Addressing Risks of Violence against Healthcare Staff in Emergency Departments: The Effects of Job Satisfaction and Attachment Style

Surveillance of Health Care-Associated Violence Using Natural Language Processing

BACKGROUND AND OBJECTIVES

Patient and family violent outbursts toward staff, caregivers, or through self-harm, have increased during the ongoing behavioral health crisis. These health care-associated violence (HAV) episodes are likely under-reported. We sought to assess the feasibility of using nursing notes to identify under-reported HAV episodes.

METHODS

We extracted nursing notes across inpatient units at 2 hospitals for 2019: a pediatric tertiary care center and a community-based hospital. We used a workflow for narrative data processing using a natural language processing (NLP) assisted manual review process performed by domain experts (a nurse and a physician). We trained the NLP models on the tertiary care center data and validated it on the community hospital data. Finally, we applied these surveillance methods to real-time data for 2022 to assess reporting completeness of new cases.

RESULTS

We used 70 981 notes from the tertiary care center for model building and internal validation and 19 332 notes from the community hospital for external validation. The final community hospital model sensitivity was 96.8% (95% CI 90.6% to 100%) and a specificity of 47.1% (39.6% to 54.6%) compared with manual review. We identified 31 HAV episodes in July to December 2022, of which 26 were reportable in accordance with the hospital internal criteria. Only 7 of 26 cases were reported by employees using the self-reporting system, all of which were identified by our surveillance process.

CONCLUSIONS

NLP-assisted review is a feasible method for surveillance of under-reported HAV episodes, with implementation and usability that can be achieved even at a low information technology-resourced hospital setting.

Prevalence and Determinants of Workplace Violence Against Pediatric Emergency Healthcare Workers and Its Effect on Their Psychological Resilience

The study aimed to determine the prevalence and risk factors of workplace violence (WPV) against pediatric emergency healthcare workers and evaluate the relationship between WPV and psychological resilience. This study is cross-sectional and correlational. According to the results, the prevalence of WPV was 69.8%, and its distribution was as follows: verbal abuse (56.9%), bullying/mobbing (37.6%), physical abuse (12.8%), and sexual abuse (2.2%). Being single/separated/divorced/widowed (odds ratio [OR]: 1.85, 95% confidence interval [CI]: 1.03-3.30), being a physician (OR: 4.74, 95% CI: 1.73-12.96), being a staff member (OR: 2.57, 95% CI: 1.10-5.99), routine direct physical contact with patients/clients (OR: 2.77, 95% CI: 1.40-5.48), and lack of encouragement to report WPV (OR: 3.76, 95% CI: 2.01-7.01) were independent predictors of WPV (P < .05), and WPV was found to be associated with low psychological resilience. Arrangements related to violence prevention, preparation, and intervention should be made and maintained in all pediatric emergency departments.

Views of Mental Health Nurses on Responding to Clinical Aggression on General Wards

The overall aim of this study was to explore the views of mental health nurses (MHNs) about their experience of responding to workplace violence (WPV) and aggression (code greys and blacks) within acute general wards. WPV continues to pose a significant source of challenge within healthcare settings despite several initiatives that have been trialled over the years. It has the potential to impact patient care and overall staff health and well-being. Nurses play a significant role in the management of WPV; hence, it is important to understand how they respond to and manage incidents of WPV. The study design was an explorative descriptive qualitative design. Data were collected through semi-structured interviews involving n = 10 MHNs working within a mental health consultation liaison team that responds to incidents of violence and aggression (codes grey and black) in acute general wards. Participants were recruited using a convenient sampling method. Data were analysed using thematic analysis. The findings of this study highlighted the following themes: (1) Patient care (subthemes: patient frustration with hospital processes, lack of time and resources); (2) Staffing skills and confidence (subthemes: lack of adequate training, inability to intervene early and communication skills); (3) Understanding patient behaviours (subthemes: it's a psychiatry problem and zero tolerance approach). The management of WPV within acute hospital settings needs to be given due attention by healthcare services. Although a number of organisations are developing measures and guidelines to manage WPV, there is still a gap in the ability of general nursing staff to properly manage such incidences. Proper attention needs to be taken to the training of staff.

Behavioral skills training for teaching safety skills to mental health service providers compared to training-as-usual: a pragmatic randomized control trial

BACKGROUND

Violence in the healthcare workplace has been a global concern for over two decades, with a high prevalence of violence towards healthcare workers reported. Workplace violence has become a healthcare quality indicator and embedded in quality improvement initiatives of many healthcare organizations. The Centre for Addiction and Mental Health (CAMH), Canada's largest mental health hospital, provides all clinical staff with mandated staff safety training for self-protection and team-control skills. These skills are to be used as a last resort when a patient is at imminent risk of harm to self or others. The purpose of this study is to compare the effectiveness of two training methods of this mandated staff safety training for workplace violence in a large psychiatric hospital setting.

METHODS

Using a pragmatic randomized control trial design, this study compares two approaches to teaching safety skills CAMH's training-as-usual (TAU) using the 3D approach (description, demonstration and doing) and behavioural skills training (BST), from the field of applied behaviour analysis, using instruction, modeling, practice and feedback loop. Staff were assessed on three outcome measures (competency, mastery and confidence), across three time points: before training (baseline), immediately after training (post-training) and one month later (follow-up). This study was registered with the ISRCTN registry on 06/09/2023 (ISRCTN18133140).

RESULTS

With a sample size of 99 new staff, results indicate that BST was significantly better than TAU in improving observed performance of self-protection and team-control skills. Both methods were associated with improved skills and confidence. However, there was a decrease in skill performance levels at the one-month follow-up for both methods, with BST remaining higher than TAU scores across all three time points. The impact of training improved staff confidence in both training methods and remained high across all three time points.

CONCLUSIONS

The study findings suggest that BST is more effective than TAU in improving safety skills among healthcare workers. However, the retention of skills over time remains a concern, and therefore a single training session without on-the-job-feedback or booster sessions based on objective assessments of skill may not be sufficient. Further research is needed to confirm and expand upon these findings in different settings.

Relationships among supervisor support, autonomy, job satisfaction and emotional labor on nurses within the Turkey context of healthcare services

Introduction

Healthcare professionals face the challenging task of regulating their emotions within the workplace, which can lead to significant pressure and stress. For nurses, who work in particularly demanding environments, fulfilling the expectations of emotional labor can be challenging.

Methods

This study explores how nurses' perceptions of supervisor support and job autonomy can positively influence emotional labor and job satisfaction via Partial Least Squares Structural Equation Modeling (PLS-SEM) technique.

Results and discussion

Job autonomy is found to negatively affect emotional labor but positively impact job satisfaction. Additionally, job satisfaction is a significant precursor to both surface and deep-acting dimensions of emotional labor. Furthermore, job satisfaction mediates the relationship between supervisor support and deep-acting emotional labor, as well as between job autonomy and both surface and deep-acting emotional labor. These findings shed light on the complex dynamics of emotional labor and job satisfaction in healthcare settings.

An International Review of Workplace Violence Against Healthcare Providers: Sudan as a Case Study

Workplace violence experienced by healthcare providers (HCPs) in Sudan has gone viral, driving many HCPs outside the country. Globally, HCPs have accepted workplace violence as a phenomenon integral to their clinical work, causing an underreporting of incidents. This study reviews the causes and explores solutions for the phenomenon. Search strategies were conducted using internet sources including PubMed, Embase, Google Scholar, and Cochrane. References to Sudan were limited to HCPs in public healthcare facilities. A descriptive analysis was conducted on the global status of workplace violence toward HCPs. Future interventions were examined and discussed considering Sudan's circumstances. Results showed the "pandemic" nature of the phenomenon. Workplace violence contributes to the deterioration of the quality and efficiency of the healthcare system with consequences for effective healthcare delivery. It is concluded that a multiapproach intervention needs to be integrated to circumvent the standing multifactorial situation. Statutory actions are needed towards the widespread violence and impunity. Workplace organizational procedures are needed to address the patient's needs that overwhelm scarce resources. Robust educational efforts are recommended by HCP training bodies, the media, and other stakeholders to improve the doctor/patient relationship.

Pattern of Violence Among Healthcare Workers in a Tertiary Care Government Hospital and a Multi-Specialty Private Hospital in Sagar, India: A Cross-Sectional Study

Background Workplace violence in hospitals is an occupational hazard that affects healthcare workers (HCWs) negatively in many aspects and causes deterioration of the doctor-patient relationship, resulting in providence of substandard healthcare. This study was conducted to compare the pattern of violence in a tertiary care government teaching hospital and a multi-specialty private trust hospital in Sagar district, Madhya Pradesh, India. Methodology After ethical clearance of this cross-sectional, observational study, participants (frontline healthcare workers, including doctors and nurses) were asked about the type, frequency, department, and place of violence, etc., along with its perceived causes, solutions, and arrangements made by hospitals for dealing with it using a pretested, semi-structured questionnaire. Data analysis was performed using IBM SPSS Version 26.0 (IBM Corp., Armonk, NY). Categorical variables were described using frequency and percentages, and inferential analysis was conducted using the chi-square/Fisher's exact test. A P-value of <0.05 was considered statistically significant. Results Among the 113 participants, 67 (59.3%) were female, 53 (46.9%) were doctors, and 60 (53.1%) were nurses. The mean age of participants was 30.9±7.3 years. Predominantly verbal, emotional, and physical violence were present in 96.5%, 43.4%, and 6.2% of participants, respectively. Violent incidents against healthcare workers were more frequent in government hospitals as compared to private hospitals. Most healthcare workers (87.6%) tried to resolve violent incidents peacefully, and 1.8% tried to fight back. The most perceived cause of violence in both setups was a lack of morality and literacy among patients and their relatives (i.e., 83.2%), followed by a lack of proper facilities and a lack of trust in healthcare workers. Conclusion Both setups faced a substantial amount of violence. The loopholes in both setups, considering resources, security, and other facilities, are clearly visible, and specific steps must be adopted to protect both systems from violence.

Violence toward staff in the inpatient psychiatric setting: Nurses' perspectives: A qualitative study

BACKGROUND

Workplace violence is a universal phenomenon faced by employees in all industries but more so by employees working in sectors that require interpersonal contact, especially with individuals who may be violent, distressed, or vulnerable. Globally, healthcare professionals working in the emergency and psychiatric sectors are at the highest risk of workplace violence. In fact, healthcare professionals in the psychiatric setting have a higher risk rate of facing workplace violence opposed to other healthcare settings. Workplace violence can lead to adverse physical and psychological outcomes and impact the quality of care provided to patients.

OBJECTIVE

This study aims to explore nurses' experiences with workplace violence and the impact of violence on nurses. Whereas the objectives of this study are to explore and analyze mental health nurses' experiences with workplace violence in Brunei Darussalam, identify and explore the impact of violence on mental health nurses, and discuss nurses' coping mechanisms following a workplace violence experience.

DESIGN

Qualitative explorative study.

SETTING(S)

Mental Health Unit Kiarong of Raja Isteri Pengiran Anak Saleha Hospital, Brunei Darussalam.

PARTICIPANTS

Nurses (n = 12).

METHODS

Data was collected by conducting individual via online platforms. The interviews were carried out in English and/or Malay, the verbatim transcripts produced were transcribed in their source languages and only relevant excerpts were translated into English for the write-up. The data were analyzed utilizing thematic analysis by the researcher independently.

RESULTS

This study identified three themes: Violence as a norm in the psychiatric setting, perceived impact of workplace violence, and "Talk, Report and Accept" as Coping mechanisms.

CONCLUSIONS

In conclusion, it is apparent that globally workplace violence is normalized in the nursing industry, especially in the psychiatric setting. Workplace violence yields a plethora of negative long-term and short-term impacts on nurses. Despite this, workplace violence often goes unreported for numerous reasons but mainly due to the lack of changes after reporting. Nurses should be encouraged to report all instances of workplace violence by demonstrating effective changes and providing hazard pay. The management should actively attempt to reduce the risk of workplace violence by preemptively equipping nurses with the necessary training including identification of potential risks of workplace violence, effective de-escalation methods, and proper control and restraint methods.

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

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

Screening for Behavioral Health Patient Aggression in Emergency Departments to Reduce Workplace Violence

INTRODUCTION

Patient violence in health care facilities occurs daily. Structured risk assessments, when regularly completed, have been effective in prompting interventions to reduce aggression in Behavioral Health (BH) settings.

METHODS

This quasi-experimental study evaluated the effectiveness of the Dynamic Appraisal of Situational Aggression - Inpatient Version (DASA) validated screening tool to reduce aggressive outbursts in an emergency department (ED) setting with BH patients awaiting transfer to a psychiatric facility. The tool was used in 4 non-psychiatric EDs from a large health care system. Chart audits were completed to record initial patient DASA scores observed at triage and at subsequent intervals during the ED encounter. ED staff documented interventions used for patients. Inclusion criteria included adults 21 years and older following a telepsychiatry consultation with a recommendation for BH inpatient admission. Pre-/post-implementation aggressive events were collected to assess ED DASA use. DASA scores from BH ED patients were examined to increase understanding of patient utilization. Staff workplace safety was examined to compare staff safety perception pre- and post-DASA implementation.

RESULTS

Violent events were reported statistically significantly higher post-DASA implementation. There was an increased risk of elevated DASA scores for specific diagnoses and genders. An increased awareness of the importance of reporting workplace violence improved documentation.

DISCUSSION

Using an evidence-based screening tool helped identify BH patients with behaviors associated with aggressive ED events. Proactive use of interventions, including use of Comfort Cart items, de-escalation, and prescribed medications, can positively influence reduction of risk from aggressive behaviors within BH patient populations in EDs.

Nurses' rationale for underreporting of patient and visitor perpetrated workplace violence: a systematic review

BACKGROUND

Patient and visitor perpetrated workplace violence (WPV) is a problem within healthcare and is known to be underreported by nurses and other healthcare workers. However, there are multiple and diverse reasons identified in the literature as to why nurses do not report. This systematic review aimed to investigate nurses' reasons and rationale related to underreporting of violence that occurs in the workplace.

METHODS

Following PRISMA guidelines for systematic review reporting, studies conducted between 2011 and early 2022 were identified from MEDLINE, CINAHL, APA PsychInfo, and Psychological and Behavioral Sciences Collection via EBSCOHost. Quantitative studies related to patient and visitor perpetrated violence containing explanations, reasons, or rationale related to underreporting were included.

RESULTS

After quality appraisals, 19 studies representing 16 countries were included. The resulting categories identified nursing, management, and organizational factors. The most prominent nursing factors included nurses' fear of consequences after reporting, nurses' perceptions, and their lack of knowledge about the reporting process. Common management factors which contributed to nursing underreporting included lack of visible changes after reporting, non-supportive culture in which to report, and the lack of penalties for perpetrators. Organizational factors included the lack of policies/procedures/training for WPV, as well as a lack of an efficient and user-friendly reporting system. Supportive interventions from management, organizations, and community sources were summarized to provide insight to improve nurse reporting of WPV events.

CONCLUSION

Underreporting of WPV is a complex and multi-faceted problem. An investigation into the rationale for underreporting a workplace violent event illustrates nurses, management, and organizations contribute to the problem. Clear and actionable interventions such as educational support for staff and the development of a clear and concise reporting processes are recommended to encourage staff reporting and to help address WPV in healthcare.

Social shaming and bullying of mental health staff by patients: A survey in a mental health centre

WHAT IS KNOWN ON THE SUBJECT?: Public shaming, especially by consumers of healthcare, is getting worse and has become a specific case of bullying Despite extensive research on physical and verbal violence directed towards mental health workers, the issue of social shaming and bullying by patients or relatives has not been sufficiently researched WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE: Mental healthcare workers are exposed to the threat of social shaming and bullying on a regular almost weekly basis Abusive behaviours by patients are associated with professional burnout, decreases in professional functioning and even a tendency to leave the workplace among mental health workers WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The stability and strength of the therapeutic alliance between healthcare giver and psychiatric patient are critical to the success of the treatment There is a need to develop a dedicated organizational policy for the prevention, early detection, intervention and support for teams exposed to social shaming and bullying An emphatic response, and effective intervention in a case of social shaming may improve professional functioning and reduce burnout and intention to leave.

ABSTRACT

INTRODUCTION: Social shaming can impair caregivers' performance. The prevalence of shaming experienced by mental health workers and the relationships to their function or burnout is unknown.

AIM

To examine the associations between exposure to social shaming and bullying by patients, the risk appraisal of negative impact of this behaviour, burnout, professional functioning and intention to leave among mental health workers.

METHOD

In this cross-sectional study, 122 workers from a psychiatric hospital completed a questionnaire.

RESULTS

Participants reported exposure to social shaming and bullying by patients on a regular basis. Shaming and bullying were significantly associated with lower professional functioning and higher intention to leave, while burnout may at least partially mediate the association between these variables.

CONCLUSIONS

The phenomenon of shaming and bullying of mental health workers by patients is common and is associated with lower functioning and higher burnout, which have a negative impact on the patient-caregiver interaction.

IMPLICATIONS FOR PRACTICE

There is a need to establish a policy for early detection of shaming of mental health workers in order to prevent burnout or intention to leave. Evidence based interventions, such as the Safewards model, accompanied by assessment of their effectiveness, may help in this effort.

Nursing management of emergency department violence-Can we do more?

BACKGROUND

Emergency departments are the services with the highest risk of violence for nurses. Reports of violence in health care have increased exponentially in the last decade. Front line hospital services are more at risk, and worldwide there are attempts to quantify, manage and prevent episodes of violence, but no consistent solutions have yet been identified.

AIMS

To stimulate reflection on causal factors of violence against nurses in emergency departments and discuss potential solutions and strategies for aspects that largely remain unresolved.

DESIGN

A position paper underpinned by experiences and evidence reported in the literature.

METHODS

A search of Scopus and CINAHL using the term 'violence' provided information concerning the prevalence of the term 'violence' in contemporary literature and enabled to capture a general overview of contributing factors of violence and current approaches to its management and prevention.

CONCLUSIONS

However, while risk factors have been identified, there is a tendency to over accentuate the extent of their contribution. The main risk factors present conditions related to or accompanied by mental illness and the impact of overcrowding and long waiting times.

RELEVANCE TO CLINICAL PRACTICE

More is needed in terms of implementation of more far-reaching, holistic, practical and effective management solutions to promote nurses' safety and adequately support vulnerable patients.

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

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.

Original Research: Patient-to-Nurse Violence During One-to-One Assignments: A Silent Epidemic

BACKGROUND

Nurses and nursing assistants given one-to-one ("sitter") assignments are placed with one patient for long periods of time. Some of these patients require a sitter for reasons that include dementia, traumatic brain injury, psychiatric disturbances such as delirium, and risk of self-harm. Some may become verbally abusive, physically violent, or both, putting the assigned staff member in danger.

PURPOSE

The study purpose was to investigate workplace violence from the perspective of nurses and certified nursing assistants working one-to-one assignments who had experienced violent encounters with patients or visitors.

METHODS

This qualitative cross-sectional study used a phenomenological approach. Participants were nurses and nursing assistants at one hospital in the western United States. Data were collected in five focus groups, which were conducted online; a semistructured interview guide allowed researchers to elicit participants' responses and foster discussion. Thematic analysis was used to identify themes in the data.

RESULTS

A total of 13 nurses and nursing assistants participated. Four themes emerged: silent epidemic, culture of unsafety, emotional occupational hazard, and policy and response.

CONCLUSIONS

This study adds to the work of researchers who are asking difficult questions about workplace violence. It's our hope that the participants' comments and insights, as well as their recommendations, can move the needle in improving prevention and follow-up practices related to patient-initiated workplace violence.

Safe and Sound: An Improvisational Theater-Based Curriculum and Behavioral Intervention to Address Violence in the Emergency Department

BACKGROUND

Emergency department (ED) workplace violence has become increasingly prevalent in the United States, warranting the development of legislation, policy, and advocacy to protect health care workers. Solutions to address ED violence remain limited, and staff-oriented trainings often exist as short, one-time didactic sessions, which are not practical nor often applicable to the ED setting. There is a paucity of evidence-based interventions that incorporate behavioral-based training to adequately prepare staff for the complicated, multifactorial presentation of violence in the ED.

OBJECTIVE

This pilot study sought to assess the feasibility of an improvisational theater-based, simulation intervention for health care professionals to address ED violence.

METHODS

A longitudinal curriculum for ED violence was developed in collaboration with a committee of emergency medicine (EM) faculty, EM simulation experts, hospital security and police personnel, professional theater and improvisational performers, resident physicians, and medical students. This pilot intervention was tailored to new EM residents (n = 25) at a large, urban, academic medical center. Sessions were led by facilitators trained in group facilitation, simulation, and improvisation.

RESULTS

Participants felt the curriculum was helpful (82.6%), engaging (91.3%), applicable (73.9%), and enjoyable (82.6%). Participation primarily by residents identifying as female and people of color suggested the efficacy of creative expression and nontraditional modalities in engaging diverse learners. Ninety-five percent of participants expressed interest in future sessions.

CONCLUSIONS

A multidisciplinary workplace violence intervention leveraging principles of improvisational theater, health equity, organizational psychology, and EM simulation may prove useful in preparing health care professionals for violence in the ED.

Professional Preparedness Implications of Workplace Violence against Medical Students in Hospitals: A Cross-Sectional Study

Workplace violence is an increasing public health concern around the world. In Vietnam, attacks on healthcare workers have become a huge issue in recent years. Our study aims to shed more light on the issue and look at what variables affect acts of violence toward healthcare workers. We conducted this cross-sectional study by surveying 550 medical students from 3 universities in Vietnam. Following this survey on SurveyMonkey's platform (surveymonkey.com), the participants were suggested to invite their associates who met the selection criteria to join in this online survey. The structured questionnaire included demographics and details on the violence. There were 90.5% of respondents were medical students, the mean age was 23.3, and verbal abuse had a prevalence rate of 29.3%. Women respondents are less likely to suffer from violent experiences than men (OR = 0.48, 95% CI = 0.28-0.84), and those specializing in nurse and technician also faced a lower rate of acts of aggression (physical violence: OR = 0.35; 95% CI = 0.19-0.63, sexual harassment: OR = 0.36; 95% CI = 0.15-0.87, and any type of violence: OR = 0.55, 95% CI = 0.37-0.82). Medical students working in Ho Chi Minh City (OR = 0.55; 95% CI = 0.34-0.89), and other regions (OR = 0.40; 95% CI = 0.19-0.85) were significantly less likely to face verbal abuse than those working in Hanoi. The workplace culture needs to be changed to make sure that people feel comfortable reporting, especially those who are younger. Protecting medical students also ensures patient safety since victims of assault in the workplace can have severe aftereffects affecting their ability to provide good patient care. Hence, policies need to be implemented at both the government and hospital administration levels to keep health workers safe.

Workplace violence against healthcare workers during the COVID-19 pandemic in Sudan: A cross-sectional study

Background

Workplace violence (WPV) against healthcare workers (HCWs) is a growing global issue. During the coronavirus diseases-2019 (COVID-19) pandemic, violent attacks on HCWs have been documented worldwide. This study aimed to investigate the magnitude and pattern of WPV among HCWs in Sudan during the COVID-19 pandemic.

Methods

A web-based cross-sectional study of WPV was conducted among registered medical and health workers (pharmacists, physicians, dentists, nurses, laboratory technicians, and administrative and paramedical staff) during the COVID-19 pandemic in Sudan. Data were collected from August to December 2021 using a self-administered questionnaire distributed through social media platforms.

Results

A total of 792 HCWs returned the online questionnaire. The mean age was 33.5 ± 8.6 years, where more than half were females (54.9%) and working during the day shift (58.8%). During the COVID-19 pandemic, three out of every four participants (78.3%) reported experiencing violence, with 65.8 % experiencing it more than three times. The common types of violence experienced were verbal (91.6%), physical (50.0%), and sexual abuse (11.0%). The emergency department reported the highest number of violent incidents (46.9%). Half of these violent events were not reported (50.3%), primarily due to a lack of a reporting system. The demographic factors that were significantly associated with exposure to violence were participants' occupation (p < 0.001), age (p = 0.001), marital status (p = 0.002), and years of working experience (p = 0.020).

Conclusion

WPV was rampant among the HCWs in Sudan during the COVID-19 pandemic. The current findings are presented to draw the attention of policy leaders and stakeholders in Sudan to this alarming problem prompting the pressing need for policy and system interventions.

Nurse, Provider, and Emergency Department Technician: Perceptions and Experiences of Violence and Aggression in the Emergency Department

INTRODUCTION

Patient/visitor violence and aggression (V&A) in the emergency department occurs daily. Few interventions exist to decrease V&A. Research describing prevalence, severity, and perceived safety among ED clinicians is limited.

METHODS

A descriptive survey explored V&A against ED clinicians in one urban emergency department. A sample of nurses, ED technicians, physicians and advanced practice providers participated. Participants completed a demographic survey, Personal Workplace Safety Instrument for Emergency Nurses (PWSI-EN), and ENA V&A frequency checklist. Analysis of Variance (ANOVA) for unadjusted and Analysis of Covariance (ANCOVA) for adjusted associations were used to assess differences in the PWSI-EN survey composite score and "feeling safe in the ED" among ED roles. ANCOVA was adjusted for potential confounders: sex, race, years working in emergency department, and shift worked.

RESULTS

Sixty-five (46.4%) of the 140 ED clinicians returned surveys, which were almost evenly distributed between ED clinician roles and sex. Mean age was 37.2 (range: 21-64) years. All (100%) nurses and providers reported being verbally abused. More nurses reported physical violence (n = 21, 87.5%) than providers (n = 7, 36.8%) and ED technicians (n = 11, 55%). Nurses and ED technicians reported experiencing greater prevalence of physical violence than providers (p < .05). Nurses (mean 3.29, range 2.95 to 3.63) were more fearful for their personal safety than ED technicians (mean 3.88, range 3.48 to 4.28) (p < .03).

DISCUSSION

V&A are common creating a fearful environment. However, little research regarding clinician perceptions exists. Our study aids in identifying areas for clinician-targeted strategies to prevent ED V&A.

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

AIM

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

BACKGROUND

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

EVALUATION

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

KEY ISSUES

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

CONCLUSIONS

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

IMPLICATIONS FOR NURSING MANAGEMENT

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

Violence against nurses by patients and visitors in the emergency department: A concept analysis

AIM

This analysis investigates the concept of violence against nurses by patients and visitors in the emergency department. It aims to differentiate, clarify, and clearly identify this specific concept, which will facilitate more apt measurement and reporting, ultimately to contribute violence reduction measures.

BACKGROUND

Due to contextual factors, occupational risk and patient characteristics, violence against nurses by patients and visitors in the emergency department varies from other types of violence against other health care staff.

METHODS

This study employed Walker and Avant's concept analysis technique.

RESULTS

The analysis found that violence against nurses by patients and visitors in the emergency department is primarily an occurrence of interpersonal violence based on the working relationship, whereby the patient and/or visitor becomes an assailant, and a nurse becomes a target in the absence of capable guardianship. There is also an intentional use of physical force or power, which results in or has a high chance of causing harm.

CONCLUSION

A clearer understanding of the antecedents, attributes, and consequences of violence against nurses by patients and visitors arising from this concept analysis provides a framework that will assist in the understanding, measurement, reporting, and prevention of violence and inform future research.

IMPLICATIONS FOR NURSING MANAGEMENT

Nursing managers are encouraged to adopt strategies that act on the factors related to attributes and antecedents that will serve to reduce the occurrence of intentional violent acts.

Workplace Violence in Healthcare Settings: Work-Related Predictors of Violence Behaviours

Healthcare workers are exposed to workplace violence such as physical assaults, psychological violence and threats of violence. It is crucial to understand factors associated with workplace violence to prevent and mitigate its consequences. This study aims to identify work-related factors that might influence workplace violence in healthcare settings. A cross-sectional study was developed between March and April of 2022 with healthcare workers. The Aggression and Violence at Work Scale was used to assess workplace violence, and psychosocial risks were assessed through the Health and Work Survey—INSAT. Statistical analysis using bivariate analysis was performed to identify the psychosocial risk factors related to physical violence, psychological violence and vicarious violence. Subsequently, a multiple linear regression was performed to identify the models that better explained the relationship between psychosocial risk factors and the three dimensions of violence. Psychological violence was frequently experienced by the healthcare workers. Significant associations were found between psychosocial risk factors and physical, psychological and vicarious violence, namely working hours, work relationships, employment relations, high demands and work intensity. These findings highlight the importance of taking into consideration work-related factors when designing interventions to prevent and address workplace violence in healthcare settings.

Workplace violence in healthcare settings: The risk factors, implications and collaborative preventive measures

Violence at work refers to acts or threats of violence directed against employees, either inside or outside the workplace, from verbal abuse, bullying, harassment, and physical assaults to homicide. Even though workplace violence has become a worrying trend worldwide, the true magnitude of the problem is uncertain, owing to limited surveillance and lack of awareness of the issue. As a result, if workplace violence, particularly in healthcare settings, is not adequately addressed, it will become a global phenomenon, undermining the peace and stability among the active communities while also posing a risk to the population's health and well-being. Hence, this review intends to identify the risk factors and the implications of workplace violence in healthcare settings and highlight the collaborative efforts needed in sustaining control and prevention measures against workplace violence.

•

Workplace violence needs to be addressed more comprehensively, involving shared responsibilities from all levels.

•

Emphasis on healthcare management's commitment, assurance, and clearly defined policy, reporting procedures, and training.

•

The healthcare workers' commitment to update their awareness and knowledge regarding workplace violence.

•

The provision of technical support and assistance from professional organizations, NGOs, and the community.

Analysis of physical violence incidents against physicians in Turkey between 2008 and 2018

BACKGROUND

Violence against physicians is a global issue that causes impaired physical and mental health, declined work quality, resignations, and even suicides. Studies regarding violence against physicians are very limited. Therefore, our aim is to investigate the physical violence incidents against physicians presented in print media between 2008 and 2018.

METHODS

A total of 8612 news reports acquired in national news database via 45 keywords were assessed. Five hundred and sixty-four of the reports met the inclusion criteria and were retrospectively analyzed.

RESULTS

Of 5964 news reports, 3754 (62.9%) were reprimands and protests against violence incidents. In 11 years, 560 individual incidents occurred where 647 physicians were physically assaulted, with 2267 news reports written on those incidents. The number of incidents increased over the years, and in 2012 both the number of incidents (n=91) and news reports count per incident were found highest. About 77.7% of assaulted physicians were male, and incident rate was higher in Western Turkey (42.15%). In 11 years, ten dedicated physicians have lost their lives in the line of duty. Emergency medicine (20.4%), primary care (9.89%) were the departments most exposed to physical violence. The claim of receiving inadequate medical attention was noted to be the primary allegation of the assailants.

CONCLUSION

The frequency of physical violence incidents against physicians is increasing. Throughout the study period, news reports containing condemnations, critiques, and protests are also more frequently, yet not adequately, placed in print media. Thus, social and public awareness ought to be enhanced through national and global media outlets. Furthermore, extensive measures must be taken by governments in order to prevent and eliminate violence.

Effects of Integrated Workplace Violence Management Intervention on Occupational Coping Self-Efficacy, Goal Commitment, Attitudes, and Confidence in Emergency Department Nurses: A Cluster-Randomized Controlled Trial

Patient and visitor violence (PVV), the most prevalent source of workplace violence, is largely ignored, underreported, and a persistent problem in emergency departments. It is associated with physical injuries, psychological distress, and occupational stress in nurses. A randomized controlled trial was conducted in Taiwan from January to December 2020. This study aimed to test the efficacy of an integrated Workplace Violence Prevention and Management Training Program on PVV in 75 emergency department (ED) nurses from a hospital. Cluster sampling was used because the policy of subdivision strategy was enforced during the COVID-19 pandemic. ED nurses received either the intervention or 1-hour in-service class. Data were collected from questionnaires. Data were analyzed mainly by the repeated measure analysis of variance and generalized estimating equations. The intervention had positive effects on developing stronger goal commitment, improving occupational coping self-efficacy, increasing confidence in ability to deal with violent situations, and modifying attitudes toward the causes and management of PVV in ED nurses (p < 0.05). The marginal R2 of the generalized estimating equation model for goal commitment, occupational coping self-efficacy, confidence, attitudes toward aggression in ED and aggressive behavior variables was high as 0.54 (p < 0.001), 0.45 (p < 0.001), 0.58 (p < 0.001), 0.29 (p < 0.05), and 0.72 (p < 0.001), respectively. These study models could effectively predict changes in the mean values. The benefit was driven by the effect of the intervention in ED nurses. Thus, the intervention, when applied in conjunction with routine in-service class, could exert synergistic improvements on outcomes measured in nurses.

Dilemmas and Repercussions of Workplace Violence against Emergency Nurses: A Qualitative Study

Nurses received the highest rate of workplace violence due to their close interaction with clients and the nature of their work. There have been relatively few qualitative studies focus on nurses' perceptions of and experiences with the antecedents, dilemma and repercussions of the patient and visitor violence (PVV), leaving a considerable evidence gap. The aim of this study was to explore nurses' experience of PVV in emergency department, the impact of PVV on quality of care, and supports needed after exposure to such incidents. We conducted semi-structured interviews with a purposive and snowball sample of nurses, and analyzed the content of the interview transcripts. A total of 10 nurses were approached and agreed to participate. Those participants ranged in age from 24 to 41 years old, eight female and two male nurses, and the majority of them (80%) held a university Bachelor degree in nursing. The average time in nursing practice was 7.2 years. We conceptualized five analytical themes, which comprised: (1) multifaceted triggers and causes of PVV; (2) experiences following PVV; (3) tangled up in thoughts and struggle with the professional role; (4) self-reflexivity and adjustment; and, (5) needs of organizational efforts and support following PVV. This paper provides compelling reasons to look beyond solely evaluating the existence of workplace, and considering the perceived professional inefficacy, impacts of being threatened or assaulted in nurses. There are also urgent needs in provision of prevention and management of workplace training programs to ensure the high-quality nursing care.

Causes of Hospital Violence, Characteristics of Perpetrators, and Prevention and Control Measures: A Case Analysis of 341 Serious Hospital Violence Incidents in China

Objective: Hospital violence remains a global public health problem. This study aims to analyze serious hospital violence causes in China and the characteristics of perpetrators. It likewise seeks to understand frontline personnel's needs and put forward targeted suggestions. Methods: Serious hospital violence cases from 2011 to 2020 in the China Judgment Online System (CJOS) were selected for descriptive statistical analysis. A total of 72 doctors, nurses, hospital managers, and security personnel from 20 secondary and tertiary hospitals in China were selected for semi-structured interviews. Results: Of the incidents, 62.17% were caused by patients' deaths and dissatisfaction with their treatment results. Moreover, it was found that out-of-hospital disputes (11.14%) were also one of the main reasons for serious hospital violence. The perpetrators were mainly males (80.3%), and had attained junior high school education or lower (86.5%). Furthermore, most of them were family members of the patients (76.1%). Healthcare workers urgently hope that relevant parties will take new measures in terms of legislation, security, and dispute handling capacity. Conclusion: In the past 10 years, serious hospital violence's frequency in China has remained high. Furthermore, their harmful consequences are more serious. The causes of hospital violence are diverse, and the characteristics of perpetrators are obvious. Frontline healthcare workers urgently need relevant parties to take effective measures in terms of legislation, security, and dispute handling capacity, to prevent the occurrence of violence and protect medical personnel's safety.

Workplace Violence Against Physicians Treating COVID-19 Patients in Peru: A Cross-Sectional Study

BACKGROUND

The COVID-19 pandemic is an unprecedented challenge to health systems that has revealed shortcomings and increased unmet demands. Such situations might exacerbate workplace violence (WPV) against physicians, as has been reported in several parts of the world.

METHODS

To identify the frequency and characteristics of WPV suffered by physicians attending COVID-19 patients in Peru, a descriptive, cross-sectional study was conducted with an online survey of 200 physicians.

RESULTS

Of the survey respondents, 84.5% had suffered some type of WPV; 97.6% of these suffered nonphysical violence. Suffering more than one incident of violence was reported by 75.7% of respondents. The primary aggressor was a patient's family member or caregiver. Violence occurred most frequently in critical areas inside the health service facility, such as COVID-19 triage, tents, and hospital units, although it also occurred during teleconsultations. Multiple shortcomings of the health services were perceived as the main trigger of violence. Being a female physician (odds ratio [OR] = 2.48, 95% confidence interval [CI] = 1.06-5.83) and working in a COVID-19 ICU (OR = 5.84, 95% CI = 1.60-21.28) were the main factors associated with WPV.

CONCLUSION

Violence against physicians attending COVID-19 patients in Peru is common. The perceived factors that contribute most to violence are linked to deficiencies in health services.

Empathy With Patients and Post-Traumatic Stress Response in Verbally Abused Healthcare Workers

OBJECTIVE

The current study examined the differential empathic capacity, post-traumatic symptoms, and coping strategies in healthcare workers (HCWs) according to the exposure of verbal or physical workplace violence (WPV).

METHODS

Using online survey, a total of 422 HCWs employed at a training general hospital of South Korea participated and completed self-reporting questionnaires including the WPV questionnaire with coping strategy, the Jefferson Scale of Physician Empathy.

RESULTS

Those who experienced either only verbal violence or both physical and verbal violence had lower Jefferson Scale of Physician Empathy scores (p<0.05). Posttraumatic stress symptom severity was higher among people who experienced verbal violence than physical violence. HCWs' exposure to verbal violence was associated with severe posttraumatic symptoms and a low level of empathy with patients (p<0.05). More than half of the victims of verbal violence responded that they did not take any action, receive organizational protection, or peer support, while most physically-abused HCWs received institutional intervention or help from others.

CONCLUSION

Our findings highlight the critical importance of reducing verbal violence, which may represent a larger psychological burden compared to physical violence, by actively implementing effective strategies and policies at the institutional level.

Exploring staff experiences: A case for redesigning the response to aggression and violence in the emergency department

INTRODUCTION

A Code Black is the coordinated response by healthcare staff and security to an act or threat of verbal and physical aggression or violence perpetrated by a patient, family member or visitor towards healthcare staff within a hospital setting. Behavioural disturbance is often verbally de-escalated by staff. However, as a last resort physical and/or chemical restraint may be necessary. Reports show that there is an increasing number of violent incidents in Emergency Departments (ED), emphasising the importance of staff training for Code Black events. This research examines the response of healthcare staff to aggression and violence in the ED, the supporting structures that manage a Code Black event and potential avenues for restructuring the response.

METHODS

We used a constructivist methodology to evaluate the training needs of healthcare staff. In 2019, we interviewed 20 staff and conducted a series of ethnographic observations in EDs across four hospitals in the Western Sydney Local Health District (WSLHD) in New South Wales (NSW), Australia. We focussed on staff experiences of Code Black events and the current departmental response. Staff recounted experiences of 45 Code Black events which were collated and thematically analysed.

RESULTS

Our findings show that there are no guidelines for: assessing the risk of an agitated patient, best practice de-escalation techniques, when exactly to call a Code Black and the pre-determined allocation of staff roles for patient restraint. Code Black response efforts lacked a systematic approach to coordinating resources and personnel, and there was confusion over the role of security. When poorly managed, this placed healthcare staff, security personnel and patients at serious risk and had a negative impact on staff wellbeing. We found training in Code Black interventions relies heavily on learning on the job from experienced staff members.

CONCLUSION

A systematic, coordinated and consistent organisational response to Code Black events is essential for the safety of ED staff. The roles and responsibilities of health workers and security require clear definition, and health workers across the WSLHD require easily accessible and repeatable experiential training in managing Code Black events.

Hospital-Based Healthcare Workers Victims of Workplace Violence in Italy: A Scoping Review

The aim of this scoping review is to synthesize the available evidence on the prevalence rates of healthcare workers being victims of violence perpetrated by patients and visitors in Italy. PubMed, Scopus, Web of Science and CINAHL were systematically searched from their inception to April 2021. Two authors independently assessed 1182 studies. All the scientific papers written in English or in Italian reporting primary quantitative and/or qualitative data on the prevalence of aggression or sexual harassment perpetrated by patients or visitors toward healthcare workers in Italy were included. Thirty-two papers were included in the review. The data extracted were summarized in a narrative synthesis organized in the following six thematic domains: (1). Methodology and study design; (2). Description of violent behavior; (3). Characteristics of health care staff involved in workplace violence (WPV); (4). Prevalence and form of WPV; (5). Context of WPV; and (6). Characteristics of violent patients and their relatives and/or visitors. The proportion of studies on WPV differed greatly across Italian regions, wards and professional roles of the healthcare workers. In general, the prevalence of WPV against healthcare workers in Italy is high, especially in psychiatric and emergency departments and among nurses and physicians, but further studies are needed in order to gather systematic evidence of this phenomenon. In Italy, and worldwide, there is an urgent need for governments, policy-makers and health institutions to prevent, monitor and manage WPV towards healthcare professionals.

A qualitative examination of graduating nurses' response to the Covid-19 pandemic

BACKGROUND

Currently, graduating nurses face pandemic-related uncertainty including gaps in risk perception, unexpected Covid-19 moral dilemmas, and distress surrounding personal health risk.

RESEARCH QUESTION/AIM/OBJECTIVES/METHOD

The purpose of this basic qualitative descriptive study is to describe the willingness of graduating nurses to provide care during the Covid-19 pandemic.

PARTICIPANTS AND RESEARCH CONTEXT

One week prior to graduation, students were required to submit a written assignment describing willingness to practice in light of the ongoing pandemic.

ETHICAL CONSIDERATIONS

This study was approved by an Institutional Review Board.

FINDINGS/RESULTS

Eighty-four (n = 84) assignments were used for analysis. Of these, 82% (n = 69) of the graduating nurses describe a willingness to voluntarily care for Covid-19 patients. After summarizing narrative responses, two themes emerged including self-assessment of personal and familial risk and conflicting obligations.

DISCUSSION

The assessment of risk to self and family are key in determining whether graduating nurses will care for Covid-19 patients. Conflicting obligations may contribute to stress and uncertainty potentially leading to early burnout.

CONCLUSION

Findings from this study can inform academicians of the need to adequality prepare graduating nurses for Covid-19-associated risks and ethical decision making. Organizations should alter residencies and orientation to support the needs of new nurses.

Workplace Violence Against Emergency Nurses: A Literature Review

Violence against health care providers is one of the most pressing problems faced by health care systems around the world. Because of unpredictability and acuity of emergency cases, emergency nurses are more vulnerable to workplace violence. Violence against emergency nurses is a complex and multidimensional problem that has a devastating impact on the physical, psychological, and social well-being of nurse victims. The purpose of this review is to integrate evidence on manifestations, contributing factors, and consequences of workplace violence perpetrated by patients and/or their relatives against emergency nurses, in addition to behavioral responses of emergency nurse victims toward workplace violence. An integrative review was conducted by searching 3 main electronic databases: Web of Sciences, MEDLINE, and ScienceDirect. Eighteen studies met the inclusion criteria and were included in the final review process. The review identified the most common forms, contributing factors, unpleasant consequences of workplace violence, and behavioral reaction of nurse victims toward violence acts. Reporting rates of workplace violence among emergency nurses were found to be low. It is recommended to develop more effective workplace violence prevention and reporting programs.

User-friendly system (a smartphone app) for reporting violent incidents in the Emergency Department: an Italian multicenter study

BACKGROUND

Nurses, particularly emergency nurses, are among the health workers most exposed to workplace violence. Although reporting systems are increasingly used, under-reporting remains high. Recent studies suggest that the use of easy registration systems could facilitate violence reporting.

OBJECTIVES

To verify if a friendly reporting system based on a Mobile-app can facilitate the reporting of violent episodes and reduce under-reporting.

METHODS

Twenty emergency departments of five North and Central Italian regions participated in an interventional, multicentric, pre-post study to verify if a user-friendly reporting system based on a mobile app can facilitate the reporting of violent episodes and reduce under-reporting.

RESULTS

Three hundred and eighty-four out of 754 potentially eligible nurses answered the short questionnaire at time T0, and 318 registered for the use of the app. One hundred and eighty-nine answered the questionnaire at time T1. The t-Test for Paired Samples, although with a low mean difference, shows a significant difference in the change in the frequency of the reporting of violent episodes. The correlational tests showed no significant differences in the subgroups divided by demographic and professional characteristics. The usability of the app was considered very high.

CONCLUSIONS

The simplification of the reporting system and the preliminary acquisition of data on the characteristics of the ED and each nurse, can save time and facilitate the reporting, but technology alone is not enough to solve the under-reporting.

Whose fault is it? Attribution of causes of patient violence among exposed and unexposed community-based family physicians

Extensive research has dealt with violence directed at healthcare workers in hospital settings; however, few studies have examined community-based settings. Furthermore, there is also scant literature regarding the perceptions of healthcare providers who were exposed to violence, compared to those who were not. This study aims to narrow these gaps in the literature by examining community-based family physicians' (CBFPs) perceptions in a large national Health Maintenance Organisation (HMO) regarding patient-initiated violence. Using a voluntary online survey, directed at all CBFPs working at the HMO, 412 CBFPs were surveyed on the following issues: exposure to violence initiated by patients or their family members; perceptions of violent occurrences and possible safety measures. The differences between CBFPs who had been exposed to violence and those who had not were compared. The majority of CBFPs reported experiencing verbal attacks (64%), and a small percentage experienced property-related violence (11.7%) or physical violence (3.4%). Comparing CBFPs who were exposed to violence with those who were not, regarding their perceptions of the 'causes of violence', revealed three differentiating factors: 'waiting time', 'failure to meet the patient's expectations' and 'the nature of the physician-patient encounter'. Regarding the desired preventive actions, the four differentiating factors were as follows: 'reduction in the number of patients per physician', 'improved queue management processes', 'longer meetings' and 'violence prevention training'. Conducting separate analyses, according to violence type (verbal abuse, vandalism or physical violence), indicated finer differentiations. In terms of Attribution Theory, one might argue that CBFPs who were directly exposed to patients' aggression attributed internal locus to the attacker, and tended to blame the attacker's personal characteristics and cultural values. Conversely, family CBFPs who were not attacked attributed external locus to situational factors such as waiting time, not receiving service, and the nature of the interaction between the attacker and the CBFP.

Aggressive Behavior and Psychiatric Inpatients: a Narrative Review of the Literature with a Focus on the European Experience

PURPOSE OF REVIEW

We summarized peer-reviewed literature on aggressive episodes perpetrated by adult patients admitted to general hospital units, especially psychiatry or emergency services. We examined the main factors associated with aggressive behaviors in the hospital setting, with a special focus on the European experience.

RECENT FINDINGS

A number of variables, including individual, historical, and contextual variables, are significant risk factors for aggression among hospitalized people. Drug abuse can be considered a trans-dimensional variable which deserves particular attention. Although mental health disorders represent a significant component in the risk of aggression, there are many factors including drug abuse, past history of physically aggressive behavior, childhood abuse, social and cultural patterns, relational factors, and contextual variables that can increase the risk of overt aggressive behavior in the general hospital. This review highlights the need to undertake initiatives aimed to enhance understanding, prevention, and management of violence in general hospital settings across Europe.

Risk assessment of workplace violence towards health workers in a Chinese hospital: a cross-sectional study

OBJECTIVE

This study aimed to assess the risk factors associated with workplace violence towards health workers (HWs) in a Chinese hospital.

METHODS

We conducted a cross-sectional survey in a Chinese secondary hospital in 2019 using an international survey questionnaire, and collected valid data from 1028 HW respondents via mobile phone. Alongside analysing the potential association between exposure to violence and respondents' characteristics, we compared the workplace violence between this survey and a baseline survey in the same hospital using the same questionnaire in 2018, and investigated the existing measures.

RESULTS

A total of 5.45% of respondents had encountered physical violence while 41.63% had experienced psychological violence. Women (OR=3.45, 95% CI 1.87 to 6.38), those working in outpatient and emergency departments (OR=7.96, 95% CI 2.27 to 27.95), and those with extremely high concern about workplace violence (OR=7.94, 95% CI 1.04 to 60.85) were significantly more likely to suffer physical violence. Working in the outpatient and emergency department (OR=2.03, 95% CI 1.23 to 3.34), having direct physical contact/interaction with patients (OR=2.98, 95% CI 1.62 to 5.49), and extremely high worry about workplace violence (OR=6.47 95% CI 3.38 to 12.40) significantly increased the risk of psychological violence. When the results of the baseline survey were compared with those in this survey, it was shown that physical violence declined significantly from 8.79% in 2018 to 5.45% in 2019, while psychological violence declined significantly from 47.14% in 2018 to 41.63% in 2019. The most recognised measures were security measures (81.03%) while the least recognised measures were check-in procedures for staff (11.19%).

CONCLUSION

Workplace violence towards HWs is a global problem with country-specific features. In our study, workplace violence in the hospital is of great concern. While demonstrating the effectiveness of measures in some degree, there is significant room for improvement. To achieve the vision of 'zero violence' in the health sector, aligned comprehensive measures should be systematically adopted.

[Workplace violence against emergency service nurses: an integrative reviewViolência no trabalho contra os profissionais de enfermagem em serviços de emergência: revisão integrativa]

Objective

Learn the worldwide frequency of physical and verbal violence against emergency service nurses, and its health and occupational impact.

Methods

An integrative review study was conducted in February 2020 of the MEDLINE, LILACS, CINAHL, and SciELO bibliographic databases, using the descriptors "Nurses," "Workplace Violence," "Physical Aggression," "Psychological Aggression," "Stress, Psychological," "Psychological Trauma," "Aggression," "Health Impact Assessment," "Health Impact," "Impacts on Health," "Impact Assessment, Health," and "Occupational Health."

Results

Of the articles located, 18 were included in the analysis. The studies confirmed that the health workers most affected by violence were nurses, and the most common types of violence were verbal aggression, followed by physical violence. In the hospital, these assaults most often occurred in the emergency service. The correlated impact on nurses' health included stress, emotional exhaustion, anxiety, and fear, among other symptoms. With regard to occupational impact, significant indirect accounts related to the reduction in productivity were evident. All these aspects led nurses to consider leaving their jobs in emergency services.

Conclusions

The results enabled identifying a risk profile for violence against nurses in emergency services, seen in the high incidence of physical and verbal violence that led to reduced productivity on the job and the onset of symptoms of burnout syndrome.

Assessment of patient safety challenges and electronic occurrence variance reporting (e-OVR) barriers facing physicians and nurses in the emergency department: a cross sectional study

BACKGROUND

The purpose of patient safety is to prevent harm occurring in the healthcare system. Patient safety is improved by the use of a reporting system in which healthcare workers can document and learn from incidents, and thus prevent potential medical errors. The present study aimed to determine patient safety challenges facing clinicians (physicians and nurses) in emergency medicine and to assess barriers to using e-OVR (electronic occurrence variance reporting).

METHODS

This cross-sectional study involved physicians and nurses in the emergency department (ED) at King Khalid University Hospital (KKUH) in Riyadh, Saudi Arabia. Using convenience sampling, a self-administered questionnaire was distributed to 294 clinicians working in the ED. The questionnaire consisted of items pertaining to patient safety and e-OVR usability. Data were analyzed using frequencies, means, and percentages, and the chi-square test was used for comparison.

RESULTS

A total of 197 participants completed the questionnaire (67% response rate) of which 48 were physicians (24%) and 149 nurses (76%). Only 39% of participants thought that there was enough staff to handle work in the ED. Roughly half (48%) of participants spoke up when something negatively affected patient safety, and 61% admitted that they sometimes missed important patient care information during shift changes. Two-thirds (66%) of the participants reported experiencing violence. Regarding e-OVR, 31% of participants found reporting to be time consuming. Most (85%) participants agreed that e-OVR training regarding knowledge and skills was sufficient. Physicians reported lower knowledge levels regarding how to access (46%) and how to use (44%) e-OVR compared to nurses (98 and 95%, respectively; p < 0.01). Less than a quarter of the staff did not receive timely feedback after reporting. Regarding overall satisfaction with e-OVR, only 25% of physicians were generally satisfied compared to nearly half (52%) of nurses.

CONCLUSION

Although patient safety is well emphasized in clinical practice, especially in the ED, many factors hinder patient safety. More awareness is needed to eliminate violence and to emphasize the needs of additional staff in the ED. Electronic reporting and documentation of incidents should be well supported by continuous staff training, help, and feedback.

Workplace violence against doctors: Characteristics, risk factors, and mitigation strategies

Workplace violence is a major occupational issue concerning doctors that has a significant impact on their physical and psychological well-being. This ultimately affects the health care services of the country. Patient-led episodes of verbal violence are more prevalent in Asian countries, especially in the emergency department, psychiatric wards, and intensive care units, mostly faced by junior doctors and residents. Some common precursors of violence against doctors are patients and their attendants' dissatisfaction and low impulse control, poor administration, miscommunication, infrastructural issues especially differences in services between private and public hospitals, and negative media portrayal of doctors. The assessment of risk factors, development and implementation of workplace violence programs, and addressing underreporting of violent episodes have been suggested as some successful organizational mitigation strategies. Recommendations on the management of workplace violence include the development of participative, gender-based, culture-based, nondiscriminatory, and systematic strategies to deal with issues related to violence. This article aims to present a comprehensive review of workplace violence against doctors, discussing the prevalence, degree of violence, predictors, impact on physical and psychological health and intervention strategies to devise practical actions against workplace violence.

Risk and Protective Factors of Well-Being among Healthcare Staff. A Thematic Analysis

The purpose of this study was to identify physical and psychosocial working conditions to improve well-being at work among healthcare staff. This is a potent area of inquiry given the relationship between healthcare staff well-being and service quality and other key organizational characteristics. However, while numerous studies in this area have used a quantitative methodology, very few have applied qualitative methodologies gathering subjective descriptions of the sources of well-being, providing in so doing significant data to explore in depth the factors that influence well-being in healthcare systems. We gathered qualitative data analyzing open-ended questions about risk and protective factors of well-being at work. The sample was made of 795 professionals answering an online questionnaire. Answers were coded and analyzed using the thematic analysis with an inductive approach (data-driven). We identified four themes strongly affecting professional well-being in health-care staff: Interactions, Working Conditions, Emotional Responses to Work, and Competence and Professional Growth. Our findings suggest possible strategies and actions that may be effective in helping to calibrate case-specific support and monitoring interventions to improve health and well-being of healthcare staff. We also discuss the implications of the study and suggest possible avenues for future empirical research.

Covid-19 pandemic and pediatric healthcare policy in Italy: time for a change

The outbreak of coronavirus disease 2019 pandemic forced the Italian Government to act extreme measures that put the entire country under lockdown. The citizens experimented a radical transformation of their lives while the healthcare system started building a novel COVID-system that quickly dissolved the former organization, included pediatric healthcare network. For a number of reasons COVID-19 pandemic is polite with children; however, the fear of this unknown disease drove to develop dedicated pathways in the Pediatric Emergency Departments for the suspected and diagnosed cases of COVID-19, together with their relatives. The combination of conflicting feelings resulted in an unexpected scenario: the number of accesses to the pediatric Hospital or Unit(s) sharply dropped to less than half. How do we explain this phenomenon? The authors believe that our health care system may learn a lesson from the catastrophe of COVID, if we will be able to redesign our way of providing our cares to children. Nothing should be taken for granted, because this might be a real "time for a change".

Correlation between patient and visitor violence and workload among public healthcare workers in China: a cross-sectional study

OBJECTIVES

We studied the characteristics of patient and visitor violence (PVV) and the workload of doctors and nurses, and identified the correlation between the incidence of PVV and healthcare worker (HCW) workload in China.

DESIGN

Cross-sectional study.

SETTING

288 public health institutions in a city in northern China.

PARTICIPANTS

Data on 87 998 HCWs were extracted from the 2015 database of the Medical Quality and Safety Notification System.

MEASURES

The data included characteristics of the healthcare institution, types of services provided, information about each complaint and reported PVV incidents by hospital level. Pearson correlation analysis and multiple linear regression modelling were used to identify the correlation between the incidence of PVV and HCW workload.

RESULTS

Three types of institutions were identified as being at particularly high risk for PVV: tertiary hospitals, specialised hospitals and institutions in a downtown district. Incidence rates of PVV at tertiary hospitals, specialised hospitals and institutions in a downtown district were 16.6%, 17.6% and 22.8%, respectively. All three types of institutions had a high inpatient workload (admissions per doctor per day): 0.15, 0.17 and 0.12, respectively. After controlling for scale, type and location, it was found that the overall incidence rate of PVV increased with increasing outpatient workload (β=0.236, p<0.01).

CONCLUSIONS

PVV poses a significant challenge to public health institutions in China, and the high workload of HCWs likely contributes to higher risk of PVV. Prevention and intervention of PVV may be targeted to HCWs at specific institutions. The patient complaint notification system needs improvement and could be, for example, a better source of PVV information for future interventions.

Cross-sectional study of aggression against Spanish nursing personnel and effects on somatisation of physical symptoms

INTRODUCTION

Violence against nursing personnel in their place of work is a severe problem generating important consequences for these workers. Even though there is a large body of research on the subject, the emotional impact of aggression against healthcare workers continues to be debated.

OBJECTIVES

The objective of this quantitative, observational cross-sectional study was to analyse the effects of aggression against nursing personnel and the mediating role of anxiety in somaticising physical symptoms.

METHOD

The sample was made up of 1357 nursing professionals who answered questionnaires evaluating their sensitivity to anxiety and the presence of somatic symptoms.

RESULTS

Of the professionals who indicated that they had been the victims of aggression by family members or patients in the previous year, 52.8% said it had happened to them on one occasion, 25.2% had experienced two episodes, while 6.9% and 15.1% said they had undergone three or more aggressions, respectively. Although 89.3% of the professionals affected by acts of indicated that they had not undergone physical or psychological consequences, there was a higher prevalence of somatic alteration among workers who had been victims of violence in the workplace. Furthermore, aggression at work had a direct effect on physical somatisation, which in turn acted as a mediator in the level of anxiety of nursing professionals. Thus, aggression increased the level of anxiety of nurses through the appearance of somatic symptoms.

CONCLUSIONS

The results are discussed based on some of the consequences that appeared after episodes of aggression in the healthcare sector and their relationship.