A survey of mental health nurses' experiences of stalking

Prevalence and Psychosocial Impacts of Stalking on Mental Health Professionals: A Systematic Review

Research examining the prevalence and impacts of stalking on mental health professionals (MHPs) has grown over the last two decades. Yet only one previous review has been undertaken examining impacts on staff and focusing on clients as stalkers, with prevalence estimated between 10% and 13%. This systematic review sought to assess prevalence of stalking, and associated impacts and methods of coping reported by MHPs, irrespective of perpetrator type. The search included all healthcare professional groups working in a mental health setting, reported in English or with available translation. Secondary searches were conducted through references cited in primary papers. Of the 7,060 papers identified in five databases, 11 peer-reviewed papers met rigorous inclusion criteria and were quality appraised. Reviewed studies reported prevalence rates between 10.2% and 50%, with higher quality papers reporting a narrower band, 13.9% and 14.3%. However, substantial variability in stalking definitions, and quality of methodology precluded precise prevalence estimation. Participants within the included studies disclosed significant adverse impacts on confidence and competence at work as a consequence of their experiences. Staff invoked substantial workplace and lifestyle changes to mitigate impacts of stalking. However, studies revealed staff disclosed stalking by perpetrators other than clients, notably colleagues and intimate partners, as often or more frequently than by clients. Limitations of the included research and future directions are discussed.

Prevalence of Stalking Among Justice Professionals in Portugal

Despite the growing interest from researchers' in recent years, stalking is a phenomenon of difficult operationalization within the scientific community. Examining the phenomenon in criminal justice professionals has become relevant since the work context is considered a fertile environment for the presence of stalking, despite underreported. This study aims specifically to know the prevalence, nature, dynamics, impact, and help-seeking behaviors (and its perceived effectiveness) of stalking victimization by criminal justice professionals stalked in Portugal. We were also interested in the professionals' perceptions of why they were stalked. The data were collected through a web-based survey, after the approval of the ethic committee. The sample was composed of 270 criminal justice professionals, mostly men (59.3%), with a mean age of 42.70 (SD = 9.07) years. The results showed that 24.8% reported having been stalked at least once in their lifetime. Stalking prevalence was higher in women compared to men. Concerning the profession, the highest prevalence was verified in the group of professionals composed of lawyers, jurists, court officials, and auditors, followed by the group of magistrates, and finally the judges and the criminal police. More diversity of stalking behaviors experienced was associated with a higher frequency of those behaviors. Psychological health (70.7%) and lifestyle/behavioral changes (62.1%) were the most reported areas of impact. Being stalked in a private context (e.g., intimate relationships), for a longer period and feeling a higher level of fear as a result of the stalking campaign were associated with more impact. Most of the victims (74.6%) revealed having sought help to cope with the stalking experience, with women seeking more help than men (88.6% vs. 59.4%). For bringing evidence that criminal justice professionals are at risk of being stalked, these findings can contribute to the adoption of policies and strategies to prevent stalking victimization among this population.

Mental health nurses' experience of challenging workplace situations: A qualitative descriptive study

Mental health nursing is acknowledged internationally as being a demanding profession; however, little is known about the range of experience and complexity of workplace challenges or their impacts on mental health nurses (MHN). This qualitative descriptive study aimed to examine and describe the range of challenging workplace situations experienced by MHN and is reported according to the Standards for Reporting Qualitative Research. An online cross-sectional survey collected demographic data and open-ended descriptions of workplace challenges experienced by n = 374 Australian MHN. Using a modified a priori framework, four categories of experience were derived through content analysis: consumer-related, colleague-related, nursing role-related, and organizational service-related challenges. Many accounts described a complex interplay of challenges. The findings extend prior knowledge on MHN experiences. Frequent workplace challenges included violence and aggression from consumers, bullying from colleagues, low staffing levels, and poor skill mix. Further extending the evidence, key challenges rarely described in prior literature were the psychological impacts of suicides and murder; the personal nature of threats from consumers; moral distress and concerns with colleagues' quality of practice; and exacerbation of practice-related issues by lack of support from colleagues and/or the organization. These have important implications for the profession and can inform targeted strategies to reduce stressors where possible, build staff well-being, support workforce retention, and improve the provision of quality care. The implementation of targeted policy and initiatives that focus on reducing key stressors and supporting practice are vital to staff retention and ensuring a high standard of practice in complex mental health workplaces.

Who Cares for Visiting Nurses? Workplace Violence against Home Visiting Nurses from Public Health Centers in Korea

Visiting nurses are commonly exposed to workplace violence, but there is a lack of research on violence against these nurses. The purpose of this study was to identify visiting nurses’ workplace violence experiences during home visits. This study used a mixed method design. Survey data of 357 home visiting nurses from public health centers were collected for the quantitative data, and a focus group interview was conducted with six visiting nurses for the qualitative data. The quantitative data were analyzed using logistic regression, and the qualitative data were analyzed using content analysis. Younger, temporary visiting nurses and those who had previously been exposed to violent clients had a higher risk of workplace violence. The violence visiting nurses faced included not only violence during the visits but also unpredicted danger and harassment after the visit. After experiencing a violent event, visiting nurses’ attitudes and emotions changed toward nursing services. Visiting nurses were likely to deal with violence at the individual level given the insufficient organizational support system. An organizational-level safety management system should be established based on the characteristics of workplace violence risks and the nurses’ experiences in this study.

Health Care Professionals' Knowledge of Stalking Perpetrators, Victims, Behaviors, and Coping Strategies: A Preliminary Study among Italian Hospitals

The aim of this study was to investigate health care professionals' level of in-depth understanding about the various types and characteristics of stalking. In particular, the study examines knowledge on the characteristics of stalkers and their victims, acted behaviors, and coping strategies used to stop the harassment. The data were collected by means of an ad hoc questionnaire. The sample comprised 210 participants working in local health units in Turin, a large city located in the northern part of Italy. The majority were women (160, 76.2%). The participants were aged 20-64 years, and the mean age was 41.63 years (SD = 11.18). The majority of participants were psychologists (99, 47.1%), 31 (14.8%) were nurses, 31 (14.8%) had an unspecified medical profession, 29 (13.8%) were psychiatrists, and 20 (9.5%) were general practitioners. According to the findings, interventions with male victims of stalking, especially when the stalker is a woman, require attention in particular. Underestimating the stalking experience is a risk, so health care professionals in their interventions must explain to the men the emotive and physical consequences of the victimization. Moreover, in suggesting coping strategies, health care professionals must consider the victim's fear of reporting the incident not only to law enforcement authorities but also to family and friends. The findings showed that health care professionals need a better understanding of the stalking phenomenon. Education courses are a valuable tool to identify characteristics of the phenomenon, validate existing knowledge, and decrease the level of missing information to develop the skills needed to take appropriate action in cases of stalking.

Psychological Impact of Stalking on Male and Female Health Care Professional Victims of Stalking and Domestic Violence

The aim of this work was to investigate stalking experiences in a sample of Health Care Professionals, or HCPs, who experienced domestic violence in their previous relationships with an intimate romantic or non-romantic who had become their stalkers. A comparison between males and females was made to highlight the differences among the genders. The findings showed that, for the most part, the victims experienced stalking by a stalker that was not of the same gender. Moreover, the nature of the relationship was romantic, for the most part, for both female and male subjects, suggesting that the principal motivation of stalking is the disruption of an intimate relationship. Regarding domestic violence, females described the phenomenon from a different perspective, indicating verbal, physical, and sexual abuse, while males indicated only verbal abuse. Females tended to amplify, more than the males, depression, and state and trait anxiety. Even if all symptoms were expressed in both females and males, the males exhibited a lack of confidence in their bodies, and the emotional literacy made the expression of distress more difficult. At the same time, the expression of anxiety presented in the women permitted them to become progressively less victimized over time; depression and anxiety allow the recognition of these symptoms as signs of distress and to intervene to reduce them.

Health Care Professionals as Victims of Stalking: Characteristics of the Stalking Campaign, Consequences, and Motivation in Italy

Stalking is a phenomenon characterized by a set of repetitive behaviors, intrusive surveillance, control, communication, and search of contact with a victim who is afraid and/or worried and/or annoyed by such unwanted attention. Literature analysis shows that Health Care Professionals (HCPs) are at greater risk of being stalked than the general population. As described by Mullen, Pathé, Purcell, and Stuart, stalkers may have different motives: relational rejection, an infatuation, an inability to express their own emotions and recognize those of others, or a desire for revenge. The aim of this study was to explore stalkers' motivation as perceived by their victims, characteristics of stalking campaigns, and consequences. A copy of the Italian modified version of The Network for Surviving Stalking (NSS) Questionnaire on Stalking, the Beck Depression Inventory (BDI) and the State Trait Inventory (STAI) Y1-Y2 scales were distributed in six Italian state hospitals. Participants included 1,842 HCPs, 256 (13.9%) of which had been victims. The majority of victims reported that stalkers were Rejected (96, 37.5%), Intimacy seekers (41, 16%), Incompetent suitors (60, 23.4%), and/or Resentful (43, 16.8%; χ² = 163.3, p = .001). Stalking campaigns were characterized by several behaviors, principally contact (by telephone calls, text message) and following. The stalking campaign caused in victims both physical and emotional consequences, the most frequent being weight changes, sleep disorders, weakness, apprehension, anger, and fear. The most used coping strategies were moving away and moving toward, the less used was moving inward. Intervention programs and preventive measures (both individual and organizational) for HCP victims and those who could be considered at risk are also discussed.

The stalking of lawyers: a survey amongst professionals in milan

This is the first study focused on the stalking of lawyers. The authors hypothesized that these professionals are at risk of being stalked by their clients and that this stalking is ascribable to RECON type I.B. A random sample of lawyers was survived. 37.3% of 166 respondents revealed to have been stalked: not only by clients, but also by adversaries and colleagues. Data seem to confirm that the stalking of lawyers mainly belongs to RECON type I.B. Female lawyers were at greater risk than male lawyers. In family law cases, the professionals tended to be stalked by the former husbands of the lawyers' clients (p < 0.01). Several female lawyers-but no male lawyers-were threatened with harm to their family members (p < 0.05). Most of the stalking victims described psychological effects of being stalked. Who suffered physical aggression or repercussions on work was more likely to lodge a complaint (p < 0.01).

Italian nurses' experience of stalking: a questionnaire survey

A literature analysis shows that nurses are at greater risk of being stalked both by ex-partners and acquaintances (such as colleagues and patients) and by unknown stalkers. The aim of this study was to explore Italian nurses' experience of stalking. A copy of the Italian modified version of the Networking for Surviving Stalking (NSS) Questionnaire on Stalking, Beck Depression Inventory (BDI), and State Trait Inventory (STAI) Y1-Y2 scales were distributed to 2,000 nurses working in 4 Italian state hospitals. There were 765 nurses who returned the questionnaire (38.4%), 107 of whom had been victims (14.0%). On average, victims had been stalked for more than 12 months by an acquaintance (41.1%), whose behavior included unwanted communications, following, control, and threatening behavior. The coping strategies used most involved offensive and interactional tactics. Stalking has both emotional and physical consequences for victims, although depression levels were not as high as we expected (BDI M = 11.05, SD = 8.84; STAI Y1 M = 42.11, SD = 11.75; STAIY2 M = 44.04, SD = 12.90). The need to adopt legal, organizational, and individual strategies is also discussed.

Stalking by patients: doctors' experiences in a Canadian urban area (Part II)--physician responses

Stalking involves recurrent unwanted communication, harassment, and intrusive behaviors. The aim of this study was to examine physicians' experiences of being stalked by their patients, with particular attention to the emotional impact on the physicians and their actions taken. A questionnaire designed to study the nature and the impact of stalking experiences among physicians was sent to 3159 randomly chosen physicians in the Greater Toronto Area. Approximately 15% (14.9%) of the 1190 physicians who responded reported having been stalked. The physicians reported feeling angry, frustrated, anxious, frightened, lacking control, and helpless. The physicians coped in a number of ways including terminating the physician-patient relationship, but many just ignored the problem. Most had no previous knowledge about stalking. Physicians experience a range of emotions as a result of being a victim of stalking. In view of the prevalence and the impact, physicians may benefit from education to help prepare them for the possibility of being stalked.

To friend or not to friend: the use of social media in clinical oncology

Online social networking has replaced more traditional methods of personal and professional communication in many segments of society today. The wide reach and immediacy of social media facilitate dissemination of knowledge in advocacy and cancer education, but the usefulness of social media in personal relationships between patients and providers is still unclear. Although professional guidelines regarding e-mail communication may be relevant to social media, the inherent openness in social networks creates potential boundary and privacy issues in the provider-patient context. This commentary seeks to increase provider awareness of unique issues and challenges raised by the integration of social networking into oncology communications.

Stalking by patients: doctors' experiences in a Canadian urban area

Stalking involves recurrent unwanted communication, harassment, and intrusive behaviors. The aim of this study was to examine doctors' experiences of being stalked by their patients in a Canadian urban area. A questionnaire designed to study the nature and prevalence of stalking experiences among physicians was sent to 3159 randomly chosen physicians in the Greater Toronto Area. Of the 1190 physicians who responded, 14.9% reported having been stalked. Although both male and female patients were stalkers, their motives and stalking behaviors were dissimilar. Psychiatrists, surgeons, and OB/GYNs reported the highest rates of being stalked. Both male and female physicians are at an increased risk of being stalked by patients who may feel loving feelings or anger and resentment. Varying reasons behind the stalking may account for the differing rates between specialties. Physicians may benefit from recognition of behaviors that tended to precede the onset of stalking behavior.

When professional kindness is misunderstood: boundaries and stalking issues: a case study for the home health clinician

There is the potential for home health nurses and other home care clinicians to be subjected to intrusive and possibly stalking behavior by current and former clients. Most healthcare clinicians do not receive training on the risk of intrusive interactions or stalking, nor on strategies to manage this objectionable client behavior. This article informs nurses and other home health clinicians about the potential risk of stalking. Included is a true case vignette, the legal definition of stalking, incidence occurrence among clinicians, the basic profile and behaviors of a stalker, the victimology and psychological consequences, and implications for policy and procedures and prevention techniques.

Stalking behaviour by patients towards psychiatrists in a large mental health organization

BACKGROUND

Mental health professionals are at greater risk than the general population of being stalked, particularly by patients.

AIMS

To assess the prevalence of stalking behaviour by patients towards psychiatrists and ascertain patient characteristics.

METHOD

Semi-structured questionnaire to all psychiatrists (n = 324) working in a large mental health organization.

RESULTS

The response rate was 61% (n = 198). Forty-one doctors (21%) reported having been stalked by patients, the majority being consultants (n = 31; 76%). No sub-speciality was over-represented. Most stalkers (n = 24; 59%) were male with a diagnosis of personality disorder (39%) or major mental illness (34%). Duration of stalking ranged from several weeks to 16 years, and most commonly occurred at work. On average, victims experienced two types of inappropriate contact. Physical threats were made against 14 psychiatrists (34%).

CONCLUSIONS

Stalking by patients towards psychiatrists is common and represents an important occupational risk. Formal training programmes and policy development within healthcare organizations may help manage risk.

Nature & prevalence of stalking among New Zealand mental health clinicians

Stalking involves recurrent and persistent unwanted communication or contact that generates fear for safety in the victims. This pilot study evaluated the nature and prevalence of stalking among New Zealand nurses and physicians working in mental health services. An anonymous questionnaire asking respondents to describe their experiences with 12 stalking behaviors was distributed to 895 clinicians. Results indicated that regardless of discipline, women were more likely than men to have experienced one or more stalking behaviors, including receiving unwanted telephone calls, letters, and approaches; receiving personal threats: and being followed, spied on, or subject to surveillance. Women also reported higher levels of fearfulness as a consequence of stalking behaviors. Nearly half of the stalkers were clients; the remaining were former partners, colleagues, or acquaintances. In client-related cases, the majority of respondents told their colleagues and supervisors first, and the majority found them to be the most helpful resource. The results of this pilot study indicate a need for further research focused on the stalking of mental health clinicians in New Zealand and for development of workplace policies for adequate response to the stalking of mental health clinicians.