Workplace Bullying and Violence on Burnout Among Bangladeshi Registered Nurses: A Survey Following a Year of the COVID-19 Pandemic

Workplace Violence and Burnout among Health Workers Two Years after the COVID-19 Outbreak in Wuhan, China: The Chain Mediation Effect of Sleep Disturbance and Work Ability

BACKGROUND

Health workers (HWs) faced considerable psychosocial hazards during the COVID-19 pandemic, which profoundly affected their occupational health and job performance. The potential indirect relationship between workplace violence (WPV) and burnout among HWs needs to be further explored. The purpose of this study is to examine the chain mediating effects of sleep disturbance and work ability in the relationship between WPV and burnout among HWs.

METHODS

A cross-sectional study was conducted in a secondary hospital two years after the COVID-19 outbreak in Wuhan, China. A sample of 571 HWs was recruited using a cluster sampling method, achieving a response rate of 80.06%. Participants completed self-report questionnaires that included demographic information and measures of WPV, burnout, sleep disturbance, and work ability.

RESULTS

The prevalence rates of burnout and WPV among HWs two years after the COVID-19 outbreak were 37.30% and 31.52%, respectively. WPV was significantly associated with burnout (β = 0.446, p < 0.001). Sleep disturbance was identified as a mediator in the relationship between WPV and burnout (β = 0.063, 95% CI: 0.027-0.105), accounting for 14.13% of the total effect. Similarly, work ability also played a mediating role in this relationship (β = 0.142, 95% CI: 0.065-0.225), accounting for 31.84%. Additionally, both sleep disturbance and work ability exhibited a chain mediation effect on the association between WPV and burnout (β = 0.020, 95% CI: 0.008-0.036), and the total indirect effect accounted for 50.67%.

CONCLUSIONS

Among Chinese HWs, WPV exerts significant direct and indirect effects on burnout symptoms, mediated by sleep disturbance and work ability. This finding provides valuable empirical insights for designing interventions to mitigate the adverse effects of psychosocial factors such as WPV and burnout among HWs. After exposure to WPV, measures focused on reducing sleep disturbance and enhancing work ability may prove effective in alleviating burnout in subsequent interventions.

Exploration of Workplace Bullying among Nurses: A Focus on Clinical Settings

PURPOSE

Healthcare practitioners in Saudi Arabia sometimes experience workplace bullying (WPB). However, more research on this issue must be carried out in the country. This study aimed to investigate the prevalence of WPB and how individual factors among nurses contribute to different experiences of WPB in clinical settings.

METHODS

This cross-sectional quantitative study occurred among registered nurses in Riyadh, Saudi Arabia. A self-administered questionnaire was used, and nurses filled it out via a Google survey that included sociodemographic details such as age, gender, education, and the WBS to gauge the prevalence of workplace bullying in hospital settings.

RESULTS

Of 416 nurses, 58.7% were aged between 31 and 40, and 76.9% were women. The prevalence of WPB was found to be 54.8%. WPB was higher among middle-aged nurses, men, charge/managerial nurses, nurses with higher education, those with 3 to 6 years of experience, and those working in specialty units.

CONCLUSIONS

More than half of the nurses had experienced WPB at some point. Middle-aged nurses, especially men with higher education and more experience in specialty units, were the most common victims of WPB compared to other registered nurses.

Occupational injuries and their sociodemographic, workplace, and behavioral determinants among large-scale factory workers in Ethiopia: a cross-sectional study

Workplace injuries constitute a serious and growing public health concern worldwide. Despite work-related injuries being highly common, especially among workers in the manufacturing industry, their growing complexities are not adequately addressed in the current literature. Therefore this study aims to investigate the association between sociodemographic, workplace, and behavioral characteristics with work-related injuries among large-scale factory workers in Ethiopia. A cross-sectional study was conducted from February to April 2020 with 457 workers selected from large-scale factories in Addis Ababa, the capital of Ethiopia. Survey data included sociodemographic characteristics, working and safety conditions, and behavioral factors as predictors of occupational injuries. A logistic regression model was fitted to estimate the probability of injury and identify its associated factors. The 12-month prevalence of work-related injuries was 25%. Most injuries occurred at midnight (8.8%). Factors associated with work-related injury were excessive working hours (OR = 3.26; 95%CI: 1.26-8.41), cigarette smoking (OR = 2.72; 95%CI: 1.22-6.08), and manual handling (OR = 2.30; 95%CI: 1.13-4.72). Use of personal protective equipment reduced the odds of injury (OR = 0.42; 95%CI: 0.21-0.83). Although our estimated prevalence of occupational injury was lower than that found in other studies, our findings suggest that actions on modifiable conditions must be taken to reduce the burden of workplace injuries in Ethiopia. The results could inform preparedness and policy efforts aimed at improving worker safety and health.

Knowledge mapping of job burnout and satisfaction of medical staff and a cross-sectional investigation of county-level hospitals in Southern China

Background

Job burnout is a worldwide public health problem that has rarely been addressed among rural medical staff, particularly in county-level hospitals. Hence, we conducted a bibliometric study to gain global insights and research trends and a cross-sectional study to assess the current situation among medical staff of county-level hospitals in Southern China. By conducting these studies, we aim to identify factors associated with burnout among medical staff of county-level hospitals in China and provide recommendations for improvement.

Methods

Relevant literature on job burnout among medical personnel was searched using the Web of Science Core Collection (WoSCC). CiteSpace was employed for an in-depth cluster analysis to determine research trends and identify the study population. Subsequently, a cross-sectional survey was randomly conducted in three county-level hospitals in Hunan Province of Southern China. Job burnout and satisfaction were assessed using the Maslach Burnout Inventory MBI-Human Services Survey (MBI-HSS) and Job Satisfaction Questionnaire in a total of 362 valid questionnaires collected. The influence factors of the prevalence of job burnout were investigated using logistic regression.

Results

In this bibliometric study, 1626 articles were retrieved from 1999 to 2022. China lags behind the United States (US) in both the number and quality of publications in the field of medical staff burnout compared with the US. However, there is a lack of comparative research on job burnout across different job types. County-level medical staff articles are more in line with research hotspots in the field. In total, 362 valid questionnaires were obtained. The total incidence of job burnout among rural medical staff was 27.3 %. Nurses (p < 0.01, OR = 5.95), doctors (p < 0.01, OR = 6.43), and those with administrative jobs (p < 0.01, OR = 7.79) were more likely to experience burnout than those with technical jobs. Medical staff aged 40-49 years (p < 0.01, OR = 0.22) and 50-59 years (p < 0.05, OR = 0.14) were less likely to experience burnout than those aged 20-29 years. Job rewards satisfaction showed a positive correlation with job burnout (p < 0.01, OR = 1.32), but negative correlations with personal development satisfaction (p < 0.05, OR = 0.81) and work internal environment satisfaction (p < 0.05, OR = 0.81).

Conclusion

Better working environments, more accessible resources, and higher job rewards contribute to job satisfaction and reduce job burnout among the medical staff of county-level hospitals in China.

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

Background

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

Objective

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

Methods

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

Results

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

Conclusion

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

A latent profile analysis of resilience and the associations with flourishing in emergency nurses exposed to workplace violence in China

Workplace violence (WPV) exposure has been particularly prevalent in emergency nurses, coupled with negative mental health outcomes. Few explored resilience after WPV exposure using the perspective of positive mental health. We aimed to identify latent profiles of resilience and examine associations with flourishing in emergency nurses with WPV exposure. A total of 1241 Chinese emergency nurses were surveyed on the frequency of WPV exposure, resilience, and flourishing. Eight hundred and twenty five participants (90.1% female, 86.6% aged 20-39) reported WPV exposure at least once in the past 3 months. Latent profile analysis identified profiles of resilience as low resilience (15.0%), moderate decision respond and interpersonal link with low rational thought and flexible adaption (18.0%), moderate resilience (31.0%), high decision respond, interpersonal link, and rational thought with moderate flexible adaption (16.0%), and high resilience (20.0%). Higher flourishing was observed in profiles of moderate resilience, high decision respond, interpersonal link, and rational thought with moderate flexible adaption, and high resilience. We differentiated profiles of resilience and the associations with flourishing in emergency nurses with WPV exposure, which informed targeted interventions for promoting positive mental health.

Violence against healthcare professionals in intensive care units: a systematic review and meta-analysis of frequency, risk factors, interventions, and preventive measures

BACKGROUND

To assess the frequency, risk factors, consequences, and prevention of violence against healthcare workers in intensive care units.

METHODS

PubMed, Scopus, Google Scholar, EMBASE, Cochrane, and Web of Science were searched for studies on violence against healthcare workers in adult intensive care units. Risk factors, patient characteristics, and implications for healthcare workers were collected. Study quality, bias, and level of evidence were assessed using established tools.

RESULTS

Seventy-five studies with 139,533 healthcare workers from 32 countries were included. The overall median frequency of violence was 51% (IQR 37-75%). Up to 97% of healthcare workers experienced verbal violence, and up to 82% were victims of physical violence. Meta-analysis of frequency revealed an average frequency of 31% (95% CI 22-41%) for physical violence, 57% for verbal violence (95% CI 48-66%), and 12% for sexual violence (95% CI 4-23%). Heterogeneity was high according to the I2 statistics. Patients were the most common perpetrators (median 56%), followed by visitors (median 22%). Twenty-two studies reported increased risk ratios of up to 2.3 or odds ratios of up to 22.9 for healthcare workers in the ICU compared to other healthcare workers. Risk factors for experiencing violence included young age, less work experience, and being a nurse. Patients who exhibited violent behavior were often male, older, and physically impaired by drugs. Violence was underreported in up to 80% of cases and associated with higher burnout rates, increased anxiety, and higher turnover intentions. Overall the level of evidence was low.

CONCLUSIONS

Workplace violence is frequent and underreported in intensive care units, with potential serious consequences for healthcare workers, calling for heightened awareness, screening, and preventive measures. The potential risk factors for violence should be further investigated.

SYSTEMATIC REVIEW REGISTRATION

The protocol for this review was registered with Prospero on January 15, 2023 (ID CRD42023388449).

Work motivation and factors associated with it among health professionals in Debre Markos Comprehensive Specialized Hospital

Motivation is the level of a person's willingness to put forth and maintain an effort in support of organizational goals. However, motivation towards task execution is affected by the organization and individual goals. For instance, low morale among the staff can damage the quality of service delivery. Hence, this study was intended to assess the working motivation status and factors associated with it among health professionals at Debre Markos Comprehensive Specialized Hospital. A hospital-based cross-sectional study was employed. Stratified sampling techniques were used to extract sample from each job category proportionally. To make the distribution fair, all health workers were grouped according to their job title and selected by using the lottery method from each group. A standardized, self-administered questionnaire was used to collect data. Data was checked, coded, and entered into EpiData 3.1 and exported for analysis into SPSS 25. Variable in the multivariable logistic regression model with a p value of < 0.05 at 95% CI were taken as significantly associated to motivation status. A total of 319 people were involved, with a 100% response rate. 20.4% of health professionals were motivated at Debre Markos Comprehensive Specialized Hospital. Job satisfaction (AOR 6.46, 95% CI 1.72, 24.35), the presence of adequate medical supplies (AOR 5.01, 95% CI 1.23, 25.37), work place security (AOR 6.78, 95% CI 1.498, 30.72), and the presence of training opportunities in health facilities (AOR 2.23, 95% CI 1.01, 4.96) were significant factors associated with motivation status. The proportion of motivated health professionals was very low compared to previous studies in Ethiopia. The presence of security at work, adequate medical equipment, drugs, and supplies, job satisfaction, and the presence of training opportunities were predominant motivational factors. The hospital administration needs to give priority and work to safeguard security, ensure adequate medical supplies, and offer training to improve their satisfaction and motivation.

Association of workplace bullying and burnout with nurses' suicidal ideation in Bangladesh

Suicidal ideation is a complex phenomenon influenced by several predisposing, contextual, and mediating factors that seem more common among healthcare workers, especially nurses. We investigated the association of bullying and burnout with suicidal ideation among Bangladeshi nurses and identified the associated factors. We conducted a cross-sectional study among 1264 nurses in Bangladesh between February 2021 and July 2021. We applied a modified Poisson regression model with robust error variance to determine the association of bullying and burnout with suicidal ideation. Among 1264 nurses, the female was 882 (70.02%), and the mean age was 28.41 (SD = 5.54) years. The prevalence of high levels of suicidal ideation was 13.26%. In the Poison regression model, high risk bullying (RR = 6.22, 95% CI 3.13-12.38), targeted to bullying (RR = 7.61, 95% CI 3.53-16.38), and burnout (RR = 8.95, 95% CI 2.84-28.20) were found to be significantly associated with suicidal ideation. Furthermore, we found significant interaction between workplace bullying and burnout with suicidal ideation (p < 0.05). The high prevalence of bullying, burnout, suicidal ideation, and their association indicate an unsafe workplace for the nurses. Initiatives are needed to make a favorable work environment to improve nurses' overall mental health and reduce suicide ideation.

Working time variation and mental health during the Covid-19 pandemic in China

The Covid-19 pandemic has brought about a significant shift in labor market dynamics, leading to a notable increase in labor market flexibilization. One prominent aspect of this transformation is the growing variation in working time patterns. The irregular and unpredictable nature of working time may contribute to increased stress levels, difficulty in establishing routines, and challenges in maintaining work-life boundaries. Drawing on China General Social survey 2021, this study aims to examine (1) the relationship between working time variation and mental health during the Covid-19 pandemic in China; (2) whether the relationship can be mediated by work-family conflict; (3) to what extent the relationship varies across occupations. We find that working time variation is associated with significantly worse mental health during the Covid-19 pandemic in China, and around half of the negative effect can be mediated by increased work-family conflict. Moreover, the negative association is more pronounced among non-professional occupations than professional occupations. Overall, these findings shed light on the detrimental impact of working time variation on mental health and its potential mechanism, highlighting how novel work paradigm may interact with existing labor market inequalities to shape workers' mental health.

Spatiotemporal Analysis of Injury Events Against Doctors in Guangdong Province by Geographic Information System

Background

Violence against doctors is a global concern. Violent injuries against doctors occur periodically in China. At least one violent injury event was witnessed by 54% of medical staff against doctors in 2020. Analyzing this phenomenon and establishing preventive measures is a common concern of the medical and criminal communities.

Methods

This study comprised 712 injury events against doctors in Guangdong Province, China, from January 2019 to October 2022. The spatial distribution and spatiotemporal changes of these events were analyzed using ArcGIS and Excel software.

Results

Considering the geographical distribution, the injury events against doctors showed a three-level concentric circle pattern where, Guangzhou and Shenzhen, adjacent cities, and distant cities were ranked as high, medium, and low-risk areas, respectively. In temporal distribution, the periods of high incidence were 9-11, 14-15, and 20 o'clock, and the incidence tended to be similar daily, with the peaks in June and July.

Conclusion

We found that the risk level of injury events against doctors was positively correlated with the medical resources level in the areas. The injury event incidence was higher during the daytime working hours. Temperature may have a strong positive effect on injury events against doctors.

Workplace violence and burnout among Chinese nurses during the COVID-19 pandemic: does the sense of coherence mediate the relationship?

BACKGROUND

Workplace violence has always been a critical issue worldwide before and after the COVID-19 pandemic, which can lead to burnout and turnover. In addition, the burnout and mental stress of nurses during the COVID-19 period have been widely described. To our knowledge, no studies have examined the mediating effect of the sense of coherence on the relationship between workplace violence and burnout among Chinese nurses over time. Therefore, this study aimed to explore the relationship between workplace violence and burnout among Chinese nurses and how the sense of coherence mediates the association.

METHODS

Using a convenience sampling method, 1190 nurses from 4 tertiary grade-A comprehensive hospitals were investigated between September 2021 and December 2021 in 3 provinces of China. The Workplace Violence Scale, Burnout Inventory, and Sense of Coherence scale were used to collect data. Data analysis was conducted using descriptive statistics, Pearson correlation, and regression analysis to estimate direct and indirect effects using bootstrap analysis.

RESULTS

The mean total scores for workplace violence and burnout were 1.67 ± 1.08 and 47.36 ± 18.39, respectively. Workplace violence was significantly negatively correlated with the sense of coherence (r = -0.25) and positively correlated with burnout (r = 0.27). Additionally, a higher level of workplace violence was associated with higher burnout (β = 1.13, 95% CI: 0.68 ~ 1.56). A higher sense of coherence was also associated with lower burnout (β = -0.98, 95% CI: -1.03 ~ -0.92). Workplace violence showed an effect on burnout through a sense of coherence. The direct, indirect and total effects were 1.13, 1.88 and 3.01, respectively. The mediating effect of the sense of coherence accounted for 62.45% of the relationship between workplace violence and burnout.

CONCLUSION

We found that the sense of coherence mediated most workplace violence on burnout. It is imperative for hospital managers to improve nurses' sense of coherence to reduce the occurrence of burnout during COVID-19. Future intervention studies should be designed to strengthen nurses' sense of coherence.

Translation and validation study of the Chinese version of the service user technology acceptability questionnaire

Objective

This study aimed to assess the reliability and validity of the translated Chinese version of the Service User Technology Acceptability Questionnaire (C-SUTAQ).

Methods

Patients with cancer (n ​= ​554) from a tertiary hospital in China completed the C-SUTAQ. Item analysis, content and construct validity test, internal consistency test, and test-retest reliability analysis were conducted on the instrument to test its applicability.

Results

The critical ratio of each item of the C-SUTAQ ranged from 11.869 to 29.656; the correlation of each item and subscale ranged from 0.736 to 0.929. The Cronbach's α value for each subscale ranged from 0.659 to 0.941, and the test-retest reliability ranged from 0.859 to 0.966. The content validity index of the scale level and the item level content validity index of the instrument were both 1. Exploratory factor analysis indicated it was reasonable that the C-SUTAQ consists of six subscales after rotation. Confirmatory factor analysis demonstrated good construct validity (χ²/df ​= ​2.459, comparative fit index ​= ​0.922, incremental fit index ​= ​0.907, standardized root mean square residual ​= ​0.060, root-mean-square error of approximation ​= ​0.073, goodness of fit index ​= ​0.875, normed fit index ​= ​0.876.

Conclusions

The C-SUTAQ had good reliability and validity and may be useful to assess Chinese patients' acceptability of telecare. However, the small sample size limited generalization and there is a need to expand the sample to include persons with other diseases. Further studies are required using the translated questionnaire.

Prevalence and correlators of burnout among health professionals during different stages of the COVID-19 pandemic in China

Background

Persistently increased workload and stress occurred in health professionals (HPs) during the past 3 years as the COVID-19 pandemic continued. The current study seeks to explore the prevalence of and correlators of HPs' burnout during different stages of the pandemic.

Methods

Three repeated online studies were conducted in different stages of the COVID-19 pandemic: wave 1: after the first peak of the pandemic, wave 2: the early period of the zero-COVID policy, and wave 3: the second peak of the pandemic in China. Two dimensions of burnout, emotional exhaustion (EE) and declined personal accomplishment (DPA), were assessed using Human Services Survey for Medical Personnel (MBI-HSMP), a 9-item Patient Health Questionnaire (PHQ-9), and a 7-item Generalized Anxiety Disorder (GAD-7) to assess mental health conditions. An unconditional logistic regression model was employed to discern the correlators.

Results

There was an overall prevalence of depression (34.9%), anxiety (22.5%), EE (44.6%), and DPA (36.5%) in the participants; the highest prevalence of EE and DPA was discovered in the first wave (47.4% and 36.5%, respectively), then the second wave (44.9% and 34.0%), and the third wave had the lowest prevalence of 42.3% and 32.2%. Depressive symptoms and anxiety were persistently correlated with a higher prevalence risk of both EE and DPA. Workplace violence led to a higher prevalence risk of EE (wave 1: OR = 1.37, 95% CI: 1.16-1.63), and women (wave 1: OR = 1.19, 95% CI: 1.00-1.42; wave 3: OR =1.20, 95% CI:1.01-1.44) and those living in a central area (wave 2: OR = 1.66, 95% CI: 1.20-2.31) or west area (wave 2: OR = 1.54, 95% CI: 1.26-1.87) also had a higher prevalence risk of EE. In contrast, those over 50 years of age (wave 1: OR = 0.61, 95% CI: 0.39-0.96; wave 3: OR = 0.60, 95% CI: 0.38-0.95) and who provided care to patients with COVID-19 (wave 2: OR = 0.73, 95% CI: 0.57-0.92) had a lower risk of EE. Working in the psychiatry section (wave 1: OR = 1.38, 95% CI: 1.01-1.89) and being minorities (wave 2: OR = 1.28, 95% CI: 1.04-1.58) had a higher risk of DPA, while those over 50 years of age had a lower risk of DPA (wave 3: OR = 0.56, 95% CI: 0.36-0.88).

Conclusion

This three-wave cross-sectional study revealed that the prevalence of burnout among health professionals was at a high level persistently during the different stages of the pandemic. The results suggest that functional impairment prevention resources and programs may be inadequate and, as such, continuous monitoring of these variables could provide evidence for developing optimal strategies for saving human resources in the coming post-pandemic era.