Insights of nurses about assault in hospital-based emergency departments

Workplace violence against female healthcare workers: a systematic review and meta-analysis

BACKGROUND

Workplace violence (WPV) is highly prevalent in the health sector and remains a major occupational issue causing significant harm, ranging from bodily and psychological harm to death. Female healthcare workers (HCWs) are at high risk of WPV.

OBJECTIVES

Identify risk factors of WPV among different professional categories of female HCWs.

DATA SOURCES

PubMed, EMBASE and Web of Science, along with their references lists January 2010 and March 2022.

ELIGIBILITY CRITERIA

English language observational studies focusing on WPV among HCWs evaluating the risk factors, impacts and consequences of WPV in female HCWs.

METHOD

Risk of bias was assessed for all studies by Joanna Briggs Institute critical appraisal checklists. We estimated the pooled prevalence of WPV and the associated 95% CI using a random-effects meta-analysis model. We then described the associated factors and effects of WPV.

RESULTS

28 reviewed studies (24 quantitative, 4 qualitative and 1 mixed-method) from 20 countries were selected. From the available results of 16 studies, the pooled prevalence of WPV was estimated at 45.0% (95% CI 32% to 58%). Types of violence included verbal abuse, verbal threats, physical assaults, sexual harassment, mobbing, bullying and discrimination. Perpetrators were patients, patients' relatives, colleagues and supervisors. Nurses were the most studied HCWs category. WPV was found to affect both mental and physical health. Age, marital status, lower occupational position, substance abuse, shorter work experience and low support at work were the main socio-demographic and organisational factors associated with higher risk of WPV.

CONCLUSION

WPV prevalence is high among female HCWs, warranting a multilevel intervention approach to address and mitigate its impact. This approach should include targeted policies and individual-level strategies to create a safer work environment and prevent adverse effects on both HCWs and the broader healthcare system. Further research is needed to better document WPV in categories of HCWs other than nurses.

PROSPERO REGISTRATION NUMBER

CRD42022329574.

How Visibility May Reduce Security Issues in Community Hospitals' Emergency Departments

This research explored the relationship between visibility and the level of security risks as perceived by nurses and physicians in emergency departments (EDs). Security in EDs has been reported as a major global concern, and visibility has been identified as a design factor impacting behavior. However, few previous studies have rigorously investigated the role of visibility in reduction of ED security risks with evidence-based design approach. There is a lot of significant questions about how visibility impacts the reduction of security issues in EDs.

METHODS

How visibility may influence ED security was explored via qualitative methods in five EDs using semi-structured one-on-one interviews with 17 clinical staff and 48 hr of field observations. The coding process for both interviews and observational notes followed the principles of naturalistic inquiry.

RESULTS

The findings suggest security risks can be decreased by improving visibility. Medical staff (registered nurses and physicians) felt more secure in the EDs with higher visibility.

DISCUSSION

This study provides a framework to identify preferable levels of visibility in EDs and proposes design strategies to minimize security issues. Registered nurses and physicians can improve their team's sense of security by considering visibility throughout their daily practices.

Caring Knowledge as a Strategy to Mitigate Violence against Nurses: A Discussion Paper

Violence against nurses is a disturbing trend in healthcare that has reached epidemic proportions globally. These violent incidents can result in physical and psychological injury, exacerbating already elevated levels of stress and burnout among nurses, further contributing to absenteeism, turnover, and intent to leave the profession. To ensure the physical and mental well-being of nurses and patients, attention to the development of strategies to reduce violence against nurses must be a priority. Caring knowledge-rooted in the philosophy of care-is a potential strategy for mitigating violence against nurses in healthcare settings. We present what caring knowledge is, analyze its barriers to implementation at the health system and education levels and explore potential solutions to navigate those barriers. We conclude how the application of models of caring knowledge to the nurse-patient relationship has the potential to generate improved patient safety and increased satisfaction for both nurses and patients.

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

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

Workplace violence and its associated factors among nurses working in public hospitals of eastern Ethiopia: a cross-sectional study

BACKGROUND

Workplace violence is one of the global health concerns. Although nurses are the backbone of the health care provision, they are highly subjected to workplace violence in healthcare. Nevertheless, there is a paucity of evidence on the extent of workplace violence against nurses in Ethiopia in general and Eastern Ethiopia in particular. Hence, this study aimed to assess the extent of workplace violence against nurses and its associated factors among nurse professionals working at public hospitals in eastern Ethiopia.

METHODS

Hospital-based cross-sectional study was conducted among 603 nurses working in public hospitals in eastern Ethiopia. Nurses were recruited using a simple random sampling method at their workplace (health facilities). A pretested self-administered questionnaire was used to collect data. Descriptive, binary and multivariable logistic regression analyses were performed. The adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to declare significant association.

RESULTS

Among the 620 estimated sample, 603(97.3%) of the nurses gave consent and completed the self-administered questionnaire. The prevalence of workplace violence against nurse professionals in the last 12 months was 64.0% (95%CI: 60.2-67.7%). Nurses who were working in surgical (AOR: 2.30, 95%CI: 1.01-5.26), psychiatric (AOR: 3.06, 95%CI: 1.11-8.46), emergency (AOR: 3.62, 95%CI: 1.46-8.98), and medical wards (AOR: 5.20, 95%CI: 2.40-11.27); being worried of workplace violence (AOR: 1.71, 95%CI: 1.09-2.69); witnessed of physical workplace violence (AOR: 5.31, 95%CI: 3.28-8.59); claimed "absence/not-aware" of reporting procedure on workplace violence (AOR: 2.24, 95%CI: 1.45-3.46); and claimed "absence/not-aware" of institutional policies against workplace violence (AOR: 2.68, 95%CI: 1.73-4.13) were factors associated with nurses' experience of workplace violence in eastern Ethiopia.

CONCLUSIONS

Workplace violence against nurses was found to be unacceptably high in the study area (eastern Ethiopia). We suggest that stakeholders could work on early risk identification and management of violent incidents, establish violence reporting and sanction mechanisms using contextual strategies to prevent workplace violence against nurse professionals.

Predictors of events of violence or aggression against nurses in the workplace: A scoping review

AIM

To identify predictors and consequences of violence or aggression events against nurses and nursing students in different work contexts.

BACKGROUND

Workplace violence against nurses and nursing students is a very common and widespread phenomenon. Actions to manage or prevent violent events could be implemented knowing the risk factors and consequences. However, there is a lack of systematic reviews that summarize knowledge on the predictors and consequences of workplace violence.

EVALUATION

A scoping review was conducted using electronic databases including APA PsycInfo, CINAHL, Cochrane, Ovid Medline, PubMed and Scopus.

KEY ISSUES

After full text analysis, 87 papers were included in the current scoping review. Risk factors of horizontal violence were grouped into 'personal' and 'Environmental and organizational', and for violence perpetrated by patients into 'personal', 'Environmental and organizational' and 'Characteristics of the perpetrators'.

CONCLUSIONS

The results of this scoping review uncover problems that often remain unaddressed, especially where these episodes are very frequent. Workplace violence prevention and management programmes are essential to counter it.

IMPLICATIONS FOR NURSING MANAGEMENT

The predictors and the consequents identified constitute the body of knowledge necessary for nurse managers to develop and implement policy and system actions to effectively manage or prevent violent events.

Workplace violence among healthcare workers in the emergency departments in Malaysia

Purpose

This study was conducted to determine the percentage and associated factors of workplace violence (WPV) among healthcare workers (HCW) working in the Emergency Departments (ED).

Design/methodology/approach

A cross-sectional study was conducted among 231 HCW using proportionate stratified random sampling. A validated and reliable self-administered questionnaire was distributed among respondents who fulfilled the eligibility criteria. Only Malaysians with a minimum employment of six months in the ED were included. The data was analysed through Multiple Logistic Regression using International Business Machines Statistical Package for Social Sciences software version 24 to determine the association between the independent variables and WPV. Significance level was set at 0.05 (p = 0.05) at 95% confidence interval (CI).

Findings

The percentage of WPV was 38%, of which 88.9% were psychological violence and were mostly perpetrated by combinations of perpetrator types (51.9%). Those aged 40 years and below, with low job support, and working in a secondary hospital have 5.4 (AOR = 5.366, 95% CI: 1.51–19.05), 2.9 (AOR = 2.871, 95% CI: 1.44–5.73) and 2.7 (AOR = 2.737, 95% CI: 1.50–5.01) times higher odds, respectively, of experiencing WPV.

Originality/value

The findings revealed a relatively high percentage of WPV among the HCW working at the ED with those of younger age with low job support and working in secondary hospitals being more at risk. Early interventions to reduce WPV are necessary in targeting those with identified risks.

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.

Strategies used by emergency care professionals to handle interpersonal difficulties with patients: a qualitative study

OBJECTIVES

Identify the strategies implemented by emergency care professionals when facing tension and interpersonal violence from patients and their friends and family.

DESIGN

Descriptive qualitative study based on 38 semidirective interviews.

PARTICIPANTS

Doctors, nurses, nursing assistants and administrative staff.

SETTING

Four emergency departments (EDs) from three French university hospitals.

RESULTS

According to the medical professionals interviewed, the difficulties that they encounter with patients or their accompanying family members can be explained by a lack of understanding of the functioning of EDs, by a general increase in individualistic behaviours leading to a lack of civility or by deviant behaviours (related to toxic substance abuse or mental illness). While managing deviant behaviours may sometimes require a collective intervention, ED staff also implement what are essentially individual communication strategies (with the use of rational explanation, seduction and empathy), confrontation or flight to deal with interpersonal difficulties.

CONCLUSIONS

Strategies used by staff members tend to be individualised for the most part, and some, such as confrontational or escape strategies, may not be adapted to all situations. In the face of difficulties between staff and patients, mediators, specialised in resolving conflict, could entrust some cases to professionals.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov Registry (NCT03139110).

Sources of Social Support After Patient Assault as Related to Staff Well-Being

Patient assault is a serious issue for the well-being of staff in psychiatric hospitals. To guide workplace responses to patient assault, more information is needed about social support from different sources and whether those supports are associated with staff well-being. The present study examines social support after patient assault from work-based and nonwork-based sources, and whether inpatient psychiatric staff desires support from them and perceive the support received as being effective. Received support across sources was examined in relations to staff well-being (physical health, mental health, anger, sleep quality) and perceptions of safety. Survey data was collected from 348 clinical staff in a large public forensic mental hospital. Among the 242 staff who reported an assault in the last year, 71% wanted support and 72% found effective support from at least one source. Generally, effective support from supervisors, coworkers, and their combination was associated with better well-being. Support from nonwork sources was related to less concerns about safety, but not to other well-being measures. However, 28% of staff did not receive effective support from any source postassault. Gaps in support as reported in this study and as found by other investigators call for systematic programming by hospital organizations to enhance the well-being of clinical staff, which in turn has implications for patient care.

[Mediators in emergency services: what missions according to the staff?]

OBJECTIVES

Violence in emergency services has become a central issue in the daily work of hospital employees. While the use of video surveillance and the training of professionals in conflict management are the most common methods used, there are few cases using the setting up of a third part such as a mediator. We conducted a qualitative study with professionals to examine their representations associated with mediation.

METHOD

Semi-directive interviews were conducted with professionals from four emergency units. The topics discussed in interviews were the definition of mediation and the missions that the mediators should fulfil. The content of 38 semi-directive interviews was analysed according to the inductive approach of the grounded theory. A content analysis was made, followed by an analysis aiming to bring out types and convergences/divergences.

RESULTS

Professionals were not aware of the definition of mediation and of its missions. They linked to it an instrumental theme, making mediation a tool for conflict prevention and management, a tool for communication with patients about their care, and about the organisation of emergency unit. The upcoming presence of mediators was seen as an help. A potential competition between professionals and mediators in the tasks performed was identified.

CONCLUSION

The study shows a favourable opinion towards mediation. It has allowed to identify obstacles to the well-functioning of the missions assigned to mediators. One of the challenges is the integration of this new actor, the mediator.

Residents' Experiences of Abuse and Harassment in Emergency Departments

The widespread epidemic of emerging abuse in Emergency Departments (ED) toward residents generates negative effects on the residents' health and welfare. The purpose of this study was to determine and highlight the high prevalence of abuse and harassment toward Emergency residents. In 2011, a multi-institutional, cross-sectional study was conducted at seven Emergency Residencies of central hospitals in Iran. Residents were asked about their age, marital status, postgraduate year (PGY) levels, and work experiences before residency. Prevalence of abuse in four categories was evaluated: verbal abuse; verbal and physical threat; physical assault and sexual harassment; and by whom. The data were analyzed by SPSS version 17.0 (SPSS, Inc., Chicago, IL, USA). Two hundred fifteen of the 296 residents (73%) completed the survey. The prevalence of any type of abuse experienced was 89%; 43% of residents experienced verbal and physical threats, 10% physical assault, and 31% sexual harassment. Verbal abuse and verbal and physical threats without the use of weapons were higher in men in comparison with women ( p< .04). Women were more likely than men to encounter sexual harassment (31% vs. 7%, p< .01). Among the sexual harassment categories, sexual jokes (51%) were the most prevalent between residents. Junior residents (PGY-1) were more likely to experience abuse than senior residents (PGY-2 and PGY-3; p< .01). Patients and their companions were the main agents of abusive behaviors. Abuse and harassment during residency in ED are highly prevalent. Educational programs and effective preventive measures against this mistreatment are urgently required.

Psychological violence against general practitioners and nurses in Chinese township hospitals: incidence and implications

Background

International reports indicating that around 10–50% of health care staff are exposed to violence every year; in certain settings, this rate might reach over 85%. Evidence has shown that people who experience psychological violence are seven times as likely to be victims of physical violence. Although there have been numerous studies on WPV in general hospitals, there is no consensus regarding the current status of psychological violence directed at health care workers in township hospitals in China. The purpose of this study was to estimate the prevalence and the risk factors of psychological violence in Chinese township hospitals.

Methods

A retrospective cross-sectional survey of township hospitals general practitioners and general nurses was conducted in Heilongjiang Province, China.Descriptive analyses and binary logistic regression analysis were used to estimated the prevalence and the risk factors of psychological violence.

Results

Regardless of whether the assessment period was the past 12 months, past 36 months, or during their entire career,GPs and nurses reported that verbal abuse was the most common type of psychological violence (28.05, 30.28, 38.69 and 40.45%, 43.86, 54.02%).The main perpetrator was patients’ relatives. Most participants responded to violence with “pretend nothing happened”, 55.63% of GPs and 62.64% of nurses reported that the perpetrator received no punishment. Around 47.62% of respondents reported that their workplace had no procedures for reporting violence. When workplaces did have a reporting system, 57.73% knew how to use them. Only 36.98% had training in managing aggression and violence. General nurses, individuals 35 years or younger, those with higher professional titles and who work in shifts are at greater risk of psychological violence.

Conclusions

Our results indicate a high prevalence of psychological violence in Chinese township hospitals, which can no longer be ignored. Effective measures should be taken to prevent and respond to workplace violence(WPV), especially psychological violence.

Trial registration

(Project Identification Code: HMUIRB20160014), Registered May 10, 2016.

Well-Being and Safety Among Inpatient Psychiatric Staff: The Impact of Conflict, Assault, and Stress Reactivity

Psychiatric staff are faced with multiple forms of hostility, aggression, and assault at work, collectively referred to as workplace violence, which typically is activated by patients but can also come from coworkers and supervisors. Whether workplace violence adversely affects staff well-being may be related not only to its presence, but also to an individual's stress reactivity. At a large public psychiatric hospital, an online survey was completed by 323 clinical care staff, of whom 69.5 % had experienced physical assault in the previous 12 months. Staff well-being (depression, anger, and physical health) and staff safety concerns were adversely affected by conflicts with other staff members and by individual reactivity to social conflict and to assault. To improve staff well-being, in addition to safety protocols, interventions should target staff relationships, personal health maintenance practices, and individual coping skills for dealing with adverse workplace experiences.

Antecedents and precipitants of patient-related violence in the emergency department: Results from the Australian VENT Study (Violence in Emergency Nursing and Triage)

INTRODUCTION

Workplace violence is one of the most significant and hazardous issues faced by nurses globally. It is a potentially life-threatening and life-affecting workplace hazard often downplayed as just "part of the job" for nurses.

METHODS

A cross-sectional design was used and data were collected using a purpose developed survey tool. Surveys were distributed to all members of the College of Emergency Nurses' Australasia (CENA) in 2010 and 537 eligible responses were received (RR=51%).

RESULTS

Patient-related violence was reported by 87% of nurses in the last six months. Precipitants and antecedents for episodes of violence were reported in three categories: nurse-related; patient-related and emergency-department specific factors. Triaging was identified as the highest risk nursing activity, and the triage area identified as the highest risk location in the department. Patients who presented with alcohol intoxication, substance misuse or mental health issues were identified as the groups at greatest risk for potential violence.

DISCUSSION

Patient-related violence was reported by the majority of emergency nurses surveyed. A number of precipitants and antecedents perceived to be risk factors by participants were found to be significant and are unavoidable in the working lives of emergency department nurses.

Experiencing violence in a psychiatric setting: Generalized hypervigilance and the influence of caring in the fear experienced

BACKGROUND

Exposure to violence in the mental health sector both affects employees and has implications for the quality of care provided.

OBJECTIVE

This phenomenological study aims to describe and understand the ways in which acts of aggression from a patient might affect workers in a psychiatric institute, their relationships with the patients and the services offered.

METHODS

Two semi-structured interviews were conducted with each of the 15 participants from various professions within a psychiatric hospital.

RESULTS

Our analysis reveals four themes: hypervigilance, caring, specific fear toward the aggressor and generalized fear of all patients. A state of hypervigilance is found among all participants. An emphasis on caring is present among the majority and unfolds as a continuum, ranging from being highly caring to showing little or no caring. A feeling of fear is expressed and is influenced by the participant's place on the caring continuum. Caring workers developed a specific fear of their aggressor, whereas those showing little or no caring developed a generalized fear of all patients. Following a violent event, caring participants maintained this outlook, whereas those demonstrating little to no caring were more inclined to disinvest from all patients.

CONCLUSIONS

Hypervigilance and fear caused by experiences of violence impact the quality of care provided. Considerable interest should thus be paid to caring, which can influence fear and its effects.

Victim Responses to Violence: The Effect of Alcohol Context on Crime Labeling

The labeling of an incident as a crime is an essential precursor to the use of criminal law, but the contextual factors that influence this decision are unknown. One such context that is a frequent setting for violence is the barroom. This study explored how the setting of a violent incident is related to the decision by victims to label it as a crime. It tested the hypothesis that violent incidents that took place in or around a licensed premises were less likely to be regarded as crimes than violence in other settings. The hypothesis was tested using a pooled sample of respondents from successive waves of the British Crime Survey (2002/2003-2010/2011). Logistic regression models controlled for demographic factors, victim behavioral characteristics, and incident-specific factors including the seriousness of the violence. Respondents who were in or around a licensed premises at the time of victimization were less likely to regard that violence as a crime (adjusted odds ratio = 0.48, 95% confidence intervals [CIs] = [0.34, 0.67]) than respondents who were victimized in other locations. Despite a disproportionate amount of violence taking place in barrooms, it appears that the criminal nature of violence in these spaces is discounted by victims. The findings emphasize how context affects victim interpretations of crime and suggest a victim-centered reconceptualization of the "moral holiday" hypothesis of alcohol settings.

Security Implications of Physical Design Attributes in the Emergency Department

BACKGROUND

Security, a subset of safety, is equally important in the efficient delivery of patient care. The emergency department (ED) is susceptible to violence creating concerns for the safety and security of patients, staff, and visitors and for the safe and efficient delivery of care. Although there is an implicit and growing recognition of the role of the physical environment, interventions typically have been at the microlevel.

OBJECTIVE

The objective of this study was to identify physical design attributes that potentially influence safety and efficiency of ED operations.

METHOD

An exploratory, qualitative research design was adopted to examine the efficiency and safety correlates of ED physical design attributes. The study comprised a multimeasure approach involving multidisciplinary gaming, semistructured interviews, and touring interviews of frontline staff in four EDs at three hospital systems across three states.

RESULTS

Five macro physical design attributes (issues that need to be addressed at the design stage and expensive to rectify once built) emerged from the data as factors substantially associated with security issues. They are design issues pertaining to (a) the entry zone, (b) traffic management, (c) patient room clustering, (d) centralization versus decentralization, and (e) provisions for special populations.

CONCLUSION

Data from this study suggest that ED security concerns are generally associated with three sources: (a) gang-related violence, (b) dissatisfied patients, and (c) behavioral health patients. Study data show that physical design has an important role in addressing the above-mentioned concerns. Implications for ED design are outlined in the article.

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.

Registered nurses' experiences of patient violence on acute care psychiatric inpatient units: an interpretive descriptive study

BACKGROUND

Nurses working in acute care psychiatry settings experience high rates of patient violence which influences outcomes for nurses and the organization. This qualitative study explored psychiatric nurses' experiences of patient violence in acute care inpatient psychiatric settings.

METHODS

An interpretive descriptive design guided this study that included 17 semi-structured interviews with a purposeful sample of 12 Canadian registered nurses who self-reported experiencing patient violence within acute care inpatient psychiatry. Thematic analysis and constant comparison techniques were used for analysis. A problem, needs and practice analysis was also used to structure overall data interpretation.

RESULTS

Thirty three unique exposures to patient violence among the sample of nurses were analysed. Nurses reported experiencing physical, emotional and verbal violence. For many, patient violence was considered "part of the job." Nurses often struggled with role conflict between one's duty to care and one's duty to self when providing care following a critical incident involving violence. Issues of power, control and stigma also influenced nurse participant perceptions and their responses to patient violence. Nurses used a variety of strategies to maintain their personal safety and to prevent, and manage patient violence. Nurses endorsed the need for improved education, debriefing following an incident, and a supportive work environment to further prevent patient violence. Present findings have implications for reducing the barriers to reporting violent experiences and the creation of best practice guidelines to reduce patient violence in the workplace.

CONCLUSIONS

Understanding the perspectives and experiences of nurses in acute inpatient psychiatry leads to greater understanding of the phenomenon of patient violence and may inform the development of interventions to prevent and to respond to patient violence, as well as support nurses working within the acute care setting.

Registered nurses' experiences of patient violence on acute care psychiatric inpatient units: an interpretive descriptive study

Background

Nurses working in acute care psychiatry settings experience high rates of patient violence which influences outcomes for nurses and the organization. This qualitative study explored psychiatric nurses’ experiences of patient violence in acute care inpatient psychiatric settings.

Methods

An interpretive descriptive design guided this study that included 17 semi-structured interviews with a purposeful sample of 12 Canadian registered nurses who self-reported experiencing patient violence within acute care inpatient psychiatry. Thematic analysis and constant comparison techniques were used for analysis. A problem, needs and practice analysis was also used to structure overall data interpretation.

Results

Thirty three unique exposures to patient violence among the sample of nurses were analysed. Nurses reported experiencing physical, emotional and verbal violence. For many, patient violence was considered “part of the job.” Nurses often struggled with role conflict between one’s duty to care and one’s duty to self when providing care following a critical incident involving violence. Issues of power, control and stigma also influenced nurse participant perceptions and their responses to patient violence. Nurses used a variety of strategies to maintain their personal safety and to prevent, and manage patient violence. Nurses endorsed the need for improved education, debriefing following an incident, and a supportive work environment to further prevent patient violence. Present findings have implications for reducing the barriers to reporting violent experiences and the creation of best practice guidelines to reduce patient violence in the workplace.

Conclusions

Understanding the perspectives and experiences of nurses in acute inpatient psychiatry leads to greater understanding of the phenomenon of patient violence and may inform the development of interventions to prevent and to respond to patient violence, as well as support nurses working within the acute care setting.

'Violence is not part of our job': a thematic analysis of psychiatric mental health nurses' experiences of patient assaults from a New Zealand perspective

This paper describes psychiatric mental health nurses' (PMHN) experiences of patient assaults within mental healthcare settings using a thematic analytical approach. The aim of the study was to explore and describe psychiatric mental health nurses' experiences of patient assaults. The major findings of the study related to the nature and impact of assaults and supportive strategies associated with violence perpetrated by patients against psychiatric mental health nurses. Perpetrator risk factors for patients include mental health disorders, alcohol and drug use and the inability to deal with situational crises. The injuries sustained by nurses in the context of the study include lacerations, head injuries, dislocations and bruises. Psychological harm has also occurred, including quite severe mental health problems, such as post-traumatic stress disorder. Protective strategies for combating negative consequences of workplace violence include practice of self-defence, social support and a supportive and consultative workplace culture with access to counselling services and assistance in all aspects, including finances. The paper concludes that while healthcare employers need to provide better support services to the healthcare professionals who are assaulted, the legal system also needs to acknowledge that assaults against nurses are a violation of human rights and violence should not to be tolerated as part of working in mental healthcare settings.

Impact of a program to prevent incivility towards and assault of healthcare staff in an ophtalmological emergency unit: study protocol for the PREVURGO On/Off trial

Background

The emergency department has been identified as an area within the health care sector with the highest reports of violence. The best way to control violence is to prevent it before it becomes an issue. Ideally, to prevent violent episodes we should eliminate all triggers of frustration and violence. Our study aims to assess the impact of a quality improvement multi-faceted program aiming at preventing incivility and violence against healthcare professionals working at the ophthalmological emergency department of a teaching hospital.

Methods/Design

This study is a single-center prospective, controlled time-series study with an alternate-month design. The prevention program is based on the successive implementation of five complementary interventions: a) an organizational approach with a standardized triage algorithm and patient waiting number screen, b) an environmental approach with clear signage of the premises, c) an educational approach with informational videos for patients and accompanying persons in waiting rooms, d) a human approach with a mediator in waiting rooms and e) a security approach with surveillance cameras linked to the hospital security. The primary outcome is the rate of incivility or violence by patients, or those accompanying them against healthcare staff. All patients admitted to the ophthalmological emergency department, and those accompanying them, will be enrolled. In all, 45,260 patients will be included in over a 24-month period. The unit analysis will be the patient admitted to the emergency department. Data analysis will be blinded to allocation, but due to the nature of the intervention, physicians and patients will not be blinded.

Discussion

The strengths of this study include the active solicitation of event reporting, that this is a prospective study and that the study enables assessment of each of the interventions that make up the program. The challenge lies in identifying effective interventions, adapting them to the context of care in an emergency department, and thoroughly assessing their efficacy with a high level of proof.

The study has been registered as a cRCT at clinicaltrials.gov (identifier: NCT02015884).

Work-related violence against educators in Minnesota: rates and risks based on hours exposed

PROBLEM

Violence is a major occupational problem; yet, rigorous studies focused on educators to address this problem are limited. The objective was to identify educators' potential risks for physical assault (PA) and nonphysical violence (NPV), based on hours exposed.

METHODS

A total of 4,731 licensed kindergarten through grade 12 Minnesota educators, identified from the Minnesota Department of Education database, participated. Specially designed mailed questionnaires (12-month recall) enabled data collection. Calculated PA and NPV rates, per 100,000 working hours, used Poisson regression. Directed acyclic graphs identified confounders for multivariable analysis, adjusted for non-response and unknown eligibility.

RESULTS

The total PA rate was 5.3; PA risks increased for educators who: were non-married versus married; held master's degrees, or education specialist degrees, versus associate/bachelor's degrees; worked in public alternative and various school types, versus public schools; worked as social workers, in special education or multiple activities, versus standard classroom teaching; worked with <10, versus 10 to <25 students in the class. The total NPV rate was 26.4; subcategory rates were: threat (34.8); sexual harassment (7.6); verbal abuse (55.5); bullying (19.6). Increased risks for NPV included: 30-39 and 60-79, versus 50-59years of age; non-married versus married; working in public alternative versus public schools; working part-time or substitute, versus full-time; teaching in special education or multiple activities, versus standard classroom teaching; teaching in class sizes <10 and ≥25, versus 10-24 students; teaching in grades 3-12 and multiple grades, versus kindergarten to second grade. The investigated results for PA and NPV were similar, with a few exceptions. DISCUSSION AND IMPACT ON INDUSTRY: Results from this study provided information about factors associated with increased and decreased risks for violence against educators, based on hours worked. In addition, they provided a basis for further investigations to reduce violence against educators in the school environment.

Workplace violence against physicians and nurses in Palestinian public hospitals: a cross-sectional study

Background

Violence against healthcare workers in Palestinian hospitals is common. However, this issue is under researched and little evidence exists. The aim of this study was to assess the incidence, magnitude, consequences and possible risk factors for workplace violence against nurses and physicians working in public Palestinian hospitals.

Methods

A cross-sectional approach was employed. A self-administered questionnaire was used to collect data on different aspects of workplace violence against physicians and nurses in five public hospitals between June and July 2011. The questionnaires were distributed to a stratified proportional random sample of 271 physicians and nurses, of which 240 (88.7%) were adequately completed. Pearson’s chi-square analysis was used to test the differences in exposure to physical and non-physical violence according to respondents’ characteristics. Odds ratios and 95% confidence intervals were used to assess potential associations between exposure to violence (yes/no) and the respondents’ characteristics using logistic regression model.

Results

The majority of respondents (80.4%) reported exposure to violence in the previous 12 months; 20.8% physical and 59.6% non-physical. No statistical difference in exposure to violence between physicians and nurses was observed. Males’ significantly experienced higher exposure to physical violence in comparison with females. Logistic regression analysis indicated that less experienced (OR: 8.03; 95% CI 3.91-16.47), and a lower level of education (OR: 3; 95% CI 1.29-6.67) among respondents meant they were more likely to be victims of workplace violence than their counterparts. The assailants were mostly the patients' relatives or visitors, followed by the patients themselves, and co-workers. Consequences of both physical and non-physical violence were considerable. Only half of victims received any type of treatment. Non-reporting of violence was a concern, main reasons were lack of incident reporting policy/procedure and management support, previous experience of no action taken, and fear of the consequences.

Conclusions

Healthcare workers are at comparably high risk of violent incidents in Palestinian public hospitals. Decision makers need to be aware of the causes and potential consequences of such events. There is a need for intervention to protect health workers and provide safer hospital workplaces environment. The results can inform developing proper policy and safety measures.

Cases of mobbing activities as commonly seen in the healthcare sector in the world and in Turkey

Service process on a site in the health sector does not only bring people and services into contact, but also all other people who share the fate of particular working medium. Although these people should cooperate and care about each other, contributing new merits to humanity with their synergy, meeting of people with the other people from time to time intertwine into a bitter, pain giving relation, like the way it happens with meeting of people with services. Owing to its controversy to humanitarian nature, religious and social values, the pain that human beings cause to one another is occasionally disguised behind a veil, thus turning into a life tragedy for individuals in the background. Mobbing which is commonly a confrontable problem in every workplace means psychological violence, enclosure, harassment, molestation or endurance. This study aims to draw attention to the precautions required to be taken against mobbing activities by analyzing situations of health employees who undergo mobbing actions in Turkey and in the World. To achieve this, the existing studies concerning mobbing in the healthcare sector have been examined. In conclusion; it is determined that mobbing activities towards healthcare workers have limited their communication possibilities, damaged social relations and social image, prevented vocational improvement and destroyed mental health of employees. With respect to mobbing behavior towards health employees, we should adopt a democratic, contributing, and guiding administration style, we should apply organizational justice, excessive work inspections must be reduced, work ethics and social responsibility awareness must be developed, we should clearly determine the duties and responsibilities, physical conditions must be improved and necessary legal arrangements concerning the subject must be made to be able to prevent mobbing.

Residents' experiences in dealing with abuse in emergency department: a survey in Iran hospitals

BACKGROUND

Abuse in Emergency Department (ED) as a widespread phenomenon, has negative effects on ED residents. This issue pertains to Western as well as Asian countries.

OBJECTIVE

The purpose of this study was to assess how Iranian ED residents deal with abuse. Awareness, educational programmes, reports, causes of abuse and ways to reduce this were considered in this survey.

METHOD

In 2011, a cross-section survey was conducted at seven ED residencies of central hospitals in Tehran, Mashhad, Ahwaz and Tabriz. ED residents were asked about their age, sex, abuse time, awareness of abuse, educational programmes, reporting abuse, causes of reluctance to report, and how to reduce abuse. The data were analysed by SPSS V.20.

RESULTS

A total of 215 questionnaires were completed. Abuse was reported to have occurred most frequently during night shifts (n=89, 41.4%),  and most of the residents were abused by men rather than women (n=132, 61% vs n=22, 10%, p<0.05). About half the residents (n=107, 49.8%) were not aware of any abuse. Only 22% (n=46) had formal or informal education in abuse, and 74% (n=158) of them had not gone through any learning programmes. Most residents (n=175, 81%) did not know how to report abuse, and among respondents, most of the residents did not report the abuse (n=86, 40%), and the cause was mostly the uncertainty towards officials being able to solve the problem of abuse (n=67, 38%). Residents most often reported not to admit patients more than the hospital's capacity as the main solution to reduce abuse (n=61, 32%).

CONCLUSIONS

Being abused during residency is a universal problem, and there is a lack of awareness and the knowledge of how to deal with abuse, and reporting it among ED residents in Iranian hospitals.

Assessment of Turkish junior male physicians' exposure to mobbing behavior

AIM

To determine the extent of Turkish junior male physicians' exposure to mobbing behavior and its correlation with physicians' characteristics.

METHODS

The study included physicians recruited for compulsory military service in April 2009. No sampling method was used, questionnaires were delivered to all physicians, and 278 of 292 (95%) questionnaires were returned. We used Leymann Inventory of Psychological Terror including 45 items for data collection and structural equation model for data analysis.

RESULTS

A total of 87.7% of physicians experienced mobbing behavior. Physicians who worked more than 40 hours a week, single physicians, physicians working in university hospitals and private hospitals, and physicians who did not have occupational commitment were more exposed to mobbing (P<0.05). Mobbing was not associated with specialty status, service period, age, and personality variables (P>0.05). All goodness-of- fit indices of the model were acceptable (χ(2)=1.449, normed fit index=0.955, Tucker Lewis index=0.980, comparative fit index=0.985, and root mean square error of approximation=0.040).

CONCLUSIONS

Workplace mobbing is a critical problem for junior male physicians in Turkey. We suggest an introduction of a reporting system and education activities for physicians in high-risk groups.

Workplace violence in emergency medicine: current knowledge and future directions

BACKGROUND

Workplace violence (WPV) has increasingly become commonplace in the United States (US), and particularly in the health care setting. Assaults are the third leading cause of occupational injury-related deaths for all US workers. Among all health care settings, Emergency Departments (EDs) have been identified specifically as high-risk settings for WPV.

OBJECTIVE

This article reviews recent epidemiology and research on ED WPV and prevention; discusses practical actions and resources that ED providers and management can utilize to reduce WPV in their ED; and identifies areas for future research. A list of resources for the prevention of WPV is also provided.

DISCUSSION

ED staff faces substantially elevated risks of physical assaults compared to other health care settings. As with other forms of violence including elder abuse, child abuse, and domestic violence, WPV in the ED is a preventable public health problem that needs urgent and comprehensive attention. ED clinicians and ED leadership can: 1) obtain hospital commitment to reduce ED WPV; 2) obtain a work-site-specific analysis of their ED; 3) employ site-specific violence prevention interventions at the individual and institutional level; and 4) advocate for policies and programs that reduce risk for ED WPV.

CONCLUSION

Violence against ED health care workers is a real problem with significant implications to the victims, patients, and departments/institutions. ED WPV needs to be addressed urgently by stakeholders through continued research on effective interventions specific to Emergency Medicine. Coordination, cooperation, and active commitment to the development of such interventions are critical.

Violence in the emergency department: an ethnographic study (part I)

Violence in the emergency department (ED) is a significant problem and it is increasing. Nevertheless the problem remains inadequately investigated as most studies that have investigated this issue are descriptive in nature. Although these studies have provided important preliminary information, they fail to reveal the complexities of the problem, in particular the cultural aspects of violence which are crucial for the ED. This paper is part I of a 2-part series which will provide an overview of the background, aims and methods of an ethnographic study about violence in the ED. The study aimed to explore the cultural aspects of violence in the ED. Contemporary ethnography was adopted to frame the study's methodology. The study was carried out at a major metropolitan ED over 3 months using observations, questionnaires and interviews. Initially, the questionnaires were analysed using SPSS before incorporating into the qualitative data. Then, a data analysis framework was adopted to assist in the analysis of data at item (domain), pattern (taxonomic and componential) and structural levels. A brief description of the cultural scene will also be highlighted before leaving the findings of the study along with its discussions to the part II of the 2-part series.

Workplace violence against Iranian nurses working in emergency departments

BACKGROUND

Nurses working in emergency departments (EDs) are in the most danger of workplace violence (WPV) because of the critical nature of the wards.

AIMS

This study aimed to find the frequency and nature of physical and verbal WPV against Iranian nurses working in EDs.

METHODS

A cross-sectional study was carried out using consensus sampling of 196 bachelor's degree nurses working in 11 EDs of teaching hospitals in Tehran, Iran. 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. The gathered data were analysed using descriptive and inferential statistics.

RESULTS

The participants were mostly (89.1%) female and their work experiences (63.2%) in nursing were between 1 and 5 years; 19.7% of the nurses had faced physical violence. All of the physical violence incidents were without-weapon; 91.6% of the participants experienced verbal abuse during the past year. Patients' relatives were the most common source of violence. Dissatisfaction was reported on the way the incidents were handled.

CONCLUSION

It is believed that finding the pattern and nature of WPV is the first step to develop suitable strategies to deal with the issue. Establishing WPV management teams and enacting appropriate laws can improve workplace safety for nurses and patients' care quality.

Violence against primary health care workers in Al-Hassa, Saudi Arabia

This self-report questionnaire study was carried out in Al-Hassa, Saudi Arabia to highlight the magnitude, predictors, and circumstances of workplace violence against primary health care (PHC) workers. A total of 1,091 workers completed a self-administered questionnaire. About 28% were exposed to at least one violent event during the past year. Logistic regression analysis revealed that the most important predictors of violence are high education of workers (OR = 9.3), working in emergency clinics (OR = 6.8), and in Hegar (OR = 3.2). Emotional and physical violence accounted for 92.1% and 7.9% of violent events, respectively. Unmet needs of patients, overcrowding, and reaction to injury or illness were the leading contributing factors for violence. There is a need for violence prevention and control program in health care facilities.

Workplace violence directed at nursing staff at a general hospital in southern Thailand

This study aimed to document the characteristics of workplace violence directed at nursing staff, an issue which has rarely been studied in a developing country. Two study methods, a survey and a key informant interview, were conducted at a general hospital in southern Thailand. A total of 545 out of 594 questionnaires sent were returned for statistical analysis (response rate=91.7%). The 12-month prevalence of violence experience was 38.9% for verbal abuse, 3.1% for physical abuse, and 0.7% for sexual harassment. Psychological consequences including poor relationships with colleagues and family members were the major concerns. Patients and their relatives were the main perpetrators in verbal and physical abuse while co-workers were the main perpetrators in cases of sexual harassment. Common factors to incidents of violence were psychological setting, illness of the perpetrators, miscommunication, and alcohol use. Logistic regression analysis showed younger age to be a personal risk factor. Working in the out-patient unit, trauma and emergency unit, operating room, or medical or surgical unit increased the odds of violence by 80%. Training related to violence prevention and control was found to be effective and decreased the risk of being a victim of violence by 40%. We recommend providing training to high risk groups as a means of controlling workplace violence directed at nursing staff.

Sexual harassment against nurses in Turkey

PURPOSE

To identify the prevalence and sources of sexual harassment against nurses in Turkey, its consequences, and factors affecting harassment experiences.

DESIGN

Descriptive survey. Participants (N=622) were selected from nurses working in eight Ministry of Health hospitals in Turkey.

METHODS

Participants were surveyed with a Sexual Harassment Questionnaire, consisting of the sociodemographic characteristics of participants, types of sexual harassment, sources, feelings, ramifications, and ways to cope with sexual harassment behaviors. Frequency and percentage distributions, chi-square, and logistic regression were used for data analysis.

FINDINGS

The results showed 37.1% of participants had been harassed sexually. Physicians were identified as the primary instigators of sexual harassment. The most common reactions against harassers were anger and fear; frequently reported negative effects of sexual harassment were disturbed mental health function, decline in job performance, and headache. "Did nothing" was the coping method used most commonly by the nurses. About 80% of sexually harassed nurses did not report the incident of sexual harassment to hospital administration.

CONCLUSIONS

The lower working status and power of nurses in the workplace, poor working conditions in healthcare settings, and insufficient administrative mechanisms, including the present law and regulations against sexual harassers, were identified as important factors in the work environment in Turkey.

Examination of Incidents of Workplace Verbal Abuse Against Nurses

The purpose of this research was to examine the incidents of verbal abuse faced by nurses in the workplace in the last year. Data were collected from 290 hospital nurses in Turkey. The study found that the majority of nurses had faced verbal abuse (n = 233, 80.3%). The findings from the research confirm the need for urgent and continuous plans for addressing verbal abuse in the workplace and for adoption of zero tolerance.

Injuries associated with teacher assaults: magnitude, nature, cost, and outcome

The purpose of this retrospective study was to describe the magnitude, nature, and costs of assault injuries among teachers, a high-risk group. Review of assault cases (N = 341) was based on internal and case management vendor records. The 3-year assault rate was 3.24 per 1,000 teachers. Assaults were predominately physical, occurring during classroom disputes and while restraining students. Assaults accounted for 2,480 lost workdays and more than dollars 714,000 in lost wages and case management fees. The most costly injuries on a per-case basis were strain-sprain injuries resulting in lost workdays and fractures not resulting in lost workdays. Less than 20% of the assaults accounted for all of the lost workdays and most of the case costs. Study variables accounted for 13% of case costs. Occupational health nurses should collaborate with school personnel, administrators, and parents to develop prevention programs, which may include de-escalation techniques for teachers as well as case management strategies.

Review of research methods used to investigate violence in the emergency department

Violence in the emergency department (ED) is of constant concern to emergency practitioners. Much research has been conducted on this topic but it appears that there has been no attempt to systematically evaluate the methods that have been used to investigate this problem. Therefore, the purpose of this paper is to review the research methods in order to identify the most effective approach for future use and to reveal gaps in the understanding of this problem. Most studies that have been conducted to investigate violence in the ED are descriptive in nature with the most common type retrospective or prospective surveys. Few interview-based studies have been conducted but these have provided an in-depth understanding of the perspectives and feelings of staff involved in the patient violence. However, none of the methods used have provided insight into the perspectives of patients or perpetrators of violence in the ED. To date, it appears that no observational or predictive studies pertaining to this problem have been conducted. Combining questionnaire-based and interview-based prospective surveys with observations could be an ideal method to investigate violence in the ED, as it would permit the researcher to investigate this complex problem more thoroughly and holistically.

Violence toward health care workers in emergency departments in Denizli, Turkey

This study sought to determine the frequency and types of violence that occurred during the previous year against health care workers in emergency departments in Denizli, Turkey, and to discern the views of workers on the prevention of such aggressive behavior. This study was conducted from March 1 to April 15, 2003, and included a group of 79 health care workers from the emergency departments of 3 hospitals in Denizli, namely, the Hospital of Pamukkale University Medical Faculty, the City Hospital of Denizli, and the Hospital of the Social Insurance Foundation. Data were collected from a self-administered questionnaire. In all, 88.6% of participants had been subjected to or had witnessed verbal violence, and 49.4% of them had been subjected to or had witnessed physical violence during the previous year. The most frequent reason (31.4%) for violence was abuse of alcohol and drugs by perpetrators. The second most frequent reason (24.7%) was the long waiting times typical of emergency departments. The most common type of violence was loud shouting; swearing, threatening, and hitting were the next most frequent violent behaviors. In all, 36.1% of subjects who had experienced violence reported that they developed psychological problems after the incident. Most participants commented on the insufficiency of currently available security systems within emergency departments and on the need for further training about violence. All health care personnel within emergency departments should be aware of the risk of violence and should be prepared for unpredictable conditions and events; in addition, security systems should be updated so that violence within emergency departments can be prevented.