The exploding spark: workplace violence in an infectious disease hospital--a longitudinal study

Association of school neighbourhood socioeconomic disadvantage and teaching staff's risk of violence at work

AIM

The aim of this study was to determine the association between neighbourhood socioeconomic disadvantage and teaching staff's risk of workplace violence and whether workplace psychosocial resources can act as effect modifiers.

METHODS

Primary school teaching staff in the six largest cities in Finland responded to a survey in 2018 and were linked to information on school neighbourhood disadvantage obtained from the national grid database (n = 3984).

RESULTS

After adjustment for confounders, staff working in schools located in the most disadvantaged neighbourhoods had a 1.2-fold (95% confidence interval 1.07-1.35) risk of encountering violence or threat of violence compared with staff working in the most advantaged neighbourhoods. The association was less marked in schools with strong support from colleagues (risk ratio 1.14, 95% confidence interval (95% CI) 0.98-1.32 for high support versus 1.23, 95% CI 1.07-1.43 for low/intermediate support), a strong culture of collaboration (1.08, 95% CI 0.93-1.26 versus 1.31, 95% CI 1.12-1.53), high leadership quality (1.12, 95% CI 0.96-1.31 versus 1.29, 95% CI 1.08-1.54), and high organizational justice (1.09, 95% CI 0.91-1.32 versus 1.29, 95% CI 1.09-1.52).

CONCLUSIONS

The association between school neighbourhood and teaching staff's risk of violence was weaker in schools with high workplace psychosocial resources, suggesting that targeting these factors might help in minimizing violence at schools, but future intervention studies are needed to confirm or refute this hypothesis.

Stress, interpersonal and inter-role conflicts, and psychological health conditions among nurses: vicious and virtuous circles within and beyond the wards

BACKGROUND

The increasing costs of nurses' occupational-stress, conflicts, and violence within healthcare services have raised international interest. Yet, research/interventions should consider that perceived stress and conflicts- but also potential resources- within the wards can crossover the healthcare settings, impacting nurses' private lives and viceversa, potentially creating vicious circles exacerbating stress, conflicts/violence or, conversely, virtuous circles of psychological/relational wellbeing. Based on the Demands-Resources-and-Individual-Effects (DRIVE) Nurses Model, and responding to the need to go in-depth into this complex dynamic, this study aims to explore potential vicious circles featured by the negative effects of the interplay (main/mediating effects) between perceived stressors in nursing linked to interpersonal conflicts (Conflicts-with-Physicians, Peers, Supervisors, Patients/their families), work-family inter-role conflicts (Work-Family/Family-Work-Conflicts), and work-related stress (Effort-Reward-Imbalance) on nurses' psychological/relational health (Anxiety, Depression, Somatization, Interpersonal-Sensitivity, Hostility). The potential moderating role of work-resources (Job-Control, Social-Support, Job-Satisfaction) in breaking vicious circles/promoting virtuous circles was also explored.

METHOD

The STROBE Checklist was used to report this cross-sectional multi-centre study. Overall, 265 nurses completed self-report questionnaires. Main/mediating/moderating hypotheses were tested by using Correlational-Analyses and Hayes-PROCESS-tool.

RESULTS

Data confirmed the hypothesized detrimental vicious circles (main/mediating effects), impairing nurses' psychological health conditions at individual level (Anxiety, Depression, Somatization), but also at relational level (Hostility and Interpersonal-Sensitivity). The moderating role of all work resources was fully supported.

CONCLUSION

Findings could be used to implement interventions/practices to effectively prevent the maintenance/exacerbation of vicious circles and promote psychological/relational wellbeing in healthcare settings and beyond.

Assessing Workplace Violence: Methodological Considerations

The risk of violence is present in all workplaces. It must be accurately assessed to establish prevention and protection measures tailored to the features of each situation. The risk management process requires compliance in a sequential order: 1) risk identification, 2) quantitative risk assessment, and 3) impact assessment. Gathering workers' experiences using lists, focus groups, or participatory ergonomics groups is necessary to identify the phenomenon. For risk assessment, spontaneous reporting of events is often insufficient. It may be complemented with two methods: systematic recording of violent events that occurred in the past year during periodic medical examinations of workers and targeted surveys. The epidemiological analysis of data from individual interviews and surveys provides the phenomenon's prevalence, incidence, and evolution. Moreover, reporting the harm suffered by victims of violence allows constructing impact matrices to allocate resources where they are most needed.

The Relationship between Patients' Demands and Workplace Violence among Healthcare Workers: A Multilevel Look Focusing on the Moderating Role of Psychosocial Working Conditions

Workplace violence against healthcare workers is a widespread phenomenon with very severe consequences for the individuals affected and their organizations. The role played by psychosocial working conditions in healthcare workers' experiences of violence from patients and their family members has received relatively scant attention. In the present study, we investigated the idea that psychosocial working conditions (workload, job control, supervisor support, and team integration), by affecting the well-being and job performance of healthcare workers, play a critical role in the relationship between patients' demands and the escalation of workplace violence. Specifically, we tested the hypothesis that psychosocial working conditions moderate the relationship between patients' demands and workplace violence. Participants were 681 healthcare workers distributed in 55 work groups of three public healthcare facilities in Italy. Multilevel analysis showed significant interactions between patients' demands and each of the investigated psychosocial factors on workplace violence, which in all the cases were in the expected direction. The results suggest that improving the quality of the psychosocial work environment in which healthcare workers operate may be a critical aspect in the prevention of workplace violence.

Workplace Bullying in Italy: A Systematic Review and Meta-Analysis

BACKGROUND

Within any work environment, employees may be affected by "workplace bullying", a form of violent and repeated social behavior towards subordinates and colleagues. This review aimed to investigate the prevalence of bullied workers in Italy, the causes of the phenomenon, and the consequences at physical, psychological, and organizational levels.

METHODS

We included observational studies and systematic reviews examining the prevalence of bullied workers and the causes and consequences in Italian workplaces. Data extraction and analysis were performed on all included studies. The research strategy included three electronic databases (PubMed, Scopus, and Web of Science). A comprehensive search was done to retrieve articles based on a PRISMA-compliant protocol registered in PROSPERO: CRD 42023394635.

RESULTS

One hundred eighty-four articles were retrieved, and once duplicates and irrelevant articles were removed, 42 useful articles were reviewed. The mean pooled prevalence, calculated based on workers complaining of mistreatment, was 6.7% (SD: 4,09) and increased significantly to 17.0% (SD: 12.88) when considering only healthcare workplaces. Causes include how impaired mental health and high workload reinforce the possibility of being bullied in the workplace, resulting in a worsening of the worker's quality of life (physical and psychological) and the work organization with increased absenteeism and job changes.

CONCLUSIONS

Workplace bullying is a very present phenomenon within workplaces in Italy. In light of this, it is necessary to put prevention plans in place and find solutions to maintain optimal organizational well-being in the work environment.

The role of sense of coherence in workplace violence directed at nurses in the shadow of COVID-19: A cross-sectional study

AIMS

To explore (a) the associations between sense of coherence (SOC), previous exposure to COVID-19, and the intention to act violently towards nurses, and (b) the role of SOC and sociodemographic variables as risk or protective factors involved in the intention to act violently.

DESIGN

A cross-sectional study with a convenience sample.

METHODS

A structured self-report questionnaire was distributed from February to March 2022. The questionnaire included socioeconomic variables, previous exposure to COVID-19, and a validated questionnaire on SOC. Three vignettes (online shaming, verbal and physical violence) describing nurse-patient communication conflicts were presented to participants. A multinomial logistic regression was conducted to explore the associations with acting violently by comparing three options of no/sometimes/high intention to act violently. The study adhered to STROBE guidelines.

RESULTS

Questionnaires were completed by 808 adults. SOC and religiosity were revealed as protective factors in the three vignettes. Verbal violent behaviour was found to be a risk factor for online and physical violent behaviour intention. Previous exposure to COVID-19, non-academic education, and ethnicity were found to be risk factors for the intention to behave violently toward nurses.

CONCLUSION

The findings suggest that training nurses in practical SOC dimensions (enhancing comprehensible, manageable and meaningful treatment processes) may reduce patients' lack of understanding and frustration and, in turn, reduce the tendency to behave violently.

IMPACT

This study focused on SOC as a variable that may affect the intention to act violently towards nurses. The results reveal that SOC may be a protective factor, where people with higher SOC will have less intention to behave violently towards nurses. The results can provide an insight for nurses, nurse leaders and policymakers, towards supplying coherent and cultural competency treatment processes for patients and assisting nurses in dealing with stressful situations during normal routines and pandemics.

PATIENT OR PUBLIC CONTRIBUTION

The questionnaire was distributed among the general public by master's degree nursing students. The students distributed the questionnaires among their friends and acquaintances using a snowball-sampling approach.

Beyond Bullying, Aggression, Discrimination, and Social Safety: Development of an Integrated Negative Work Behavior Questionnaire (INWBQ)

Negative work behavior (NWB) threatens employee well-being. There are numerous constructs that reflect NWBs, such as bullying, aggression, and discrimination, and they are often examined in isolation from each other, limiting scientific integration of these studies. We aim to contribute to this research field by developing a diagnostic tool with content validity on the full spectrum of NWBs. First, we provide a full description of how we tapped and organized content from 44 existing NWB measurement instruments and 48 studies. Second, we discussed our results with three experts in this research field to check for missing studies and to discuss our integration results. This two-stage process yielded a questionnaire measuring physical, material, psychological, sociocultural, and digital NWB. Furthermore, the questions include a range of potential actors of NWB, namely, internal (employees, managers) and external actors (clients, customers, public, and family members) at work and their roles (i.e., target, perpetrator, perpetrator's assistant, target's defender, outsider, and witness of NWBs). Finally, the questionnaire measures what type of harm is experienced (i.e., bodily, material, mental, and social harm).

Implementation of a workplace protection system and its correlation with experiences of workplace violence: a cross-sectional study

BACKGROUND

While customer interactions are inherent and essential aspects of the service industry, instances of violence against service workers have brought social attention to the need for a system to ensure their protection. In South Korea, a protection system for the health of service workers has been implemented to prevent this type of violence and its negative consequences. This study conducted a comparative analysis to clarify the impacts of this protection system across a sample of service workers. We collected data on their general characteristics, occupational characteristics, and experiences with the service protection system to determine how those factors were related to workplace violence, with a focus on whether the system has reduced such occurrences.

METHODS

We collected self-reported survey data over 28 days (March 2 to March 30, 2020), resulting in 1,349 (99.3%) responses for our final analysis. We conducted a chi-square test and logistic regression analysis to investigate the general and occupational characteristics, experiences of violence, and experiences with the worker protection system.

RESULTS

We found workplace violence is more observed among males, older workers, electronic equipment repairers, irregular workers, and those who worked for extended periods. On the other hand, we found a reduction in the occurrence of workplace violence in businesses that provided service workers with regular counseling from professional counselors, had designated persons responsible for grievance procedures, and/or had grievance procedure committees. We found the lowest likelihood of workplace violence in businesses that operated stress relaxation programs (all p < 0.01).

CONCLUSIONS

This study identified a correlation between the adoption of the protection system for service workers and the prevalence of workplace violence. We also clarified the effects of the service protection system and developed a plan for its expansion.

KEY POINTS

This study clarified the correlation between the adoption of the protection system for service workers and the occurrence of workplace violence. Along with our investigation of the protection system's effects, these findings provide a basis for expanding Korea's existing worker protection system.

Workplace Health Promotion Embedded in Medical Surveillance: The Italian Way to Total Worker Health Program

In 2011, NIOSH launched the Total Worker Health (TWH) strategy based on integrating prevention and health promotion in the workplace. For several years now, in Italy, this integration has led to the creation of workplace health promotion embedded in medical surveillance (WHPEMS). WHPEMS projects, which are also implemented in small companies, focus each year on a new topic that emerges from the needs of workers. During their regular medical check-up in the workplace, workers are invited to fill in a questionnaire regarding the project topic, its outcome, and some related factors. Workers receive advice on how to improve their lifestyles and are referred to the National Health Service for any necessary tests or treatments. Results collected over the past 12 years from more than 20,000 participants demonstrate that WHPEMS projects are economical, sustainable, and effective. The creation of a network of occupational physicians who are involved in WHPEMS projects could help to improve the work culture, health, and safety of workers.

[Violence at work and work engagement against nursing professionals in Spain: a cross-sectional study.]

OBJECTIVE

Nurses are one of the groups most exposed to violence in the workplace. The objective of this study was to analyze the relationship between violence at work and engagement in a sample of nurses in Spain.

METHODS

A descriptive cross-sectional study was carried out in a national sample of Spanish nurses. A questionnaire was administered that collected the sociodemographic variables, the Utrecht Work Engagement Scale (UWES-9) and an ad hoc scale on violence at work. The Mann-Whitney U test was performed as the statistical test with Bonferroni correction and the CHAID algorithm.

RESULTS

The sample consisted of a total of 1,648 active nurses. It was observed that 42.17% of them had personally suffered some type of aggression or violence in the workplace, verbal aggression being the most frequent. The results indicated that there was a negative association between work engagement and exposure to situations of violence at work.

CONCLUSIONS

There is a relationship between having suffered attacks and the degree of work engagement against nurses, hence the need to establish effective preventive and intervention policies to promote an adequate work environment, and therefore stop episodes of violence in their initial stages.

Associations between work-related variables and workplace violence among Chinese medical staff: A comparison between physical and verbal violence

Background

Workplace violence (WPV) against medical staff has been an important public health and societal problem worldwide. Although numerous studies have implied the differences between physical violence (PV) and verbal violence (VV) against medical staff, few studies were conducted to analyze the different associations between work-related variables, PV, and VV, especially in China.

Methods

A cross-sectional study was conducted among Chinese medical staff in public hospitals, and 3,426 medical staff were interviewed and analyzed. WPV, including PV and VV, were evaluated by the self-report of the medical staff. Work-related variables, physical disease, depression, and social-demographic variables were also measured. The work-related variables included types of medical staff, professional titles, hospital levels, managers, working years, job changing, working hours/week, night duty times/week, monthly income, self-reported working environment, and social position. Logistic regressions were conducted to examine the factors associated with PV and VV.

Results

A total of 489 medical staff (23.0%) reported the experience of PV and 1,744 (50.9%) reported the experience of VV. Several work-related variables were associated with PV and VV, including nurse (OR = 0.56 for PV, p < 0.01; OR = 0.76 for VV, p < 0.05), manager (OR = 1.86 for PV, p < 0.01; OR = 1.56 for VV, p < 0.001), night duty frequency/week (OR = 1.06 for PV, p < 0.01; OR = 1.03 for VV, p < 0.01), bad working environment (OR = 2.73 for PV, p < 0.001; OR = 3.52 for VV, p < 0.001), averaged working environment (OR = 1.51 for PV, p < 0.05; OR = 1.55 for VV, p < 0.001), and bad social position (OR = 4.21 for PV, p < 0.001; OR = 3.32 for VV, p < 0.001). Working years (OR = 1.02, p < 0.05), job changing (OR = 1.33, p < 0.05), and L2 income level (OR = 1.33, p < 0.01) were positively associated with VV, but the associations were not supported for PV (all p>0.05). The other associated factors were male gender (OR = 1.97 for PV, p < 0.001; OR = 1.28 for VV, p < 0.05) and depression (OR = 1.05 for PV, p < 0.001; OR = 1.04 for VV, p < 0.001).

Conclusion

Both PV and VV were positively associated with work-related variables, such as doctor, manager, more night duty frequency, perceived bad working environment, or social position. Some variables were only associated with VV, such as working years, job changing, and monthly income. Some special strategies for the work-related variables should be applied for controlling PV and VV.

Exposure to work-related violence and/or threats of violence as a predictor of certified sickness absence due to mental disorders: a prospective cohort study of 16,339 Swedish men and women in paid work

OBJECTIVES

The aim of this prospective cohort study was to investigate if exposure to work-related violence and/or threats of violence predict certified sickness absence due to mental disorders.

METHODS

Information on work-related exposure to violence and/or threats of violence were derived from the biannual Swedish Longitudinal Occupational Survey of Health (SLOSH) study 2012-2016, including individuals in paid work across Sweden and from different occupations/sectors (n = 16,339). Certified sickness absence due to mental disorders were ascertained from register data from the Swedish Social Insurance Agency. Odds ratios of certified sickness absence due to mental disorders according to exposure to work-related violence were estimated using multiple logistic regression. Several potential confounding variables, such as demographic and socio-economic factors, age, sex, cohabitation, children living at home, socio-economic status, educational level, as well as other types of psychosocial work environmental factors, were adjusted for in the analyses.

RESULTS

In the total study sample, 9% reported exposure to violence and/or threats of violence and the prevalence of sickness absence due to mental disorders was 5%. Exposure to work-related violence and/or threats of violence was associated prospectively with certified sickness absence due to mental disorders (odds ratio 1.46, 95% confidence interval 1.17-1.82, p < 0.01). Analysis of possible interaction showed no difference in association when comparing women to men and different age groups.

CONCLUSIONS

Exposure to work-related violence and/or threats of violence appear to increase the odds of certified sickness absence due to mental disorders. Preventive measures aiming to lower the risk of exposure is thus of great importance.

The Management of Workplace Violence against Healthcare Workers: A Multidisciplinary Team for Total Worker Health® Approach in a Hospital

The risk of aggression against healthcare workers (HCWs) is a globally well-known topic. However, workplace violence (WV) is often considered as part of HCW’s job, leading to a general underreporting. This cross-sectional study aims at providing a descriptive analysis of aggressive acts against HCWs registered in a 34-month period in a pediatric hospital. According to a specific protocol, each aggressive act was analyzed by a multidisciplinary team using the “Modified Overt Aggression Scale” (MOAS), the “General Health Questionnaire-12” (GHQ-12), and the “Short Form-36 Health Survey” (SF-36) to build a report addressing improvement measures. A three-domain model of WV was also developed considering: (1) assaulted HCWs, (2) attacker-related issues, and (3) environmental context. Contributing factors to overt aggression were outlined and tested using univariate analyses. Statistically significant factors were then included in a multiple linear regression model. A total of 82 aggressive acts were registered in the period. MOAS scores registered a mean value of 3.71 (SD: 4.09). Verbal abuse was the most common form of WV. HCWs professional category, minor psychiatric disorder, emotional role limitation, type of containment used, and emotion intensity were significantly associated with overt aggression (p < 0.05), as well as the attacker’s role in the hospital (p < 0.05). The multiple regression analysis confirmed these findings (p < 0.001). Raising awareness on the aggression risk and contributing factors may lead to a relevant improvement of workplace environment, individual workers’ health, and organizational well-being.

Association between high burn-out and workplace violence among healthcare workers in China: a WeChat-based survey

OBJECTIVES

This study is conducted to examine whether overall workplace violence (WPV) and its five types are associated with high burn-out among healthcare workers in China.

DESIGN

A WeChat-based cross-sectional survey. Snowball sampling was used in this study.

PARTICIPANTS

Front-line healthcare workers (N=3706) from 149 cities across 23 provinces in China responded to the survey, and 22 questionnaires were excluded because of incomplete data.

PRIMARY AND SECONDARY OUTCOME MEASURES

(1) The Chinese Maslach Burnout Inventory-General Survey was used to measure high burn-out. (2) WPV was assessed using the Chinese version of the Workplace Violence Scale. (3) An anonymous self-designed web-based questionnaire consisting of demographic, behavioural and occupational information was used to identify covariates.

RESULTS

A total of 3684 front-line healthcare workers (934 physicians and 2750 nurses) were included. Of all participants, 13.3% (491/3193) experienced high burn-out. Adjusted logistic regression revealed that experience of WPV in the past year was associated with high burn-out (OR 2.10, 95% CI 1.69 to 2.62). Healthcare workers who had suffered emotional abuse, threat or verbal sexual harassment were more vulnerable to high burn-out.

CONCLUSION

This study finds that healthcare workers with WPV, especially emotional abuse, threat and verbal sexual harassment, are more likely to experience burn-out. These types of WPV should be considered in interventions to reduce and prevent burn-out for healthcare workers.

The Impact of Workplace Violence on Headache and Sleep Problems in Nurses

Workplace violence (WV) is a significant occupational hazard for nurses. Previous studies have shown that WV has a reciprocal relationship with occupational stress. Headaches and sleep problems are early neuropsychological signs of distress. This cross-sectional study aims to ascertain the frequency of physical or verbal assaults on nurses and to study the association of WV with headaches and sleep problems. During their regular medical examination in the workplace, 550 nurses and nursing assistants (105 males, 19.1%; mean age 48.02 ± 9.98 years) were asked to fill in a standardized questionnaire containing the Violent Incident Form (VIF) concerning the episodes of violence experienced, the Headache Impact Test (HIT-6) regarding headaches, and the Pittsburgh Sleep Quality Inventory (PSQI) on sleep quality. Occupational stress was measured using the Effort/Reward Imbalance questionnaire (ERI). Physical and non-physical violence experienced in the previous year was reported by 7.5% and 17.5% of workers, respectively. In the univariate logistic regression models, the workers who experienced violence had an increased risk of headaches and sleep problems. After adjusting for sex, age, job type, and ERI, the relationship between physical violence and headaches remained significant (adjusted odds ratio aOR = 2.25; confidence interval CI95% = 1.11; 4.57). All forms of WV were significantly associated with poor sleep in a multivariate logistic regression model adjusted for sex, age, job type, and ERI (aOR = 2.35 CI95% = 1.44; 3.85). WV was also associated with the impact of headaches and with sleep quality. WV prevention may reduce the frequency of lasting psychoneurological symptoms, such as headaches and poor sleep quality, that interfere with the ability to work.

Current Status of Intergroup Threats Perceived by Chinese Physicians and Its Association with Organizational Psychology, Behavior, and Well-Being during the COVID-19 Pandemic: A Cross-Sectional Survey

(1) Background: Chinese physicians have encountered serious physical and verbal attacks in recent decades due to poor patient−physician relationships, leading to a broad spectrum of negative consequences. This study aims to assess the status of intergroup threats perceived by physicians and explore its association with organizational psychology, behavior, and well-being during the COVID-19 pandemic. (2) Methods: We conducted a cross-sectional online survey with physicians from November to December 2020 in three provinces: Heilongjiang Province, Henan Province, and Zhejiang Province, in China. A total of 604 physicians were recruited to complete an anonymous questionnaire. There were 423 valid questionnaires. (3) Results: We developed a 25-item intergroup threat scale with four dimensions: interest damage, performance impairment, value derogation, and unjust sentiment. Internal consistency reliability analyses showed that the four dimensions and overall scale exhibited high internal consistency (0.756−0.947). Additionally, the average scores for physicians’ perceived overall intergroup threat, interest damage, performance impairment, value derogation, and unjust sentiment were 4.35 ± 0.51, 4.24 ± 0.73, 4.33 ± 0.58, 4.22 ± 0.65, and 4.53 ± 0.55, respectively. Moreover, this study shows that the intergroup threats perceived positively by physicians were associated with psychological stress (β = 0.270, p < 0.01), emotional exhaustion (β = 0.351, p < 0.01), turnover intention (β = 0.268, p < 0.01), and defensive medical behavior (β = 0.224, p < 0.01), and were negatively associated with job satisfaction (β = −0.194, p < 0.01) and subjective well-being (β = −0.245, p < 0.01). (4) Conclusions: The newly developed scale in this study is a reliable tool for measuring intergroup threats perceived by Chinese physicians. Physicians in China were suffering high-level intergroup threats during the anti-COVID-19 pandemic, which has a significant impact on damage to organizational psychology, behavior, and well-being. Intergroup threats perceived by physicians not only enlarged the risk of emotional exhaustion and psychological stress but also threatened organizational well-being. Moreover, greater intergroup threats were associated with a lower job satisfaction, more frequent defensive medical behavior, and a higher turnover intention for physicians. The results of this study suggest that essential intervention and governance measures should be considered to protect physicians’ well-being and benefits in China, which are urgently needed.

Violence and unsafety in Italian hospitals: Experience and perceptions of nursing students

BACKGROUND: Assessment of workplace violence towards healthcare workers represents a challenge for healthcare organizations worldwide. Workers’ experience and perceived risk of violence may have a serious impact on job satisfaction and retention of workers. To date, no studies have been conducted on nursing students. OBJECTIVES: To assess the prevalence of physical and non-physical violence among nursing students during their clinical experiences and to analyze the perceived risk of violence. METHODS: Multicentre, cross-sectional survey. We enrolled a convenience sample of nursing students of the bachelor’s degree in Nursing of the University of Milan (Italy). The students completed a structured questionnaire prepared in accordance with the available literature on violence in healthcare settings. RESULTS: Out of 1185 questionnaires sent, 603 were collected (50.89%). 35.1% had experience of verbal violence during the clinical internship training period, while 8.1% were victims of physical violence. 202 students (33.5%) reported unsafety, which was related to experience of physical or psychological violence, witnessed episodes of violence, gender, hospital structure and efficacy of the safety policies. CONCLUSIONS: Our findings highlight that nursing students are exposed to the risk of violence which influences their perception of risk.

The mediating effect of job satisfaction on the relationship between workplace bullying and organizational citizenship behavior in nurses

BACKGROUND: Establishing strategies for improving nursing shortages, which are labor challenges in the current health care industry. OBJECTIVE: This study aimed to examine the correlation between workplace bullying and organizational citizenship behavior (OCB) in nurses and the mediating effects of job satisfaction on this relationship. METHODS: A total of 164 valid samples were obtained. The Negative Acts Questionnaire-Revised, the Minnesota Satisfaction Questionnaire, and an OCB scale were measured. RESULTS: The results indicate that a significantly larger proportion of nurses working in operating rooms (Δ odds ratio, odds = 2.30, p = 0.043), the emergency room, and the ICU (Δ odds = 2.79, p = 0.019) had suffered workplace bullying compared with nurses working in patient wards. No experience of workplace bullying exerted a positive and significant effect on job satisfaction (p < 0.001), and job satisfaction exerted a positive and significant effect on overall OCB (p < 0.001). No experience of workplace bullying exerted a significant mediating effect on the influence of job satisfaction on overall OCB (p < 0.001). CONCLUSIONS: The department of service in which a nurse works influences the occurrence of workplace bullying, previous experience with bullying reduces job satisfaction, and greater job satisfaction promotes higher OCB performance. Based on the study results, we advise that nursing executives address and prevent workplace bullying to increase the job satisfaction of nurses so that nurses are willing to display OCB, apply their expertise, and expand the role and functions of nursing.

Mental Health Status of Medical Staff Exposed to Hospital Workplace Violence: A Prospective Cohort Study

Objective

Hospital workplace violence is one of the most frequently reported types of workplace violence in the world, and it harms the mental and physical health of medical staff. Existing research on workplace violence focused more on cross-sectional studies, than longitudinal studies. Therefore, this study examined the dynamic impact of hospital workplace violence on the mental health of medical staff, with the aim of providing appropriate countermeasures and suggestions for hospitals to develop targeted psychological intervention measures in time for medical staff who experience workplace violence.

Design

A prospective cohort study.

Participants

A total of 112 medical staff who had experienced workplace violence in the hospital for the first time were chosen.

Setting

An unconditional latent variable growth curve model was established based on the average value of the general health scale scores of medical staff, and gender and violence types (intimidation threats, physical violence) as control variables. Each medical staff was assessed for depression and anxiety at 4 different time points and the changes in the trajectories was observed.

Results

There were significant differences in the incidence of mental health and anxiety among medical staff at different observation times. There were significant individual differences in the initial mental health status, growth rate of anxiety and depression of medical staff.

Conclusions

Hospitals should undertake various psychological intervention strategies based on the staff's mental health to safeguard those who have experienced workplace violence.

Prevalence and Consequences of Verbal Aggression among Bank Workers: A Survey into an Italian Banking Institution

Robberies and other violent acts by strangers and intruders are common in banks, which can lead to post-traumatic stress disorder in employees. However, the literature indicates that more subtle and less measurable forms of violence, such as psychological violence, can also cause discomfort among employees. The aim of the present work is to investigate the prevalence of verbal aggression and its consequences among 311 Italian bank employees. A self-administered questionnaire was completed by 197 employees. The results showed a high prevalence of verbal aggression in the sample. It is important to investigate and find the causes and effects of verbal aggression in order to understand the phenomenon in this workplace. Cases of verbal aggression need to be prevented and responded to appropriately. In addition, it should be noted that the effects of verbal aggression do not only affect the victim, but also the workplace, as productivity decreases, and the feeling of a safe environment is missing.

Workplace Violence among Healthcare Providers during the COVID-19 Health Emergency: A Cross-Sectional Study

(1) Background: Workplace violence among healthcare providers (HCPs) is a tangible barrier to patient care. The purpose of this study was to gain insight into physicians’ and nurses’ perceptions of workplace violence and their perceptions of communication skills during the COVID-19 health emergency. We also sought to assess and compare the association between types of workplace violence, communication skills, and several sociodemographic factors of physicians and nurses including gender, marital status, site of work, age, and educational level during this era. (2) Methods: We performed a cross-sectional study of a selected hospital in Jordan using the Arabic version of the workplace violence and communication skills scales for September to November 2020. We included a total of 102 physicians and 190 nurses via a self-reported questionnaire. (3) Results: During the COVID-19 health emergency, physicians (48%) experienced workplace violence more than nurses (31.6%). More than two-thirds of the participants did not formally report any type of violence. Multinomial logistic regression analysis showed that marital status, gender, age, site of work, educational levels, and communication skills were associated with different types of violence among the two samples. (4) Conclusions: A high prevalence of workplace violence is noted among HCPs in Jordan compared with before the pandemic, which highlights the importance of promoting public awareness during crises.

Effort-Reward Imbalance in Emergency Department Physicians: Prevalence and Associated Factors

Objectives

To examine the prevalence of effort-reward imbalance and explore its associated factors among emergency department physicians in China.

Methods

A cross-sectional survey was conducted in the Chinese emergency department in 2018. A total of 10,457 emergency department physicians completed a structured questionnaire containing demographic characteristics, work-related data, and effort-reward imbalance scale. All the data were analyzed using descriptive analysis and stepwise logistic regression.

Results

The prevalence of effort-reward imbalance was 78.39% among emergency department physicians in China. The results showed that the male emergency department physicians with a bachelor's degree, an intermediate title, long years of service, a high frequency of night shift, and who suffered workplace violence were at a higher risk of effort-reward imbalance. In contrast, physicians with higher monthly income and perceived adequate staff were associated with a lower risk of effort-reward imbalance.

Conclusions

The situation of effort-reward imbalance was serious among emergency department physicians in China. Administrators should pay more attention to key groups and take measures from the perspectives of effort and reward to improve the effort-reward imbalance in emergency department physicians.

Mediating Effect of Work Stress on the Associations Between Psychological Job Demands, Social Approval, and Workplace Violence Among Health Care Workers in Sichuan Province of China

Objective: The aim of this study was to investigate the prevalence of workplace violence against health care workers, to explore the combined association of work stress, psychological job demands, and social approval with workplace violence and their respective mechanisms among health care workers. Methods: Using data from the Chinese Sixth National Health Service Survey (NHSS) in 2018 conducted among 1,371 health care workers in Sichuan province of China. A self-administered structured questionnaire was used to collect data on health care workers' socio-demographic and work-related characteristics, work stress, psychological job demands, social approval, and workplace violence. We used structural equation modeling (SEM) to test the hypothesized relationship among the variables. Results: The results showed that a total of 77.0% health care workers were exposed to workplace violence. Work stress was directly related to workplace violence (β = 2.167, 95%CI: 1.707, 2.627), while psychological job demands and social approval had indirect associations with workplace violence via work stress [β = 0.427, 95%CI: 0.297, 0.557; β = -0.787, 95%CI: (-0.941)-(-0.633)]. Both psychological job demands (β = 0.197, 95%CI: 0.139, 0.255) and social approval [β = -0.346, 95%CI: (-0.399)-(-0.294)] had direct associations with work stress, while social approval had direct association with psychological job demands [β = -0.085, 95%CI: (-0.136)-(-0.034)]. Psychological job demands mediated the relationship between social approval and work stress. Conclusion: Overall, decreasing workplace violence among health care workers requires to promote interventions to reduce work stress and psychological job demands by improving social approval.

Prevalence and determinants of workplace violence among nurses in the South-East Asian and Western Pacific Regions: a systematic review and meta-analysis

BACKGROUND

Workplace violence (WPV) includes verbal abuse, physical violence, bullying or mobbing, assault and sexual harassment. The area has been well researched in the developed and high-income countries among nurses and healthcare professionals, but in the case of the low and upper-middle-income countries, there remains a paucity of comprehensive data on the prevalence of WPV and its contributing factors.

AIMS

To estimate the prevalence and determinants of WPV among nurses working in the South-East Asian Region and Western Pacific Regions.

DESIGN

Systematic review and Meta-analysis.

METHOD

A comprehensive search was done to retrieve articles based on a PRISMA compliant protocol registered in PROSPERO: CRD 42020223605. Study selection, quality assessment and data abstraction were independently done by the team members and discrepancies addressed through mutual consensus. Random-effect meta-analysis, I2 statistics and subgroup analysis were done.

RESULTS

The review included 41 studies conducted among 42,222 nurses from 13 countries. The pooled prevalence of WPV, verbal abuse, physical violence, threatening behaviour, physical assault, sexual harassment and bullying/mobbing were 58% (CI 51%-64%), 64% (CI 59%-70%), 23% (CI 14%-34%), 30(CI-11%-52%), 21% (CI 8%-38%), 12% (CI 7%-17%) and 25% (17%-33%), respectively. The various determinants of WPV included attributes related to the patient, nurses and organisation. Moreover, the impact of WPV included physical, psychological repercussions on nurses and the various measures used to manage it.

CONCLUSION

Nurses encounter a high level of WPV especially verbal abuse in their workplace settings. Nursing councils and professional nursing organisations should put in their effort towards the formulation and implementation of occupational safety legislation in their respective countries through appropriate political lobbying.

RELEVANCE TO CLINICAL PRACTICE

Our review highlights the emerging need to focus on the prevention of WPV among nurses working in lower, middle and upper-middle-income countries. Legislation changes and organisational commitment are vital for ensuring effective policies to combat WPV.

Common Occupational Trauma: Is There a Relationship with Workers’ Mental Health?

Exposure to major trauma can have significant consequences for workers’ mental health, but common trauma may also result in poor mental health outcomes. This cross-sectional study retrospectively investigated the occurrence of common physical or psychological workplace trauma in 901 health, social service, and trading company workers and studied these experiences in relation to occupational stress, anxiety, and depression. Stress was measured with the effort/reward imbalance (ERI) model while anxiety and depression were evaluated with the Goldberg Anxiety and Depression Scale (GADS). Healthcare workers reported a high frequency of trauma and significantly higher levels of stress, anxiety, and depression than other workers. Even in the entire population of workers of the various professional categories, verbal violence (harassment and threats), traffic accidents, home injuries, and family bereavement were significantly associated with high levels of stress, anxiety, and depression. Major trauma survivors are known to be at increased risk of mental disorders and require support in the workplace, however, even minor repeated emotional trauma and injuries can affect mental health. During mandatory health surveillance, the occupational physician should systematically collect information on minor trauma and mental health outcomes when assessing the occupational fitness of the workers assigned to him.

Analysis of Career Stage, Gender, and Personality and Workplace Violence in a 20-Year Nationwide Cohort of Physicians in Norway

IMPORTANCE

Workplace violence (WPV) is a worldwide problem in health services. Several studies have pointed to organizational factors, such as working in psychiatry and work stress. However, there is a lack of long-term longitudinal cohort studies with respect to trends during the career and individual factors among physicians.

OBJECTIVE

To investigate WPV trends during Norwegian physicians' careers and assess individual and work-related factors associated with WPV in a long-term longitudinal study.

DESIGN, SETTING, AND PARTICIPANTS

This cohort study involved 2 nationwide medical student cohorts who graduated 6 years apart and were surveyed at graduation (T1: 1993-1994 and 1999) and 4 years later (T2), 10 years later (T3), 15 years later (T4), and 20 years after graduation (T5). Generalized estimated equations were used. Statistical analysis was performed from January to September 2020.

EXPOSURES

Medical career during 20 years in Norway.

MAIN OUTCOMES AND MEASURES

WPV was measured as threats or acts of violence from a patient or visitor experienced at least twice, at each of the stages after leaving medical school. Individual factors were obtained at T1 and work-related factors at T2 through T5. We analyzed WPV by repeated measures.

RESULTS

At T1, a total of 893 participants (with a mean [SD] age of 28 (2.83) years; 499 [56%] women) responded to the questionnaire. The prevalence of multiple threats of violence was 20.3% (156 of 769) at T2, 17.1% (118 of 691) at T3, 11.2% (66 of 588) at T4, and 8.6% (46 of 536) at T5; and the prevalence of multiple acts of violence was 4.3% (33 of 763) at T2, 5.2% (36 of 687) at T3, 3.1% (18 of 584) at T4, and 2.2% (12 of 532) at T5. There was a decline from T2 to T5 of both multiple threats (β = -1.06; 95% CI, -1.31 to -0.09; P < .001) and acts of violence (β = -1.13; 95% CI, -1.73 to -0.53; P < .001). In adjusted analysis, factors associated with multiple threats of violence were male gender (odds ratio [OR], 2.76; 95% CI, 1.73 to 4.40; P < .001), vulnerability trait (neuroticism) (OR, 0.90; 95% CI, 0.82 to 0.99; P = .03), young physician cohort (OR, 1.63; 95% CI, 1.04 to 2.58; P = .04), and working in psychiatry (OR, 7.50; 95% CI, 4.42 to 12.71; P < .001). Factors associated with multiple acts of violence in adjusted analysis were male gender (OR, 3.37; 95% CI, 1.45 to 7.84; P = .005), young physician cohort (OR, 6.08; 95% CI, 1.68 to 21.97; P = .006), and working in psychiatry (OR, 12.34; 95% CI, 5.40 to 28.23; P < .001). There were no interactions with gender or cohort in the significant associated factors.

CONCLUSIONS AND RELEVANCE

Higher rates of multiple threats and acts of violence were observed during early medical careers, among male physicians, and in psychiatry. Low levels of the vulnerability trait (neuroticism) were associated with the experience of multiple threats. There was an association between the young physician cohort and WPV. Preventive efforts should include early-career and male physicians, with additional emphasis on personality.

Workplace physical aggressions in Italy and Emilia Romagna region

Background:

Workplace physical aggressions determine severe consequences for people and organizations. Previous studies reported their spread in organizations and described factors related to their occurrence (e.g. aggressor within/outside the organization, type of activity, etc.). However, such data are not available in the Italian work contexts, limiting the possibility of intervention.

Objectives:

This study aims to provide a description of workplace physical aggressions in the Italian context and the Emilia-Romagna region, considering the main variables described in the literature.

Methods:

We used data available from the "Flussi informativi" database, containing national data provided by INAIL (National Institute for Insurance against Accidents at Work), which concern all injuries, occupational illness and insured companies’ information, from 2000 to 2018. Information about aggressions in the workplace in Italy and Emilia-Romagna are derived from a subset of these data, coded according to ESAW (European Statistics for Accidents at Work) requirements. The number of events per year per 100,000 estimated insured employees by INAIL is considered as an indicator.

Results:

In the period 2014-2018, 23,084 injures from aggression were registered in Italy (an average of 28.7 events per 100,000 employees) and 2,308 in Emilia Romagna (30.2). Aggressions by people outside the organization accounted for 85.14 % in Italy and 87.87 % in Emilia-Romagna region. “Health and social services”, “Offices and other activities” and “Transportation” were the sectors that showed the highest numbers of events and rates. Furthermore, we reported detailed results about the variation of the events between professions, the site and nature of the lesion and gravity of events.

Discussion:

The study provides a description of workplace physical aggressions in the Italian context and we discuss the implication of these results for primary, secondary and tertiary prevention strategies of intervention.

Impact of Psychological Aggression at the Workplace on Employees' Health: A Systematic Review of Personal Outcomes and Prevention Strategies

Psychological aggression perpetrated by customers, coworkers, and supervisors is a behavior frequently experienced in the workplace with negative consequences for an individual's health. The aim of this systematic review was to examine the personal outcomes of overt workplace psychological aggression and summarize empirical evidence on how to prevent and reduce its effects. A search on PubMed, Scopus, ProQuest, and Web of Science electronic databases was made. Data were obtained from 30 studies (26 cross-sectional, 3 longitudinal, 1 quasi-experimental) representing 20,683 employees. Longitudinal studies indicated that workplace psychological aggression is significantly associated with musculoskeletal injury and psychological strains (anxiety, depression, anger) over time. Research also suggests that psychological aggression at work predicts fear, emotional exhaustion, depersonalization, personal accomplishment, and physical symptoms, for example. Additionally, the information collected suggested that support from coworkers, supervisors, and management; informational support; political skills; job resources; and confidence to prevent and respond to aggression moderate significantly the impact of workplace psychological aggression on personal and organizational outcomes. Perceptions of a violence-prevention climate, aggression-preventive supervisor behavior, and aggression-preventive employee effort are also significantly associated with a reduction in psychological aggression at work and strains. In conclusion, this review allows us to understand the effects of the psychological aggression by identifying the preventive strategies that could be adopted by managers, supervisors, or leaders to deal with it and promote individual's health in the workplace.

Prevalence of burnout syndrome among Italian volunteers of the Red Cross: a cross-sectional study

Burnout syndrome (BOS) is a work-related constellation of symptoms characterized by emotional exhaustion, depersonalization, and personal accomplishment. A cross-sectional survey was performed to study the prevalence of BOS among a randomly selected sample of 280 Italian Red Cross volunteers. A socio-demographic questionnaire and the Maslach Burnout Inventory (MBI)-HSS were used to collect data. 241 volunteers participated (response rate: 86.1%). A significant proportion of the workers had BOS subscale scores in the highest tertile: emotional exhaustion 8.0%, depersonalization 35.9% and perceived lack of accomplishment 23.5%, respectively. Volunteers in emergency care reported higher levels of emotional exhaustion (p=0.004) and depersonalization (p=0.001), and lower level of personal accomplishment (p=0.042) than volunteers engaged in non-healthcare social and administrative duties. These findings support the opportunity of a set of administrative, organizational and individual preventive interventions for emergency volunteers' mental health.

The relationship between onset of workplace violence and onset of sleep disturbances in the Swedish working population

The study investigated the association between onset of workplace violence and onset of sleep disturbances. We used self-reported data from the Swedish Longitudinal Occupational Survey of Health (SLOSH) collected in 2014, 2016, and 2018. A two-wave design was based on participants who had no exposure to workplace violence or sleep disturbances at baseline (n = 6,928). A three-wave design was based on participants who in addition were unexposed to sleep disturbances in the second wave (n = 6,150). Four items of the Karolinska Sleep Questionnaire were used to measure sleep disturbances and one question was used to measure the occurrence of workplace violence or threats of violence. Multivariate logistic regression analyses were performed. In the two-wave approach, onset of workplace violence was associated with onset of sleep disturbances after adjustment for sex, age, occupational position, education, and civil status (adjusted odds ratio 1.41, 95% confidence interval 1.02-1.96). The association was no longer statistically significant after further adjustment for night/evening work, demands, control, and social support at work. In the three-wave approach, results were only suggestive of an association between onset of workplace violence and subsequent onset of sleep disturbances after adjustment for sex, age, occupational position, education, and civil status. Onset of frequent exposure to workplace violence was associated with subsequent onset of sleep disturbances in the adjusted analyses, but these analyses were based on few individuals (13 exposed versus 5,907 unexposed). The results did not conclusively demonstrate that onset of workplace violence predicts development of sleep disturbances. Further research could elucidate the role of other working conditions.

Experience of aggressive behaviour of health professionals in home care services and the role of persons with dementia

AIMS

To explore the view of health professionals on the form and frequency of aggressive behaviour of clients against health professionals in home care services.

DESIGN

An explorative cross-sectional survey was conducted.

METHODS

We conducted a survey using the Survey of Violence Experienced by Staff German version Revised (SOVES-G-R) and the Impact of Patient Aggression on Carers Scale (IMPACS). A convenience sample of 852 healthcare professionals from German-speaking Switzerland participated. Data collection was conducted between July-October 2019. Data were analysed descriptively using IBM SPSS Statistics.

RESULTS

Of the health professionals, 78.9% (N = 672) experienced aggressive behaviour since they worked in home care services. The most frequent aggressive behaviour was verbal aggression (75.6%, N = 644), while the most common predisposing factor was restriction in cognitive ability (71.3%, N = 67). Fear, burden and impairment of nursing relationship were common consequences of aggressive behaviour.

High strain and low social support at work as risk factors for being the target of third-party workplace violence among healthcare sector workers

INTRODUCTION

Healthcare workers are particularly vulnerable to third-party workplace violence. The experience of work-related stress, by threatening the psychological balance of healthcare workers, making them less effective in managing the relationship with patients and their family members, may significantly contribute to third-party violence.

OBJECTIVE

To investigate whether stress-related psychosocial situations at work as defined by the widely known Demand-Control model, and the level of work-related social support, act as risk factors for third-party violence among healthcare workers. Specifically, we explored whether the risk of violence is higher in situations associated with higher levels of work-related stress (i.e., active or passive situations, and especially the high strain situation) when compared to a work situation related to lower levels of stress (i.e., low strain situation). We also explored whether the risk of violence is lower at higher levels of social support.

METHOD

Cross-sectional study on 633 healthcare workers. Psychosocial work situations and third-party workplace violence have been operationalized by using well validated scales.

RESULTS

Logistic regressions including a number of relevant covariates (e.g., gender, job role, night shift work) revealed that, compared to a low strain situation, an active or passive situation had an increased risk for workplace violence. However, the highest risk was observed for a high strain situation (i.e., the situation associated with the highest level of work-related stress). High social support acted as a protective factor.

CONCLUSION

Healthcare workers' experience of stress at work may make them more vulnerable to third-party violence. Ensuring better psychosocial working conditions may contribute to the prevention of workplace violence and its consequences.

Symptoms in Health Care Workers during the COVID-19 Epidemic. A Cross-Sectional Survey

In March–April 2020, the Corona Virus Disease 19 (COVID-19) pandemic suddenly hit Italian healthcare facilities and in some of them many staff members became infected. In this work 595 health care workers from a public company were tested for Severe acute respiratory syndrome coronavirus 2 (82 positive) and asked to complete a questionnaire on early COVID-19 symptoms. Respiratory symptoms were present in 56.1% of cases. Anosmia and dysgeusia in COVID-19 cases were found to have an odds ratio (OR) = 100.7 (95% Confidence Interval [CI] = 26.5–382.6) and an OR = 51.8 (95%CI 16.6–161.9), respectively. About one in three of the cases (29.3%) never manifested symptoms. Anxiety was reported by 16.6% of COVID-19 cases and depression by 20.3%, with a significant increase in the estimated risk (OR = 4.3; 95%CI = 2.4–7.4 for anxiety, OR = 3.5; 95%CI = 2.0–6.0 for depression). In cases, sleep was a significant moderating factor in the relationship between occupational stress, or organizational justice, and anxiety. The early diagnosis of COVID-19 in health care workers, must consider, in addition to respiratory disorders and fever, anosmia, dysgeusia, exhaustion, myalgias and enteric disorders. The frequency of anxiety and depression disorders in the population examined was not higher than that commonly recorded in the same company during periodic checks in the years preceding the epidemic. In COVID-19 cases there was a significant risk of anxiety, especially in those who had low sleep quality. Mental health support and improvement interventions must mainly concern workers with positive tests and should also tend to improve sleep quality.

Work-related stress among health professionals in Swiss acute care and rehabilitation hospitals-A cross-sectional study

AIMS AND OBJECTIVES

This study aimed to identify significant work stressors associated with stress symptoms, job satisfaction, intention to leave and health-related outcomes among health professionals.

BACKGROUND

The workforce shortage of health professionals is a current concern, and a reduction of work-related stress is thus essential for retaining health professionals. Studies on the extent of work-related stress in different health professions are limited.

METHODS

The research was conducted with a cross-sectional study encompassing 26 randomly selected acute care and rehabilitation hospitals. The sample consisted of 3,398 health professionals. The study was undertaken in accordance with the STROBE checklist for observational studies.

RESULTS

Work-private life conflicts were significantly associated with health professionals' stress symptoms, job satisfaction, intention to leave the organisation and profession, their general health status, burnout symptoms and quality of sleep. Also, opportunities for development and the behaviour of the direct line manager (e.g. quality of leadership, unfair behaviour, rewards given) along with various profession-specific stressors were the important predictors revealed.

CONCLUSIONS

This study shows the high relevance of preventing and reducing work-private life conflicts, enhancing leadership qualities as well as opportunities for development among health professionals working in acute care and rehabilitation hospitals. Also, differences between health professions should be taken into consideration in developing strategies for reducing stress at work.

RELEVANCE TO CLINICAL PRACTICE

The results of this study are particularly relevant for health professional leaders and reveal the urgent need in hospital practice for effective strategies to improve health professionals' work-private life balance, opportunities for development and quality of leadership.

Workplace violence and health in human service industries: a systematic review of prospective and longitudinal studies

OBJECTIVES

To provide systematically evaluated evidence of prospective associations between exposure to physical, psychological and gender-based violence and health among healthcare, social care and education workers.

METHODS

The guidelines on Preferred Reporting Items for Systematic Reviews and Meta-Analyses were followed. Medline, Cinahl, Web of Science and PsycInfo were searched for population: human service workers; exposure: workplace violence; and study type: prospective or longitudinal in articles published 1990-August 2019. Quality assessment was performed based on a modified version of the Cochrane's 'Tool to Assess Risk of Bias in Cohort Studies'.

RESULTS

After deduplication, 3566 studies remained, of which 132 articles were selected for full-text screening and 28 were included in the systematic review. A majority of the studies focused on healthcare personnel, were from the Nordic countries and were assessed to have medium quality. Nine of 11 associations between physical violence and poor mental health were statistically significant, and 3 of 4 associations between physical violence and sickness absence. Ten of 13 associations between psychological violence and poor mental health were statistically significant and 6 of 6 associations between psychological violence and sickness absence. The only study on gender-based violence and health reported a statistically non-significant association.

CONCLUSION

There is consistent evidence mainly in medium quality studies of prospective associations between psychological violence and poor mental health and sickness absence, and between physical violence and poor mental health in human service workers. More research using objective outcomes, improved exposure assessment and that focus on gender-based violence is needed.

Violence against healthcare workers and other serious responses to medical disputes in China: surveys of patients at 12 public hospitals

Background

Workplace violence against healthcare workers is a global issue that is on the rise, with Chinese healthcare workers facing growing challenges with hospital violence. Attacks on medical staff have increased in recent years with no clear resolution. Prior research focused on policies to improve the doctor-patient relationship and better protect clinicians, but few studies addressed the patient perspective. This paper examines patients’ choices when facing a medical dispute and identifies groups who are more likely to respond to conflict with violence or other serious actions.

Methods

Patient survey responses were collected in 12 leading public hospitals in five Chinese provinces with 5556 participants. The survey asked sociodemographic information, patients’ attitudes (e.g., general optimism, trust in their physicians, perceived healthcare quality), and their primary response to a medical dispute. From least to most severe, the options range from “complaining within the family” to “violence.” We used t-tests and Chi-square tests to explore the relationships between reactions and patient characteristics. We also performed multivariable logistic regressions to determine the impact of sociodemographics and provider trust on the seriousness of responses.

Results

The primary response of a third of respondents was complaining to hospital or health department officials (32.5%). Seeking legal help (26.3%) and direct negotiation with doctors (19.6%) were other frequent responses. More serious responses included 83 stating violence (1.5%), 9.7% expressing a desire to expose the issue to the news media, and 7.4% resorting to seeking third-party assistance. Patients who were more likely to report “violence” were male (OR = 1.81, p < .05), high-income earners (OR = 3.71, p < .05), or reported lower life satisfaction (OR = 1.40, p < .05). Higher trust scores were associated with a lower likelihood of a serious response, including violence (OR = 0.80, p < .01).

Conclusion

Most respondents reported mild reactions when facing a medical dispute. Among those who reported the intent of serious reactions, some sociodemographic characteristics and the trust of physicians could be predictive. To prevent future hospital violence, this work helps identify the characteristics of patients who are more likely to seek severe approaches to medical dispute resolution, including resorting to violence. From these results, hospitals will be better able to target specific groups for interventions that build patient-provider trust and improve general patient satisfaction.

Quality of Life in Nursing Professionals: Burnout, Fatigue, and Compassion Satisfaction

The objective of this research was to analyse the quality of life of nursing professionals and its relationship with socio-demographic variables and the work context. A multi-centre, descriptive, cross-sectional design was used. Questionnaires were administered to 1521 nurses working in the Andalusian Public Health System (APHS), Spain. Professional quality of life (ProQOL v. IV) was measured, as well as several socio-demographic and work-related variables. To this end, a descriptive analysis and multiple exploratory analyses were conducted. The levels of compassion fatigue (CF) and burnout (BO) were elevated. The level of compassion satisfaction (CS) was below the estimated mean. Marital status, the healthcare setting, the area where the centre is located, and the work shift are variables associated with CF. According to the multiple linear regression model, the predicting factors for the occurrence of CF were being married, working in primary care, in urban areas, and working a morning/evening/night shift. The variables related to CS were the professional’s age, sex, marital status, the healthcare setting of the centre, the location of the centre, and the work shift. Specifically, according to the exploratory model, the factors that predicted a reduction in CS were working in primary care, in urban areas, and working a morning/evening/night shift. However, being divorced increased CS. BO was influenced only by the work shift. Nursing professionals are exposed to certain factors that may influence professional quality of life. Some of these factors are related to the work context.

Sleep Problems and Workplace Violence: A Systematic Review and Meta-Analysis

Background: This systematic review with meta-analysis was carried out to study the relationship between workplace violence and sleep problems.

Methods: The PRISMA statement was used to conduct a systematic search of the literature on PubMed/MEDLINE, Scopus, Sociological abstract, DOAJ, Web of Science, and Google Scholar databases. Of the original number of 749 studies, 34 were included in the systematic review, and 7 in the meta-analysis.

Results: A total of 119,361 participants from 15 different countries took part in these studies which were published between 1999 and 2019. Significant heterogeneity was observed among the studies (I² = 96%). In a random-effects meta-analysis model, pooled odds ratio (OR) analysis revealed that there was a direct relationship between occupational exposure to violence and sleep problems (OR = 2.55; 95% CI = 1.77–3.66). According to the GRADE guidelines, the quality of evidence of the association was low.

Conclusions: The findings of this study demonstrate that occupational exposure to physical, verbal, or sexual violence is associated with sleep problems. Further research on the relationship between violence and sleep is needed so that appropriate measures can be taken to prevent violence and improve sleep hygiene in the workplace.

Trial Registration Number: PROSPERO International prospective register of systematic reviews (CRD42019124903) February 9, 2019.

Institutional strategies to prevent violence in nursing work: an integrative review

ABSTRACT Objective: To analyze the production of research that adopted as object of investigation: institutional strategies, actions and programs to curb and/or prevent the nursing workplace violence. Method: Integrative review of 14 articles in full, available in the databases LILACS, PubMed Central, Scopus, CINAHL and Web of Science. Results: Of the articles analyzed, most arise from quantitative research (71%), carried out in the United States (65%), with educational actions (57%) and programs (43%), denoting policies. Conclusion: Results showed various ways to curb or prevent nursing workplace violence. These are specific strategies, there are few programs deployed worldwide, usually centered in the United States, Canada and Sweden. Most of them is well evaluated and can serve as a model for the development and dissemination of policies according to the needs of each location.

Psychosocial Risk Prevention in a Global Occupational Health Perspective. A Descriptive Analysis

This study aimed to find out which countries around the world require psychosocial hazards and workplace violence to be assessed by employers through a mandatory occupational risk assessment process and to compare the type of legislation between countries. We systematically searched the International Labour Office (ILO) “LEGOSH” database for documents published during the period between December 2017 and February 2018. The search included 132 countries, of which 23 were considered as developed and 109 as developing according to the United Nations. Our review showed that most countries (85, i.e., 64%) have not included mandatory psychosocial risk assessment and prevention in their national occupational safety and health legislation. Moreover, we found differences between developed and developing countries, showing that developed countries more frequently have legislative measures. Within developed countries, we also found differences between countries following the Scandinavian model of workplace health and safety culture and other countries. Moreover, in many countries, workplace violence was prohibited only if it involves an offence to moral or religious customs. In conclusion, the marked difference in psychosocial hazards and workplace violence regulations among countries leads to unequal levels of workers’ protection, with adverse effects on global health.

Gender Division of Labor, Burnout, and Intention to Leave Work Among Young Female Nurses in Japan: A Cross-Sectional Study

Women in Japan face difficulties balancing work and personal life due to the gender division of labor, and medical professions are no exception. The purpose of this study was to investigate if the gender division of labor affects the intention to leave the workplace among the nursing profession. Among 328 female nurses working for three university-affiliated hospitals in Tokyo, Japan, above 70% were in their 20s and 30s and single, and agreed with the gender division of labor that men should be the breadwinner and women should assume family responsibilities. Adjusting for three types of Copenhagen burnout inventory, stepwise multivariable logistic regression models identified that being younger (all p-values < 0.05), each domain of burnout score (each p < 0.001 for work-, personal-, and client-related burnout) increased a risk of intention to leave, and high support decreased the risk (all p < 0.001). Women who agreed with the gender division of labor were more likely to have intentions to leave (p = 0.003 but this association disappeared when adjusted. The findings of study demonstrate that perceptions toward gender division of labor are not a determinant of intention to leave the workplace but the young nurses and those who scored high on burnout were the most vulnerable population.

Gender differences in workplace violence against physicians of obstetrics and gynecology in China: A questionnaire in the national congress

Background

China has witnessed a surge in violence against medical personnel, including widely reported incidents of violent abuse, riots, attacks, and protests in hospitals, but little is known about the impact of gender differences on the workplace violence against physicians of obstetrics and gynecology. The aim of this study was to analyse gender differences in workplace violence against physicians of obstetrics and gynecology in China.

Methods

Printed questionnaires were sent to participants of a national congress of obstetricians and gynecologists. The questionnaire consisted of items relevant to epidemiologic characteristics, workplace violence experienced in the past 12 months, participants’ attitudes toward violence and physician–patient relationship. Data from female and male physicians were compared in univariate and multivariate analyses.

Results

We sent out 1,425 questionnaires, and 1,300 (91.2%) physicians responded. Among 1,247 participants with specified gender, female and male physicians consisted of 162 (13.0%) and 1,085 (87.0%), respectively. Over the past 12 months, about two-thirds of these physicians suffered verbal abuse in the workplace, gender difference aside. After adjustment for education status, working hospital and subspecialty, male physicians had suffered more physical assaults than female colleagues (18.8% vs. 10.5%, adjusted odds ratio [OR] 2.3, 95% confidence interval [CI], 1.4–3.7), most attacks without apparent physical injuries (adjusted OR 2.3, 95% CI, 1.4–3.7). Male physicians also suffered more sexual assaults than female colleagues (5.0% vs. 1.3%, adjusted OR 4.8, 95% CI, 1.8–13.3), nearly all of verbal harassment. There were only two sexual attacks on female physicians, and no rapes occurred. Although almost all physicians regarded the current circumstance as “unhealthy and stressful”, more than half of them would take various active initiatives to create and maintain healthy and friendly physician–patient relationships.

Conclusion

Male physicians of obstetrics and gynecology in China suffered the same number of verbal abuse incidents but more physical and sexual assaults than their female colleagues. Both genders had similar opinions about causes, consequences and management about work violence against physicians, and had the same pessimistic perspectives but innovative wishes for the physician–patient relationship.

Impact of workplace violence and compassionate behaviour in hospitals on stress, sleep quality and subjective health status among Chinese nurses: a cross-sectional survey

OBJECTIVES

The aim of this study is to describe the current state of workplace violence (WPV) and compassionate behaviour towards nurses and to explain how they affect nurses' stress, sleep quality and subjective health status.

DESIGN

A cross-sectional online survey study.

SETTING

The survey was conducted across eight provinces in China.

PARTICIPANTS

A total of 1024 nurses were recruited to complete an online questionnaire survey from February to May 2016 in China.

RESULTS

Approximately 75.4% participants had experienced some form of violence. Most of the participants experienced WPV such as verbal violence (65.2%), made difficulties (54.5%), tarnished reputation (37.5%), mob behaviour (34.9%), intimidation behaviour (18.8%), physical violence (14.6%) and sexual harassment (5.9%). In this study, 92.4% participants experienced compassionate behaviour from their coworkers (84.9%), supervisors (67.3%), and from their patients (65.3%). The results show that the exposure to WPV behaviour significantly affected the psychological stress (β=0.295, p<0.01), sleep quality (β=-0.198, p<0.01) and subjective health status (β=-0.252, p<0.01) of nurses. The exposure to compassionate behaviour significantly affected the psychological stress (β=-0.229, p<0.01), sleep quality (β=0.326, p<0.01) and subjective health status (β=0.342, p<0.01) of nurses. The results of the mediation analysis showed that psychological stress is a partial mediator in the relationship between violence and sleep quality (β=-0.458, p<0.01) and between violence and subjective health (β=-0.425, p<0.01). Moreover, psychological stress also partially mediated the relationship between compassionate behaviour and sleep quality (β=-0.473, p<0.01), and between compassionate behaviour and subjective health (β=-0.405, p<0.01).

CONCLUSION

In China, most nurses have experienced different forms of WPV from patients and/or their relatives, as well as experiencing various forms of compassionate behaviour from their coworkers, supervisors and/or patients. This study investigates the prevalence of the different types of WPV and compassionate behaviour. Several aspects of harm to nurses from exposure to violence is confirmed. We found that WPV can damage nurses' health outcomes, while compassionate behaviours were beneficial to their health outcomes. A harmonious nursing environment should be provided to minimise threats to nurses' health status.

Nurses' Occupational and Medical Risks Factors of Leaving the Profession in Nursing Homes

This study aimed to evaluate the association between intention to leave work, and working conditions and health status among female care-staff in nursing homes. A multicenter cross-sectional study included female care-staff in 105 nursing homes for the elderly. We used validated questionnaires to assess occupational, psychosocial and medical data in a multicenter transverse study. Univariate analysis on chi² test was performed with stratification according to job (nurse, nursing assistant), and variables found to be significant on each dimension were included on multivariate models. 1428 nursing assistants and 342 registered nurses were included. 391 nursing assistants and 85 registered nurses intended to leave their work with the elderly. The registered nurses' intention to leave was associated with deteriorated care-team or residents relations, and with perceived elevated hardship due to the proximity of residents' death. The nursing assistants' intention to leave was associated with deteriorated management relation, with job insecurity and elevated hardship due to the residents' intellectual deterioration. Impaired physical or psychological health status also correlated with this intention. Policy to reduce voluntary turnover of care-staff in nursing homes for the elderly could be based on multifactorial management, acting on work organization and reducing psychosocial stress.

Prevalence and Consequences of Aggression and Violence towards Nursing and Care Staff in Germany-A Survey

Acts of aggression by patients or clients are a part of the average working day for many Health care employees. The objective of the survey was to study the frequency and nature of violence and the handling of aggressive behavior by facility management. The cross-sectional study was conducted in 2017, 81 different healthcare facilities and 1984 employees participated. The questionnaire encompassed socio-demographic details, the frequency of physical violence and verbal abuse, consequences of violence and the stress of employees. In the previous twelve months, 94.1% of the employees in the survey had experienced verbal abuse and 69.8% had experienced physical aggression. Acts of aggression were most commonly encountered in hospitals and residential facilities for the disabled. One third of the employees felt under high levels of stress as a result of the incidents. If the workplace prepares effectively, however, this reduces the perceived stress odds ratio (OR) 0.6, 95% CI 0.4–0.8). Violence and aggression are very common. Healthcare facilities are increasingly dealing with this topic. Awareness raising is likely to lead to higher incident reporting rates. Good preparation and an open approach to the topic in the facilities have a positive effect on the feeling of stress and work ability.