Report of workplace violence by Hispanic nurses

Job morale of physicians and dentists in Kazakhstan: a qualitative study

BACKGROUND

Job morale is thought to be particularly low in Kazakhstan, adversely affecting job motivation, job satisfaction and burnout rates. Previous research suggests that high job morale has a better effect on patient outcomes and care quality. We, therefore, conducted a qualitative study to explore experiences underpinning positive and negative job morale, and to generate potential strategies for improving job morale of physicians and dentists working in public healthcare settings in Kazakhstan prior to the COVID-19 pandemic.

METHODS

Three focus groups containing 23 participants and 30 individual interviews were conducted, evidencing respondents' explanations of what affects job morale, and possible strategies to improve it. Data was synthesised using a thematic analysis.

RESULTS

The themes about what influences job morale were: being unfairly rewarded for work; feeling vulnerable and undervalued; poor working styles and practices; and high internal value-based motivation. Various strategies were identified by participants to improve job morale, and these included: ensuring adequate and equitable financial income; improving the current malpractice system; eliminating poor working styles and practices; and creating a shared responsibility for health.

CONCLUSIONS

The current study has found that despite prevailing threats, job morale amongst physicians and dentists working in public healthcare settings in Astana have been prevented from becoming negative by their strong sense of calling to medicine and the satisfaction of helping patients recover. Emphasising this rather traditional understanding of the role of physicians and dentists may be a way to improve job morale throughout training and practice.

Negative Behavior Among Healthcare Professionals: Integrative Review of Instruments

BACKGROUND

Behaviors that undermine a culture of safety pose a serious threat to the overall wellbeing of healthcare workers as well as to patient outcomes.

PURPOSE

The purpose of this integrative review is to compare reported psychometrics, feasibility, and identify commonalities among available instruments measuring negative behaviors among healthcare professionals.

METHODS

Whittemore and Knafl's integrative review methods were used to analyze pertinent instruments designed to measure negative behaviors among healthcare professionals. Multiple computerized databases including CINAHL, MEDLINE, and Scopus databases were searched in the fall of 2017 without date restrictions.

RESULTS

Violence, incivility, and bullying are the most frequently measured behaviors in healthcare workers, and a robust number of valid and reliable instruments are available.

CONCLUSIONS

To date a comprehensive review of psychometric properties and feasibility of administration is lacking. This review synthesizes the instruments measuring these behaviors, providing a resource for future research focused on mitigation and intervention strategies.

Violence-prevention climate in the turnover intention of nurses experiencing workplace violence and work frustration

AIMS

To determine the moderating effect of a violence-prevention climate and the mediating effect of work frustration on the relationship between workplace violence (WPV) and the turnover intention of nurses.

BACKGROUND

To maintain the stability and work quality of nurses, WPV should be studied to provide effective prevention measures.

METHODS

A cross-sectional study with a convenience sample was adopted. Participants were nurses from three hospitals in Taiwan. Of 1,531 questionnaires, 973 were valid for analysis (63.6%).

RESULTS

A total mediating effect of work frustration on nurses' own experiences of WPV increased turnover intention. Witnessing WPV toward coworkers caused a significant partial mediating effect on work frustration that further increased turnover intention. A violence-prevention climate had a significant moderating effect on the work frustration and turnover intention of nurses after they had witnessed violence against others.

CONCLUSION

Effective policies and an incentivized reporting system can foster a safe and friendly work environment not only for nurses who experience violence but also for those who witness violence.

IMPLICATIONS FOR NURSING MANAGEMENT

Nursing managers and leaders must create a positive consultative pipeline to ensure a safe climate and environment for both the victims of WPV and the nurses who witness violence against others.

Workplace Aggression in Cuban Health Care Settings

PURPOSE

Workplace aggression (WPA) is an international problem; however, no published reports of WPA in Cuba were found. This research describes WPA in Cuba and identifies prevention strategies for adoption in the United States.

DESIGN

A qualitative case study design was used. Procedures included visiting several health care settings in the region of Havana, Cuba. Interviews were conducted with 18 Cuban key informants and digital photographs documented the environment.

FINDINGS

WPA is a rare occurrence and typically demonstrates as verbal abuse. The use of illicit substances and prolonged wait times, common U.S. factors associated with WPA, are less problematic in Cuba.

DISCUSSION AND CONCLUSION

Primary reasons for the low incidence of WPA may be the caring Cuban culture itself, tolerance for wait times, and less access to illicit and controlled substances.

IMPLICATIONS FOR PRACTICE

Adopting Cuba's model to acknowledge WPA risk and implement prevention plans could reduce WPA incidence in the United States.

A National Study on Nurses' Exposure to Occupational Violence in Lebanon: Prevalence, Consequences and Associated Factors

Background

Healthcare institutions have commonly reported exposure of employees, particularly nurses, to high levels of occupational violence. Despite such evidence in the Middle East Region, there is a dearth of national studies that have systematically investigated this phenomenon. This study investigates the prevalence, characteristics, consequences and factors associated with nurses’ exposure to occupational violence in Lebanon.

Methods

A cross-sectional design was utilized to survey a nationally representative sample of 915 nurses registered with the Order of Nurses in Lebanon. Stratified random sampling by governorate was utilized. Individually-mailed questionnaires collected information on exposure to violence, degree of burnout and demographic/professional background. The main outcome variables were exposure to verbal abuse (never, 1–3, 4–9 and 10+ times) and physical violence (never, ever) over the past 12-months. Descriptive statistics were used to estimate prevalence of violence. Multivariable, binomial and multinomial regression models were carried out to investigate the correlates of exposure to verbal abuse and physical violence, respectively.

Results

Response rate was 64.8%. Over the last year, prevalence of nurses’ exposure to verbal abuse was 62%, (CI: 58–65%) and physical violence was 10%, (CI: 8–13%). Among respondents, 31.7% of nurses indicated likelihood to quit their jobs and 22.3% were undetermined. Furthermore, 54.1% reported high levels of emotional exhaustion and 28.8% reported high levels of depersonalization. Compared to nurses with no exposure to verbal abuse, nurses reporting high exposure had high levels of emotional exhaustion (OR:6.4; CI:1.76–23.32), depersonalization (OR:6.8; CI: 3–15) and intention to quit job (OR:3.9; CI: 1.8–8.3). They further reported absence of anti-violence policies at their institutions (OR: 3; CI: 1.5–6.3). Nurses that were ever exposed to physical violence were more likely to be males (OR: 2.2; CI: 1.1–4.3), working day and night shifts (OR: 2.8; CI: 1.4–5.5) and subject to ten or more incidents of verbal abuse per year (OR: 46.7; CI: 10.1–214).

Conclusions

An alarming two-thirds of respondents reported exposure to verbal abuse which was found to be a significant predictor of the three subscales of burnout, intention to quit and exposure to physical violence. The prevalence of exposure to physical violence is disconcerting due to its severe consequences. Policy and decision-makers are urged to use study findings for policy and practice interventions to create safe work environments conducive to nurses’ productivity and retention.

Frequency and risk factors of workplace violence on psychiatric nurses and its impact on their quality of life in China

This study examined the frequency of violence on nurses in Chinese psychiatric hospitals and explored its risk factors and impact on nurses' quality of life (QOL). A survey was conducted with 387 frontline psychiatric nurses in China. Information about experience of workplace violence in the past 6 months, type of workplace violence, and demographic characteristics was collected by a questionnaire. Altogether 319 (82.4%) of 387 nurses reported having experienced at least one type of violent event in the past 6 months. The prevalence of sexual assault, physical and verbal harassment was 18.6%, 61.5% and 78.6%, respectively. Compared to those with no exposure to violence, nurses who were exposed to violence had lower QOL in both the physical and mental domains. Significant predictors of violence against nurses are male sex, receiving college level or higher education and working on rotating duty were independently associated with high risk of violence. Workplace violence against psychiatric nurses commonly occurs in China. Considering the deleterious effects of violence, comprehensive strategies from the perspective of nursing education and training, organizational policy, patient care and staff support are recommended to promote occupational safety in psychiatric settings in China.

Vertical and lateral workplace bullying in nursing: development of the hospital aggressive behaviour scale

Healthcare staff is one of the professional groups that suffers the highest exposure to sources of occupational stress such as hostility from coworkers and superiors. In order to contribute to the assessment of bullying behaviors in the healthcare sector and to obtain a brief and manageable instrument for the assessment of this psychosocial risk, we developed the Hospital Aggressive Behaviour Scale-version Co-workers-Superiors (HABS-CS). By means of thorough qualitative analysis, an initial pool of 166 items was obtained, which were reviewed according to precise criteria until concluding with a total of 57 items, which were administered to a sample of 1,484 healthcare professionals from 11 public hospitals. The analyses concluded with the selection of 17 items distributed in two subscales. The internal 5-factor structure is the result of exploratory and confirmatory factor analysis conducted in two samples. Both the resulting questionnaire and the factors identified present adequate psychometric properties: high-internal consistency (Cronbach's α of .86) and adequate criterion validity, analyzed by means of significant correlations between the HABS-CS and job satisfaction, burnout components, and psychological well-being. This instrument may be of great utility for the assessment and prevention of psychosocial risks.

Violence in the nursing workplace - a descriptive correlational study in a public hospital

AIMS AND OBJECTIVES

To explore the prevalence, types and sources of violence in the nursing workplace and to assess the factors related to violence.

BACKGROUND

Workplace violence in nursing is not a new phenomenon; in recent years, much more attention has been paid to the issue in Taiwan. Few studies, however, have investigated the overall distribution of violence and the reasons for not reporting these incidents in nursing workplaces.

DESIGN

This descriptive, correlational study used structured questionnaires to collecting information about workplace violence experienced by nurses over the last year.

METHODS

Nurses (n = 880) working in a public hospital in southern Taiwan were invited to complete the questionnaires, with a response rate of 89·9%.

RESULTS

Nurses working in outpatient units and emergency rooms experienced more frequent violence than those on surgical wards and intensive care units.

CONCLUSION

These findings provide evidence of workplace violence in hospitals and may aid hospital and nursing administration to reduce and control violence. RELEVANCE TO NURSING PRACTICE: These results provide evidence in relation to the importance of effective communication training to nurses and will assist hospital administrations in establishing higher-quality, healthy workplace environments.

Exposure of Iranian emergency medical technicians to workplace violence: a cross-sectional analysis

OBJECTIVES

Emergency medical technicians (EMTs) in Iran experience concerning levels of workplace violence, although until now there has been no investigation of this phenomenon. The objectives of the present study were to describe the exposure of Iranian EMTs to workplace violence and to identify the importance of related factors from their viewpoint.

METHODS

In this descriptive, exploratory study, 160 EMTs agreed to participate in a survey that collected data regarding their exposure to the following forms of workplace violence: verbal abuse, physical assault, cultural harassment, sexual harassment and sexual assault.

RESULTS

A total of 138 questionnaires were returned, representing a response rate of 86%. The majority of participants 75% (n = 103) experienced at least one form of workplace violence in the 12 months before completing the questionnaire. The most frequently reported form of workplace violence was verbal abuse (71%), followed by physical assault (38%) and cultural harassment (9%). Violence resulting in serious injuries was reported by only 4% of participants, with no more than 8% of participants experiencing workplace violence that included the use of weapons. The most reported response to workplace violence was to 'invite the offender to calm down'. Participants took this approach because they believed that 'follow up of workplace violence is ineffectual' (34%), considered the workplace violence as a common in their job (30%), and did not know whom to report workplace violence to (13%).

CONCLUSION

Iranian EMTs experience a considerable amount of workplace violence. The present study highlights the recommendation for formal training programmes and clearer protocols about how to manage workplace violence, especially verbal abuse in the Iranian prehospital setting.

Workplace violence in healthcare settings: risk factors and protective strategies

This article describes the risk factors and protective strategies associated with workplace violence perpetrated by patients and visitors against healthcare workers. Perpetrator risk factors for patients and visitors in healthcare settings include mental health disorders, drug or alcohol use, inability to deal with situational crises, possession of weapons, and being a victim of violence. Worker risk factors are gender, age, years of experience, hours worked, marital status, and previous workplace violence training. Setting and environmental risk factors for experiencing workplace violence include time of day and presence of security cameras. Protective strategies for combating the negative consequences of workplace violence include carrying a telephone, practicing self-defense, instructing perpetrators to stop being violent, self- and social support, and limiting interactions with potential or known perpetrators of violence. Workplace violence is a serious and growing problem that affects all healthcare professionals. Strategies are needed to prevent workplace violence and manage the negative consequences experienced by healthcare workers following violent events.

Perceived aggression towards nurses: study in two Italian health institutions

AIMS

The goal of the present study was to quantify the perceived aggression towards nurses working in two Italian health care institutions and to verify the hypothesis of an association between the characteristics of aggressors and the type of aggression.

BACKGROUND

Violence and aggressiveness, particularly aimed at nurses, are a common, but inadequately investigated phenomenon in Italian health care institutions.

DESIGN

A cross-sectional study.

METHODS

The study was performed, studying a sample of 700 nurses (37% of the personnel in 94 units) in two health care institutions in northeast Italy using an anonymous multiple-choice questionnaire.

RESULTS

Forty-nine percent of the nurses responded that they had experienced aggression in the previous year, 82% of that was only verbal. This happened more often to female nurses working in the emergency department and in geriatric and psychiatric units. A statistically significant association (p < 0.001) was found between the perception of fatigue, stress and work dissatisfaction and the frequency of aggression. Aggressors were usually patients or their relatives (57%) and were mainly men (66%). Fifty-three percent of assaulted nurses did not ask for help after the event.

CONCLUSIONS

This study confirms the high incidence of perceived, mainly verbal aggression towards nurses.

RELEVANCE TO CLINICAL PRACTICE

Action to prevent aggressive episodes may include concentrating on job motivation, encouraging participatory leadership and promoting the best possible working conditions. The absence of any systematic event reporting and documentation makes the assaulted workers feel defenceless.

Violence against women: the phenomenon of workplace violence against nurses

Registered nurses have been the recipients of an alarming increase in workplace violence (WPV). Emergency and psychiatric nurses have been found to be the most vulnerable and yet few solid reporting procedures exist to fully account for a true number of incidents. Further compounding the problem is the lack of a standard definition of violence to guide reporting procedures, interventions, legislation, and research. While there are certain risk factors that not only predispose the nurse and the patient to WPV, research continues to attempt to parse out which risk factors are the key determinants of WPV and also which interventions prove to be significant in reducing WPV. The nursing shortage is expected only to increase; recruitment and retention of qualified staff members may be deterred by WPV. This necessitates focused research on the phenomenon of workplace violence in health care.

Violence against nurses working in US emergency departments

OBJECTIVE

The objective of this study was to investigate emergency nurses' experiences and perceptions of violence from patients and visitors in US emergency departments (EDs).

BACKGROUND

The ED is a particularly vulnerable setting for workplace violence, and because of a lack of standardized measurement and reporting mechanisms for violence in healthcare settings, data are scarce.

METHODS

Registered nurse members (n = 3,465) of the Emergency Nurses Association participated in this cross-sectional study by completing a 69-item survey.

RESULTS

Approximately 25% of respondents reported experiencing physical violence more than 20 times in the past 3 years, and almost 20% reported experiencing verbal abuse more than 200 times during the same period. Respondents who experienced frequent physical violence and/or frequent verbal abuse indicated fear of retaliation and lack of support from hospital administration and ED management as barriers to reporting workplace violence.

CONCLUSION

Violence against ED nurses is highly prevalent. Precipitating factors to violent incidents identified by respondents is consistent with the research literature; however, there is considerable potential to mitigate these factors. Commitment from hospital administrators, ED managers, and hospital security is necessary to facilitate improvement and ensure a safer workplace for ED nurses.

Levels of violence among nurses in Cape Town public hospitals

BACKGROUND

The paper presents findings from a study examining violence in nursing.

DESIGN

A combined ethno-phenomenology was identified as the most appropriate approach. Ethnography is to understand the culture of nursing that permits violence to occur within the profession. Phenomenology is to explore and capture nurse-on-nurse experiences of violence. The population is all nurses registered with the South African Nursing Council. The research participants are nurses employed in eight public hospitals in Cape Town during 2005. METHOD OF DATA COLLECTION: The first stage of data collection was the distributions of confidential questionnaires to nurses employed in eight hospitals and willing to participate in the study.

ANALYSIS

Responses to close-ended questions were analyzed using Microsoft Excel. Responses to open-ended questions were grouped per question. The qualitative data were then compared for similarities and differences in information provided.

CONCLUSIONS

Six levels of violence exist among nurses. The highest forms of violence among nurses occurred at the psychological level, with the least at the physical level of interaction. The other four levels of violence among nurses were vertical, horizontal, covert, and overt. All categories of nurses in the study had resorted to one or more levels of violence against other nurses during their nursing career. Professional nurses and senior nurse managers were identified as the main category of nurses that frequently resort to mistreating other nurses. However, auxiliary nurses were identified as the main perpetrators of physical violence against other nurses.

Strategies and Tools to Reduce Workplace Violence

The U.S. health care system is in the beginning of a crisis that can barely be comprehended. If projections are accurate, the demand for nurses will increase 40% and a 400,000-hour full-time equivalent registered nurse shortfall will occur by 2020. Not only are nurses leaving the field, but fewer candidates are entering. The reasons are unclear, but research has shown that nursing is a dangerous occupation—four times more dangerous than most other occupations. Protection from an unsafe workplace is guaranteed under Occupational Safety and Health Administration regulations, and many national and international groups call for zero tolerance of workplace violence. Health care worksites must develop specific plans to minimize and prevent workplace violence. Additional research is necessary to determine which methods are most effective. This article examines the necessary components of a workplace violence prevention program.

Strategies and Tools to Reduce Workplace Violence

The U.S. health care system is in the beginning of a crisis that can barely be comprehended. If projections are accurate, the demand for nurses will increase 40% and a 400,000-hour full-time equivalent registered nurse shortfall will occur by 2020. Not only are nurses leaving the field, but fewer candidates are entering. The reasons are unclear, but research has shown that nursing is a dangerous occupation—four times more dangerous than most other occupations. Protection from an unsafe workplace is guaranteed under Occupational Safety and Health Administration regulations, and many national and international groups call for zero tolerance of workplace violence. Health care worksites must develop specific plans to minimize and prevent workplace violence. Additional research is necessary to determine which methods are most effective. This article examines the necessary components of a workplace violence prevention program.

Ensuring Nurses' Safety in Violent Workplaces

Occupational and environmental health nurses can play a critical role in encouraging nurses to report workplace violence. By empowering nurses to be assertive, they may stop violent behavior.

Personnel exposure to violence in hospital emergency wards: a routine activity approach

This study analyzes violence against personnel in the emergency wards of all 25 general hospitals in Israel using a self-report questionnaire (N=2,356). Informed by the routine activity theory, the hypotheses related to the major concepts of this approach: exposure, target suitability, guarding and proximity to offenders. A General Exposure to Violence Index (GEVI) was constructed, based on the participants' reports about type and frequency of their victimization to violence during the preceding year. The multiple regression analysis for explaining the GEVI was composed of 15 independent variables relating to participants' professional and personal characteristics as well as to structural features of hospitals. As predicted, higher exposure to violence was related to security or nursing staff and positions of authority; high weekly workload; working in a profession other than that of training; inability of coping with verbal violence; having no access to an emergency button, and working in settings restricting the number of accompanying persons to one only. Unexpectedly, previous training in coping with violence was related to higher victimization. Younger age, male gender and being of European/American origin (mainly from the former Soviet Union) was also related to higher risk of victimization. The results support the utility of the routine activities approach in explaining differences in emergency ward personnel victimization. The findings also indicate, however, the need to add domain-specific contextual analyses to this approach to reach a fuller understanding of the behaviors under discussion. Implications of the finding to coping with violence against emergency ward personnel are discussed, and suggestions are put forward for further study in this field.

The impact of workplace violence on nurses in South Taiwan

The purpose of this study was to explore the prevalence of workplace violence (WPV) committed by patients and their family members against healthcare workers in south Taiwan. WPV incident questionnaires were completed by 205 nurses from a medical facility in south Taiwan. Sixty-two percent of the nurses reported experiencing WPV. The majority of the cases consisted of verbal abuse including threats of violence or threatening words from patients or families. The verbal expressions of violence were mainly due to misunderstanding and drunkenness on the part of patients and their families, and personal problems in the nurses' relationships with doctors and co-workers. The cases of physical WPV reported by the nurses were perpetrated by patients who were mentally unstable. The findings of this study may help hospitals and nurses in avoiding, reducing, and controlling incidents of WPV.

Nurses' health: work and family influences

Nurses represent the largest group of professional caregivers. Most are also informal caregivers for family members, including children, parents, spouses, and other relatives. The impact of these caregiving roles, individually and in combination, has important implications for the health of nurses. This article focuses on nurses' health, emphasizing research on the influence of the work and family stress on physical and psychosocial dimensions of health. Health and safety concerns of nurses are discussed and findings from longitudinal studies of nurses' health are presented. Challenges for maintaining a healthy nursing workforce for the future are discussed.