care, and their perspectives of the effectiveness of in-service, violence-prevention education. Ten mental health nurses from two different inpatient mental health facilities were interviewed using a semistructured interview guide. Thematic analysis of interview data found six themes: (i) violence is unpredictable; (ii) violence is normal; (iii) lasting psychological trauma; (iv) limited support from peers and the administrator; (v) violence prevention requires team cooperation; and (vi) doubting the effectiveness of in-service education on violence prevention. Psychiatric ward administrators should assess nurses' learning and skill needs to determine whether these needs are met by existing in-service training programmes. A culture of safety should also be promoted by building a warm and supportive ward climate for both staff and patients, which would include team cooperation and support for colleagues who suffer a violent incident.

Physical Violence against General Practitioners and Nurses in Chinese Township Hospitals: A Cross-Sectional Survey

Purpose

The purpose of this study is to identify risk factors of physical violence in Chinese township hospitals.

Methods

A cross-sectional survey was used in a sample of 442 general practitioners and 398 general nurses from 90 township hospitals located in Heilongjiang province, China (response rate = 84.8%).

Results

A total of 106 of the 840 (12.6%) respondents reported being physically attacked in their workplace in the previous 12 months. Most perpetrators were the patients’ relatives (62.3%), followed by the patient (22.6%); 73.6% of perpetrators were aged between 20 and 40 years. Of the physical violence incidents, about 56.6% (n = 60) resulted in a physical injury, and 45.4% of respondents took two or three days of sick leave. Reporting workplace violence in hospitals to superiors or authorities was low (9.4%). Most respondents (62.8%) did not receive training on how to avoid workplace violence. Logistic regression analyses indicated that general nurses, aged 35 years or younger, and with a higher-level professional title were more likely to experience physical violence. Healthcare workers with direct physical contact (washing, turning, lifting) with patients had a higher risk of physical violence compared to other health care workers. Procedures for reporting workplace violence were a protective factor for physical violence; when in place, reporting after psychological violence (verbal abuse, bullying/mobbing, harassment, and threats) was more protective than waiting until an instance of physical violence (beating, kicking, slapping, stabbing, etc.).

Conclusions

Physical violence in Chinese township hospitals is an occupational hazard of rural public health concern. Policies, procedures, and intervention strategies should be undertaken to manage this issue.

The impact of training program on nurses' attitudes toward workplace violence in Jordan

BACKGROUND

Nurses' attitudes toward workplace violence are still inadequately explored, and possess an impact in preventing, and managing the violent incidents and the quality of nursing care. Creating a demand for an effective intervention program to improve nurses' knowledge of and attitudes toward workplace violence.

OBJECTIVE

To study the impact of the training program on nurses' attitudes toward workplace violence in a military hospital in Jordan.

METHODS

One group before-after design was employed. A stratified random sample of 100 nurses working in three shifts was recruited. Data were collected earlier and after the preparation program using the Attitudes Toward Patient Physical Assault Questionnaire. "The Framework Guidelines for addressing workplace violence in the health sector", was adopted in this work. The preparation sessions were for one day each week over five weeks. The post-test assessment was over five weeks using the same questionnaire.

RESULTS

A total of 97 nurses completed the survey. The outcomes demonstrated the significant impact of the training program on nurses' attitudes towards workplace violence (t=6. 62, df=96, p=0.000). The prevalence of verbal abuse by patients and visitors was 63.9% and for physical abuse, 7.2% were from patients and 3.1% of visitors. Most violent incidents occurred during day duty and during delivering nursing care (40.2% and 32%, respectively). Major source of emotional support for abused nurses was from the nursing team (88.7%), while the legal support was from nursing management (48.5%).

CONCLUSION

The study highlights a general concern among nursing staff about workplace violence. Confirming that violence prevention education for staff is a necessary step forward to deescalate the problem. A significant effect of the training program was evident in this study.

A National Study on Nurses' Exposure to Occupational Violence in Lebanon: Prevalence, Consequences and Associated Factors

Background

Healthcare institutions have commonly reported exposure of employees, particularly nurses, to high levels of occupational violence. Despite such evidence in the Middle East Region, there is a dearth of national studies that have systematically investigated this phenomenon. This study investigates the prevalence, characteristics, consequences and factors associated with nurses’ exposure to occupational violence in Lebanon.

Methods

A cross-sectional design was utilized to survey a nationally representative sample of 915 nurses registered with the Order of Nurses in Lebanon. Stratified random sampling by governorate was utilized. Individually-mailed questionnaires collected information on exposure to violence, degree of burnout and demographic/professional background. The main outcome variables were exposure to verbal abuse (never, 1–3, 4–9 and 10+ times) and physical violence (never, ever) over the past 12-months. Descriptive statistics were used to estimate prevalence of violence. Multivariable, binomial and multinomial regression models were carried out to investigate the correlates of exposure to verbal abuse and physical violence, respectively.

Results

Response rate was 64.8%. Over the last year, prevalence of nurses’ exposure to verbal abuse was 62%, (CI: 58–65%) and physical violence was 10%, (CI: 8–13%). Among respondents, 31.7% of nurses indicated likelihood to quit their jobs and 22.3% were undetermined. Furthermore, 54.1% reported high levels of emotional exhaustion and 28.8% reported high levels of depersonalization. Compared to nurses with no exposure to verbal abuse, nurses reporting high exposure had high levels of emotional exhaustion (OR:6.4; CI:1.76–23.32), depersonalization (OR:6.8; CI: 3–15) and intention to quit job (OR:3.9; CI: 1.8–8.3). They further reported absence of anti-violence policies at their institutions (OR: 3; CI: 1.5–6.3). Nurses that were ever exposed to physical violence were more likely to be males (OR: 2.2; CI: 1.1–4.3), working day and night shifts (OR: 2.8; CI: 1.4–5.5) and subject to ten or more incidents of verbal abuse per year (OR: 46.7; CI: 10.1–214).

Conclusions

An alarming two-thirds of respondents reported exposure to verbal abuse which was found to be a significant predictor of the three subscales of burnout, intention to quit and exposure to physical violence. The prevalence of exposure to physical violence is disconcerting due to its severe consequences. Policy and decision-makers are urged to use study findings for policy and practice interventions to create safe work environments conducive to nurses’ productivity and retention.

Patients' perceptions of transgressive behaviour in care relationships with nurses: a qualitative study

AIM

To gain insight in the onset and meaning of transgressive behaviour in care relationships with nurses, from the perspective of patients.

BACKGROUND

Aggression and transgressive behaviour in health care have been a focus of research over the last decades. Most studies describe staff experiences on patient aggression. Patient' perspectives on aggression and transgressive behaviour in interactions with nurses are rarely sought.

DESIGN

Qualitative interview study.

METHODS

Twenty patients were purposefully sampled from six wards of two general hospitals. Semi-structured interviews were carried out in 2011. Data were analysed using the constant comparative method influenced by the grounded theory approach.

FINDINGS

On elaborating on what constitutes experiences of transgressive behaviour, patients employ a framework of suppositions towards hospital care and nurse-patient relationships. This framework leads to implicit ideas on how competent professional caregivers will be and on how relationships with nurses will be characterized as normal human interactions. When these anticipated ideas are not met, patients feel obliged to address this discrepancy by adjusting their expectations or behaviour. Patients become more vigilant with regard to care given by nurses; search for own solutions; make excuses for nurses or reprioritize their expectations. Because of this adjustment, perceptions of transgressive behaviour are reinforced, mitigated or put into perspective.

CONCLUSION

Patients adjust their behaviour based on what they experience in care relationships with nurses or the hospital care. It is crucial that patients feel free to discuss their assumptions or untoward needs and nurses learn to understand and reflect on those experiences.

Prevalence and predictors of verbal aggression in a secure mental health service: Use of the HCR-20

Despite evidence about the negative effects of verbal aggression in mental health wards there is little research about its prevalence or about the factors that predict the behaviour among inpatients. This study aimed to determine the prevalence of verbal aggression in a secure mental health service, and to examine the relationship of verbal aggression with risk factors for aggression in the risk assessment tool HCR-20 in order to establish whether, and with which factors, the behaviour can be predicted. Verbal aggression was measured using the Overt Aggression Scale (OAS) over a 3-month period across a heterogeneous patient group (n = 613). Over half the patients (n = 341, 56%) engaged in 1594 incidents of verbal aggression. The HCR-20 total, clinical, and risk management subscale scores predicted verbal aggression, though effect sizes were not large. Item-outcome analysis revealed that impulsivity, negative attitudes, and non-compliance with medication were the best predictors of verbal aggression and, therefore, should be targeted for intervention. There are key synergies between factors predicting verbal aggression and the core mental health nursing role. Nurses, therefore, are in a prime position to develop and implement interventions that may reduce verbal aggression in mental health inpatients.

Patient Violence Towards Counselors in Substance Use Disorder Treatment Programs: Prevalence, Predictors, and Responses

Workplace violence disproportionately impacts healthcare and social service providers. Given that substance use and abuse are documented risk factors for the perpetration of violence, SUD treatment personnel are at risk for patient-initiated violence. However, little research has addressed SUD treatment settings. Using data nationally representative of the U. S., the present study explores SUD counselors' experiences of violent behaviors perpetrated by patients. More than half (53%) of counselors personally experienced violence, 44% witnessed violence, and 61% had knowledge of violence directed at a colleague. Counselors reported that exposure to violence led to an increased concern for personal safety (29%), impacted their treatment of patients (15%), and impaired job performance (12%). In terms of organizational responses to patient violence, 70% of organizations increased training on de-escalation of violent situations, and 58% increased security measures. Exposure to verbal assault was associated with age, minority, tenure, recovery status, 12-step philosophy, training in MI/MET, and higher caseloads of patients with co-occurring disorders. Exposure to physical threats was associated with age gender, minority, tenure, recovery status, and higher caseloads of patients with co-occurring disorders. Exposure to physical assault was associated with age, gender, and sample. Implications of these findings for organizations and individuals are discussed.

Workplace violence against emergency versus non-emergency nurses in Mansoura university hospitals, Egypt

Workplace violence (WPV) against nurses is a common but neglected problem in Egypt. The objectives are to estimate the prevalence and associated risk factors of different types of violence against nurses working in the emergency hospital compared with those working in non-emergency clinics, circumstances of violence, type of perpetrators, and victims' response. This cross-sectional comparative study was carried out at Mansoura University Hospitals, Egypt, during January 2013. The data were collected through the adapted version of a self-administered questionnaire developed by the International Labor Office/International Council of Nurses/World Health Organization/Public Services International on WPV in the health sector. All types of WPV are common among nurses. Precipitating factors for violent incidents identified by respondents are emergency specialty, having work shift, and younger age. Violent incidents result in work dissatisfaction and consequently impair work productivity. Nurses working in emergency hospital experienced a higher level of different types of WPV. There is an urgent need to formulate and implement a policy for dealing with violent events.

Determining the frequency, kinds and cues of violence displayed by patients in an acute older person ward environment: findings from an observational study

BACKGROUND

Workplace violence is one of the most complex and significant occupational hazards experienced by nurses in healthcare settings. Verbal abuse and physical violence are particularly prevalent in older person assessment wards, owing to the prevalence of illnesses involving cognitive dysfunction; the high frequency and nature of contact with staff; and the frustration caused by high levels of disability.

AIM

To determine the frequency, kinds and cues of violence displayed by patients towards nurses in an acute older person assessment ward environment using a structured observational tool - the Violence Assessment Tool (VAT).

DESIGN

Observational study.

METHOD

Non-participant structured observations of behavioural cues for violence towards nurses in an acute older person hospital ward were gathered and analysed.

RESULTS

One hundred and twelve hours of observations were undertaken, resulting in 95 behavioural cues for violence in 19 patients. Four of these patients subsequently escalated to physical violence. Pacing around the bed was the only commonality in the behavioural cues of patients who became violent. All patients who became violent had previously demonstrated showing.

CONCLUSIONS

To date, the assessment of potentially violent older patients has not been adequately addressed. The VAT may be one way of addressing this challenge through early identification of the more subtle behavioural cues that could indicate potential for violence. Further research on the VAT using a larger data set could determine its predictability for physically violent acts displayed by older people.

Patient and visitor assault on nurses and midwives: an exploratory study of employer 'protective' factors

Most Australian public health-care services have established a range of initiatives designed to help 'protect' nurses and midwives from patient and visitor assault (PVA); however, few studies have specifically examined their effectiveness. The present study is part of a larger survey that explored nurses' and midwives' experiences of PVA using the Department of Human Services, Victoria (2007) definition of occupational violence and bullying. Participants were asked about the presence of 'protective' factors in their workplace and the importance of having these factors to prevent and manage workplace aggression. Binary logistic regression was applied to ascertain the association between 'protective' factors and the occurrence of PVA, with adjusted odds ratios and their reported 95% confidence intervals for ascertaining the significance of the associations. The study found more 'protection' from assault when there was a high standard of patient facilities, sufficient staffing, effective enforcement of policies, and when staff were provided with personal protective equipment. Working in private health care, and being a registered nurse, also conferred 'protection'. A higher occurrence of staff assault was associated with specific clinical settings, and being on rotation and on night duty. Findings point to important insights into factors associated with 'protection' for PVA.

Violence experienced by nurses at six university hospitals in Turkey

This research was conducted to analyse the violence experienced by nurses employed at six university hospitals. A descriptive and cross-sectional study was conducted. The research sample consisted of 441 nurses who worked in the emergency, intensive care and psychiatry units of six university hospitals in Turkey between June 2008 and June 2009 and who voluntarily agreed to participate. It was found that 60.8% of the nurses were subjected to verbal violence and/or physical violence from patients, visitors or health staff. Of the nurses who were subjected to workplace violence, 42.9% stated that their experience of verbal and/or physical violence had a negative impact on their physical and/or psychological health, and 42.9% stated that their work performance was negatively affected. Of these nurses, 1.8% stated that they received professional help, 13.6% stated that a report was made and 9.5% stated that they contacted the hospital police in some way. According to the findings of this research, similar to the situation worldwide, nurses in Turkey are subjected to verbal and/or physical violence from patients, visitors and health staff.

Psychological Violence in the Workplace Among Jordanian Hospital Nurses

Purpose: The purposes of the study are to (a) assess the incidence and frequency of psychological violence (verbal abuse) among Jordanian hospital nurses, (b) explore the complaints and the reactions of nurses to such violence, and (c) identify the factors that contribute to workplace violence and the management modalities from the Jordanian nurses’ point of view. Design: A descriptive survey was used to investigate verbal abuse among a convenience sample of 422 Jordanian nurses. The Questionnaire of Workplace Violence, which was developed in 2003 by the International Labor office, International Council of Nurses, World Health Organization, and Public Services International, was used to collect the data. Results: The findings indicated that almost 70% of participants was exposed to verbal abuse in the workplace. Patients’ families were the main perpetrators of these incidents. The contributing factors to psychological violence as perceived by participants were related to administration, staff, patients and their families, workplace setting, and security. The majority of participants indicated that their employers had no polices against psychological workplace violence. Implications: Helpful strategies for reducing psychological violence include implementing security measures, restricting public access, and maintaining adequate staffing.

Staff's perception of adolescent aggressive behaviour in four European forensic units: a qualitative interview study

BACKGROUND

Aggressive behaviour among patients is extremely common in forensic adolescent psychiatry compromising the safety of the treatment milieu and posing a treatment challenge to the staff. The staff's perception of aggression is likely to contribute to the aggression management practices among disturbed adolescents.

AIMS

To examine staff's perceptions of adolescent aggressive behaviour and factors contributing it.

METHODS

Qualitative interviews were conducted in four adolescent forensic units in four European countries. Data was analysed using qualitative content analysis.

FINDINGS

Aggressive behaviour was perceived to be verbal and physical in nature with various levels of severity. Several factors were perceived to contribute to aggressive acts, including adolescents' early life experiences. Participants mainly shared perceptions of adolescent aggressive behaviour in the four units studied.

CONCLUSIONS

The study provides new international knowledge about how staff perceive adolescent aggressive behaviour in the forensic setting. The shared understanding of adolescents' aggressive behaviour enables the implementation of safe, ethically sound and more consistent aggression management in clinical forensic practice. Reduced occurrence of aggression may improve the therapeutic milieu of the unit and may strengthen the staff's occupational health.

Oppression and exposure as differentiating predictors of types of workplace violence for nurses

AIMS AND OBJECTIVES

To extend a model of the antecedents of workplace bullying to apply to a wider range of types of workplace aggression, including bullying and several types of violence, among nurses.

BACKGROUND

Research that has focused on workplace bullying has found that the Demand-Control-Support model, negative affectivity and certain demographic factors play important roles as antecedents of bullying.

DESIGN

A cross-sectional design.

METHODS

A validated questionnaire was sent to the work addresses of all nursing and midwifery staff in a medium-to-large hospital in Australia. A total of 273 nurses and midwives returned their completed questionnaires. Ordinal regressions were conducted to assess the antecedents of workplace aggression across bullying and violence.

RESULTS

Aspects of the Demand-Control-Support model and job tenure significantly predicted particular forms of violence, while negative affectivity and work schedule were significant for bullying.

CONCLUSIONS

The patterns of the results suggest key mechanisms that characterise certain forms of violence and distinguish between bullying and types of violence across the range of workplace aggression. In particular, oppression and exposure appear to differentiate types of workplace violence.

RELEVANCE TO CLINICAL PRACTICE

The study suggests ways in which nursing and hospital managers may act to reduce the likelihood of certain forms of aggression, particularly violence, from occurring.