Does Psychological Capital Mediate Between Workplace Violence and Depressive Symptoms Among Doctors and Nurses in Chinese General Hospitals?

Associations between workplace violence and suicidal ideation among Chinese medical staff: a propensity score matching analysis

Physical and mental health problems had been identified as the negative outcomes of workplace violence (WPV) against medical staff. Considering the proven associations between physical and mental health and suicidal ideation, it is reasonable to assume that WPV may associate with suicidal ideation. However, few studies were conducted to explore the relationship between WPV and their suicidal ideation against medical staff. Based on a cross-sectional design, 3, 426 medical staff working in general hospitals were interviewed in Shandong Province, China. Socio-demographic characteristics, work-related factors, psychological variables, WPV, and suicidal ideation were evaluated. Propensity score matching (PSM) was performed to explore the association between WPV and suicidal ideation. The prevalence of suicidal ideation among medical staff was 9.1% (312/3426), and 52.2% (1788/3426) of medical staff reported the WPV experience. Before PSM, we found that the association between WPV and suicidal ideation was statistically significant (aOR = 1.606, p < 0.01). After PSM, there was a statistically significant correlation between WPV and suicidal ideation (aOR = 1.525, p < 0.01). This study supported the correlations between WPV against medical staff and their suicidal ideation. The results of PSM further implied that WPV might cause suicidal ideation among medical staff. Psychological health, especially for suicidal ideation, should be paid attention for medical staff with WPV experiences.

Pathways linking workplace violence and suicidal ideation/non-suicidal self-injury among nurse staff: the mediating role of loneliness and depressive symptoms

BACKGROUND

Nurses face disproportionately high rates of suicidal ideation and non-suicidal self-injury (NSSI). The role of workplace violence, loneliness, and depressive symptoms in exacerbating these issues is poorly understood. This study aims to explore these relationships to inform interventions for improving nurses' mental health.

METHODS

A cross-sectional study involving 1,774 Chinese nurse staff selected through convenient sampling methods was conducted. Workplace violence, depressive symptoms, and loneliness were assessed using the Chinese versions of the Workplace Violence Scale (WVS), the 9-item Patient Health Questionnaire (PHQ-9), and a three-item loneliness scale, respectively. Participants completed self-report questionnaires anonymously to ensure adherence to ethical standards. Statistical analysis utilized structural equation modeling (SEM) to examine the intricate relationships among variables, thereby elucidating the impact of workplace violence, loneliness, and depressive symptoms on nurses' suicidal ideation/NSSI outcomes.

RESULTS

Nurse staff 165 (7.8%) were reported different level of suicidal ideation and 139 (7.8%) participants were reported different level of NSSI. And the final model of workplace violence on suicidal ideation shown a good model fit index (CMIN/DF = 3.482 NFI = 0.969 CFI = 0.977 TLI = 0.955 RFI = 0.938, RMSEA = 0.037 SRMR = 0.035). The pathway of workplace violence to loneliness (β = 0.163, P < 0.001), the indirect effect of workplace violence on suicidal ideation via loneliness and depressive symptoms were 0.100 (95%CI = 0.085, 0.121), the indirect effect of loneliness on suicidal ideation via depressive symptoms were 0.128 (95%CI = 0.100, 0.158). Similarly, the final model of workplace violence on NSSI shown a good model fit index (CMIN/DF = 3.482 NFI = 0.967 CFI = 0.976 TLI = 0.953 RFI = 0.935, RMSEA = 0.037 SRMR = 0.034), the pathways of workplace violence to NSSI (β = 0.115, P < 0.001), the indirect effect of workplace violence on NSSI via loneliness and depressive symptoms were 0.075 (95%CI = 0.055, 0.096), the indirect effect of loneliness on NSSI via depressive symptoms were 0.102 (95%CI = 0.076, 0.130).

CONCLUSION

Our study unveils the role of workplace violence in nurses' suicidal ideation and NSSI, mediated by loneliness and depressive symptoms. Interventions targeting workplace violence are crucial for nurses' well-being, potentially reducing loneliness and depressive symptoms and lowering the risk of suicidal ideation and NSSI. However, further research is needed to explore additional mediators and pathways, employing longitudinal designs to establish causality and develop tailored interventions for nurses affected by workplace violence.

Workplace violence and depressive symptoms: the mediating role of fear of future workplace violence and burnout among Chinese nurses

BACKGROUND

The mechanisms underlying the relationship between workplace violence (WPV) and depressive symptoms in nurses have been less studied. This study aims to examine the mediating role of fear of future workplace violence (FFWV) and burnout in the association between WPV and depressive symptoms.

METHODS

We conducted a cross-sectional web survey at 12 tertiary hospitals in Shandong province, China, in 2020. The Center for Epidemiologic Studies Depression Scale (CESD-10), the Chinese version of the Maslach Burnout Inventory-General Survey and the Fear of Future Violence at Work Scale were used to collect data. Descriptive statistics, independent sample t-test, one-way analysis of variance, Pearson's correlation coefficient, and ordinary least squares regression with bootstrap resampling were used to analyze the data.

RESULTS

The prevalence of depressive symptoms was 45.9% among nurses. The regression model showed that FFWV and burnout mediated the relationship between WPV and depressive symptoms. The total effects of WPV on depressive symptoms (3.109, 95% bootstrap CI:2.324 - 3.713) could be decomposed into direct (2.250, 95% bootstrap CI:1.583 - 2.917) and indirect effects (0.769, 95% bootstrap CI:0.543 - 1.012). Indirect effects mediated by FFWV and burnout were 0.203 (95% bootstrap CI:0.090 - 0.348) and 0.443 (95% bootstrap CI:0.262 - 0.642), respectively. Furthermore, serial multiple mediation analyses indicated that the indirect effect mediated by FFWV and burnout in a sequential manner was 0.123 (95% bootstrap CI:0.070 - 0.189).

CONCLUSION

The prevalence of depressive symptoms among Chinese nurses was high. The WPV was an important risk factor for depressive symptoms and its negative effect was mediated by FFWV and burnout. The importance of decreasing WPV exposure and level of FFWV and burnout was emphasized to prevent depressive symptoms among nurses. The findings implied that hospital managers and health policy makers should not only develop targeted interventions to reduce exposure to WPV in daily work among all nurses, but also provide psychological support to nurses with WPV experience to reduce FFWV and burnout.

Registered nurses' psychological capital: A scoping review

AIMS

The aim was to examine the extent and scope of empirical research concerning registered nurses' psychological capital.

BACKGROUND

In a time of global nursing shortage, identifying variables that could positively contribute to the retention of the nursing workforce is essential. Prior research has shown that psychological capital correlates positively with employees' better performance and well-being.

DESIGN

A scoping review.

DATA SOURCES

A systematic literature search was conducted in the following databases: PubMed, CINAHL, PsycINFO, Web of Science and Scopus covering the period from 1 January 2005 to 7 May 2023.

REVIEW METHODS

The JBI methodological guidance for scoping reviews was followed. The results were summarized narratively.

RESULTS

A total of 111 studies reported in 114 peer-reviewed articles were included. Studies were carried out across 20 countries, with the majority from China (45), Australia (nine), Pakistan (nine), Canada (eight), South Korea (eight) and the United States (eight). A positive correlation was found between registered nurses' psychological capital and desirable work-related outcomes, such as work engagement, commitment and retention intention.

CONCLUSION

A comprehensive overview of research evidence suggests that psychological capital is associated with many positive work-related outcomes and might therefore be a valuable resource for reducing nurse turnover.

Analysis of the characteristics and risk factors affecting the judgment results of medical damage liability disputes in 3172 second-instance and retrial cases in China

BACKGROUND

Medical disputes remain a global public health problem. However, an analysis of the characteristics and risk factors affecting the judgment results of medical damage liability disputes in second-instance and retrial cases in China has yet to be conducted.

METHODS

We conducted a systematic search and evaluation of second-instance and retrial cases among all medical damage liability disputes in China Judgments Online; SPSS 22.0 was used for the statistical analysis. A χ² test or likelihood ratio Chi-square test was used to compare differences between groups, and multivariate logistic regression analysis was performed to determine independent risk factors that could affect the judgment results of medical disputes.

RESULTS

We included 3172 second-instance and retrial cases among all medical damage liability disputes in the analysis. The results showed that 48.04% of cases were unilateral appeals by the patient, and medical institutions were responsible for providing compensation in 80.64% of these cases. Cases involving compensation ranged from Chinese Yuan (CNY) 100 000 to 500 000 ranked first (40.95%); 21.66% were non-compensation cases. Cases involving mental damage compensation of less than CNY 20 000 accounted for 39.03%. Violations of medical treatment and nursing routines accounted for 64.25% of all cases. In addition, re-identification in 54.59% of cases changed the initial appraisal opinion. Independent risk factors for medical personnel to lose a lawsuit in a multivariate logistic regression model included appeal originator [patient side: OR = 18.809 (95% CI 11.854-29.845); both sides: OR = 22.168 (95% CI 12.249-40.117)], change of the original verdict (OR = 5.936, 95% CI 3.875-9.095), judicial identification (OR = 6.395, 95% CI 4.818-8.487), violations of medical treatment and nursing routines (OR = 8.783, 95% CI 6.658-11.588), and non-standard medical document writing (OR = 8.500, 95% CI 4.805-15.037).

CONCLUSION

Our study clarifies the characteristics of second-instance and retrial cases among all medical damage liability disputes in China from multiple perspectives and identifies the independent risk factors for medical personnel losing a lawsuit. This study could help medical institutions prevent and reduce medical disputes, at the same time, it could be helpful for medical institutions to provide better medical treatment and nursing services for patients.

Mediating role of depression between workplace violence and job burnout among healthcare workers

OBJECTIVES

Health workers are at risk of workplace violence, which can seriously affects their mental health and work status. This study aims to explore the mediating role of depression between workplace violence and job burnout among healthcare workers.

METHODS

From January 10 to February 5, 2019, a questionnaire was distributed to frontline healthcare workers through the wenjuanxing platform using convenient sampling (snowball sampling). The questionnaire included the Chinese version of the Workplace Violence Scale, Maslach Burnout Inventory, and Patient Health Questionnaires (PHQ-2). Descriptive statistics, correlation analysis, and mediation model tests were conducted on the cross-sectional data collection.

RESULTS

The study included 3 684 participants, with (31.63±7.69) years old. Among them 2 079(56.43%) were experienced workplace violence, 687(18.65%) were screened positive for depression, and 2 247(60.99%) were experienced high levels of occupational burnout. Correlation analysis showed positive association between workplace violence and depression, workplace violence and occupational burnout, depression and occupational burnout (r=0.135, r=0.107, r=0.335, respectively, all P<0.001). After controlling for covariates, workplace violence had an indirect effect on occupational burnout through depression, with a standardized coefficient of 0.25 (SE=0.02, 95% CI 0.21 to 0.28), accounting for 13.87% of the total effect.

CONCLUSIONS

The study highlights the close relationship between workplace violence, depression, and occupational burnout among healthcare workers, with depression acting as a mediator between workplace violence and occupational burnout. This study suggests that it is necessary to improve the communication skills of healthcare workers, increase the installation of security systems and emergency plans, use new media platforms to convey positive energy between doctors and patients, and open channels for medical consultation and complaints. It is also necessary to provide guidance for healthcare workers' depressive emotions. Addressing depression among health care workers will help reduce the harm caused by workplace violence, protect the physical and mental health of healthcare workers, and reduce work burnout.

Associations Between Workplace Violence and Mental Health Among Chinese Health Technicians: A Moderated Mediation Analysis of Sleep Quality and Physical Activity

Background

Workplace violence (WPV) had always been the focus of attention in all walks of lives, especially in the health fields. Previous studies had shown it adversely affected mental health for healthcare workers. In addition, both sleep quality and physical activity were supported to have impact on mental health. However, the mechanism of sleep quality and physical activity influence the association between WPV and mental health had not been explored, so the purpose of this paper was to explore this mechanistic link among workplace violence, sleep quality, physical activity, and mental health in Chinese health technicians.

Methods

Cross-sectional study was conducted in 3 cities of China, totally 3426 valid questionnaires were collected. WPV, physical activity, and social-demographic variables were evaluated. The Pittsburgh Sleep Quality Index and the Kessler Psychological Distress Scale were used to measure sleep quality and mental health. Descriptive analysis, univariate analysis, Pearson correlation, and moderated mediation analysis were used to estimate prevalence of WPV, association between WPV and mental health, and the role of sleep quality and physical activity on association between WPV and mental health.

Results

The prevalence of WPV was 52.2% among Chinese health technicians. After controlling social-demographic and work-related variables, sleep quality partially mediated the effect of WPV on mental health (indirect effect=0.829). Physical activity moderated the relationship between WPV and sleep quality (β=0.235, p=0.013), but not find the moderating role between WPV and mental health (β=0.140, p=0.474), and between sleep quality and mental health (β=0.018, p=0.550).

Conclusion

The rate of WPV among health technicians remained at an alarming level. Sleep quality and physical activity could mitigate the adverse effect of WPV on mental health. In the future, we could improve sleep quality and encourage health technicians to engage physical activity to decrease the negative effect of WPV on mental health.

The association between fear of future workplace violence and depressive symptoms among nurses based on different experiences of workplace violence: a cross-sectional study

BACKGROUND

Fear of future workplace violence (FFWV) has a negative impact on individuals' health. However, no study has investigated the association between FFWV and depressive symptoms. Nurses with different experiences of workplace violence may have different levels of FFWV and differences in mental health. This study explored the association between FFWV and depressive symptoms among Chinese nurses with different experiences of workplace violence.

METHODS

A cross-sectional study was conducted involving 1888 Chinese nurses from 12 tertiary hospitals in Shandong Province. The Fear of Future Violence at Work scale was used to measure FFWV. Depressive symptoms were assessed using the 10-item Center for Epidemiologic Studies Depression scale. Multiple logistic regression analysis was used to examine the association between FFWV and depressive symptoms.

RESULTS

The prevalence of depressive symptoms was 45.9% (no aggression group: 24.3%; non-physical violence group: 46.1%; physical violence group: 63.7%), and 72.8% of nurses had high levels of fear of future workplace violence (no aggression group: 60.2%; non-physical violence group: 75.6%; physical violence group: 70.8%). Compared with low levels of FFWV, high levels of FFWV were associated with more depressive symptoms among nurses in the no aggression group (odds ratio [OR] = 3.269, 95% confidence interval [CI]: 1.102-9.695) and in the non-physical violence group (OR = 2.338, 95% CI: 1.385-3.945).

CONCLUSION

Nurses who had experienced physical violence had the most depressive symptoms and nurses with experience of non-physical violence had the greatest FFWV. Our findings suggested that there was a significant association between FFWV and depressive symptoms among Chinese nurses in the no aggression and non-physical violence groups. Hospital administrators need to address FFWV needs when developing strategies to reduce depressive symptoms among nurses.

Crisis social support after work-related violence and threats and risk for depressive symptoms: a 3-months follow-up study

INTRODUCTION

Employees working at psychiatric wards are at risk for work-related threats and violence that may impact their physical and mental health. Studies have found that crisis social support may mitigate these adverse health effects.

PURPOSE

To examine the effects crisis social support on depressive symptoms 3 months after a violent or threating work incident and furthermore, to examine the effect of variations in prolonged social support on depressive symptoms during 3 months after a violent or threating incident.

METHODOLOGY

After exposure to work-related violence and threats at work, the employees received a questionnaire within the first month and after 3 months. Right after the incident, 374 employees answered both the depression and crisis support items and were included in the analyses. 3 months later 276 employees answered both the depression and social support items. Prospective associations between crisis social support and depression were calculated using stepwise regressions and linear mixed models.

RESULTS

Crisis social support at T1 was significantly and inversely associated with a lower level of depressive symptoms at T2, Std. Beta =  - 012, t (3) =  - 2.1, p = .040. Employees experiencing either a stable or increasing level of support from T1 to T2 had significantly lower levels of depressive symptoms compared to employees who experienced a decrease in support in the same period, mean difference_{Stable-Decreasing} = 4.0 t (190) = 5.2, p = 0.006 and mean difference_{Increasing-Decreasing} = 7.6, t (189) = 5.3, p < .001.

CONCLUSION

The study results indicate that depressive symptoms following work-related violence or threats can be mitigated by prolonged social support. We recommend that organizations continue to offer crisis social support in the subsequent months, and not just immediately after a violent or threating incident.

Family incivility and burnout: a moderated mediation model of life satisfaction and psychological capital

Purpose

This study investigates the relationship between family incivility (FI) and burnout in line with the conservation of resources theory and work–home resources model. The authors also examine the conditional indirect effects of psychological capital (PsyCap) and life satisfaction (LS) in the aforementioned relationship. The purpose of this paper is to address these issues.

Design/methodology/approach

Data were collected using a time-lagged methodological design by administering a structured questionnaire among 296 rural doctors. The collected data were analyzed using PROCESS macro in Statistical Package for the Social Sciences (SPSS) 23.

Findings

The study indicates that FI is an emotional home demand and influences burnout at the workplace through the depletion of LS. At the same time, PsyCap proves to be a vital resource that mitigates the adverse effects of FI and burnout.

Research limitations/implications

This study adds to the work–family and well-being literature by exploring the underlying mechanism through which FI connects to different outcomes. The implications of these findings for applications and extension of the work–home resources model to the family domain is elaborated in detail.

Originality/value

This study is among the first to empirically substantiate the long-term adverse consequences of FI and its potential for negatively affecting the work domain by inducing long-term psychological disorder “burnout.”

The impact of psychological capital on turnover intention among Chinese nurses: A moderated mediation model

AIMS

This study examined how the mediating effect of psychological distress and the moderating role of social support influence the connection between psychological capital and turnover intention among Chinese nurses.

BACKGROUND

Nurses play a crucial role in medical and health services, but turnover intentions are common among them.

METHODS

A cross-sectional survey was conducted involving 4,865 nurses in China. The Chinese Psychological Capital Questionnaire, Depression, Anxiety and Stress Scale, Social Support Rating Scale, and Turnover Intention Scale were used to gather data. Bootstrap and simple slope methods were used to test the mediating effect of psychological distress and the moderating effect of social support.

RESULTS

Psychological capital had a significant direct impact on turnover intention among nurses (B = -0.040, t = -10.032, P < 0.001). Psychological distress had a mediation effect of 46.89% between psychological capital and turnover intention. Moreover, social support had a moderating role in the relationship between psychological distress and psychological capital and between psychological distress and turnover intention.

CONCLUSIONS

Psychological capital correlated negatively with psychological distress and turnover intention and indirectly influenced turnover intention through psychological distress. Social support moderated the first and second half of the path in the mediating model of psychological distress. These findings have implications for early intervention for and the prevention of turnover intention in nurses.

IMPLICATIONS FOR NURSING MANAGEMENT

This study's findings can inform the design of effective nurse support programs to reduce the impact of psychological distress on turnover intention among nurses.

Causes of Hospital Violence, Characteristics of Perpetrators, and Prevention and Control Measures: A Case Analysis of 341 Serious Hospital Violence Incidents in China

Objective: Hospital violence remains a global public health problem. This study aims to analyze serious hospital violence causes in China and the characteristics of perpetrators. It likewise seeks to understand frontline personnel's needs and put forward targeted suggestions. Methods: Serious hospital violence cases from 2011 to 2020 in the China Judgment Online System (CJOS) were selected for descriptive statistical analysis. A total of 72 doctors, nurses, hospital managers, and security personnel from 20 secondary and tertiary hospitals in China were selected for semi-structured interviews. Results: Of the incidents, 62.17% were caused by patients' deaths and dissatisfaction with their treatment results. Moreover, it was found that out-of-hospital disputes (11.14%) were also one of the main reasons for serious hospital violence. The perpetrators were mainly males (80.3%), and had attained junior high school education or lower (86.5%). Furthermore, most of them were family members of the patients (76.1%). Healthcare workers urgently hope that relevant parties will take new measures in terms of legislation, security, and dispute handling capacity. Conclusion: In the past 10 years, serious hospital violence's frequency in China has remained high. Furthermore, their harmful consequences are more serious. The causes of hospital violence are diverse, and the characteristics of perpetrators are obvious. Frontline healthcare workers urgently need relevant parties to take effective measures in terms of legislation, security, and dispute handling capacity, to prevent the occurrence of violence and protect medical personnel's safety.