Patient Safety Culture: The Impact on Workplace Violence and Health Worker Burnout

Patient mistreatment, emotional exhaustion and work-family conflict among nurses: a moderated mediation model of social sharing of negative work events and perceived organizational support

BACKGROUND

Nursing literature suggested that patient mistreatment has significant impacts on nurses' emotions and job burnout. Yet, further research is needed to understand the underlying mechanism and the spillover effect on nurses' families. Leveraging the goal progress theory, this study aimed to examine the association between patient mistreatment, nurses' emotional exhaustion, and work-family conflict, as well as the mediating role of social sharing of negative work events and the moderating role of perceived organizational support.

METHODS

During the COVID-19 pandemic in China, a cross-sectional study was conducted with a sample of 1627 nurses from the Hematology Specialist Alliance of Chongqing from October to November 2022. Questionnaires were administered to measure patient mistreatment, perceived organizational support, social sharing of negative work events, emotional exhaustion, and work-family conflict. Hierarchical linear regression and conditional processes were used for statistical analyses.

RESULTS

Patient mistreatment was positively associated with emotional exhaustion (β = 0.354, p < 0.001) and work-family conflict (β = 0.314, p < 0.001). Social sharing of negative work events played a partial mediating role in the relationship between patient mistreatment and emotional exhaustion (effect = 0.067, SE = 0.013), and work-family conflict (effect = 0.077, SE = 0.014). Moderated mediation analysis found that the mediation effect was stronger when the perceived organizational support was high.

CONCLUSION

Our findings reveal the amplifying effect of social sharing of negative work events on nurses' emotional exhaustion and work-family conflict. Perceived organizational support strengthens the positive effect of patient mistreatment on the social sharing of negative work events, thus resulting in increased emotional exhaustion and work-family conflict. We also discuss practical implications, limitations, and directions for future research.

Associations Between Oversedation and Agitation in Postanesthesia Recovery Room and Subsequent Severe Behavioral Emergencies

OBJECTIVES

Hospital-based behavioral emergency response teams (BERT) respond to acute behavioral disturbances among hospitalized patients. We aimed to examine associations between altered mental status in postanesthesia care unit (PACU) and behavioral disturbances on surgical wards requiring BERT activation.

METHODS

Electronic medical records of patients who underwent general anesthesia and were admitted to the PACU between May 2018-December 2020 were reviewed for episodes of BERT activations on surgical wards. Characteristics of BERT patients were compared with the rest of surgical population during the same period to examine risk factors for BERT.

RESULTS

Of 56,275 adult surgical patients, 133 patients had 178 BERT activations (incidence 2.4, 95% confidence interval [CI] 2.0-2.8 per 1000 admissions), with 21 being for physical assault. The risk for BERT activation was increased with each decade over age of 50 as well as younger age (30 versus 50 y), male sex (odds ratio [OR] = 2.48, 95% CI 1.69, 3.62), longer procedures (OR = 1.08 per 30 minutes, 95% CI 1.05, 1.11), and alterations in mental status in PACU, with both moderate/deep sedation (OR = 1.63, 95% CI 1.04, 2.57) and agitation/combative state (OR = 8.47, 95% CI 5.13, 14.01), P < 0.001 for all comparisons.

CONCLUSIONS

Early postoperative agitation and oversedation are associated with BERT activation on surgical wards. Altered mental status in PACU should be conveyed to accepting hospital units so healthcare staff can be vigilant for the potential development of behavioral disturbances.

Nursing students' work readiness and its influencing factors before participating in a nurse residency program: a multicenter cross-sectional study

Background

Studies have shown that work readiness is closely related to nurses' role adaptation, career development, and patient safety. However, we know little about the nursing students' work readiness and its influencing factors before participating in a nurse residency program, and whether factors have changed from before.

Aim

(1) To investigate the work readiness of nursing students ready to engage in a nurse residency program; (2) to identify the factors affecting the nursing students' work readiness and the associations between emotional intelligence and work readiness; and (3) to discuss the changes of factors affecting nursing students' work readiness.

Design

An online, multicenter cross-sectional study.

Methods

878 nursing students from eight tertiary hospitals in Chongqing, China were recruited. The online investigation used the General Information Questionnaire, the Nursing Students' Work Readiness Scale, and the Emotional Intelligence scale. The data were analyzed using IBM SPSS V23.0.

Results

768 valid questionnaires were included in this study. The nurses obtained a work readiness score of 277.08 ± 44.39 and an emotional intelligence score of 89.57 ± 13.89. Univariate analysis revealed that the following factors affected work readiness: age, sex, family support for becoming a nurse, voluntary choice of nursing major, previous experience as a student cadre, scholarship recipient status, willingness to engage in nursing work during the COVID-19 pandemic and confidence in clinical nursing practice. Frequent incidents of violence, poor salary for nurses for the nurse residency program, and low social acceptance were the top three reasons for decreased confidence in clinical nursing among nursing students. Furthermore, multiple linear regression analysis indicated that age, voluntary choice of nursing major, student leadership experience, confidence in clinical nursing work, self-emotion, and emotional application significantly influenced nurses' work readiness.

Conclusion

Clinical instructors and administrators should dynamically assess nurses' work readiness, prioritize individuals aged ≤23, who have chosen the nursing profession involuntarily, lack prior experience as student cadres, and exhibit low confidence in clinical nursing work. This focus will enhance their emotional self-management skills and ability to apply emotions effectively, improving their work readiness and training efficacy.

Associations between patient safety culture and workplace safety culture in hospital settings

BACKGROUND

Strong cultures of workplace safety and patient safety are both critical for advancing safety in healthcare and eliminating harm to both the healthcare workforce and patients. However, there is currently minimal published empirical evidence about the relationship between the perceptions of providers and staff on workplace safety culture and patient safety culture.

METHODS

This study examined cross-sectional relationships between the core Surveys on Patient Safety Culture™ (SOPS®) Hospital Survey 2.0 patient safety culture measures and supplemental workplace safety culture measures. We used data from a pilot test in 2021 of the Workplace Safety Supplemental Item Set, which consisted of 6,684 respondents from 28 hospitals in 16 states. We performed multiple regressions to examine the relationships between the 11 patient safety culture measures and the 10 workplace safety culture measures.

RESULTS

Sixty-nine (69) of 110 associations were statistically significant (mean standardized β = 0.5; 0.58 < standardized β < 0.95). The largest number of associations for the workplace safety culture measures with the patient safety culture measures were: (1) overall support from hospital leaders to ensure workplace safety; (2) being able to report workplace safety problems without negative consequences; and, (3) overall rating on workplace safety. The two associations with the strongest magnitude were between the overall rating on workplace safety and hospital management support for patient safety (standardized β = 0.95) and hospital management support for workplace safety and hospital management support for patient safety (standardized β = 0.93).

CONCLUSIONS

Study results provide evidence that workplace safety culture and patient safety culture are fundamentally linked and both are vital to a strong and healthy culture of safety.

Development and validation of burnout factors questionnaire in the operating room nurses

Nurses may experience burnout more than other professions. Occupational burnout is a serious concern considering the importance of nurses' jobs in patient care. This study was carried out with the aim of designing and validating the questionnaire of burnout factors in the operating room nurses. Mixed method study was done in two qualitative and quantitative phases in 2022 on Iranian operating room nurses. In the first stage, the concept of operating room nurses' burnout was explained using interviews and literature review, and items were generated. In the second stage, the face validity, content and construct validity of the questionnaire was examined with 342 operating room nurses, and also the reliability of the questionnaire was tested using internal consistency (Cronbach's alpha) and stability (test-retest). After conducting the interview and literature review, 65 questions were extracted. Based on face validity, 4 items were modified. After content validity, 40 items remained. In construct validity, after exploratory factor analysis, 34 items with 5 dimensions were extracted. These dimensions included Organizational, Individual, Interpersonal, Occupational Nature and Managerial factors. Cronbach's alpha and intra-class correlation coefficient were equal to 0.937 and 0.946, respectively. The designed tool based on understanding the concept of burnout in operating room nurses has appropriate and acceptable validity and reliability. Therefore, it can be used to measure burnout in operating room nurses.

Predictive modeling of burnout based on organizational culture perceptions among health systems employees: a comparative study using correlation, decision tree, and Bayesian analyses

Burnout is a significant concern, particularly within the healthcare field, affecting both nurses and physicians. It is a common issue in health systems, which encompass a range of healthcare facilities, such as hospitals, physician practices, ambulatory sites, and administrative offices like finance. Despite this, there has not been an extensive exploration of burnout in employees working directly with patients versus those in non-patient-facing roles within these health systems. It is important to note that organizational culture plays a crucial role in influencing various aspects of employees' work-life balance and their experiences of burnout. This study adopts a cross-sectional design, involving the distribution of a 57-question Likert scale survey to employees in health systems. These employees serve in various roles, both patient-facing and non-patient-facing, within jointly owned healthcare organizations, which encompass hospitals, ambulatory sites, and administrative offices. The survey was disseminated through trade organizations and employees at the managerial level and above within these health systems. Data was collected between October 2022 and January 2023, resulting in a total of 67 responses. The study employs correlation analysis to explore the connection between organizational culture and burnout. Furthermore, a decision tree model is constructed to predict burnout scores based on survey responses, specifically the question regarding the perceived positivity of the organizational culture. The decision tree models indicate that perceiving organizational culture as positive, safety-oriented, and supportive predicts various outcomes for individuals, including job retention, positive experiences with patients, increased callousness, and stimulation while working with colleagues. Bayesian analysis, considering the small sample size, reinforces these findings and provides a different perspective, incorporating prior knowledge and credible intervals. An association test suggests a strong link between a positive organizational culture and burnout symptoms, while another test supports a connection with engagement signs. Similar to nurses and physicians, administrative health systems' personnel are susceptible to burnout. Organizational culture can affect burnout. Therefore, health systems' leaders should cultivate an organizational culture that protects against burnout.

Violence against healthcare professionals in intensive care units: a systematic review and meta-analysis of frequency, risk factors, interventions, and preventive measures

BACKGROUND

To assess the frequency, risk factors, consequences, and prevention of violence against healthcare workers in intensive care units.

METHODS

PubMed, Scopus, Google Scholar, EMBASE, Cochrane, and Web of Science were searched for studies on violence against healthcare workers in adult intensive care units. Risk factors, patient characteristics, and implications for healthcare workers were collected. Study quality, bias, and level of evidence were assessed using established tools.

RESULTS

Seventy-five studies with 139,533 healthcare workers from 32 countries were included. The overall median frequency of violence was 51% (IQR 37-75%). Up to 97% of healthcare workers experienced verbal violence, and up to 82% were victims of physical violence. Meta-analysis of frequency revealed an average frequency of 31% (95% CI 22-41%) for physical violence, 57% for verbal violence (95% CI 48-66%), and 12% for sexual violence (95% CI 4-23%). Heterogeneity was high according to the I2 statistics. Patients were the most common perpetrators (median 56%), followed by visitors (median 22%). Twenty-two studies reported increased risk ratios of up to 2.3 or odds ratios of up to 22.9 for healthcare workers in the ICU compared to other healthcare workers. Risk factors for experiencing violence included young age, less work experience, and being a nurse. Patients who exhibited violent behavior were often male, older, and physically impaired by drugs. Violence was underreported in up to 80% of cases and associated with higher burnout rates, increased anxiety, and higher turnover intentions. Overall the level of evidence was low.

CONCLUSIONS

Workplace violence is frequent and underreported in intensive care units, with potential serious consequences for healthcare workers, calling for heightened awareness, screening, and preventive measures. The potential risk factors for violence should be further investigated.

SYSTEMATIC REVIEW REGISTRATION

The protocol for this review was registered with Prospero on January 15, 2023 (ID CRD42023388449).