Occupational violence in nursing: explanations and coping strategies

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.

Workplace bullying in the nursing profession: A cross-cultural scoping review

BACKGROUND

Globally, nurses are at high risk of exposure to workplace bullying, and there is a growing body of literature addressing bullying in the nursing profession. Yet, our understanding of cross-cultural variations in bullying among nurses is lacking. An analysis of what is currently known about bullying in different parts of the world is critical for our understanding of cross-cultural effects of bullying among nurses.

OBJECTIVES

We aimed to examine workplace bullying research among nurses with the focus on sources, antecedents, outcomes and coping responses from a cross-cultural perspective during the years 2001-2019.

DESIGN

This is a scoping review of published literature on workplace bullying among nurses.

DATA SOURCES

A literature search was conducted using the CINAHL, PubMed, PsychINFO and Web of Science databases. A total of 166 articles provided data from the following cultural clusters: Anglo, Latin Europe, Eastern Europe, Nordic Europe, Middle East, Latin America, Confucian Asia, Southern Asia and Sub-Saharan Africa.

PROCEDURE

Studies were identified through a database search. Relevant data were extracted using a narrative approach. Categories were thematically organized according to the study topics. Cultural differences regarding the variation in the perceptions of and responses to bullying were analysed in relation to the cultural dimensions: power distance, assertiveness, in-group collectivism and performance orientation.

RESULTS

Research was mostly conducted in the Anglo cluster. Antecedents and outcomes of bullying were the most often studied topics across all cultural clusters. Vertical bullying was most prevalent in higher power distance cultures, whereas horizontal bullying was either more or equally prevalent in lower power distance cultures. The risk of bullying decreased as nurses' length of service and age increased in most of the clusters. Individual antecedents were more frequently reported in high in-group collectivist cultures. Organizational antecedents such as lack of bullying prevention measures, unsupportive leadership and stressful work characteristics were frequently reported across different cultural clusters. Yet, an organizational culture that tolerates bullying was most commonly addressed in Anglo, a highly performance-oriented culture. Negative outcomes of bullying were very similar across the world. Nurses used emotion-focused coping strategies more frequently almost in all clusters; yet, there were reports of problem-focused coping strategies especially in relatively higher assertiveness cultures.

CONCLUSIONS

Analysis revealed both similarities and differences in the nurses' reports of bullying by world region. Cultural factors were found to be important for understanding the variation in the nurses' perceptions of and responses to bullying.

Ethical violations in the clinical setting: the hidden curriculum learning experience of Pakistani nurses

Background

The importance of the hidden curriculum is recognised as a practical training ground for the absorption of medical ethics by healthcare professionals. Pakistan’s healthcare sector is hampered by the exclusion of ethics from medical and nursing education curricula and the absence of monitoring of ethical violations in the clinical setting. Nurses have significant knowledge of the hidden curriculum taught during clinical practice, due to long working hours in the clinic and front-line interaction with patients and other practitioners.

Methods

The means of inquiry for this study was qualitative, with 20 interviews and four focus group discussions used to identify nurses’ clinical experiences of ethical violations. Content analysis was used to discover sub-categories of ethical violations, as perceived by nurses, within four pre-defined categories of nursing codes of ethics: 1) professional guidelines and integrity, 2) patient informed consent, 3) patient rights, and 4) co-worker coordination for competency, learning and patient safety.

Results

Ten sub-categories of ethical violations were found: nursing students being used as adjunct staff, nurses having to face frequent violence in the hospital setting, patient reluctance to receive treatment from nurses, the near-absence of consent taken from patients for most non-surgical medical procedures, the absence of patient consent taking for receiving treatment from student nurses, the practice of patient discrimination on the basis of a patient’s socio-demographic status, nurses withdrawing treatment out of fear for their safety, a non-learning culture and, finally, blame-shifting and non-reportage of errors.

Conclusion

Immediate and urgent attention is required to reduce ethical violations in the healthcare sector in Pakistan through collaborative efforts by the government, the healthcare sector, and ethics regulatory bodies. Also, changes in socio-cultural values in hospital organisation, public awareness of how to conveniently report ethical violations by practitioners and public perceptions of nurse identity are needed.

Factors associated with bullying at nurses' workplaces

OBJECTIVE: To identify nurses who are subject to workplace bullying and its associated factors. METHOD: Descriptive and exploratory study with a quantitative approach. The sample consisted of 199 nurses working in public and private sectors (N=388). For data collection, a graphic socio-professional questionnaire and the Leymann Inventory Psychological Terrorization were used, both in print or electronic format (May/September 2010). RESULTS: According to the data collected, 11.56% of the participants had been subject to bullying. Multivariate analysis showed that having children, working at Public Healthcare Units, working at an institution for a period between one and three years, currently dealing with acts of bullying and to feel bullied are risk factors for bullying. CONCLUSION: This study permitted a better understanding of the factors associated with bullying; however, a research based on samples of Brazilian nurses is only the first step to evaluate other factors of influence related to the organizational context.

Moral distress in nursing personnel

OBJECTIVE: to analyze the frequency and intensity of moral distress experienced by nursing personnel in southern Brazil, covering elements of their professional practice. METHOD: a survey was undertaken in two hospitals in Rio Grande do Sul, Brazil, with 247 nurses. Data was collected by means of the adapted Moral Distress Scale. RESULTS: the perception of situations that lead to moral distress is enhanced in nurses and in nursing staff working in institutions with greater openness to dialogue, which hold team meetings, with fewer working hours and a greater ratio of professionals to patients. CONCLUSION: understanding moral distress allows us to go beyond solving the problems of the workers themselves, enabling the development of an ethics of active individuals and wide opportunities, defined mainly by the relationship with oneself.