"…they think we are conversing, so we don't care about them…" Examining the causes of workplace violence against nurses in Ghana

Moral caring competency and moral distress among Ghanaian nurses in adult care settings: A descriptive-correlational study

Background

Nurses in adult care settings frequently encounter moral distress due to the daily ethical obligations they must fulfill. In contrast to other healthcare professionals, nurses often grapple with a heightened frequency of moral dilemmas, resulting in increased moral distress.

Objective

This study aimed to explore the levels and relationship between moral caring competency and moral distress among Ghanaian nurses in adult care settings.

Methods

This quantitative study utilized a descriptive-correlational design. A multistage sampling was used to select three public hospitals. Simple random sampling was used to recruit 231 nurses from the three public hospitals. Data were collected from June to July 2023 using validated questionnaires. The study utilized frequency and percentages, mean and standard deviation, and Spearman's Correlation.

Results

The nurses had a low level of moral caring competency (M = 2.18, SD = 0.340). The composite moral distress score was 227.31, indicating a high level of moral distress among the nurses. Furthermore, there was a moderate, negative significant relationship between moral caring competency and moral distress (rs = -.474, N = 231, p <0.001).

Conclusions

Nurses in public hospitals had limited personal cognitive, affective, and psychomotor abilities to address patient moral issues. The nurses also experience significant moral distress when delivering patient care. Furthermore, to decrease the level of moral distress, moral caring competency should be strengthened among nurses. Therefore, it is recommended that nurse administrators provide adequate organizational support and implement continuous moral training to improve nurses' moral caring competency and mitigate their moral distress. Healthcare policymakers are encouraged to develop or refine policies to navigate moral dilemmas and reduce moral distress among nurses. Future studies employing qualitative designs can explore the influence of culture on moral caring competency within the Ghanaian setting.

Violence on the front line: a qualitative comparative analysis of the causes of patient violence towards medical staff in China during the COVID-19 pandemic

COVID-19, reduced funding and a shortage of healthcare workers has led to growing international concern about patient violence towards medical staff in medical settings. As the number of reported physical and verbal assaults increases, many medical staff are considering leaving their positions due to the resulting impact on their mental and physical wellbeing, creating a critical need to understand the causes for violence towards medical staff working on the front line. This study aims to examine the causes for patient violence towards medical staff in China during the COVID-19 pandemic. A case library was created containing twenty reported incidents of patient violence towards medical staff during the pandemic in China. Based on the Triadic Reciprocal Determinism (TRD) theory, we identify the personal, environmental, and behavioral factors, that cause incidents of violence towards medical staff. The outcome was set as 'Medical Staff Casualties', referring to whether, due to the violence experienced, the medical staff member was injured or died, or only experienced threatening or insulting behavior. Data was analyzed using Qualitative Comparative Analysis (QCA) to clarify the relationship between the different conditions and their relationship with the outcome. The study's results reveal that Relationship Closeness is a necessary condition for patient violence in the presence of outcome. Secondly, four distinct types of causes for patient violence towards medical staff were identified: Strong Relationship Oriented Violence, Healthcare Resources and Services Mismatched Violence, Violence caused by Ineffective Patient-Physician Communication, and Ineffective Communication Superimposed Low Patient Compliance Violence. Scientific guidance is provided for the creation of measures to prevent future violence towards medical staff from occurring. Strict precautions should be taken for preventing violence to protect a healthy society and harmonious medical environment, emphasizing the need for joint governance of multiple participants.

Triggers of Workplace Violence in Emergency Departments: A Qualitative Study

Background: Workplace violence has become an alarming phenomenon facing healthcare systems worldwide. Emergency nurses were the most victimized from workplace violence incidents. There is a crucial need for conducting qualitative research addressing the unique contextual factors associated with workplace violence against emergency nurses in Jordan.Purpose: This study aimed to explore circumstances that Jordanian emergency nurses, who were victims of workplace violence from clients and/or their relatives, perceive as provocative for workplace violence events.Methods: A qualitative phenomenological method was used. Purposive sampling was utilized to recruit participants (n=15), who were victims of workplace violence, and working in eight emergency departments distributed over all regions of Jordan. Semi-structured face-to-face interviews were conducted. All interviews were recorded and transcribed into Arabic. The Interpretive Phenomenological Analysis (IPA) was used to manually analyse the gathered data. Member checking, prolonged engagement with data, stepwise replication, and personal journaling were used to enhance the rigor of the study.Results: Findings of this study resulted in four superordinate themes that represents the main individual, social, and organisational factors contributing to workplace violence in Jordanian emergency departments. These themes include aggressors’ misconceptions and misbehaviours with four subordinate themes, inappropriate Jordanian social customs with two subordinate themes, organisational circumstances of emergency department with two subordinate themes, and escalator nurses with three subordinate themes.Conclusion: This study highlighted how specific social, cultural, legal, and administrative aspects of Jordanian society were inappropriately employed so as to lead to spread of the workplace violence. This study has provided insight into the need for change at personal level of emergency nurses, social level of Jordanian public, and organizational level of hospital administration and environment in order to mitigate workplace violence incidence in emergency departments.

The Image of Nurses and Midwives in Ghana: Patient and Family Perspectives

This study aims to explore the perceptions of patients and family caregivers on the image of nurses and midwives in Ghana. The study adopted a qualitative exploratory descriptive approach. A total of 25 participants were interviewed during data collection. Content and thematic analysis were applied in the data analysis to develop themes. The findings are captured under two major themes that describe the primary influences on participant images of nurses: Thus, (1) nurses' and midwives' attributes with four subthemes; staff appearance, communication strategies and behaviors, work attitudes, and professional competence and (2) patients' status and subthemes were; uneducated poor and educated rich. We conclude that patients and families in Ghana recognize the professional attributes of the nurse and midwife, which reflect in their personality, grooming, communication, competencies, and attitudes. However, low publicity of the professional roles of nurses and midwives may have negative repercussions for their professional image. A policy to perform a regular public audit on the image of the Nurse/Midwife is important for professional advancement.

'God helps those who help themselves'… religion and Assisted Reproductive Technology usage amongst urban Ghanaians

Assisted Reproductive Technology (ART) is increasingly becoming a viable option for infertile couples in Ghana. There exists significant literature that explores the gender, legal, religious and socio-cultural implications of ART usage. In this paper, we expand the discourse on the nexus between religion and ART usage by looking at how the former is used as a frame of reference in the decision-making process, as well as how it is employed to explain treatment successes and failures. Irrespective of religious orientation, there was a general acceptance of ART by participants in the study-with exceptions only when it came to some aspects of the procedure. Even here, participants' desperate desire to have children, tended to engender some accommodation of procedures they were uncomfortable with because of their religious beliefs. Thus, in contrast to some studies that suggest religion as interfering with ART use, we posit that religion is not an inhibiting factor to ART usage. On the contrary, it is an enabling factor, engendering the agentic attitude of participants to find a solution to their infertility in ART; as well as providing the strength to endure the physical and emotional discomfort associated with the biomedical process of conception and childbirth. In this context, religion thus provides participants with a frame of reference to navigate the spaces between decision-making, treatment processes and outcomes, and attributions of responsibility for the outcomes whatever they may be.

The Relationship Between Violent Behavior in Healthcare Settings and Communication Skills: An Empirical Study on Provincial Hospitals in Ankara

OBJECTIVE

Violence in the health care is a multifaceted and complex social phenomenon that attracts the attention of researchers and policymakers in many countries around the world. Violence against healthcare workers has several factors, but there are limited data on the association between violence against healthcare workers and the communication skills of healthcare workers. In this study, we examine the relationship between healthcare professionals' communication skills and violent incidents experienced or witnessed by healthcare workers.

METHODS

The sociodemographic and professional data of 296 healthcare professionals were obtained. All participants were assessed using a communication skills inventory. The total and categorical scores of the communication skills inventories were compared between participants who had been exposed to violence and those who had not.

RESULTS

It was found that the emotional score of individuals who had suffered more than one physical attack was lower than that of others (P = .037). In addition, nurses were found to have more verbal violent behavior experience than their counterparts. Other comparisons were found to be insignificant.

DISCUSSION

Healthcare professionals should not only evaluate complex problems such as violence in the health care but also emphasize the role of patients and their relatives. Violence against healthcare professionals cannot be based on a simple factor. We believe that there are many factors that lead to violence. The causes of violence in the health care should be examined by future studies.

Factors in healthcare violence in care of pregnancy termination cases: A case study

Background

Workplace violence is a widely-reported phenomenon among healthcare providers and negatively affects quality of care and treatment. This study aims to understand the potential factors related to HCV through the experiences of women who have undergone a pregnancy termination due to fetal anomaly.

Methods

Qualitative interview was used to collect data in this case study. Forty-one pregnant women who decided to terminate their pregnancy due to fetal anomaly were recruited from four Chinese hospital facilities, including three general hospitals and one specialty hospital in Changsha, Hunan, China. In-depth interviews were conducted from May to September 2017. Content analysis was used to analyze the data.

Results

Several potential factors related to violence in healthcare facilities were identified, including preventive factors, which possibly relieve healthcare violence; and negative experiences, which potentially related to healthcare violence. Preventive factors include healthcare providers gaining patient trust with detailed observation, expressing patient-centered care through discreet behavior, and showing patience and professionalism. Factors related to violence include busy work schedules, hurried visits, mechanized process, patients’ scant medical knowledge and mental distress.

Conclusions

This study highlights potential factors related to healthcare violence. The results will be submitted to the Chinese government’s policy making department in order to improve the healthcare system. We also suggest several important strategies to prevent HCV in a healthcare setting, both in China and globally.