[Violence, Burnout and Minor Psychiatric Disorders in Hospital Work]

Perpetrators of gender-based workplace violence amongst nurses and physicians-A scoping review of the literature

In healthcare settings worldwide, workplace violence (WPV) has been extensively studied. However, significantly less is known about gender-based WPV and the characteristics of perpetrators. We conducted a comprehensive scoping review on Type II (directed by consumers) and Type III (perpetuated by healthcare workers) gender based-WPV among nurses and physicians globally. For the review, we followed the Preferred Reporting Items for Systematic and Meta Analyses extension for Scoping Review (PRISMA-ScR). The protocol for the comprehensive review was registered on the Open Science Framework on January 14, 2022, at https://osf.io/t4pfb/. A systematic search in five health and social science databases yielded 178 relevant studies that indicated types of perpetrators, with only 34 providing descriptive data for perpetrators' gender. Across both types of WPV, men (65.1%) were more frequently responsible for perpetuating WPV compared to women (28.2%) and both genders (6.7%). Type II WPV, demonstrated a higher incidence of violence against women; linked to the gendered roles, stereotypes, and societal expectations that allocate specific responsibilities based on gender. Type III WPV was further categorized into Type III-A (horizontal) and Type III-B (vertical). With Type III WPV, gendered power structures and stereotypes contributed to a permissive environment for violence by men and women that victimized more women. These revelations emphasize the pressing need for gender-sensitive strategies for addressing WPV within the healthcare sector. Policymakers must prioritize the security of healthcare workers, especially women, through reforms and zero-tolerance policies. Promoting gender equality and empowerment within the workforce and leadership is pivotal. Additionally, creating a culture of inclusivity, support, and respect, led by senior leadership, acknowledging WPV as a structural issue and enabling an open dialogue across all levels are essential for combating this pervasive problem.

Workplace violence against female healthcare workers: a systematic review and meta-analysis

BACKGROUND

Workplace violence (WPV) is highly prevalent in the health sector and remains a major occupational issue causing significant harm, ranging from bodily and psychological harm to death. Female healthcare workers (HCWs) are at high risk of WPV.

OBJECTIVES

Identify risk factors of WPV among different professional categories of female HCWs.

DATA SOURCES

PubMed, EMBASE and Web of Science, along with their references lists January 2010 and March 2022.

ELIGIBILITY CRITERIA

English language observational studies focusing on WPV among HCWs evaluating the risk factors, impacts and consequences of WPV in female HCWs.

METHOD

Risk of bias was assessed for all studies by Joanna Briggs Institute critical appraisal checklists. We estimated the pooled prevalence of WPV and the associated 95% CI using a random-effects meta-analysis model. We then described the associated factors and effects of WPV.

RESULTS

28 reviewed studies (24 quantitative, 4 qualitative and 1 mixed-method) from 20 countries were selected. From the available results of 16 studies, the pooled prevalence of WPV was estimated at 45.0% (95% CI 32% to 58%). Types of violence included verbal abuse, verbal threats, physical assaults, sexual harassment, mobbing, bullying and discrimination. Perpetrators were patients, patients' relatives, colleagues and supervisors. Nurses were the most studied HCWs category. WPV was found to affect both mental and physical health. Age, marital status, lower occupational position, substance abuse, shorter work experience and low support at work were the main socio-demographic and organisational factors associated with higher risk of WPV.

CONCLUSION

WPV prevalence is high among female HCWs, warranting a multilevel intervention approach to address and mitigate its impact. This approach should include targeted policies and individual-level strategies to create a safer work environment and prevent adverse effects on both HCWs and the broader healthcare system. Further research is needed to better document WPV in categories of HCWs other than nurses.

PROSPERO REGISTRATION NUMBER

CRD42022329574.

A gender-based review of workplace violence amongst the global health workforce-A scoping review of the literature

Workplace violence (WPV) impacts all levels of the health workforce, including the individual provider, organization, and society. While there is a substantial body of literature on various aspects of WPV against the health workforce, gender-based WPV (GB-WPV) has received less attention. Violence in both the workplace and broader society is rooted in gendered socio-economic, cultural, and institutional factors. Developing a robust understanding of GB-WPV is crucial to explore the differing experiences, responses, and outcomes of GB-WPV with respect to gender. We conducted a scoping review and report on the prevalence and risk factors of GB-WPV in healthcare settings globally. The review followed the Preferred Reporting Items for Systematic and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). We registered the scoping review protocol on the Open Science Framework on January 14, 2022, at https://osf.io/t4pfb/. A systematic search was conducted of empirical literature in five health and social science databases. Of 13667, 226 studies were included in the analysis. Across the studies, more women than men experienced non-physical violence, including verbal abuse, sexual harassment, and bullying. Men experienced more physical violence compared to women. Younger age, less experience, shifting duties, specific clinical settings, lower professional status, organizational hierarchy, and minority status were found to be sensitive to gender, reflecting women's structural disadvantages in the workplace. Given the high prevalence and impact of GB-WPV on women, we provided recommendations to address systemic issues in clinical practice, academia, policy, and research.

The relationship between workplace violence, emotional exhaustion, job satisfaction and turnover intention among nurses during the COVID-19 pandemic

Objectives

Workplace violence is a major issue in society, business and healthcare settings. It adversely affects both employee safety and their ability to provide healthcare services.

Aim

This study examined the association between workplace violence, emotional exhaustion, job satisfaction and turnover intention among nurses during the COVID-19 pandemic.

Methods

We collected data from 513 nurses. We conducted 'Process Macro' analysis. Firstly, we included three mediators in the model: job satisfaction, workplace violence and emotional exhaustion. Secondly, we used work hours and anxiety as moderators of the relationship between workplace violence and turnover intention.

Results

The findings revealed statistical significance that job satisfaction and workplace violence mediated the relationship between emotional exhaustion and nurse turnover intentions. Work hours and anxiety also moderated the relationship between workplace violence and nurses' turnover intention.

Conclusion

Respondents indicated that they were most affected by verbal violence during this time. Workplace violence is a negative factor that affects nurses' work, affecting them physically and psychologically. This occupational risk should be considered when evaluating nurses exposed to violence, as it affects job satisfaction and turnover intentions. The main theoretical contribution of this research is the identification of the association between workplace violence, emotional exhaustion, job satisfaction and turnover intention among nurses during the COVID-19 pandemic. It is clear that the research findings will be useful for healthcare professionals. The findings may have practical implications for healthcare administrators and their staff.

Predictors of Defensive Practices among Italian Psychiatrists: Additional Findings from a National Survey

Background: Defensive medicine is characterized by medical decisions made primarily as a precaution against potential malpractice claims. For psychiatrists, professional responsibility encompasses not only the appropriateness of diagnosis and treatment but also the effects of their interventions on patients and their behaviors. Objective: To investigate the socio-demographic, educational, and occupational characteristics and work-related attitudes that may serve as predictors of defensive medicine among Italian psychiatrists. This research extends the results of a previous analysis based on a national survey. Methods: A secondary analysis of the database of a national survey on attitudes and behaviors of Italian psychiatrists regarding defensive medicine and professional liability was performed for this study. Results: Among 254 surveyed psychiatrists, 153 admitted to practicing defensive medicine, while 101 had this attitude with less than half of their patients. The first group was predominantly comprised of women (p = 0.014), who were younger in age (43.34 y 9.89 vs. 48.81 y 11.66, p < 0.001) and had fewer years of professional experience (12.09 y ± 9.8 vs. 17.46 y ± 11.2, p < 0.001). There were no significant differences in prior involvement in complaints (p = 0.876) or the usual place of work (p = 0.818). The most prominent predictors for practicing defensive medicine were (1) considering guidelines and good clinical practices not only for their clinical efficacy but also or exclusively for reducing the risk of legal complaints for professional liability (OR = 3.62; 95%CI, 1.75-7.49), and (2) hospitalizing patients with violent intentions even if not warranted according to their mental state (OR = 2.28; 95%CI, 1.50-3.46, p < 0.001). Prioritizing protection from professional liability over patients' actual needs in prescribing or adjusting drug dosages and in involuntary hospitalization, as well as prescribing lower dosages than recommended for pregnant patients, were identified as additional predictors. Finally, years of professional experience exhibited a protective function against defensive practices. Conclusions: Psychiatrists advocate the need to implement a 'risk management culture' and the provision of more balanced duties in order to ensure ethical and evidence-based care to their patients. A particular source of concern stems from their professional responsibility towards not only the health of patients but also their behavior. However, these aspects conflict with a limited potential for assessment and intervention based on effective clinical tools. A reform of professional liability that considers the specificities of patients cared for by mental health services could contribute to reducing the risk of defensive medicine.

Predictors of Defensive Practices among Italian Psychiatrists: Additional Findings from a National Survey

Background: Defensive medicine is characterized by medical decisions made primarily as a precaution against potential malpractice claims. For psychiatrists, professional responsibility encompasses not only the appropriateness of diagnosis and treatment but also the effects of their interventions on patients and their behaviors. Objective: To investigate the socio-demographic, educational, and occupational characteristics and work-related attitudes that may serve as predictors of defensive medicine among Italian psychiatrists. This research extends the results of a previous analysis based on a national survey. Methods: A secondary analysis of the database of a national survey on attitudes and behaviors of Italian psychiatrists regarding defensive medicine and professional liability was performed for this study. Results: Among 254 surveyed psychiatrists, 153 admitted to practicing defensive medicine, while 101 had this attitude with less than half of their patients. The first group was predominantly comprised of women (p = 0.014), who were younger in age (43.34 y 9.89 vs. 48.81 y 11.66, p < 0.001) and had fewer years of professional experience (12.09 y ± 9.8 vs. 17.46 y ± 11.2, p < 0.001). There were no significant differences in prior involvement in complaints (p = 0.876) or the usual place of work (p = 0.818). The most prominent predictors for practicing defensive medicine were (1) considering guidelines and good clinical practices not only for their clinical efficacy but also or exclusively for reducing the risk of legal complaints for professional liability (OR = 3.62; 95%CI, 1.75–7.49), and (2) hospitalizing patients with violent intentions even if not warranted according to their mental state (OR = 2.28; 95%CI, 1.50–3.46, p < 0.001). Prioritizing protection from professional liability over patients’ actual needs in prescribing or adjusting drug dosages and in involuntary hospitalization, as well as prescribing lower dosages than recommended for pregnant patients, were identified as additional predictors. Finally, years of professional experience exhibited a protective function against defensive practices. Conclusions: Psychiatrists advocate the need to implement a ‘risk management culture’ and the provision of more balanced duties in order to ensure ethical and evidence-based care to their patients. A particular source of concern stems from their professional responsibility towards not only the health of patients but also their behavior. However, these aspects conflict with a limited potential for assessment and intervention based on effective clinical tools. A reform of professional liability that considers the specificities of patients cared for by mental health services could contribute to reducing the risk of defensive medicine.

Gender and Violence in the Daily Routine of Community Health Workers in Fortaleza, Brazil

Community Health Workers (CHWs) are the link between the Brazilian primary health care system and the community. Since CHWs live in the same neighborhoods they work, they are involved in what happens in the community, including observants and or potential targets of violence. However, it is not known if female and male CHWs perceive and suffer violence similarly. This study aimed to investigate the violence to which CHWs are exposed and if female CHWs experience and or perceive violence the same way as male CHWs. A structured questionnaire was used to collect information from CHWs. Two periods (2019 [n=1402] and 2021 [n=364]) were compared. The data show that more than 80% of CHWs were exposed to violence, either as victims or witnesses within the community they served. In general, while the occurrence of violence towards CHWs decreased, their perception of community violence increased. Over time, the perception of urban/community violence remained constant among male CHWs, but increased among female CHWs, as shown by the significant rise between 2019 and 2021 in the percentage of female CHWs reporting witnessing or hearing about manifestations of violence (e.g., physical aggression; assault; stabbing; lethal gunshot; non-lethal gunshot; and gang violence). Among male CHWs, perception only increased with regard to the item assault. Given the complexity of violence and its repercussions on the daily routines of CHWs, intersectoral and interdisciplinary partnerships between health workers and other stakeholders are needed to create strategies capable of dealing with expressions of violence in the territories served.

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.

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.

Doctors and Nurses: A Systematic Review of the Risk and Protective Factors in Workplace Violence and Burnout

The present study aims analyze the risk factors that lead to high levels of burnout among nurses and physicians and the protective factors that prevent them. Thus, it is also intended to explore the possible correlation between physical and verbal violence produced at work and the symptoms derived from burnout. Methods: The search was carried out on the Scopus, PubMed and Web of Science databases between 2000 and 2019 (on which date the bibliographic search ends). Descriptive studies estimating the prevalence of workplace violence and risk and protective factors and burnout were included. An adapted version of the Downs and Black quality checklist was used for article selection. 89.6 percent of the studies analysed were in the health sector. There is a significant correlation between burnout symptoms and physical violence at work. On the one hand, the risk factors that moderate this correlation were of structural/organisational type (social support, quality of the working environment, authoritarian leadership, little autonomy or long working days, etc.) and personal type (age, gender, nationality or academic degree, etc.). On the other hand, protective factors were the quality of the working environment, mutual support networks or coping strategies. The results were analysed in-depth and intervention strategies were proposed.

INTERVENING VARIABLES OF BURNOUT IN HEALTH PROFESSIONALS OF EMERGENCY SERVICES

ABSTRACT Objective: to analyze the association between Burnout, stress, mental suffering and other personal and work factors associated with this syndrome. Method: cross-sectional, descriptive and correlational study with 282 health professionals from the emergency services of the city of Ribeirão Preto, Brazil, collected from October 2015 to March 2016. The instruments used were: sociodemographic questionnaire, Maslach Burnout Inventory, Childhood Trauma Questionnaire, Stress Symptom Inventory, Perceived Stress Scale, Psychiatric Screening Questionnaire, Fantastic Lifestyle Checklist, Hospital Anxiety and Depression Scale and Holmes-Rahe Social Readjustment Rating Scale. Descriptive writing of the data. Pearson's Chi-Square or Fisher's Exact Tests to check the association between variables and later regression analysis, in which ORs were calculated, with 95% CI and 5% significance level. Results: there was statistical evidence of an association between Burnout and education, early stress, stress, common mental disorders, lifestyle, anxiety and depression. The regression analysis shows that the variables that influence Burnout are: type of service (p=0.032; OR=0.187), education (p=0.029; OR=2.313), perception of stress (p=0.037; OR=1.67) and social readjustment (p=0.031; OR=1.279). Conclusion: this study points to a profile for the development of Burnout, consisting of health professionals with higher education, who suffered early stress, who have symptoms and perception of stress, who do not have a healthy lifestyle and show symptoms of mental suffering. Such results can assist in the development and implementation of strategies aimed at reducing both work stress and the prevalence of Burnout syndrome.

Workplace Violence and Neurosurgery: Insights from a Nationwide Survey

OBJECTIVE

Workplace violence (WPV) against neurosurgeons is an understudied phenomenon, as previous research has focused on high-risk specialties like emergency medicine and psychiatry. We sought to fill in this gap in the literature by determining the frequency and type of WPV that neurosurgeons experience.

METHODS

We sent a 26-question online survey to members of the American Association of Neurological Surgery via SurveyMonkey. This survey contained questions about WPV experienced over the previous two years, as well as questions about security measures and workplace protocols for WPV.

RESULTS

We received 107 responses of 4757 surveys disseminated, a response rate of 2.25%. Although small, this response rate is representative of historical survey response rates. In total, 53.3% of our sample reported WPV, and 4.7% reported at least one physical assault. In total, 50.5% of respondents were afraid of becoming a victim of WPV, and 40.4% felt less secure today than when they began practicing. A total of 17.8% of respondents reported that they had obtained a weapon or a concealed weapon permit due to a perceived threat. Tests for association revealed that early career and female neurosurgeons were significantly more likely to receive verbal threats than other neurosurgeons (P = 0.049 and 0.01, respectively).

CONCLUSIONS

WPV is prevalent in neurosurgery at rates comparable with a range of other specialties. Many neurosurgeons feel unsafe in the workplace, with some taking significant actions such as weapon acquisition. An opportunity for education and resources regarding WPV exists, especially among early career and female neurosurgeons.

Violence at work in emergency care units: nurses' experiences

Objectives:

to understand the perception of nurses in emergency care units about the violence experienced at work.

Method:

qualitative study conducted through 21 individual interviews between November and December 2018 in two emergency care units in a city in Paraná. Symbolic Interactionism was adopted as the theoretical framework and the Thematic Content Analysis technique was used to evaluate the data.

Results:

from the thematic category experiencing psychological violence in the nurses’ daily work, it was evidenced that it was related to threats against their lives, cursing, humiliation, embarrassment, attempt to defame them, as well as pressure from subordinates. In the category experiencing physical violence in the nurses’ daily work, it was found that it was imposed through pushing, pulling hair, throwing objects, the presence of firearms and knives and, even, witnessing murder.

Conclusion:

nurses suffered acts of violence by external and internal people, from the emergency care units themselves. Managers, nurses and society need to look reflexively and critically at the violence that happens and implement actions to avoid them, thus providing a safe working environment for all involved and educate society in order to make the reduction of violence a priority in public policies.

The Influence of Electronic Health Record Use on Physician Burnout: Cross-Sectional Survey

Background

Physician burnout has a direct impact on the delivery of high-quality health care, with health information technology tools such as electronic health records (EHRs) adding to the burden of practice inefficiencies.

Objective

The aim of this study was to determine the extent of burnout among physicians and learners (residents and fellows); identify significant EHR-related contributors of physician burnout; and explore the differences between physicians and learners with regard to EHR-related factors such as time spent in EHR, documentation styles, proficiency, training, and perceived usefulness. In addition, the study aimed to address gaps in the EHR-related burnout research methodologies by determining physicians’ patterns of EHR use through usage logs.

Methods

This study used a cross-sectional survey methodology and a review of administrative data for back-end log measures of survey respondents’ EHR use, which was conducted at a large Canadian academic mental health hospital. Chi-square and Fisher exact tests were used to examine the association of EHR-related factors with general physician burnout. The survey was sent out to 474 individuals between May and June 2019, including physicians (n=407), residents (n=53), and fellows (n=14), and we measured physician burnout and perceptions of EHR stressors (along with demographic and practice characteristics).

Results

Our survey included 208 respondents, including physicians (n=176) and learners (n=32). The response rate was 43.2% for physicians (full-time: 156/208, 75.0%; part-time: 20/199, 10.1%), and 48% (32/67) for learners. A total of 25.6% (45/176) of practicing physicians and 19% (6/32) of learners reported having one or more symptoms of burnout, and 74.5% (155/208) of all respondents who reported burnout symptoms identified the EHR as a contributor. Lower satisfaction and higher frustration with the EHRs were significantly associated with perceptions of EHR contributing toward burnout. Physicians’ and learners’ experiences with the EHR, gathered through open-ended survey responses, identified challenges around the intuitiveness and usability of the technology as well as workflow issues. Metrics gathered from back-end usage logs demonstrated a 13.6-min overestimation in time spent on EHRs per patient and a 5.63-hour overestimation of after-hours EHR time, when compared with self-reported survey data.

Conclusions

This study suggests that the use of EHRs is a perceived contributor to physician burnout. There should be a focus on combating physician burnout by reducing the unnecessary administrative burdens of EHRs through efficient implementation of systems and effective postimplementation strategies.

Mapping the Scientific Research on Healthcare Workers' Occupational Health: A Bibliometric and Social Network Analysis

In the last few years, the occupational health (OH) of healthcare workers (HCWs) has been shown increasing concern by both health departments and researchers. This study aims to provide academics with quantitative and qualitative analysis of healthcare workers’ occupational health (HCWs+OH) field in a joint way. Based on 402 papers published from 1992 to 2019, we adopted the approaches of bibliometric and social network analysis (SNA) to map and quantify publication years, research area distribution, international collaboration, keyword co-occurrence frequency, hierarchical clustering, highly cited articles and cluster timeline visualization. In view of the results, several hotspot clusters were identified, namely: physical injuries, workplace, mental health; occupational hazards and diseases, infectious factors; community health workers and occupational exposure. As for citations, we employed document co-citation analysis to detect trends and identify seven clusters, namely tuberculosis (TB), strength training, influenza, healthcare worker (HCW), occupational exposure, epidemiology and psychological. With the visualization of cluster timeline, we detected that the earliest research cluster was occupational exposure, then followed by epidemiology and psychological; however, TB, strength training and influenza appeared to gain more attention in recent years. These findings are presumed to offer researchers, public health practitioners a comprehensive understanding of HCWs+OH research.

A cross-sectional study of job burnout, psychological attachment, and the career calling of Chinese doctors

Background

The main objectives of this study were as follows: (1) evaluate the prevalence of burnout syndrome among doctors, (2) establish associations with demographic factors in China, and (3) examine the mediating role of psychological attachment in the relationship between job burnout and career calling.

Methods

This cross-sectional survey was conducted by administering an online questionnaire in May 2016. The survey was performed across Thirty provinces. In total, A total of 3016 Chinese doctors were selected as participants, of which 2617 completed valid questionnaires (effective response rate: 86.77%).

Results

The overall prevalence of burnout symptoms among Chinese doctors was 85.79%. Little variance was reported for burnout symptoms according to age (Waldχ² = 6.843, P < 0.05, OR < 1), professional title (Waldχ² = 13.110, P < 0.05, OR > 1), and daily working hours (Waldχ² = 7.226, P < 0.05, OR > 1). However, the burnout of Chinese doctors was found to be associated with psychological attachment (B = − 0.6433, P < 0.0001) and career calling (B = 0.3653, P < 0.0001); furthermore, psychological attachment (B = 0.2350, P < 0.001) mediated the relationship between job burnout and career calling.

Conclusion

Burnout symptoms among Chinese doctors were prevalent and associated with age, professional title, and long working hours. Chinese doctors aged 20–30 experienced a much higher level of burnout symptoms. The longer hours doctors worked, the more likely they were at risk of burnout symptoms, especially among attending physicians. Doctors who endured high-level burnout tended to exhibit decreasing psychological attachment, which threatened their sense of career calling. Finally, this paper proposed related explanations for the function mechanisms based on both theoretical and practical perspectives.

Psychosocial aspects of work and minor psychic disorders in nursing: use of combined models

OBJECTIVE

to analyze the combined use of models for the evaluation of work-related psychosocial aspects and their association with the prevalence of Minor Psychics Disorders among nursing workers.

METHOD

cross-sectional study with a sample of 285 nursing workers. Data collection was performed through the application of a structured sociodemographic and occupational questionnaire and the Demand-Control-Support, Effort-Reward Imbalance and Self-Reporting Questionnaire. Descriptive analysis and a multiple logistic regression were performed.

RESULTS

the prevalence of suspicion of minor psychics disorders was 32.6%. The dimensions of both models were associated with mental health. The full Effort-Reward Imbalance and Demand-Control and Social Support models predict Minor Psychics Disorders to a greater extent than the combined use of partial models.

CONCLUSION

it was found that the Effort-Reward Imbalance model captured better the magnitude of the Minor Psychics Disorders in this sample of workers compared to the Demand-Control and Social Support model. However, the concomitant use of the theoretical models revealed unique contributions in the evaluation of Minor Psychics Disorders. Considering the complexity of mental illnesses, it is important that different factors be evaluated.

Risk of illness and human cost at work in a psychiatric hospital

Abstract Objective: To investigate the risk of illness and to the human cost at work from the point of view of the nursing team of a psychiatric hospital. Method: A cross-sectional study performed in a psychiatric hospital with 74 nursing workers. The Human Cost of Labor Scale was applied. Results: In the evaluation of the human cost at work, the cognitive cost factor was evaluated as a critical risk for the sickness of the nursing worker, while the factors affective cost and physical cost demonstrated a satisfactory evaluation. The items considered critical for illness referred to: having control of emotions, dealing with the aggressiveness of others, use of vision and memory, and repeated and repeated use of the legs and hands. Conclusion: The evaluated items reveal conditions critical to the health of the nursing worker in mental health, revealing risk of illness.

Work-related mental disorders among nursing professionals: a Brazilian integrative review

Work-related mental disorders have several causes and might affect all healthcare professionals. Nursing professionals are exposed to high physical and psychological demands which contribute to the development of mental illnesses. The aim of the present study was to survey studies conducted in Brazil to investigate the causal relationship between mental disorders and nursing professionals' work. Integrative review of studies conducted in Brazil from 2010 to 2017. The literature search was performed on the Virtual Health Library database. Combination of descriptors and application of filters resulted in seven articles. Duplicates, doctoral dissertations and articles which did not meet the study aims were excluded. Mental suffering impairs the family, social, personal and professional life of nursing professionals, their studies, self-comprehension and understanding of others, self-criticism ability, acceptance of problems and possibility to take pleasure in life as a whole. The physical load resulting from a large volume of activities, understaffing, large numbers of patients and psychological pressure in the workplace contribute to the development of mental disorders. The pressure to which nursing professionals are exposed in the workplace and double shifts, together with coping modalities and low salary contribute to sick leaves due to mental disorders. However, broader scoped studies are needed.

A violência contra os profissionais da enfermagem no setor de acolhimento com classificação de risco

RESUMO Objetivo Conhecer os tipos de violência e os fatores que contribuem para os atos violentos sofridos pela equipe de enfermagem no acolhimento com classificação de risco (ACCR). Métodos Estudo descritivo de abordagem qualitativa, realizado em um hospital regional referência em urgência e emergência do oeste do Estado do Rio Grande do Norte, com 10 profissionais da enfermagem. Coletou-se os dados através de entrevista e analisou-se pela técnica do discurso do sujeito coletivo. Resultados Evidencia-se que os profissionais sofrem violência por parte dos usuários, de outros profissionais e predomina a violência verbal. Apontam como causas a falta de informação do usuário, a postura profissional e a falha da atenção primária. Conclusão Há a necessidade de trabalhar a educação permanente com os profissionais de saúde e atividades educativas com os usuários sobre o ACCR, no sentido de promover relações harmônicas entre profissionais e usuários e que estes possam compreender a dinâmica do trabalho nas redes de atenção.

A Cross-Sectional Multicenter Study of Workplace Violence against Prehospital Emergency Medical Technicians

Background and Purpose

Workplace violence is a global phenomenon and violation of human rights affects the people's self-esteem and quality of work and causes inequality, discrimination, disorder, and conflict at work. The present study was carried out aiming at determining the workplace violence against the prehospital emergency medical technicians (PEMTs) in three provinces of Fars, Kohgiluyeh and Boyer-Ahmad, and Bushehr, Iran.

Materials and Methods

This was a cross-sectional multicenter study in which 206 PEMTs from Fars, Bushehr, and Kohgiluyeh and Boyer-Ahmad provinces participated. Simple random sampling was used in this study. In order to collect data, a researcher-made tool was used. Descriptive statistics and SPSS® software version 22 were used to analyze the data.

Results

Among various types of workplace violence, the most frequent ones were verbal violence (78.1%), physical violence (60.3%), and cultural violence (31.7%), respectively. The most important factor in the occurrence of workplace violence was the lack of the awareness of people about the duties of the PEMTs. With regard to the handling of the violent situations, the results indicated that 61.6% of the personnel asked the attacker to calm down. 48.5% of PEMTs believed that violence was normal in their work.

Conclusion

Due to the high rate of workplace violence against PEMTs, it is suggested that methods such as formal training and retraining programs for the employees, general education with regard to the duties of the PEMTs, and socially supporting them should be used to reduce and control violence.

Minor psychiatric disorders in nursing: prevalence and associated factors

ABSTRACT Objective: to investigate the prevalence of Minor Psychiatric Disorders and associated factors in nursing workers. Method: observational and analytical sectional study. Data were collected from 285 nursing workers. A questionnaire containing sociodemographic, occupational, psychosocial aspects of work and mental health was used. Bivariate and multivariate analysis were performed by binary logistic regression. Results: the global prevalence of suspected Minor Psychiatric Disorders among nursing workers was 32.6%. Higher prevalence rates were found among female, young, married/common-law married individuals, in the nursing assistant/technician categories, with income up to four minimum wages, developing high-demand work with low social support, high effort-reward imbalance, and over-commitment. Conclusion: the variables that remained associated with the mental health outcome in the final model were: female gender, married/common-law married, high-demand work, high effort-reward imbalance, and over-commitment.

Strategies used by nursing staff in situations of workplace violence in a haemodialysis unit

Objective

To identify strategies that nursing staff use at a haemodialysis unit in situations of violence by patients during care.

Method

Qualitative descriptive and exploratory research with focus groups and the participation of eight workers of the nursing staff of a private haemodialysis unit in southern Brazil. The data were subjected to thematic content analysis.

Results

The adopted strategies are described in the following categories: Tolerating violence due to the patient's health condition; Working around conflicting situations and giving in to patient's requests; Adopting a position of rejection to violence; and Staying away from the aggressor patient.

Final considerations

Workers and, above all, the institution in the role of mediator, must work together to prevent and discourage violence in the workplace.

A cross-sectional study on the prevalence and associated risk factors for workplace violence against Chinese nurses

OBJECTIVES

The purpose of the present study was to explore the characteristics of workplace violence that Chinese nurses at tertiary and county-level hospitals encountered in the 12 months from December 2014 to January 2016, to identify and analyse risk factors for workplace violence, and to establish the basis for future preventive strategies.

DESIGN

A cross-sectional study.

SETTING

A total of 44 tertiary hospitals and 90 county-level hospitals in 16 provinces (municipalities or autonomous regions) in China.

METHODS

We used stratified random sampling to collect data from December 2014 to January 2016. We distributed 21 360 questionnaires, and 15 970 participants provided valid data (effective response rate=74.77%). We conducted binary logistic regression analyses on the risk factors for workplace violence among the nurses in our sample and analysed the reasons for aggression.

RESULTS

The prevalence of workplace violence was 65.8%; of this, 64.9% was verbal violence, and physical violence and sexual harassment accounted for 11.8% and 3.9%, respectively. Frequent workplace violence occurred primarily in emergency and paediatric departments. Respondents reported that patients' relatives were the main perpetrators in tertiary and county-level hospitals. Logistic regression analysis showed that respondents' age, department, years of experience and direct contact with patients were common risk factors at different levels of hospitals.

CONCLUSIONS

Workplace violence is frequent in China's tertiary and county-level hospitals; its occurrence is especially frequent in the emergency and paediatric departments. It is necessary to cope with workplace violence by developing effective control strategies at individual, hospital and national levels.

Workplace Violence in Mental Health: A Victorian Mental Health Workforce Survey

The international literature suggests workplace violence in mental health settings is a significant issue, yet little is known about the frequency, nature, severity and health consequences of staff exposure to violence in Australian mental health services. To address this gap, we examined these aspects of workplace violence as reported by mental health services employees in Victoria, Australia. The project used a cross-sectional, exploratory descriptive design. A random sample of 1600 Health and Community Services Union members were invited to complete a survey investigating exposure to violence in the workplace, and related psychological health outcomes. Participants comprised employees from multiple disciplines including nursing, social work, occupational therapy, psychology and administration staff. A total of 411 members responded to the survey (26% response rate). Of the total sample, 83% reported exposure to at least one form of violence in the previous 12 months. The most frequently reported form of violence was verbal abuse (80%) followed by physical violence (34%) and then bullying/mobbing (30%). Almost one in three victims of violence (33%) rated themselves as being in psychological distress, 54% of whom reported being in severe psychological distress. The more forms of violence to which victims were exposed, the greater the frequency of reports of psychological distress. Workplace violence is prevalent in mental health facilities in Victoria. The nature, severity and health impact of this violence represents a serious safety concern for mental health employees. Strategies must be considered and implemented by healthcare management and policy makers to reduce and prevent violence.

Understanding the burnout experience: recent research and its implications for psychiatry

The experience of burnout has been the focus of much research during the past few decades. Measures have been developed, as have various theoretical models, and research studies from many countries have contributed to a better understanding of the causes and consequences of this occupationally-specific dysphoria. The majority of this work has focused on human service occupations, and particularly health care. Research on the burnout experience for psychiatrists mirrors much of the broader literature, in terms of both sources and outcomes of burnout. But it has also identified some of the unique stressors that mental health professionals face when they are dealing with especially difficult or violent clients. Current issues of particular relevance for psychiatry include the links between burnout and mental illness, the attempts to redefine burnout as simply exhaustion, and the relative dearth of evaluative research on potential interventions to treat and/or prevent burnout. Given that the treatment goal for burnout is usually to enable people to return to their job, and to be successful in their work, psychiatry could make an important contribution by identifying the treatment strategies that would be most effective in achieving that goal.