Encouraging employees to report verbal violence in primary health care in Serbia: A cross-sectional study

A Qualitative Systematic Review of Healthcare Practitioners' Experience of Workplace Violence

Healthcare practitioners face significant risks of workplace violence due to various reasons such as hospital congestion, miscommunication, and aggressive behaviours of patients and relatives. Exposure to workplace violence may disrupt the workflow process and compromise patient care in healthcare facilities, ultimately affecting job performance, reducing job satisfaction, and negatively affecting the physical and mental health of healthcare practitioners. This study aimed to review all the published studies conducted on the experiences of workplace violence among healthcare practitioners. This study is a systematic review of qualitative studies. Data were collected through online databases including ScienceDirect, PubMed, MEDLINE and JSTOR were searched from the year 2015-2021. The inclusion criteria were: qualitative methods and mixed methods of data collection and analysis; studies that were carried out among healthcare practitioners who have been experience on workplace violence; scope of the primary studies included experience of workplace violence; and published in English/Malay in academic journal between 2015 and 2021. A total of 15 papers were included in the final analysis. The overall quality of the included papers was high. Of the 15 papers, 12 studies fully met the CASP criteria. The results of the 15 included studies were organised into the thematic groups of: i) verbal violence as the common workplace violence; ii) perceived causes of workplace violence and iii) seeking help. Across different countries, verbal violence was the most common type of workplace violence reported by healthcare practitioners. This review also identified that a lack of information, failure to meet patient expectations, and delayed treatment were the main contributing factors to workplace violence.

Workplace violence against healthcare workers in Pakistan; call for action, if not now, then when? A systematic review

BACKGROUND

Workplace violence (WPV) is a global problem that affects healthcare workers' physical and mental health and impairs work performance. Pakistan's healthcare system is not immune to WPV, which the World Health Organization recognises as an occupational hazard.

OBJECTIVES

The primary objective of this systematic review is to determine the prevalence of physical, verbal, or other forms of WPV in healthcare workers in Pakistan. Secondary objectives include identifying the associated risk factors and perpetrators of WPV.

METHODS

A systematic review of six electronic databases was conducted through August 2022. Studies were included if they met the following criteria: 1) healthcare workers (HCWs), including physicians, nurses, and paramedic staff working in the private or public sector of Pakistan; 2) exposure to physical, verbal, or any type of violence. Data were extracted and analysed for the prevalence of WPV, types of violence, associated risk factors, and perpetrators of violence.

RESULTS

Twenty-four studies including 16,070 HCWs were included in this review. Verbal violence was the most common form of violence levied, with its highest prevalence (100%) reported in Islamabad and lowest verbal violence prevalence (25%) in Karachi. Verbal abuse was preponderant against female HCWs, while physical abuse was directed more towards males. The most common perpetrators were patient attendants, followed by the patients.

CONCLUSION

Our review determines a 25-100% prevalence of WPV against HCWs in Pakistani medical setups. This occupational hazard needs the attention of relevant authorities in the country to put protective enforcement policies in place. Large-scale surveys should be conducted to better gauge the current plight of HCWs in the nation.

Application of the theory of planned behaviour for predicting the determinants of workplace violence reporting behaviour among public hospital healthcare workers in Malaysia: A cross-sectional study

Introduction

Reporting workplace violence (WPV) is a crucial preventive measure. Given the great impact of WPV on mental health and well-being, this study aimed to determine the prevalence and determinants of WPV reporting among healthcare workers (HCWs).

Method

A total of 557 public hospital HCWs in Melaka were recruited via probability sampling. A questionnaire guided by the theory of planned behaviour was developed, pre-tested and distributed. Malaysians with a minimum employment period of 12 months who experienced WPV within the same period in the selected public hospitals were eligible for inclusion. Multiple logistic regression analysis was conducted to determine the association between the independent variables and WPV reporting.

Results

Psychological violence was the most common WPV (80.3%), with only 177 (31.8%) respondents reporting such. The respondents who had high subjective norm (adjusted odds ratio [AOR]=2.160, 95% confidence interval [CI]=1.32-3.53) and perceived behavioural control scores (AOR=3.976, 95% CI=2.41-6.55); were clinical (AOR=2.679, 95% CI=1.43-5.02) and non-clinical (AOR=4.271, 95% CI=2.23-8.18) support staff; experienced physical WPV (AOR=13.157, 95% CI=3.83-45.24) and both physical and psychological WPV (AOR=2.029, 95% CI= 1.13-3.65); and perceived that WPV was intentional (AOR=11.111, 95% CI=6.50-19.00) were more likely to report WPV.

Conclusion

HCWs who experience physical WPV have the highest likelihood to report, followed by those who perceive WPV as intentional. The prevalence of reported WPV among public hospital HCWs is low, potentially underestimating its true occurrence owing to underreporting. Ensuring readily available reporting mechanisms for WPV, especially the psychological type, is crucial for HCWs.

Contemporary evidence of workplace violence against the primary healthcare workforce worldwide: a systematic review

Violence against healthcare workers recently became a growing public health concern and has been intensively investigated, particularly in the tertiary setting. Nevertheless, little is known of workplace violence against healthcare workers in the primary setting. Given the nature of primary healthcare, which delivers essential healthcare services to the community, many primary healthcare workers are vulnerable to violent events. Since the Alma-Ata Declaration of 1978, the number of epidemiological studies on workplace violence against primary healthcare workers has increased globally. Nevertheless, a comprehensive review summarising the significant results from previous studies has not been published. Thus, this systematic review was conducted to collect and analyse recent evidence from previous workplace violence studies in primary healthcare settings. Eligible articles published in 2013-2023 were searched from the Web of Science, Scopus, and PubMed literature databases. Of 23 included studies, 16 were quantitative, four were qualitative, and three were mixed method. The extracted information was analysed and grouped into four main themes: prevalence and typology, predisposing factors, implications, and coping mechanisms or preventive measures. The prevalence of violence ranged from 45.6% to 90%. The most commonly reported form of violence was verbal abuse (46.9-90.3%), while the least commonly reported was sexual assault (2-17%). Most primary healthcare workers were at higher risk of patient- and family-perpetrated violence (Type II). Three sub-themes of predisposing factors were identified: individual factors (victims' and perpetrators' characteristics), community or geographical factors, and workplace factors. There were considerable negative consequences of violence on both the victims and organisations. Under-reporting remained the key issue, which was mainly due to the negative perception of the effectiveness of existing workplace policies for managing violence. Workplace violence is a complex issue that indicates a need for more serious consideration of a resolution on par with that in other healthcare settings. Several research gaps and limitations require additional rigorous analytical and interventional research. Information pertaining to violent events must be comprehensively collected to delineate the complete scope of the issue and formulate prevention strategies based on potentially modifiable risk factors to minimise the negative implications caused by workplace violence.

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.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Patient and Family Perpetrated Cyber-Incivility and Cyber-Aggression Within Healthcare: A Cross-Sectional Descriptive Study

Introduction

Verbal violence may manifest in written form as cyber incivility within patient portal communications. As a form of digital technology, patient portal messages create a physical and emotional distance leading the sender to be disinhibited and disassociated from the recipient nurse. Written patient portal messages may contain uncivil language deemed verbally violent when the content escalates beyond professional standards. When these messages are encountered as part of patient care, they may lead to nurses' psychological distress. Although cyber-incivility has been studied within social media and business, little is known about cyber-incivility within healthcare.

Objectives

The purpose of the study was to define cyber-incivility as it manifests within healthcare compared to business, determine sender demographics, and quantify the impact on nurses.

Methods

A cross-sectional descriptive study was conducted to analyze portal communications. Nurses forwarded aggressive messages to leadership and quantified their level of distress after receiving the message. Sender demographics were tracked, and content was analyzed using Braun and Clarke's Thematic Analysis.

Results

Of the 31 included messages, senders were of varying ages, genders, and marital statuses. Messages rarely related to medications and rarely contained expletives. The most distressing messages were ad hominem, demanding, accusatory, or contained threats. These messages illustrated how healthcare cyber-incivility manifested and deviated from appropriate professional standards to become a form of verbal workplace violence. Message content also identified antecedents; related to unmet expectations, patient accountability, or difficulty navigating healthcare.

Conclusions

Written incivil/uncivil/aggressive patient portal messages contained personal attacks and professionally degrading content, which were distressing to nurses. A healthcare-specific framework was created and provided context to understand the difficult and aggressive messages nurses received while providing digital patient care. Awareness of cyber-incivility within healthcare allows for better support of nurses who are exposed to this form of workplace violence and is foundational to future intervention development.

Assessment of Non-physical User Violence and Burnout in Primary Health Care Professionals. The Modulating Role of Job Satisfaction

Introduction

Growing concern about workplace violence shows the need for an evaluation in specific contexts in order to identify the particularities of each professional group. The health sector consists of a group of professionals with high exposure to violence, specially from users. There are differences depending on the professional category or unit in which the professional works. In this regard, Primary Health Care (PHC) is characterized by a personalized and continuous patient treatment over time, which is not exempt from cases of violence. Among the commonly studied consequences of these situations are decreases in job satisfaction and burnout.

Objective

The main objective of this study is to analyze the modulating role of job satisfaction in the relationship between non-physical user violence and the onset of burnout.

Methods

Cross-sectional comparative descriptive design. The sample consisted of 574 professionals from 39 PHC centers of the Murcian Health Service. Data were collected using two-stage cluster sampling. For data analysis, descriptive analysis, correlations and stepwise hierarchical regression were used to analyze the interaction between the variables.

Results

Regression analysis draws a model where non-physical violence and low intrinsic and extrinsic job satisfaction act as modulators of non-physical violence, cynicism and emotional exhaustion.

Conclusions

This study provides evidence of the psychological consequences of the perception of user violence in the PHC staff. Furthermore, it is evident that the emergence of burnout syndrome in these professionals is related to exposure to verbal or non-physical violence together with low job satisfaction. In this sense, a circular and bidirectional relationship between the variables studied is proposed as a possible explanatory model.

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.

Associations Between Workplace Violence, Mental Health, and Physical Health among Korean Workers: The Fifth Korean Working Conditions Survey

BACKGROUND

Workplace violence (WPV) is a global public health problem and a threat to the health of Korean workers. This study assessed the prevalence and risk factors of WPV and its association with mental and physical health among Korean workers.

METHODS

Data obtained for 50,205 respondents to the Fifth Korean Working Conditions Survey were utilized for this study. Verbal abuse, threats, physical violence, and sexual harassment were assessed individually and as a composite for "any WPV." Workers were characterized by education, income, shift work status, access to a health and safety education program, work sector and overall health. Descriptive analyses and multiple logistic regression analyses were used to estimate the prevalence of WPV and its association with mental and physical health.

FINDINGS

Overall, 5.6% of workers reported experiencing one of four forms of WPV. The prevalence of verbal abuse, threats, physical violence, and sexual harassment were 4.9%, 0.7%, 0.2%, and 1.1%, respectively. Most perpetrators were customers. Prevalence of WPV was associated with lower education level, poor health status, long working hours, shift work, and no experience of health and safety education; 9.0% of service workers experienced violence. Workers who had experienced WPV were more likely to experience anxiety, sleep-related problems, depressive symptoms, back pain, headache/eye strain, and overall fatigue.

CONCLUSIONS/APPLICATIONS TO PRACTICE

Workplace violence is a serious occupational and public health concern in Korea. These results suggest managing WPV may improve workers' well-being and that violence-prevention strategies, policies, and regulations should be implemented across most industries.

Validation of the Croatian Version of Work Ability Index (WAI) in Population of Nurses on Transformed Item-Specific Scores

Aim

To assess the psychometric properties of the Croatian version of a Work Ability Index Questionnaire (WAIQ-CRO) in the population of nurses by using a specific methodological approach.

Methods

A cross-sectional survey was conducted in a sample of 711 Croatian nurses in 2018 in Zagreb, Croatia. The instrument’s internal consistency was assessed by using Cronbach’s alpha coefficient (α). The factor structure was verified by confirmatory (CFA) and exploratory factor analysis (EFA), with the assumption of a single-factor structure. To ensure the equality of importance of items in the assessment, the item-specific scores were transformed.

Results

The internal consistency of the instrument was satisfactory (α=0.71). CFA showed poor first model (Model-1) compatibility data (p<0.001, CFI=0.85, GFI=0.93, RMSEA=0.13). The modificated indexes suggested the introduction of correlation parameters residual variances of results from WAIQ-CRO Item-1 and Item-2. After introducing these covariances, the index model assentation (Model-2) showed desirable assentation measures (p<0.001, CFI=0.95, GFI=0.97, RMSEA=0.08). Comparison showed better compatibility of Model-2 (p<0.001). The implementation of EFA has identified three factors. Replication of this model in CFA resulted in relatively good model assentation approaches with data (p<0.001, CFI=0.96, GFI=0.98, RMSEA=0.07). Comparison of this model (Model-3) with Model-2 showed a significantly better compatibility of Model-3 (p<0.001).

Conclusion

The WAIQ-CRO proved to be a reliable and valid instrument which can be used in research among Croatian nurses. The results suggest that it would be better to consider a three-factor structure than a single-factor structure, as a three-factor structure can direct decision-makers to which segment to locate interventions.

Workplace Violence and Sanctioning of Family Medicine Physicians Due to the Rules of Health Insurance Funds in the Western Balkan

INTRODUCTION

After family medicine's famous beginnings in the early 60's through introduction of the world's first family medicine specialization, with transitional changes and war also come changes in former Yugoslavia's healthcare systems.

AIM

The primary aim of this article is to analyze frequency and causes of sanctioning of family physicians by Health insurance funds in the countries of former Yugoslavia. The secondary aim is to evaluate frequency and types of workplace violence family physicians experienced due to insurance boundaries for patients.

METHODS

The comparative, cross-sectional survey was carried out from October 2017 to February 2018. Study participants were general practitioners' (GPs), family physicians (FPs) and those without a specialty designation but providing family medicine services in one of the five Western Balkans countries: Croatia, Slovenia, Serbia, Macedonia and Bosnia and Herzegovina (B&H). The questionnaire was designed for the purpose of the study.

RESULTS

Forty-nine percent of participating physicians have been sanctioned by Health Insurance Fund and 77. 5% has been exposed to workplace violence. The most common type of violence was verbal (76.6%). Financial penalties according to the scale had the highest rates in Macedonia (73.9%) and Slovenia (43.9%).

CONCLUSION

It is necessary to educate creators of healthcare policies, doctors and patients for the purpose of establishing partner relations which would lead to strengthening of primary healthcare, but also to a more efficient healthcare system.