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Benning L, Teepe GW, Kleinekort J, Thoma J, Röttger MC, Prunotto A, Gottlieb D, Klöppel S, Busch HJ, Hans FP. Workplace violence against healthcare workers in the emergency department - a 10-year retrospective single-center cohort study. Scand J Trauma Resusc Emerg Med 2024; 32:88. [PMID: 39285387 PMCID: PMC11403778 DOI: 10.1186/s13049-024-01250-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 08/17/2024] [Indexed: 09/22/2024] Open
Abstract
BACKGROUND Medical staff are regularly confronted with workplace violence (WPV), which poses a threat to the safety of both staff and patients. Structured de-escalation training (DET) for Emergency Department (ED) staff has been shown to positively affect the reporting of WPV incidents and possibly reduce its impact. This study aimed to describe the development of incidence rates, causes, means, targets, locations, responses, and the time of WPV events. Additionally, it explored the effect of the staff trained in DET on the objective and subjective severity of the respective WPV events. METHODS In a retrospective, single-center cohort study, we analyzed ten years of WPV events using the data of Staff Observation Aggression Scale-Revised (SOAS-R) score (ranging from 0 to 22) in a tertiary ED from 2014 to 2023. The events were documented by ED staff and stored in the electronic health record (EHR). RESULTS Between 2014 and 2023, 160 staff members recorded 859 incidents, noting an average perceived severity of 5.78 (SD = 2.65) and SOAS-R score of 11.18 (SD = 4.21). Trends showed a non-significant rise in incident rates per 10,000 patients over time. The WPV events were most frequently reported by nursing staff, and the cause of the aggression was most often not discernible (n = 353, 54.56%). In total, n = 273 (31.78%) of the WPV events were categorized as severe, and the most frequent target of the aggressive behavior was the staff. WPV events occurred most frequently in the traumatology section and the detoxification rooms. While the majority of events could be addressed with verbal interventions, more forceful interventions were performed significantly more often for higher severity WPV events. More WPV events occurred during off-hours and were of a significantly higher objective and subjective severity. Overall, the presence of staff with completed DET led to significantly higher SOAS-R scores and higher perceived severity. CONCLUSION The findings underline the relevance of WPV events in the high-risk environment of an ED. The analyzed data suggest that DET significantly fostered the awareness of WPV. While most events can be addressed with verbal interventions, WPV remains a concern that needs to be addressed through organizational measures and further research.
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Affiliation(s)
- Leo Benning
- University Emergency Center, Medical Center-University of Freiburg, Freiburg, Germany
| | - Gisbert W Teepe
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Jan Kleinekort
- University Emergency Center, Medical Center-University of Freiburg, Freiburg, Germany
| | - Jorun Thoma
- Medical Center, University of Freiburg, CNO Office, Freiburg, Germany
| | | | - Andrea Prunotto
- Data Integration Center, University Medical Center Freiburg, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Dominik Gottlieb
- University Emergency Center, Medical Center-University of Freiburg, Freiburg, Germany
| | - Stefan Klöppel
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Hans-Jörg Busch
- University Emergency Center, Medical Center-University of Freiburg, Freiburg, Germany
| | - Felix P Hans
- University Emergency Center, Medical Center-University of Freiburg, Freiburg, Germany.
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Challen K. No safe harbour: triage nurses as targets. Emerg Med J 2024; 41:500. [PMID: 39038834 DOI: 10.1136/emermed-2024-214368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Accepted: 07/05/2024] [Indexed: 07/24/2024]
Affiliation(s)
- Kirsty Challen
- Emergency Department, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
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Zaboli A, Sibilio S, Magnarelli G, Mian M, Brigo F, Turcato G. Nurses in the eye of the storm: a study of violence against healthcare personnel working in the emergency department. Emerg Med J 2024; 41:501-502. [PMID: 38448216 DOI: 10.1136/emermed-2023-213646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2024] [Indexed: 03/08/2024]
Affiliation(s)
- Arian Zaboli
- Innovation, Research and Teaching Service (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Alto Adige Health Agency, Bolzano, Italy
| | - Serena Sibilio
- Public Health, Universität Basel Institut für Pflegewissenschaft, Basel, Switzerland
| | | | - Michael Mian
- Innovation, Research and Teaching Service (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Alto Adige Health Agency, Bolzano, Italy
- Claudiana Higher Provincial School of Health Professions, Bolzano, Italy
| | - Francesco Brigo
- Innovation, Research and Teaching Service (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Alto Adige Health Agency, Bolzano, Italy
| | - Gianni Turcato
- Department of Internal Medicine, Intermediate Care Unit, Alto Vicentino Hospital (AULSS-7), Santorso, Italy
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Christensen SS, Wilson BL, Cummins MR, Eaton J, Iacob E, Hansen SD. Exploring nurses' emotional reactions to and reporting of patient-on-nurse workplace violence: A mixed-methods study. Int J Nurs Stud 2024; 153:104724. [PMID: 38437757 DOI: 10.1016/j.ijnurstu.2024.104724] [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: 09/24/2023] [Revised: 01/04/2024] [Accepted: 02/12/2024] [Indexed: 03/06/2024]
Abstract
BACKGROUND Workplace violence, including violent, intimidating, and disruptive acts, commonly occurs in healthcare settings. Type 2 workplace violence in nursing refers to patient/visitor behaviors directed toward clinicians, contributing to physical and psychological harm. Nurse victims often do not report these events to employers or law enforcement, making it challenging to address workplace violence. OBJECTIVES Our research examined nurse reactions to Type 2 workplace violence by identifying what behaviors they perceived as aggressive and reportable. Specific aims included: 1) developing and testing video vignettes to portray realistic patient aggression scenarios; 2) identifying nurse understandings of aggressive events that prompt affective reactions, and; 3) examining clinical characteristics related to the nurse victim's likelihood to report. DESIGN Through a sequential mixed-methods design, we qualitatively developed novel video vignettes portraying Type 2 workplace violence to experimentally examine how nurses interpreted them within a quantitative repeated measures survey. METHODS Two expert nurse research panels (n = 10) created five vignettes, from which nurses (n = 282) completed a survey with 1382 unique responses. Analyses included descriptive statistics and repeated measures ANOVA/regression models. RESULTS Video vignettes realistically portrayed workplace violence events, eliciting negative emotional responses among nurses that increased in magnitude with statistical significance as the level of displayed aggression escalated. Statistically significant factors influencing nurse reporting of workplace violence included; 1) the level of aggression displayed by the patient; 2) the level of harm received by the nurse; 3) whether the nurse felt the patient's actions were intentional, and; 4) the nurse's perceived frequency of exposure to workplace violence. CONCLUSIONS Results suggested that nurse victims of Type 2 workplace violence experience depression, anger, fear, and anxiety, which may contribute to long-term mental health consequences. Findings also identified factors related to nurse reporting behaviors, which may help mitigate workplace violence in healthcare settings by informing research and promoting workplace practices that encourage reporting and safety. REGISTRATION Not registered. TWEETABLE ABSTRACT Nurse reactions to workplace violence: Video vignettes reveal escalating aggression's impact on reporting. #EndNurseAbuse #WorkplaceViolence.
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Affiliation(s)
- Scott S Christensen
- College of Nursing, University of Utah, Salt Lake City, UT, USA; Department of Nursing, University of Utah Health Hospitals and Clinics, Salt Lake City, UT, USA.
| | | | | | | | - Eli Iacob
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | - S Duane Hansen
- Department of Business and Economics, Western Oregon University, Monmouth, OR, USA
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Hou Y, Corbally M, Timmins F. Violence against nurses by patients and visitors in the emergency department: An integrative review. J Adv Nurs 2024; 80:430-445. [PMID: 37658637 DOI: 10.1111/jan.15837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 08/10/2023] [Accepted: 08/14/2023] [Indexed: 09/03/2023]
Abstract
AIM This integrative review explored violence against emergency nurses by patients/visitors, examining its nature, contributing factors and consequences. DESIGN Integrative review. DATA SOURCES Articles were obtained from PubMed, CINAHL, EMBASE, Web of Science and PsycInfo databases, up until December 2021. REVIEW METHODS 26 articles were reviewed, evaluating study quality with the Crowe Critical Appraisal Tool and synthesizing conclusions through theme development and coding. RESULTS This review delves into the issue of violence perpetrated against emergency nurses by patients and visitors. It elucidates three overarching themes: the nature of violence, the contributing factors and the consequences of such acts. CONCLUSION The findings inform healthcare policy for the development of prevention approaches while identifying research gaps and emphasizing the need for alternative study designs and methodologies. IMPACT This review has implications for nursing practice, policymaking and research, emphasizing the need for stakeholder engagement and tailored interventions for at-risk emergency nurses. NO PATIENT OR PUBLIC CONTRIBUTION This project was an integrative review of the literature therefore no patient or public contribution was necessary. WHAT ALREADY IS KNOWN Violence by patients and visitors in healthcare settings, especially in emergency departments, has garnered considerable attention. WHAT THIS PAPER ADDS This review specifically examines violence-targeting emergency department nurses from patients and visitors, assessing its characteristics, contributing factors and consequences. IMPLICATIONS FOR PRACTICE/POLICY The findings will guide stakeholder engagement in developing interventions to support vulnerable emergency nurses.
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Affiliation(s)
- Yongchao Hou
- Emergency Department, ShanXi Provincial People's Hospital, Taiyuan, ShanXi, China
- School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - Melissa Corbally
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Fiona Timmins
- School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
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Mithen LM, Weaver N, Walker FR, Inder KJ. Feasibility of biomarkers to measure stress, burnout and fatigue in emergency nurses: a cross-sectional study. BMJ Open 2023; 13:e072668. [PMID: 37643845 PMCID: PMC10465916 DOI: 10.1136/bmjopen-2023-072668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 08/16/2023] [Indexed: 08/31/2023] Open
Abstract
INTRODUCTION Retaining nurses in the workforce is an urgent concern in healthcare. Emergency nurses report high levels of stress and burnout, however, there is no gold standard of how to measure these responses. This study aims to measure stress, burnout, and fatigue in emergency nurses using biomarkers and psychometric instruments. Biomarkers will be used to better understand nurses' levels of stress and burnout and to assess the feasibility of using biomarkers as a viable stress measurement tool in a real-world setting. METHODS AND ANALYSIS A two stage cross-sectional design to measure stress, burnout and fatigue in emergency nurses while they work is proposed. All registered and enrolled nurses working in the emergency department from four hospitals in Australia will be invited to participate. Validated psychometric tools will be used in stage 1 to measure depression, anxiety, acute stress, chronic stress, burnout and fatigue. Biomarkers comprising hair cortisol, saliva alpha amylase and heart rate variability will be collected as an objective measure of stress and burnout in stage 2 over one working shift per participant. Written consent will be sought for stage 2 where nurses will provide one hair sample, wear a heart rate sensor and be asked to collect their saliva at three different time points of one shift. Data analysis will measure the domains of acute stress, chronic stress and burnout and explore relationships and correlation between psychometric measures and biomarkers. ETHICS AND DISSEMINATION Ethics approval obtained from the Human Research Ethics Committee of the Hunter New England Local Health District (approval number: HREC/2020/ETH01684) and University of Newcastle HREC (H-2022-0169). Results will be reported in peer-reviewed publications using the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. Public dissemination will occur by presenting at conferences and to the participating local health district.
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Affiliation(s)
- Lucinda M Mithen
- School of Nursing & Midwifery, The University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, HMRI, New Lambton, New South Wales, Australia
| | - Natasha Weaver
- Hunter Medical Research Institute, HMRI, New Lambton, New South Wales, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Frederick R Walker
- Hunter Medical Research Institute, HMRI, New Lambton, New South Wales, Australia
- School of Biomedical Sciences, The University of Newcastle, Callaghan, New South Wales, Australia
- Priority Research Centre for Stroke and Brain Injury, The University of Newcastle, Callaghan, New South Wales, Australia
- Centre for Advanced Training Systems, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Kerry J Inder
- School of Nursing & Midwifery, The University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, HMRI, New Lambton, New South Wales, Australia
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Cao Y, Gao L, Fan L, Zhang Z, Liu X, Jiao M, Li Y, Zhang S. Effects of verbal violence on job satisfaction, work engagement and the mediating role of emotional exhaustion among healthcare workers: a cross-sectional survey conducted in Chinese tertiary public hospitals. BMJ Open 2023; 13:e065918. [PMID: 36898752 PMCID: PMC10008349 DOI: 10.1136/bmjopen-2022-065918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
OBJECTIVE Recently, Chinese ministries and commissions have issued a series of policies and systems in response to violent injuries to doctors, physical violence have been managed to a certain extent. However, verbal violence has not been deterred and is still prevalent, it has not received appropriate attention. This study thus aimed to assess the impact of verbal violence on the organisational level and identify its risk factors among healthcare workers, so as to provide practical methods for verbal violence reduction and treatment of the complete period. METHODS Six tertiary public hospitals were selected in three provinces (cities) in China. After excluding physical and sexual violence, a total of 1567 remaining samples were included in this study. Descriptive, univariate, Pearson correlation and mediated regression analyses were employed to assess the difference between the variables, emotional responses of healthcare workers to verbal violence and the relationship between verbal violence and emotional exhaustion, job satisfaction, and work engagement. RESULTS Nearly half of the healthcare workers in China's tertiary public hospitals experienced verbal violence last year. Healthcare workers who experienced verbal violence had strong emotional response. The exposure of healthcare workers to verbal violence significantly positively predicted the emotional exhaustion (r=0.20, p<0.01), significantly negatively predicted job satisfaction (r=-0.17, p<0.01) and work engagement (r=-0.18, p<0.01), but was not associated with turnover intention. Emotional exhaustion partially mediated the effects of verbal violence on job satisfaction and work engagement. CONCLUSIONS The results indicate that the incidence of workplace verbal violence in tertiary public hospitals in China is high and cannot be ignored. This study is to demonstrate the organisational-level impact of verbal violence experienced by healthcare workers and to propose training solutions to help healthcare workers reduce the frequency and mitigate the impact of verbal violence.
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Affiliation(s)
- Yiyin Cao
- Health Management, Harbin Medical University, Harbin, Heilongjiang, China
| | - Lei Gao
- Health Management, Harbin Medical University, Harbin, Heilongjiang, China
| | - Lihua Fan
- Health Management, Harbin Medical University, Harbin, Heilongjiang, China
| | - Zhong Zhang
- Health Management, Harbin Medical University, Harbin, Heilongjiang, China
| | - Xinyan Liu
- Health Management, Harbin Medical University, Harbin, Heilongjiang, China
| | - Mingli Jiao
- Health Management, Harbin Medical University, Harbin, Heilongjiang, China
| | - Ye Li
- Health Management, Harbin Medical University, Harbin, Heilongjiang, China
| | - Shu'e Zhang
- Health Management, Harbin Medical University, Harbin, Heilongjiang, China
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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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