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.

Exploring nurses' difficulties and strategies when caring for patients with dementia in a neurological ward

Nurses in neurological wards face numerous challenges when caring for patients with dementia, particularly those who also present other acute illnesses. However, studies focusing on this area are limited. This study aimed to explore the difficulties and strategies in caring for patients with dementia among nurses working in a neurological ward. A qualitative descriptive design was adopted. Twelve nurses from a neurology ward participated in individual semi-structured interviews. The data collected through these interviews were subjected to qualitative content analysis. Two main themes emerged from the analysis: (i) various shortcomings and concerns, which include subthemes: insufficient support, worry about patient safety, inadequate care ability of the caregiver, and insufficient self-competence, and (ii) unique clinical strategies, which include subthemes: cooperate with the caregiver, improve self-competence in dementia care, and employ meticulous resorts. The findings highlighted the nurses' dedication to minimizing patient risks and utilizing available resources as well as stakeholders to provide optimal care. To enhance patient care quality, it is essential to support nurses by addressing care-related barriers, offering continuous education, and establishing care pathways.

Transgressive incidents targeted on staff in forensic psychiatric healthcare: a latent class analysis

Transgressive incidents directed at staff by forensic patients occur frequently, leading to detrimental psychological and physical harm, underscoring urgency of preventive measures. These incidents, emerging within therapeutic relationships, involve complex interactions between patient and staff behavior. This study aims to identify clusters of transgressive incidents based on incident characteristics such as impact, severity, (presumed) cause, type of aggression, and consequences, using latent class analysis (LCA). Additionally, variations in incident clusters based on staff, patient, and context characteristics were investigated. A total of 1,184 transgressive incidents, reported by staff and targeted at staff by patients between 2018-2022, were extracted from a digital incident reporting system at Fivoor, a Dutch forensic psychiatric healthcare organisation. Latent Class Analysis revealed six incident classes: 1) verbal aggression with low impact; 2) verbal aggression with medium impact; 3) physical aggression with medium impact; 4) verbal menacing/aggression with medium impact; 5) physical aggression with high impact; and 6) verbal and physical menacing/aggression with high impact. Significant differences in age and gender of both staff and patients, staff function, and patient diagnoses were observed among these classes. Incidents with higher impact were more prevalent in high security clinics, while lower-impact incidents were more common in clinics for patients with intellectual disabilities. Despite limitations like missing information, tailored prevention approaches are needed due to varying types of transgressive incidents across patients, staff, and units.

Improving Employee Safety Through a Comprehensive Patient Behavioral Program

BACKGROUND

Health care workers in the United States are facing increasing rates of exposure to aggressive behavior, resulting in an increase in employee injuries related specifically to patient behavioral events. By leveraging interprofessional collaboration and system-level innovation, we aimed to reduce the rate of employee injuries related to patient behavioral events at a children's hospital by 50% over a 3-year period.

METHODS

An interdisciplinary quality improvement team comprising physicians, behavior analysts, nursing, and other key stakeholders developed a comprehensive behavior program in our children's hospital. The team developed 5 key pillars: aggression mitigation tools, clinical resources, advanced training, screening and management, and behavior emergency response. The outcome measure was rate of reported employee safety events related to patient behavioral events. This was tracked via prospective time series analysis statistical process control chart using established rules to detect special cause variation.

RESULTS

The average rate of employee injuries resulting from patient behavioral events decreased from 0.96 to 0.39 per 1000 adjusted patient-days, with special cause variation observed on a statistical process control U-chart. This improvement has been sustained for 16 months. Staff members who experienced injuries included nurses and patient technicians, with common antecedents to injuries including medical interventions or patient requests that could not be safely met.

CONCLUSIONS

A unified and multimodal system aimed to address pediatric patient behavioral events can reduce employee injuries and foster a culture of employee safety in the pediatric inpatient setting.

Characteristics and Influencing Factors of Post-Traumatic Growth: A Cross-Sectional Study of Psychiatric Nurses Suffering from Workplace Violence in Guangdong China

Background

Workplace violence (WPV) had become an important issue that endangered the occupational safety of psychiatric nurses. A growing number of studies showed positive post-traumatic growth (PTG) resulting from coping with trauma.

Objective

To investigate the characteristics of PTG in psychiatric nurses who experienced violence in the workplace and analyze its influencing factors.

Methods

A total of 1202 psychiatric nurses participated in the study. From October 2022 to December 2022, this cross-sectional study collected data on psychiatric nurses from five tertiary hospitals in Guangdong Province, China. Twenty-item Chinese version post-traumatic growth inventory (PTGI), Jefferson Scale of Empathy Health Professional (JSE-HP), Confidence in Coping with Patient Aggression Instrument (CCPAI), Post-traumatic Stress Disorder Checklist-Civilian Version (PCL-C), and Connor-Davidson Resilience Scale (CD-RISC) measured PTG level, empathy, the confidence in coping with WPV, post-traumatic stress disorder, and resilience, respectively. Bivariate analysis and multiple linear regression explored potential influencing factors of PTG. This study complies with the EQUATOR (STROBE) checklist.

Results

The sample was composed of a total of 1202 psychiatric nurses suffering from WPV. The average score of PTGI in psychiatric nurses was above average (65.75 points; SD = 20.20). Linear regression analyses showed from single-child family (β=0.052,95% CI=0.342,5.409, P<0.05), education background (β=0.108,95% CI=1.833,5.097, P<0.001), the confidence in coping with patient aggression (β=0.106,95% CI=1.385,4.317, P<0.001), empathy (β=0.057,95% CI=0.312,4.374, P<0.05), and resilience (β=0.484,95% CI=7.737,9.575, P<0.001) were associated with PTG level.

Conclusion

Psychiatric nurses who were non-single child, had received higher education, had confidence in coping with patient aggression, had good resilience and strong empathy were prone to PTG after experiencing WPV. The study findings could help hospitals and nursing managers identify vulnerable individuals and take early intervention measures against such populations.

A cross-sectional survey on the relationship between workplace psychological violence and empathy among Chinese nurses: the mediation role of resilience

BACKGROUND

Workplace violence is one of the most serious public health issues worldwide in healthcare occupations, nurse is a profession which faces the greatest risk of exposure to workplace violence among healthcare occupations.

OBJECTIVE

The present study aimed to explore the relationship between workplace psychological violence and empathy among Chinese nurses, and further examine the mediation role of resilience in this relationship.

METHOD

A cross-sectional survey was conducted among a convenience sample of clinical registered nurses in Xinjiang China from 29 September 2023 to 19 October 2023.The online questionnaire, contained the general information form, the Workplace Psychologically Violent Behaviors Instrument, the Jefferson Scale of Empathy-Healthcare Professionals Version, and the Connor-Davidson Resilience Scale, was used to collect data. The IBM SPSS statistics software version 22.0 was used to perform data analyses in forms of descriptive statistics, correlation analysis, and mediation analysis.

RESULT

This survey recruited a convenience sample of 1613 clinical registered nurses aged 22 to 55 years who come from diverse ethnicities and worked in different departments. A total of 534 nurse experienced psychological violent, which yielded a positive rate of 33.1% for psychological violent among nurses. Pearson analysis reported a negative correlation between psychological violences and empathy (r=-0.724, P < 0.01) as well as a negative correlation between psychological violences and resilience (r=-0.681, P < 0.01). Mediation analysis reported that resilience mediated the negative relationship between psychological violence and empathy, the mediation effect accounted for ab/(ab + c') = 23.40% of the total effect.

CONCLUSION

This study supported an inverse ralationship between psychological violence and empathy among Chinese nurses where resilience acted as a protective factor to mediated the negative impacts of psychological violences on empathy These results directed health policies and clinical interventions to equip nurses with resilience to copy with and recover from workplace psychological violence.

Understanding the Workplace-Violence-Related Perceptions and Coping Strategies of Nurses in Emergency Rooms

BACKGROUND

Workplace violence (WPV) is a well-known and serious issue in most countries, and WPV against healthcare providers is of particular concern, especially among nurses working in emergency rooms (ERs).

PURPOSE

We aimed to develop a deeper understanding of nurses' perceptions and coping strategies related to WPV that took place over a 1-year period from the perspective of nursing victims still working in ERs in southern Taiwan.

METHODS

This is a qualitative study with in-depth and semistructured interviews. Nineteen ER nurse victims were recruited from six hospitals in southern Taiwan from June 2015 to April 2016. All of the interview recordings were analyzed using content analysis.

RESULTS

The content analysis identified two themes of perceptions and two themes of coping strategies toward WPV. The two themes of perceptions were "adversity" and "dilemma," with the former covering the three subthemes of "misunderstanding of health policy," "unsafe environment," and "nursing shortage" and the latter covering the two subthemes of "burnout" and "keeping or quitting the job." The two themes of coping strategies were "adjustment" and "resilience," with the former covering the three subthemes of "acceptance of the reality of WPV," "self-regulation," and "culture and belief" and the latter covering the two subthemes of "living with WPV" and "problem solving."

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

The findings revealed that ER nurse victims of WPV experienced a complicated journey after encountering WPV. Their coping strategies may be referenced by other ER nurses to better prevent and manage violent events in ERs. To prevent and manage violence in ERs, hospital managers should create a safe working environment through, for example, assigning sufficient security personnel and staff; provide relevant training to ER nurses in communications and other skills; and implement support systems to strengthen nurse resilience.

Occupational violence in a tertiary emergency department: A retrospective descriptive study

OBJECTIVE

Occupational violence in emergency departments (EDs) impacts staff and patients. Most hospitals have a response mechanism called a 'Code Black' or similar. We aimed to determine the incidence of Code Black activations in a tertiary ED and describe contributory factors, management strategies and adverse events.

METHODS

Descriptive study in a tertiary ED in South-East Queensland in 2021. Adult patients for who a Code Black had been activated were eligible. Data were obtained from a prospectively collected Code Black database, supplemented with retrospective electronic medical records.

RESULTS

There were 386 Code Black events. The incidence of Code Black activation was 11.0 per 1000 adult ED presentations. Individuals requiring Code Black activation were 59.6 % male with a mean age of 40.9 years. The primary diagnosis was mental illness related in 55.1 %. Alcohol was a suspected factor in 30.9 %. When Code Black activation occurred, median length of stay increased. Restraint including physical, chemical or both were used in 54.1 % of Code Blacks.

CONCLUSION

Occupational violence occurs at a three-fold greater incidence within this ED than reported elsewhere. This study reinforces other literature suggesting an increase in occupational violence, demonstrating the need for dedicated preventative strategies for patients at risk of agitation.

Construction and evaluation of a predictive model for compassion fatigue among emergency department nurses: A cross-sectional study

BACKGROUND

Compassion fatigue is a syndrome resulting from long-term work-related traumatic event stress exposure of medical staff. The emergency department is considered to be a high-risk, high-intensity and high-stress work environment, with a high prevalence of trauma and violence. Nurses in the emergency department are more prone to compassion fatigue than nurses in other departments. Compassion fatigue not only affects the physical and mental health, and job satisfaction of emergency department nurses, but also causes serious consequences for patients, such as poor patient outcome, medical errors, and increased patient mortality during hospitalization.

OBJECTIVES

Our study aims to develop and evaluate a predictive model for compassion fatigue among emergency department nurses.

DESIGN

A cross-sectional study.

DATA SOURCES

The emergency department nurses (N = 1014) were recruited from 21 tertiary hospitals (from Chengdu, Chongqing, Guiyang, Guangzhou and Shanghai) in central, southwestern, southern, and eastern China from July 25, 2022 to October 30, 2022.

METHODS

Univariate and multiple logistic regression analyses were used to determine the potential predictive factors associated with compassion fatigue in emergency department nurses. A nomogram was built based on the predictive factors and internally evaluated using a bootstrap resampling method (1000 bootstrap resamples). The performance of the predictive model was evaluated by measuring the Hosmer-Lemeshow goodness of fit test and calibration curve.

RESULTS

The prevalence of compassion fatigue among emergency department nurses was 75.9 %. The multiple logistic regression analysis revealed that the independent predictive factors for compassion fatigue among emergency department nurses were working position, job satisfaction, diet habit, sleep hours per day, occupational stress, physical harassment and the level of workplace violence, all of which were identified to create the nomogram. The Hosmer-Lemeshow goodness of fit test indicated that the predictive model was well calibrated (χ2 = 11.520, P = 0.174). The bootstrap-corrected concordance index of nomogram was 0.821 (95 % CI: 0.791-0.851). The calibration curve of the nomogram showed good consistency between the predicted and actual probabilities.

CONCLUSIONS

A predictive model of compassion fatigue among emergency department nurses has been developed, based on the general demographic, work-related and lifestyle characteristics, occupational stress, and workplace violence, with satisfactory predictive ability. This model can identify emergency department nurses who are at high risk of compassion fatigue. Our study provides an empirical basis for early detection, early diagnosis and early intervention of emergency department nurses at high risk of compassion fatigue.

"It is because of the love for the job that we are still here": Mental health and psychosocial support among health care workers affected by attacks in the Northwest and Southwest regions of Cameroon

Attacks on health care have important consequences for the mental health (MH) and work availability of health care workers (HCW). In the conflict-affected Northwest and Southwest (NWSW) regions of Cameroon, health care attacks are common; however, little is known on the MH burden and/or (mental) health-seeking behavior among affected HCW. We therefore conducted a survey on mental conditions (relying on SRQ-20 and WASSS assessments) and access to MH services among 470 HCW from 12 districts in NWSW Cameroon in January-February 2022. In-depth interviews on personal experiences with attacks and on accessing MH services were conducted with a subset of 96 HCW. Among surveyed HCW, 153 (33%) had experienced an attack in the past 6 months, and a further 121 (26%) had experienced attacks more than 6 months ago. HCW facing attacks <6 months ago had significantly higher odds of exhibiting mental disorders (aOR 5.8, 95%CI 3.0-11.3, p<0.001) and of being unable to function (aOR 3.3, 95%CI 1.9-5.7, p<0.001). HCW who experienced an attack >6 months also had higher odds of being unable to function (aOR 2.9, 95%CI 1.7-5.2, p<0.001), and of missing time off work in the week preceding the survey (aOR 3.1, 95%CI 1.8-5.5, p<0.001). Previous access to MH services was also higher among HCW facing attacks. HCW showed a good understanding of the added values of accessing MH services, but faced multiple access barriers (including poor availability of services and their own prioritization of the care of others) and indicated a preference for self-care, peer-support and/or religious support. In conclusion, health care attacks in NWSW Cameroon contributed significantly to severe mental conditions and absenteeism rates among HCW. Strengthening access to MH support among attack-affected HCW is indicated; this should include strengthening of formal MH services and building the capacity of HCW and religious leaders to provide peer-support.

A qualitative study of ICU nurses assisting in Wuhan who suffered from workplace violence during the COVID-19 outbreak

AIM

To explore the psychological experience and coping methods of nurses exposed to workplace violence and to propose measures to prevent and control workplace violence and provide psychological assistance for health workers.

DESIGN

We adopted a phenomenological qualitative design. Twelve nurses in intensive care units assisting in Wuhan who experienced workplace violence during the COVID-19 outbreak were selected using purposeful sampling. Data were collected through semi-structured individual telephone interviews and analysed using Colaizzi's 7-step method.

RESULTS

Analysis revealed three main categories including "Full of negative emotions", "Facing challenges and danger" and "Coping methods". The subjects experienced stress, fear, anger, helplessness, disappointment, sympathy and job burnout after suffering from workplace violence. The coping methods for workplace violence mainly included seeking support and help, escaping, making explanations, exercising tolerance and confronting the issue.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution since nurses' experiences were explored.

Experience of verbal violence among Chinese nursing students in clinical practice: a qualitative study

BACKGROUND

Workplace violence is prevalent in the nursing profession, and as a relatively junior link of the professional hierarchy, nursing students are not immune to it. Among these, verbal violence may have more serious consequences for the victims than physical violence, but the literature on verbal violence among nursing students in Chinese clinical settings is limited.

AIMS

To explore the verbal violence experience among Chinese nursing students in clinical practice, and the strategies used by nursing students to cope with violence.

DESIGN

A descriptive qualitative study.

METHODS

From January 2022 to June 2022, semi-structured interviews were conducted with 21 nursing students in clinical practice by purposive snowball sampling. Nvivo12 software and inductive content analysis were used for data analysis. This paper followed the COREQ (Consolidated criteria for Reporting Qualitative Research) guidance.

RESULTS

Through data analysis, three themes were defined:(1) Multiform verbal violence; (2) Hurting and impacting and (3) Struggling or Coping. The findings indicated that nursing students were subjected to multiple forms of verbal violence in clinical practice, not only from patients and caregivers, but also from peers such as clinical tutors and doctors, which not only harmed students' personal health and well-being, but may also contribute to the nursing industry's future loss of human resources. Seeking emotional support from others and forcing themselves to grow up were the most commonly used coping strategies.

CONCLUSION

Nursing educators and nursing managers need to pay attention to verbal violence in the clinical environment, and actively develop the ability of nursing students to deal with uncivilized behavior. Establishing relevant courses and training such as communication, resilience, and violence prevention, establishing a stricter clinical mentor appointment system, and teaching assessment system may be strategies to help nursing students better perform clinical practice.

Impact of Alzheimer's disease and related dementias (ADRD) on the quality of room cleaning in nursing homes

Persons with Alzheimer's disease and related dementias (ADRD) are prone to receiving reduced quality of care. We compared the quality of room cleaning of rooms with ADRD residents and rooms with non-ADRD residents in nursing homes using an ultraviolet (UV) marker. ADRD status was associated with greater failure of UV marker removal (odds ratio, 1.68; 95% confidence interval, 1.04-2.71; P = .03).

User violence prevention and intervention measures to minimize and prevent aggression towards health care workers: A systematic review

Workplace violence in the health care setting is a social problem of great interest both at the health care level and in research in recent decades. The most common type of violence is the one coming from the user towards the professional. Although the bibliography includes multiple preventive actions focused on working with professionals, there are hardly any studies that explore and collect actions aimed at the user. The aim of this study is to analyze the results of the literature to provide an overview of the current evidence. Specifically, it aims to describe the various user-directed strategies or interventions aimed at reducing workplace violence experienced by professionals within the healthcare sector. A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), methodology of publications published up to December 2022 in the main databases. Studies that met the previously established eligibility criteria were identified. A peer review of the risk of bias was performed and the data were extracted from a previously elaborated template. The search yielded 5231 articles of which 11 were finally included in the review. Of these, 3 had a quantitative design, 7 had a qualitative design and one had a combined design. Of these, 38 measures or actions aimed at the user were compiled, grouped into four blocks according to the attitudinal objective pursued: Improvement of communication and creation of links, involvement of the user in joint decisions with the staff, informing and training the user, and other independent proposals. This study makes it possible to explore actions aimed at users with the objective of reducing violence towards health professionals. It collects and makes available to the scientific community a set of measures aimed at making a change of attitude in the perpetrator themselves, with the involvement of the perpetrator in the health system. This set of collected measures provides researchers with a basis to be taken into account for the implementation of future prevention plans according to the new multicomponent prevention models and with the involvement of the perpetrator themselves.

Violence in the Nursing Workplace in the Context of Primary Health Care: A Qualitative Study

Violence demands considerable attention due to its complexity and social consequences. The objective of this study was to analyze violence in the nursing professional workplace in the context of primary health care in Brazil. It is a qualitative study with theoretical and methodological reference to institutional analysis. It was carried out in basic health units in Brazil. Nursing professionals (N = 11) participated in semi-structured interviews and discussion groups, in addition to a research diary and participant observation. Data collection took place from October to December 2021. The results are presented in five categories: types of violence and aggressors from the perspective of nursing professionals; the causes of violence reported by professionals; strategies for the management of violence; professionals' proposals for preventing violence in health contexts; the consequences of violence in the workplace. Nursing professionals make up a large part of the workforce and have reported verbal, physical, moral, and psychological violence. The main causes are associated with user access to services. For the prevention of violence, professionals do not see themselves as protagonists of change. The consequences are the loss of quality of work and the health of professionals who requested sick leave and transfers. The study's findings can help in the development of public policies and educational and management actions.

The Link between Patients' Aggressive Communication and Nurses' Emotional Health Outcomes

The aggressive conduct of patients is a perennial problem that nurses face in health care. Studies have shown that such aggressiveness can be detrimental to the work and emotional wellbeing of nurses. Yet, the literature has had inconsistent findings; in some cases nurses are negatively affected by aggression, while in other cases nurses are not affected. Street and colleagues contended that such inconsistencies in research exist because social mechanisms embedded in communication are often not taken into consideration. This study adopts Street et al.'s pathways model and links patients' aggressive communication to nurses' emotional health outcomes, via the proximal outcome of communication satisfaction and the intermediate outcome of organizational identity. Results support Street et al.'s postulation and demonstrates that patients' aggressive communication does not have a direct effect on nurses' emotional health. Instead, the effect is indirect, mediated by communication satisfaction and organizational identity.

A Literature Review: Violence and Aggression in Neuroscience Nursing

ABSTRACT

BACKGROUND: Violence and aggression is commonly encountered in nursing worldwide and is an increasing concern, although it is largely underreported by staff. Violence and aggression can take many forms, from verbal and physical abuse to sexual assault. This study aims to define agitation, violence, and aggression and to explore the prevalence of violence and aggression among neuroscience patients. This review also examines why violence and aggression occurs for neuroscience patients and to determine the effects on the patients, the environment, and the nursing staff. METHODS: A review of articles was conducted using CINAHL, PubMed, the Cochrane Database, and Google Scholar between 2012 and 2022. DISCUSSION: Agitation can escalate to violence and aggression. The reasons a neuroscience patient may become agitated are multifactorial. An injury to the brain may not cause agitation; however, the effect on the frontal lobe, hypothalamus, and hippocampus may cause a lack of self-control, impulsivity, an inability to control emotions, and an uncontrolled release of hormones, leading to a heightened sympathetic response. The effects of violence and aggression can be detrimental to the patient and include isolation, increased sedation, reduced observations, and even death. The effects on the nurse are profound including a decline in productivity at work, an increased risk of drug errors, and posttraumatic stress disorder or burnout as longer-term consequences. CONCLUSION: Violence and aggression is commonly experienced within neuroscience nursing, and the contributing factors are multifactorial. The effects for the patients and staff can be profound, and this is why prevention of agitation is fundamental to ensure the safety and retention of nursing staff.

An International Study on Violence and Aggression in Neuroscience Nursing

ABSTRACT

INTRODUCTION: The primary rationale for this study was to evaluate neuroscience registered nurses' (RNs') experience of violence and aggression internationally. The objectives were to determine how prevalent violence and aggression is in neuroscience nursing and the support and education provided. METHODS: Two online surveys were developed for neuroscience RN educators and RNs through SurveyMonkey. The questionnaires were distributed through RN organizations internationally in 2021. RESULTS: Two hundred seventy-two RNs responded to the survey. Most staff felt safe at work but had experienced some type of violence or aggression, with most experiencing verbal aggression. A variety of support existed for staff but lacked consistency, with some of the staff receiving more support from colleagues than their manager. Most RNs had received education in the management of violence and aggression, but some mentioned this was not specific to their neuroscience patient population, and most required further training. Thirty-one RN educators completed the survey, and the results were similar to those of the RN for education provision. Surprisingly, many neuroscience areas did not have a code system or personal alarms to alert staff to a violence or aggression emergency. CONCLUSION: Most RNs felt safe at work despite the high prevalence of violence and aggression experienced. Education was considered beneficial, but they desired more and further research into effective RN education. Effective support post incident needs to be determined. Protection for staff is paramount: few areas had code systems to raise an alarm for agitation, and few places of work had personal alarms that, if implemented, might enable a quicker response to prevent harm.

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.

Predicting Workplace Violence in the Emergency Department Based on Electronic Health Record Data

INTRODUCTION

Emergency departments are extremely vulnerable to workplace violence, and emergency nurses are frequently exposed to workplace violence. We developed workplace violence prediction models using machine learning methods based on data from electronic health records.

METHODS

This study was conducted using electronic health record data collected between January 1, 2016 and December 31, 2021. Workplace violence cases were identified based on violence-related mentions in nursing records. Workplace violence was predicted using various factors related to emergency department visit and stay.

RESULTS

The dataset included 1215 workplace violence cases and 6044 nonviolence cases. Random Forest showed the best performance among the algorithms adopted in this study. Workplace violence was predicted with higher accuracy when both ED visit and ED stay factors were used as predictors (0.90, 95% confidence interval 0.898-0.912) than when only ED visit factors were used. When both ED visit and ED stay factors were included for prediction, the strongest predictor of risk of WPV was patient dissatisfaction, followed by high average daily length of stay, high daily number of patients, and symptoms of psychiatric disorders.

DISCUSSION

This study showed that workplace violence could be predicted with previous data regarding ED visits and stays documented in electronic health records. Timely prediction and mitigation of workplace violence could improve the safety of emergency nurses and the quality of nursing care. To prevent workplace violence, emergency nurses must recognize and continuously observe the risk factors for workplace violence from admission to discharge.

Cognitive impairment and behavioural emergencies within the acute hospital setting

BACKGROUND

Patients with cognitive impairment exhibiting agitation and aggression are challenging to manage in the acute hospital setting. When a patient's behaviours place themselves or others at risk of harm, a Clinical Aggression Response Team (C-ART) is dispatched.The aims of this project were to describe the characteristics of patients receiving a C-ART call and the experiences of C-ART staff members via semistructured interviews. Additionally, to audit local practice against two established standards of practice (Local C-ART Call Guideline and Australian Cognitive Impairment Guideline), to develop interventions to address identified shortfalls in adherence to these standards of practice and finally to re-evaluate adherence postintervention.

METHODS

A retrospective pre and postintervention audit using qualitative (interview) and quantitative (file review) mixed method research approach was used. Interventions targeted doctor hospital orientation sessions, distribution of hospital guidelines including a new pharmacological sedation guideline and finally ward-based brief education sessions.

RESULTS

Themes identified postintervention included improved familiarity with C-ART terminology, better understanding of C-ART member roles and improved communication among medical teams. However, there was continued pressure to use pharmacological sedation, a lack of debriefing and poor patient handover.File review of patients postintervention showed improvement from 36.8% to 65.6% in recording a provisional diagnosis and differentials for a patient behaviour necessitating a C-ART call. Additionally, the use of psychotropics during C-ART calls was lowered by 3.3% but did not reach significance (p=0.62).

CONCLUSION

Behavioural disturbances in the elderly present many challenges for health staff. Interactive orientation sessions for doctors and distribution of hospital guidelines were shown to improve compliance with Local C-ART Call and Australian Cognitive Impairment Guidelines. Patients who receive multiple C-ART calls require further exploration and consideration, as this subset of the patient population present unique challenges.

Workplace Violence against Health Care Providers in Emergency Departments of Public Hospitals in Jordan: A Cross-Sectional Study

Workplace violence (WPV) against healthcare providers is a serious problem that carries health, safety, and legal consequences. Healthcare providers working in emergency departments (ED) are more susceptible to WPV compared to other healthcare settings. This study aimed to assess the prevalence of physical and verbal violence against ED physicians and nurses in public hospitals in Amman, Jordan, and to explore the relationship between WPV and the socio-demographic characteristics of the participants. A quantitative descriptive cross-sectional study design was used to assess physical and verbal violence against ED physicians and nurses. A self-administered questionnaire was completed by 67 physicians and 96 nurses from three public hospitals in Amman. In the past year, 33% and 53% of the participants experienced physical and verbal violence, respectively. Compared to their female counterparts, males were more frequently physically (43.7% vs. 2.3%, p-value < 0.001) and verbally (61.3% vs. 29.5%, p-value < 0.001) abused. The main perpetrators of physical and verbal violence were the patients' relatives. Out of 53 physical and 86 verbal abuse incidents, only 15 cases (10.8%) were followed up with legal persecution. In conclusion, there is a widespread occurrence of physical and verbal violence against ED physicians and nurses in the public sector hospitals in Jordan. A collaborative effort by all stakeholders should be instituted to ensure the safety of the physicians and nurses and to improve the quality of the healthcare provided.

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

BACKGROUND

Patient and health care worker safety is an interconnected phenomenon. To date, few studies have examined the relationship between patient and worker safety, specifically with respect to work safety culture. Therefore, we examined patient safety culture, workplace violence (WPV), and burnout in health care workers to identify whether patient safety culture factors influence worker burnout and WPV.

METHODS

This cross-sectional study used secondary survey data sent to approximately 7,100 health care workers at a large academic medical center in the United States. Instruments included the Hospital Survey on Patient Safety Culture, a WPV scale measuring physical and verbal violence perpetrated by patients or visitors, and the Emotional Exhaustion scale from the Maslach Burnout Inventory.

FINDINGS

These analyses included 3,312 (47%) hospital staff who directly interacted with patients. Over half of nurse (62%), physician (53%), and allied health professional respondents (52%) reported experiencing verbal violence from a patient, and 39% of nurses and 14% of physicians reported experiencing physical violence from a patient. Burnout levels for nurses (2.67 ± 1.02) and physicians (2.65 ± 0.93) were higher than the overall average for all staff (2.61 ± 1.0). Higher levels of worker-reported patient safety culture were associated with lower odds of WPV (0.47) and lower burnout scores among workers (B = -1.02). Teamwork across units, handoffs, and transitions were dimensions of patient safety culture that also influenced WPV and burnout.

CONCLUSIONS/APPLICATION TO PRACTICE

Our findings suggest that improvements in hospital strategies aimed at patient safety culture, including team cohesion with handoffs and transitions, could positively influence a reduction in WPV and burnout among health care workers.

Occurrence and correlated factors of physical and verbal violence among emergency physicians in China

Background

Workplace violence against emergency physicians is a global concern. However, there was relatively little research on the incidence and correlated factors of workplace violence among emergency physicians in China. We aimed to investigate the occurrence and correlated factors of physical and verbal violence among emergency physicians in China.

Methods

We conducted a nationwide cross-sectional study from July 2018 to August 2018. We included a total of 10 457 emergency physicians from 31 provinces across China in the analysis. The questionnaire covered socio-demographic characteristics, work-related factors, psychological characteristics, and workplace violence. We applied binary logistic regression to examine the correlated factors of physical and verbal violence among emergency physicians.

Results

The prevalence of physical and verbal violence among emergency physicians in China was 27.63% and 81.81%, respectively. Regarding socio-demographic factors, male emergency physicians with bachelor's degrees or higher, poor sleep quality, and unfavorable health conditions were more likely to experience workplace violence. Concerning work-related factors, emergency physicians who had longer years of service, worked a higher frequency of night shifts per month and served more patients per day had a greater prevalence of workplace violence. As for individual psychological characteristics, negative affect was positively correlated with workplace violence, while self-efficacy and positive affect were negatively correlated with workplace violence.

Conclusions

The situation of physical and verbal violence against emergency physicians in China is severe, especially verbal violence. Hospital administrators should pay more attention to the workplace violence of emergency physicians and take measures to decrease the occurrence of workplace violence efficiently, such as reducing their workload and cultivating their positive affect and self-efficacy.

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

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

"TRIPLE-A: ACQUAINT, ANALYZE, AND ACT": THE INSIGHTS OF NURSE EDUCATORS TOWARD A BETTER UNDERSTANDING OF WORKPLACE VIOLENCE IN SAUDI ARABIA

AIM

To investigate the experiences and insights of nurse educators in order to acquire a better understanding of the nature and various factors associated with workplace violence, which could lead to the establishment of future actions and recommendations to eliminate or reduce aggression, abuse, incivility, and any other forms of violence in the health sector.

BACKGROUND

Workplace violence is one of the social phenomena that has not been fully explored in various settings such as educational institutions and healthcare facilities. A worker who had experienced violence could provide valuable insights that could help to better understand and sustainably protect an individual, a group, or an organization from workplace violence and its unfavorable consequences.

METHODS

Qualitative descriptive phenomenological study. A total of 18 nurse educators who met the inclusion criteria were enrolled as the study participants in a government university located in the Eastern Region of Saudi Arabia. Purposive sampling method was used in the recruitment. In addition, a semi-structured interview guide was employed to explore the participants' experiences and insights from February to June 2021. Data were analyzed using Colaizzi methods, and a COREQ checklist was utilized to report the study's results.

RESULTS

The participants' narratives generated three major themes, namely the "Triple-A": (1) "acquaint"; (2) "analyze"; and (3) "act," to better understand workplace violence themes.

CONCLUSION

The "Triple-A: Acquaint, analyze, and act" workplace violence themes can serve as a simple guide to better understand the nature and different factors associated with workplace violence: "acquaint" illustrates self-awareness; "analyze" pertains to the recognition to possible indications and signals; and "act" depicts an individual's proactiveness and responsiveness to workplace violence and conceivably catalyzes the decrease of this social hazard's prevalence.

IMPLICATION FOR NURSING MANAGEMENT

Leaders and managers in the nursing field should prioritize their participation in developing creative strategies and their implementation of policies to manage and mitigate violence in the workplace, such as initiating ongoing education (acquaint), creating robust procedures for reporting and referral (analyze), and establishing support networks, listening to victims' experiences, and promoting respect to individual differences (act).

Aggressive incidents in home care services and organizational support: A cross-sectional survey in Switzerland

AIMS

To explore the available organizational structures addressing aggressive incidents towards home care services staff.

BACKGROUND

Organizational structures how professional caregivers deal with care recipients' aggressive incidents.

METHODS

An explorative cross-sectional survey using the Violence Experienced by Staff (German version revised) and the Impact of Patient Aggression on Carers Scale was conducted. Data from 852 health care professionals in the German-speaking part of Switzerland were collected between July and October 2019. Multiple logistic regression models were used to investigate associations. The STROBE-Checklist was used as the reporting guideline.

RESULTS

Organizational support and management support in home care services were generally rated high and found to cause a significant decrease in negative feelings. Some self-rated skills regarding aggression management were linked to a decrease in perceived burden after aggressive incidents, whereas others increased the perceived burden.

CONCLUSION

Organizational structures including official procedures for affected professional caregivers should be established in home care services. This should contain efficient reporting systems and aggression management training for the specific setting.

IMPLICATIONS FOR NURSING MANAGEMENT

The study highlights the importance of organizational support regarding aggressive incidents in the home care setting as well as of aggression management training.

Reporting Incidents in the Psychiatric Intensive Care Unit: A Retrospective Study in an Italian University Hospital

ABSTRACT

To evaluate the characteristics of the reported workplace violence in a psychiatric intensive care unit (PICU) by analyzing an electronic hospital incident reporting system (IRS). One hundred thirty reports were retrieved from January 2017 to June 2020, referring to assaults committed by patients (71% males) with an average age of 29.8 years (SD, 14.9). The most frequent psychiatric diagnosis was a neurodevelopmental disorder (33%). Physical aggression (84%) was more frequent than the other types of aggression. Nurses and unlicensed assistive personnel were the most frequent victims (65%). Aggressions were more frequent on Friday (18%) and between 4 p.m. and 8 p.m. (35%). A total of 64.9% of the incidents happened in the first 5 days of hospitalization. A significant association between physical aggression and diagnosis of neurodevelopmental disorder emerged. IRS could be helpful to identify high-risk patient groups and develop clinical strategies to reduce adverse events in clinical practice.

Lessons learned from two clinical trials on nutritional supplements to reduce aggressive behaviour

BACKGROUND

Setting up and conducting a randomised controlled trial (RCT) has many challenges-particularly trials that include vulnerable individuals with behavioural problems or who reside in facilities that focus on care as opposed to research. These populations are underrepresented in RCTs.

APPROACH

In our paper, we describe the challenges and practical lessons learned from two RCTs in two care settings involving long-stay psychiatric inpatients and people with intellectual disabilities. We describe five main difficulties and how these were overcome: (1) multisite setting, (2) inclusion of vulnerable participants, (3) nutritional supplements and placebos, (4) assessment of behavioural outcomes, and (5) collecting bio samples.

CONCLUSIONS

By sharing these practical experiences, we hope to inform other researchers how to optimally design their trials, while avoiding and minimising the difficulties that we encountered, and to facilitate the implementation of a trial. Both trials were registered in the Clinical Trials Register (RCT A: NCT02498106; RCT B: NCT03212092).

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

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

The Permeating Effects of Violence on Health Services and Health in Mexico

Mexico's violence related to organized crime activity has grown to epidemic levels in the last 12 years. We interviewed 22 Mexican health care providers from five states to examine how violence impacts health care services and health. We transcribed and analyzed semi-structured interviews using framework analysis. Our findings describe the ways in which community violence in Mexico permeates health care services, impacting health care providers, and the health of patients. We developed a model to reflect our main themes that illustrate how violence permeates health care services over geographic space and time. We identified three thematic categories: (a) the impact of violence on health care facilities and service provision, (b) the impact of violence on providers, and (c) the impact of violence on the health of the community. Our model articulates a dynamic process of the spread and permeation of violence. Prior literature focuses on the impact of violence as an occupational hazard and the effect of war or civil conflict on health care services. We extend this literature by documenting the impacts of widespread violence on Mexican health care services and providers. We discuss how violence impacts services, providers, and health in a country that is not officially at war. We compare our findings to previous literature on occupational violence in health professions and the impacts on health services in official war zones. Finally, we highlight the implications for health care practice and policy. We suggest that violence should be considered throughout the care continuum in Mexico and make the case for violence as a structural contributor to health and health disparities in Mexico. We suggest additional research on this under-investigated topic.

Determinants and consequences of workplace violence against hospital-based nurses: a rapid review and synthesis of international evidence

Workplace violence against nurses is an international public health issue with likely detrimental consequences for individuals, systems and societies. To effectively address workplace violence against nurses, its root causes must be understood and its effect on nurse outcomes quantified. In line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the authors rapidly reviewed the international literature to identify determinants of workplace violence against hospital-based nurses and the effects of workplace violence on nurse outcomes. Twenty-one studies (22 articles) formed the final sample - 16 quantitative, three qualitative and two mixed-methods studies. Supervisors, other nurses and physicians were the major perpetrators of workplace violence against nurses. Perpetrators of workplace violence were other nurses or physicians, the workplace, patients, and organisational management. Workplace violence was linked to deficits in nurses' health, job satisfaction and intention to stay in their role. To address workplace violence, evidence-based zero-tolerance policies, preventive interventions and appropriate disciplinary actions must be implemented at organisational and national level.

Violence by clients and patients against social and healthcare staff - An integrative review of staff's well-being at work, implementation of work and leaders' activities

AIM

The aim of this study was to compile, assess and synthesise empirical research on violence by social and healthcare clients or patients against staff and its connections to staff's well-being at work, implementation of work and activities of leaders related to it.

BACKGROUND

Workplace violence against social and healthcare staff is a global and daily problem. One in three employees encounters violence from patients or clients and the risk of this is 16 times higher compared to other professions. None of the recent reviews on this topic were focused on the well-being at work, implementation of work or leaders' role in the cases of violence of clients or patients against the staff.

DESIGN

An integrative review reported according to PRISMA Checklist.

METHODS

The search was conducted to CINAHL, PubMed, PsychINFO and Scopus databases resulting in 21 articles. The quality of the articles was evaluated, and the data were analysed narratively.

RESULTS

The workplace violence committed by clients and patients was negatively connected to staff's psychological, emotional and physical well-being at work and to their work performance and commitment. The leaders found this form of workplace violence challenging and ethically conflicted and felt that they were left alone without training and support. The employees expressed disappointment with their leaders' activities and suggested many measures to make environment safer to staff and patients.

CONCLUSIONS

In future, intervention studies are needed for prevention of workplace violence by patients and clients against staff and for supporting the well-being at work of staff in relation to violent incidents.

RELEVANCE TO CLINICAL PRACTICE

Workplaces should introduce uniform protocols for reporting, preventing and processing workplace violence committed by clients and patients. An open dialogue with leaders and co-workers of the cases is of high importance. Leaders and staff need training that ensure patient and work safety.

Effectiveness of an Aggression Management Training Program in Japan: A Quasi-Experimental Study

This study evaluated the effects of the Comprehensive Violence Prevention and Protection Program (CVPPP) training for managing patient aggression in 95 participants who attended the FY 2019 program using a single-group pretest-posttest design. The comparison of findings before and 1 month after the training showed a significant improvement in staff anger (p < 0.01) and their negative (p < 0.01) and positive attitudes (p < 0.01) toward psychiatric inpatient aggression and confidence (p < 0.01). Staff with controlling and self-affirming traits provided more effective care and demonstrated a positive attitude toward inpatient aggression (p < 0.05).Supplemental data for this article is available online at https://doi.org/10.1080/01612840.2021.1999542 .

Experience of Workplace Violence from the Patients among Mental Health Nurses in Indonesia: A Mixed Method Study

Background: Workplace violence by patients and visitors (PVV) against nurses is regarded a devastating occupational issue around the world. The most frequent perpetrators of violence against nurses were patients, followed by their families and other healthcare professionals. Aim:This study aimed to use a mixed method to analyze violence by patients and visitors against nurses in mental health hospital in Indonesia. Methods: The 250 mental health nurses at two general public hospitals in Bandung were recruited with stratified convenience sampling by years of working experience. Result: All nurses experienced workplace violence from both patients and their families. At least nurses experienced more than 3 types of violence with the most frequent type of violence were verbal and physical violence. The six themes were emerged including variation of violence in nurse, traumatic impact of violence, impacts of violence on profession, violence not only come form patients but also family, reason of violence, and spiritual coping. Conclussion: It is necessary to prioritize more efficient and approachable methods for nurses to deal with patients’ aggresive behavior, and to establish constant training program.

Prevalence and health correlates of workplace violence and discrimination against hospital employees - a cross-sectional study in German-speaking Switzerland

Background

Violence and discrimination are common events at work, especially in health care. Moreover, such workplace experiences are considered to have negative impacts and particularly adverse health consequences on health care workers. Nevertheless, the problem is still highly underreported and thus largely ignored and unexplored in Switzerland as comprehensive data and studies on their prevalence and health correlates among hospital staffs and health professionals are widely missing.

Methods

This cross-sectional study was based on secondary data from a company survey among several public hospitals and rehabilitation clinics in German-speaking Switzerland conducted in 2015/16. The study population was limited to a subsample of 1567 health professionals among the surveyed staffs of five participating hospitals and clinics. Relative frequencies of different forms of violence and discrimination at work and the total number of such experiences were calculated for the entire study population and for occupational subgroups. These data were compared with a nationally representative subsample of the Swiss Health Survey 2017 as a reference population. Multiple logistic regression analyses were further computed to investigate the association between the number of different experienced forms of violence and/or discrimination at work and several poor general and mental health outcomes.

Results

23% of the inverviewed hospital employees experienced at least one form of discrimination or violence at work in the past year, compared to 18% of the general working population. Nurses were by far the most affected occupational group regarding all forms of violence. More and particularly the most exposed and affected hospital employees with regard to experiences of violence and/or discrimination at work showed almost consistently increased frequencies and relative risks for the studied poor mental and general health outcomes. Prevalence rates and odds ratios for strong sleep disorders, strong stress feelings and increased burnout symptoms were between 3 and 4 times higher among the most exposed compared to the non-exposed group of hospital employees.

Conclusions

Study findings underline the importance of an active combat against violent and discriminatory behaviors in health care. Prevention strategies should particularly focus on nurses and midwives, which turned out to be the most affected and exposed group of all health professions.

A Comparative Cross-Sectional Study Assessing the Psycho-Emotional State of Intensive Care Units’ Physicians and Nurses of COVID-19 Hospitals of a Russian Metropolis

Working in intensive care units (ICUs) is stressful and potentially leads to various psycho-emotional disorders. Today, this issue represents a serious concern to the healthcare sector and affects the quality of healthcare provided. This study aimed to assess and compare the psycho-emotional state in COVID-19 and non-COVID-19 hospitals’ ICU healthcare workers (HCWs). From January to July 2021, we conducted an anonymous cross-sectional web survey of ICU physicians and nurses (N = 1259) of various hospitals in a metropolis with a population of over 10 million people. The statistical distributions of non-COVID-19 ICU HCWs showed the following results: emotional exhaustion levels (low 14.6%, average 30.8%, and high 54.6%); depersonalization levels (low 11.6%, average 16.5%, and high 71.9%); and reduced personal accomplishment levels (low 23.5%, average 40.3%, and high 36.2%). The statistical distributions of COVID-19 ICU HCWs showed the following results: emotional exhaustion levels (low 16.5%, average 31.5%, and high 52%); depersonalization levels (low 7.4%, average 9.4%, and high 83.1%); and reduced personal accomplishment levels (low 25.4%, average 45.4%, and high 29.1%). This study found a strong correlation between emotional exhaustion, aggression, and depersonalization in non-COVID-19 ICU HCWs and also found a correlation between their age, aggression, emotional exhaustion, and occupational stress.

Factors associated with residents’ responsive behaviours towards staff in long-term care homes: A systematic review

Background and Objectives

When staff experience responsive behaviors from residents, this can lead to decreased quality of work-life and lower quality of care in long-term care homes. We synthesised research on factors associated with resident responsive behaviours directed towards care staff and characteristics of interventions to reduce the behaviours.

Research Design and Methods

We conducted a mixed-methods systematic review with quantitative and qualitative research. We searched 12 bibliographic databases and “grey” literature, using two keywords (long-term care, responsive behaviours) and their synonyms. Pairs of reviewers independently completed screening, data extraction, and risk of bias assessment. We developed a coding scheme using the ecological model as an organising structure and prepared narrative summaries for each factor.

Results

From 86 included studies (57 quantitative, 28 qualitative, 1 mixed methods), multiple factors emerged, such as staff training background (individual level); staff approaches to care (interpersonal level); leadership and staffing resources (institutional level); and racism and patriarchy (societal level). Quantitative and qualitative results each provided key insights, such as qualitative results pertaining to leadership responses to reports of behaviours, and quantitative findings on the impact of staff approaches to care on behaviours. Effects of interventions (n=14) to reduce the behaviours were inconclusive.

Discussion and Implications

We identified the need for enhanced understanding of the interrelationships among factors associated with resident responsive behaviours towards staff and processes leading to the behaviours. To address these gaps and to inform theory-based effective interventions for preventing or mitigating responsive behaviours, we suggest intervention studies with systematic process evaluations.

Incivility toward nurses: a systematic review and meta-analysis

One important part of a nurse’s job is to create and help maintain a safe work environment. Evidence shows that negative behaviors such as incivility are not uncommon in the nursing profession. This systematic review and meta-analysis aimed to examine the prevalence of incivility toward nurses. For this purpose, all observational studies that primarily investigated the rate of incivility toward nurses were selected. The electronic databases PubMed, Embase, Web of Sciences, Magiran, IranDoc, and Scopus were searched for studies published during the period of January 1, 1996 to December 31, 2019. The quality of studies was assessed using Hoy’s Critical Assessment Checklist. The study was undertaken using the random effects model, and data were analyzed using STATA14. Data on 60 articles, including data on 30801 individuals, published between 1997 and 2019, entered the study. The findings showed the prevalence of incivility to be 55.10% (95%, CI: 48.05, 62.06).

Due to the high prevalence of uncivil behavior, especially of the verbal type, nursing managers should identify risk factors in the workplace. Planners should develop programs to increase workplace safety, especially in centers that are most exposed to these behaviors. It is also recommended that future studies focus on implementation of effective evidence-based interventions based on organizational culture.

Burnout syndrome and workplace violence among nursing staff: a cross-sectional study

BACKGROUND

Among healthcare professionals, nursing workers are the most prone to becoming victims of workplace violence and present the highest burnout levels.

OBJECTIVES

To investigate the association between burnout syndrome and workplace violence among nursing workers.

DESIGN AND SETTING

Cross-sectional study carried out at a teaching hospital in southern Brazil.

METHODS

This study involved 242 nursing workers. We collected data over a six-month period using a sociodemographic and occupational survey, the Survey Questionnaire Workplace Violence in the Health Sector and the Maslach Burnout Inventory - General Survey. For occupational violence, we selected the Survey Questionnaire Workplace Violence in the Health Sector. Burnout syndrome was evaluated using the Maslach Burnout Inventory - General Survey. The data were analyzed in the Statistical Package for the Social Sciences (SPSS). Categorical variables were described as absolute and relative frequencies and numerical variables in terms of central trend and dispersion measurements. For data analysis, we applied descriptive statistics and multiple logistic regression.

RESULTS

The multiple models indicated that the workers who had experienced verbal abuse, physical violence and concern about workplace violence over the past 12 months had significantly higher chances of presenting high emotional exhaustion (P < 0.05) and depersonalization (P < 0.05) and low professional accomplishment (P < 0.05).

CONCLUSION

Occurrence of violence significantly increased the chances of great emotional exhaustion and depersonalization and low professional achievement, within burnout syndrome. Therefore, workplace violence prevention strategies need to be put in place to provide workers with a safe workplace in which to conduct their activities.

Work-related violences and associated variables in oncology nursing professionals

Occupational violence is a problem that health professionals are exposed to daily. This cross-sectional study aimed at identifying the prevalence of violence at work (verbal/physical) and the variables related to it in nursing professionals working in oncology. Physical or verbal aggression was assessed through self-report. The relationship between sociodemographic, psycho-emotional and work-related violence (verbal/physical) variables was analyzed using the Chi-Square, Fisher's Exact, Student T and Mann-Whitney tests. The study sample consisted of 231 nursing professionals. The prevalence of physical or verbal aggression reported in the last year was 61.5%. A higher prevalence of aggression was evidenced in professionals who stated that they were tired at the end of the shift and presented reduced concentration during the shift. It is noteworthy that workers who suffered violence presented high levels of burnout in all subscales, a higher Mean score on the work stress scale and a lower Mean with regards to sleep quality. The findings of this study point to the need for institutional measures to prevent and control occupational violence.

Burnout in Mental Health Care Professionals Working with Inpatients in Open or Closed Wards in Psychiatric Hospitals

Mental health care professionals are at risk of experiencing burnout. This cross-sectional study aims to investigate burnout in two settings: open and closed psychiatric wards, and two professions: registered nurses and social healthcare assistants in eight psychiatric wards in Denmark. A total of 114 professionals completed the Copenhagen Burnout Inventory and a demographic questionnaire. No statistically differences in burnout in professionals working in closed and open wards were found. However, we found professionals to score highest on personal and work-related burnout and lowest on client-related burnout. This indicates that patients may only play a minor role in burnout in health professionals.

Verbal Abuse in the Operating Room: A Survey of Three General Hospitals in the Peloponnese Region

Background

The operating room is a special place in a hospital structure, which has a very high psychological load and many moments of tension, often leading to difficulties in communication between the health professionals involved, as well as cases of verbal and physical violence.

Purpose

The purpose of the study was to investigate the existence of verbal violence in the operating rooms of three general hospitals in the Peloponnese region of Greece.

Methods

A cross-sectional survey was conducted of health professionals (physicians and nurses) employed in the operating rooms of three general hospitals in the Peloponnese region. For the data collection, the Verbal Abuse Scale questionnaire (VAS) was used. A total number of 80 questionnaires were self-completed and collected. The statistical analysis was performed with the SPSS Statistics software v.25 (IBM Corp., Armonk, NY).

Results

Regarding the frequency of verbal violence faced by health professionals, 36.8% of physicians stated that they experience verbal violence once a year whereas more than 20% of nurses reported that such incidents occur more than once a month (p=0.148). For the physicians, the abuser was usually their supervisor, while for the nurses, a physician. The majority of physicians stated that they felt mainly anger (2.94 ± 1.35), disgust (2.58 ± 1.54), and sadness/hurt (2.35 ± 1.37) after the verbal abuse, whereas most of the nurses felt anger (3.49 ± 1.39), disgust (3.05 ± 1.52) and frustration (2.95 ± 1.47).

Conclusion

Nurses are more often the victims of verbal abuse than physicians and are more likely to feel frustrated after experiencing verbal abuse. Gradual change to the organizational culture is an important measure to stop the occurrence of such incidents.

Workplace violence on healthcare professionals and underreporting: Characterization and knowledge gaps for prevention

Work-related violence against healthcare workers inflicted by healthcare users is a rising multidimensional phenomenon, a cause of concern among those who ensure the safety and health of these professionals. Although different studies indicate high percentages of attacks against healthcare workers, statistics from reports reveal much lower data. Underreporting of occupational violence against healthcare workers is a well-known fact reported in many studies. It is presented as a major obstacle when it comes to proposing adequate preventive measures, because the data on which to base these measures do not correspond to the true incidence of all the assaults that take place. Underreporting also makes it difficult to correctly assess the usefulness of preventive measures implemented. The following article looks at the latest studies carried out on the subject, presenting an overview of the factors accompanying these assaults, as well as the main reasons for this underreporting. It also highlights the lack in the literature of instruments designed to measure underreporting that have undergone a validation process. For all these reasons, this problem requires further study with validated tools to determine the reasons and circumstances that accompany and promote the underreporting of violence against healthcare workers. Knowing these reasons is a preliminary step in the fight against workplace violence and to measure the true magnitude of the problem, to provide the occupational health services with precise data and develop and assess the preventive measures implemented.

Prevalence of Second Victims, Risk Factors, and Support Strategies among German Nurses (SeViD-II Survey)

Background: Second victim phenomena (SVP) are critical to workplace and patient safety, and epidemiological data are limited to investigate the causes and impact on German health care. We investigated SVP in German nurses regarding prevalence, causes, and predisposition compared to a preceding study on German physicians (Second Victims in Deutschland/SeViD-I). Methods: We conducted a nationwide anonymous cross-sectional online study in 2020 using a modified SeViD questionnaire including the BFI-10 (personality traits). Statistical analysis was conducted using chi² tests and binary logistic regression models. Results: Of 332 nurses, 60% reported to experience SVP at least once a working lifetime, with a 12-month prevalence among SVP of 49%. Of the nurses, 24% reported recovery times of more than 1 year. In contrast to physicians from SeViD-I, a main cause for becoming a second victim was aggressive behavior by patients. High neuroticism values, higher age, and medium work life experience, but neither gender nor workplace position, were predisposing for SVP. Like SeViD-I, nurses reported demand for an institutional response in cases of SVP. Conclusions: SVP is common among German nurses and comprises other causes and a different course than in physicians. Further research should concentrate on specific prevention strategies, e.g., profession- and workplace-based educational programs.

Attitudes of psychiatric nurses towards aggression: A polish study

WHAT IS KNOWN ABOUT THE SUBJECT?

(SCIENTIFIC RATIONALE)

Mental health care in Poland lags behind that of many other countries, and coercive measures are used on a regular basis. Scant research has been conducted in Poland regarding the treatment of psychiatric patients. The perspectives of Polish psychiatric nurses towards aggression remain unknown. WHAT DOES THIS PAPER ADD TO THE EXISTING KNOWLEDGE?: The translated and validated Attitude Towards Aggression Scale (ATAS) in Polish will serve as an instrument that gauges Polish nurses' attitudes towards aggression. The Polish nurses have unenlightened and negative attitude towards aggression. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: There is now an instrument in Polish by which we can gauge the attitudes of mental health nurses, which must precede any educational efforts. Polish nurses showed more restrictive and antiquated attitudes about patient violence than nurses in some other parts of the world. With a shift to more positive attitudes, the use of coercion could be reduced, resulting in improved patient care.

INTRODUCTION

In Poland, the mode and site of patient treatment have changed little in the past 75 years, despite therapeutic advances worldwide. There is limited information regarding attitudes of nurses towards aggression in psychiatric settings in Poland, nor has there been an instrument in Polish to measure it.

AIM

To translate and validate the Attitudes Towards Aggression Scale (ATAS) for use in Poland, and to assess the attitudes of three groups of nursing personnel towards aggression.

METHOD

We surveyed 980 psychiatric and general nurses as well as nursing students. We translated the ATAS into Polish, and validated it using exploratory factor analysis.

RESULTS

The Polish version of the ATAS showed good psychometric properties. We found that Polish nurses perceived patient aggression extremely negatively.

DISCUSSION

Polish nurses perceive aggression as destructive, negative and not to be tolerated, leading to use of restraints. Among the three groups, psychiatric nurses showed the most negative attitude towards aggression. Thus, education is needed for preservice and inservice nurses alike to address this issue.

WHAT THIS STUDY ADDS TO EXISTING EVIDENCE

We now have a validated instrument to assess nurses' attitudes about aggression. We also know that Polish nurses have exceedingly negative attitudes towards aggression.

IMPLICATIONS FOR PRACTICE

The Polish version of ATAS was found valid and reliable. Therefore, we can now measure the attitudes of Polish nurses towards aggression, which was not possible previously. The baseline data provide a starting point from which to determine effects of educational efforts.