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Shafran Tikva S, Gabay G, Shkoler O, Kagan I. Association of quality of nursing care with violence load, burnout, and listening climate. Isr J Health Policy Res 2024; 13:22. [PMID: 38659017 PMCID: PMC11040785 DOI: 10.1186/s13584-024-00601-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 03/08/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Violence against nurses is common. Previous research has recommended further development of the measurement of violence against nurses and integration of the individual and ward-related factors that contribute to violence against hospital nurses. This study was designed to address these issues by investigating the associations between violence, the listening climate of hospital wards, professional burnout, and perceived quality of care. For this purpose, we used a new operationalization of the violence concept. METHODS We sought nurses to participate in the study through social media which yielded 765 nurses working in various healthcare systems across Israel who volunteered to complete a self-administered online questionnaire. 80% of the sample were hospital nurses, and 84.7% were female. The questionnaire included validated measures of burnout, listening climate, and quality of care. Instead of using the traditional binary measure of exposure to violence to capture the occurrence and comprehensive impact of violence, this study measured the incremental load of violence to which nurses are subjected. RESULTS There were significant correlations between violence load and perceived quality of care and between constructive and destructive listening climates and quality of care. Violence load contributed 14% to the variance of burnout and 13% to the variance of perceived quality of care. The ward listening climate moderated the relationship between burnout and quality of care. CONCLUSIONS The results of this study highlight the impact of violence load among nurses and the ward listening climate on the development of burnout and on providing quality care. The findings call upon policymakers to monitor violence load and allocate resources to foster supportive work environments to enhance nurse well-being and improve patient care outcomes.
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Affiliation(s)
- Sigal Shafran Tikva
- Jerusalem College of Technology; Head, Hadassah Research and Innovation Center in Nursing, Hadassah University Medical Center, Jerusalem, Israel.
| | - Gillie Gabay
- School of Sciences, Multi-Disciplinary Studies, Achva Academic College, Arugot, Israel
| | | | - Ilya Kagan
- Nursing Department, Ashkelon Academic College, Ashkelon, Israel
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Robinson S. Maintaining a safe environment in emergency department waiting rooms. Emerg Nurse 2024; 32:33-41. [PMID: 38111266 DOI: 10.7748/en.2023.e2189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2023] [Indexed: 12/20/2023]
Abstract
Increasing demand, overcrowding and insufficient resources have led to situations where patient care is delivered in emergency department (ED) waiting rooms. For nurses undertaking triage in the ED waiting room, overcrowding is challenging, particularly in terms of assessing patients in a timely fashion, monitoring patients for clinical deterioration and ordering investigations. Additionally, long waiting times and a lack of information can lead to communication breakdowns with patients and, at times, patient confrontations with ED staff. This article explores the effects of the busy environment in ED waiting rooms on patients and staff such as triage nurses and waiting room nurses.
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Affiliation(s)
- Suzanne Robinson
- clinical skills and simulation lead, School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth, England
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Ramacciati N. Empowering understanding and mitigating workplace violence: The role of sense of coherence and the global approach to violence toward emergency nurses framework. J Adv Nurs 2024; 80:399-400. [PMID: 37589378 DOI: 10.1111/jan.15831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 08/07/2023] [Indexed: 08/18/2023]
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Timmins F, Catania G, Zanini M, Ottonello G, Napolitano F, Musio ME, Aleo G, Sasso L, Bagnasco A. Promoting holistic approaches to management of violence in the ED-a response to Ramacciati (2023). J Clin Nurs 2023; 32:6771-6772. [PMID: 37661313 DOI: 10.1111/jocn.16847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/02/2023] [Indexed: 09/05/2023]
Affiliation(s)
- Fiona Timmins
- School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin 4, Ireland
| | - Gianluca Catania
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Milko Zanini
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Giulia Ottonello
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | | | - Maria Emma Musio
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Giuseppe Aleo
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Loredana Sasso
- Department of Health Sciences, University of Genoa, Genoa, Italy
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Ramacciati N. Nursing management of emergency department violence: We can do more! J Clin Nurs 2023; 32:6757-6759. [PMID: 37210679 DOI: 10.1111/jocn.16757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 04/24/2023] [Indexed: 05/22/2023]
Affiliation(s)
- Nicola Ramacciati
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, Italy
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Zhang S, Zhao Z, Zhang H, Zhu Y, Xi Z, Xiang K. Workplace violence against healthcare workers during the COVID-19 pandemic: a systematic review and meta-analysis. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023:10.1007/s11356-023-27317-2. [PMID: 37209334 DOI: 10.1007/s11356-023-27317-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 04/26/2023] [Indexed: 05/22/2023]
Abstract
Workplace violence (WPV) is a prevalent phenomenon, especially in the healthcare setting. WPV against healthcare workers (HCWs) has increased during the COVID-19 epidemic. This meta-analysis determined the prevalence and risk factors of WPV. A database search was conducted across six databases in May 2022, which was updated in October 2022. WPV prevalence among HCWs was the main outcome. Data were stratified by WPV/HCW type, pandemic period (early, mid, late), and medical specialty. WPV risk factors were the secondary outcome. All analyses were conducted through STATA. Newcastle Ottawa Scale evaluated the quality. Sensitivity analysis identified effect estimate changes. A total of 38 studies (63,672 HCWs) were analyzed. The prevalence of WPV of any kind (43%), physical (9%), verbal (48%), and emotional (26%) was high. From mid-pandemic to late-pandemic, WPV (40-47%), physical violence (12-23%), and verbal violence (45-58%) increased. Nurses had more than double the rate of physical violence (13% vs. 5%) than physicians, while WPV and verbal violence were equal. Gender, profession, and COVID-19 timing did not affect WPV, physical, or verbal violence risk. COVID-19 HCWs were more likely to be physically assaulted (logOR = 0.54; 95% CI: 0.10: 0.97). Most healthcare employees suffer verbal violence, followed by emotional, bullying, sexual harassment, and physical assault. Pandemic-related workplace violence increased. Nurses were twice as violent as doctors. COVID-19 healthcare employees had a higher risk of physical and workplace violence.
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Affiliation(s)
- Shuisheng Zhang
- Department of Geriatrics, Jilin Academy of Chinese Medical Sciences, No. 1745, Gongnongda Road, Changchun, 130012, Jilin, China
| | - Zhen Zhao
- Department of Geriatrics, Jilin Academy of Chinese Medical Sciences, No. 1745, Gongnongda Road, Changchun, 130012, Jilin, China
| | - Huan Zhang
- Nursing Department, Changchun Children's Hospital, Changchun, 130061, Jilin, China
| | - Yanhua Zhu
- Department of Geriatrics, Jilin Academy of Chinese Medical Sciences, No. 1745, Gongnongda Road, Changchun, 130012, Jilin, China
| | - Zhongyuan Xi
- Department of Pulmonary Disease, Jilin Academy of Chinese Medical Sciences, Changchun, 130012, Jilin, China
| | - Ke Xiang
- Department of Geriatrics, Jilin Academy of Chinese Medical Sciences, No. 1745, Gongnongda Road, Changchun, 130012, Jilin, China.
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Reducing Violence in Riyadh’s Emergency Departments: The Critical Role of Healthcare Providers. Healthcare (Basel) 2023; 11:healthcare11060823. [PMID: 36981480 PMCID: PMC10048218 DOI: 10.3390/healthcare11060823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/05/2023] [Accepted: 03/09/2023] [Indexed: 03/16/2023] Open
Abstract
Emergency department staff are at high risk of experiencing violence and aggression from patients and visitors, which can have negative impacts on healthcare providers in the ED. The aim of this study was to explore the role of healthcare providers in addressing local violence in Riyadh EDs and investigate their preparedness for managing violent incidents. We used a descriptive, correlational design with survey methodology to collect data from a convenience sample of nurses, ED technicians, physicians, and advanced practice providers in Riyadh city’s EDs. To examine the associations, we used an analysis of variance (ANOVA) for unadjusted relationships and an analysis of covariance (ANCOVA) for adjusted associations. Measures included a demographic survey, and clinicians responded to an online survey. A total of 206 ED staff participated in the questionnaire, and 59% reported experiencing physical violence during an ED shift, with 61% of incidents being caused by relatives. Additionally, 32% of the participants witnessed workplace violence. Our findings revealed that male healthcare workers, physicians, and those working in the governmental sector were at the highest risk of experiencing violence. We also found a statistically significant association between the rate of patients seen in the ED and the frequency of assault (physical or verbal) in the ED. Our results suggest that the rate of workplace violence in Riyadh EDs is high, and more efforts are needed to protect the health and well-being of healthcare providers. Senior management should take a position against ED domestic violence and reinforce managerial and healthcare provider resources by adopting policies and procedures that protect healthcare workers’ safety. This study provides valuable insights into the nature and prevalence of violence in Riyadh EDs and highlights the critical role of healthcare providers in reducing violence in EDs.
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Reißmann S, Wirth T, Beringer V, Groneberg DA, Nienhaus A, Harth V, Mache S. "I think we still do too little": measures to prevent violence and aggression in German emergency departments - a qualitative study. BMC Health Serv Res 2023; 23:97. [PMID: 36717889 PMCID: PMC9885053 DOI: 10.1186/s12913-023-09044-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 10/17/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Healthcare workers employed in emergency departments (EDs) are particularly affected by physical and verbal violence. Violent assaults can be committed by both patients and their attendants. Research on interventions for violence prevention is limited and previous studies report that ED employees feel unprepared for violent incidents. Thus, the current study aims to explore ED staff's perceptions regarding available prevention measures, their effectiveness, barriers, and further needs in terms of violence prevention. METHODS In accordance with the qualitative study design, 27 semi-structured interviews were conducted via telephone with doctors and nurses working in direct contact with patients in German EDs. Main subjects were advantages and disadvantages of currently available measures, barriers regarding their implementation, their perceived effectiveness, as well as further needs concerning violence prevention. The transcribed interviews were analysed according to Mayring's qualitative content analysis. RESULTS Participants described environmental (e.g., alarm systems), organisational (e.g., security service), and individual-focused measures (staff training, verbal de-escalation). Measures perceived as effective were, for instance, communication and security service. Both demands and barriers were often related to financial constraints, e.g., staff shortage led to higher workloads and less time to consider violence prevention. In most cases, guidelines or standard operating procedures (SOPs) regarding violence prevention were missing, unknown, or not perceived as helpful in their current form. Furthermore, screening tools were not applied in any of the EDs. CONCLUSIONS The workload in EDs needs to be decreased in order to enable violence prevention, e.g., by reducing patient inflow or by increasing personnel. In addition, violence prevention guidelines tailored to the requirements of the respective ED need to be developed. Hospitals should supply ED staff with such guidelines, e.g., in the form of SOPs, but more importantly, prevention measures have to be practiced and communicated. Furthermore, there is a need for research on the implementation of screening tools for violent behaviour, so that the focus would shift from managing violence to preventing violence.
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Affiliation(s)
- Sonja Reißmann
- grid.13648.380000 0001 2180 3484Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), 20459 Hamburg, Germany ,grid.7839.50000 0004 1936 9721Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University Frankfurt, 60590 Frankfurt, Germany
| | - Tanja Wirth
- grid.13648.380000 0001 2180 3484Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), 20459 Hamburg, Germany
| | - Vanessa Beringer
- grid.13648.380000 0001 2180 3484Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), 20459 Hamburg, Germany
| | - David A. Groneberg
- grid.7839.50000 0004 1936 9721Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University Frankfurt, 60590 Frankfurt, Germany
| | - Albert Nienhaus
- grid.491653.c0000 0001 0719 9225Department of Occupational Medicine, Hazardous Substances and Public Health, Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services (BGW), 22089 Hamburg, Germany ,grid.13648.380000 0001 2180 3484Institute for Health Services Research in Dermatology and Nursing (IVDP), Competence Center for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), University Medical Center Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany
| | - Volker Harth
- grid.13648.380000 0001 2180 3484Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), 20459 Hamburg, Germany
| | - Stefanie Mache
- grid.13648.380000 0001 2180 3484Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), 20459 Hamburg, Germany ,grid.7839.50000 0004 1936 9721Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University Frankfurt, 60590 Frankfurt, Germany
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Grinberg K, Revach C, Lipsman G. Violence in hospitals and burnout among nursing staff. Int Emerg Nurs 2022; 65:101230. [DOI: 10.1016/j.ienj.2022.101230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 09/17/2022] [Accepted: 10/01/2022] [Indexed: 11/28/2022]
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Brigo F, Zaboli A, Rella E, Sibilio S, Canelles MF, Magnarelli G, Pfeifer N, Turcato G. The impact of COVID-19 pandemic on temporal trends of workplace violence against healthcare workers in the emergency department. Health Policy 2022; 126:1110-1116. [PMID: 36171162 PMCID: PMC9502437 DOI: 10.1016/j.healthpol.2022.09.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 08/11/2022] [Accepted: 09/20/2022] [Indexed: 11/12/2022]
Abstract
Background It is known that there has been an increase over the years in attacks by patients admitted to the emergency department (ED) on healthcare workers; it is unclear what effect the COVID-19 pandemic has on these attacks. Aim to verify through a long-term time analysis the effect of COVID-19 on ED attacks on healthcare workers. Mothods a quasi-experimental interrupted time-series analysis on attacks on healthcare workers was performed from January 2017 to August 2021. The main outcome was the monthly rate of attacks on healthcare workers per 1000 general accesses. The pandemic outbreak was used as an intervention point. Results 1002 attacks on healthcare workers in the ED were recorded. The rate of monthly attacks on total accesses increased from an average of 13.5 (SD 6.6) in the pre-COVID-19 era to 27.2 (SD 9.8) in the pandemic months, p < 0.001. The pandemic outbreak led to a significant increase in attacks on healthcare workers from 0.05/1000 attacks per month (p = 0.018), to 4.3/1000 attacks per month (p = 0.005). Conclusions The COVID-19 pandemic has led to a significant increase in attacks on healthcare workers in the ED. Trends compared to pre-pandemic months do not seem to indicate a return to normality. Health institutions and policymakers should develop strategies to improve the safety of the working environment in hospitals and EDs.
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Affiliation(s)
- Francesco Brigo
- Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy.
| | - Arian Zaboli
- Emergency Department, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy
| | - Eleonora Rella
- Emergency Department, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy
| | - Serena Sibilio
- Emergency Department, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy
| | | | | | - Norbert Pfeifer
- Emergency Department, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy
| | - Gianni Turcato
- Emergency Department, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy
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Schablon A, Kersten JF, Nienhaus A, Kottkamp HW, Schnieder W, Ullrich G, Schäfer K, Ritzenhöfer L, Peters C, Wirth T. Risk of Burnout among Emergency Department Staff as a Result of Violence and Aggression from Patients and Their Relatives. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19094945. [PMID: 35564338 PMCID: PMC9105776 DOI: 10.3390/ijerph19094945] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/11/2022] [Accepted: 04/16/2022] [Indexed: 02/06/2023]
Abstract
Emergency department staff are often affected by incidents of violence. The aim of the study was to generate data on the frequency of violence by patients and accompanying relatives and the correlation between experienced aggression, a possible risk of burnout and a high sense of stress. Additionally, the buffering effect of good preventive preparation of care staff by the facility on aggressive visitors and patients was examined. In this cross-sectional study, members of the German Society for Interdisciplinary Emergency and Acute Medicine were surveyed. The investigation of risk factors, particularly experiences of verbal and physical violence, as well as exhaustion and stress, was carried out using ordinal regression models. A total of 349 staff from German emergency departments took part in the survey, 87% of whom had experienced physical violence by patients and 64% by relatives. 97% had been confronted with verbal violence by patients and 94% by relatives. Violence by relatives had a negative effect on perceived stress. High resilience or effective preparation of employees for potential attacks was shown to have a protective effect with regard to the burnout risk and perceived stress. Therefore, management staff play a major role in preventing violence and its impact on employees.
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Affiliation(s)
- Anja Schablon
- Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (J.F.K.); (A.N.); (C.P.)
- Correspondence:
| | - Jan Felix Kersten
- Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (J.F.K.); (A.N.); (C.P.)
| | - Albert Nienhaus
- Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (J.F.K.); (A.N.); (C.P.)
- Department of Occupational Medicine, Hazardous Substances and Public Health, Institution for Statutory Accident Insurance and Prevention in the Healthcare and Welfare Services, 22089 Hamburg, Germany
| | | | - Wilfried Schnieder
- Klinikum Herford, Emergency Department, Medizin Campus OWL of the Ruhr University Bochum, 32049 Herford, Germany;
| | - Greta Ullrich
- Zentrale Notaufnahme, Paracelsus-Klinik Henstedt-Ulzburg, 24558 Henstedt-Ulzburg, Germany;
| | - Karin Schäfer
- Prevention Service, Institution for Statutory Accident Insurance and Prevention in the Healthcare and Welfare Services, Helmholtzstrasse 2, 80636 Munich, Germany;
| | - Lisa Ritzenhöfer
- Prevention Department, Accident Insurance Institution Hessen, Leonardo-da-Vinci-Allee 20, 60486 Frankfurt am Main, Germany;
| | - Claudia Peters
- Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (J.F.K.); (A.N.); (C.P.)
| | - Tanja Wirth
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), 20459 Hamburg, Germany;
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