Prevalence and Consequences of Aggression and Violence towards Nursing and Care Staff in Germany-A Survey

Poor Work Ability Is Associated with Workplace Violence in Nurses: A Two-Wave Panel Data Analysis

Healthcare personnel must deal with two problems of growing importance: violence in the workplace and the loss of work ability due to the aging of the workforce. Our objective was to evaluate, with a two-wave perspective design, the relationships of work ability, social support, and occupational stress with workplace violence in nurses. In an Italian public health company, we asked nurses to self-assess their work ability using the Work Ability Index (WAI) and we analyzed the relationship between this indicator and the violence experienced in the previous and following years. A total of 321 out of 344 nurses (99.3%) participated. In a logistic regression model, the WAI score was a significant protective factor for violence experienced in the previous year (OR = 0.94 CI95% = 0.90; 0.98 p < 0.01) and in the following year (OR = 0.88 CI95% = 0.84; 0.92 p < 0.01). In a hierarchical logistic regression model, social support acted as a protective factor (OR = 0.87 CI95% = 0.79; 0.95 for violence experienced in the previous year), while occupational stress was a significant determinant of the risk of aggression (OR = 3.65 CI95% = 1.90; 7.03 in the previous year, OR = 3.54 CI95% = 1.801; 6.947 in the following year). The difficulties that nurses encounter in carrying out their growing work demands in an environment that is not promptly adapted to their changing physical and mental states can lead to an increased risk of violence. Prevention of workplace violence should include organizational and ergonomic measures that reduce stress and increase staff support and work ability.

Work-related violence, occupational stress and psychological distress among medical staff in China: A structural equation modeling analysis

BACKGROUND

Psychological issues and work-related violence are the main challenges faced by medical staff. The situation has become even more prevalent during the COVID-19 pandemic.

OBJECTIVE

This research aimed to analyze the relationships among work-related violence, occupational stress and psychological distress and to further identify the direct or indirect effects of violence on psychological distress.

METHODS

A total of 1,765 medical staff members were surveyed using the Kessler Psychological Distress Scale and Revised Occupational Stress Inventory. Work-related violence was assessed using a self-made 5-question questionnaire. STATA 14.0 and Amos 21.0 software were used for correlation analysis, variance analysis, and structural equation modeling analysis.

RESULTS

A total of 66.1% of the medical staff suffered workplace violence, and 61.2% witnessed workplace violence. The psychological distress score (Kessler 10 Scale) of the medical staff was 22.7±7.67. The psychological strain score and physical strain score were 26.8±7.14 and 24.2±6.51, respectively. Work-related violence (suffered: β= 0.467; witnessed: β= 0.258) and occupational stress (psychological strain: β= 0.269; physical strain: β= 0.317) were predictors of psychological distress, and social support (β= -0.265) was a protective factor. Work-related violence and social support had both direct and indirect effects on psychological distress, and the intermediate factor was occupational stress. The total effects of suffered workplace violence and witnessed workplace violence were 0.181 and 0.092, respectively, and the total effect of social support was -0.262.

CONCLUSIONS

Work-related violence may exacerbate symptoms of occupational stress and psychological distress. Reducing workplace violence and protecting medical staff from work-related violence are extremely important aspects of mental health prevention.

Resident Aggression and Staff Burnout in Nursing Homes in Hong Kong

This study examined the effects of exposure to resident aggression, self-efficacy, neuroticism, and attitudes toward dementia on burnout among direct care workers (DCWs) in nursing homes. A convenience sample of 800 DCWs from 70 randomly selected nursing homes in Hong Kong were recruited and individually interviewed. DCWs reported past-month experiences of resident aggression, levels of burnout, self-efficacy, neuroticism, attitudes toward dementia, and other personal and facility characteristics. Hierarchical multiple regression analysis revealed that, while physical environment of the facilities, and demographic background and self-efficacy of DCWs were not significant contributing factors, DCWs' exposure to resident aggression, insufficient experience and training in dementia care, negative attitudes toward dementia, and neurotic personality were associated with higher levels of staff burnout. Findings point to the importance of mitigating resident aggression and adequately screen and train staff to optimize their empathy and competence in minimizing the risk of burnout.

Nurses' experiences of racism in mental health settings through patient and family interactions: A systematic review

Nursing staff engage readily with patients and associates in mental health/forensic inpatient settings. These settings are known to have instances of workplace violence directed towards staff and such violence includes racism. Racism is a form of workplace violence that must be better understood and supported within this complex setting. Completing a systematic review to coalesce preexisting research and suggested interventions can be beneficial to supporting nurses. Systematic review following PRISMA guidelines. CINAHL, PsycInfo, Medline, British Nursing Database and Web of Science databases were searched. Reviewers screened the papers for inclusion (29 articles out of 7146 were selected for inclusion) and completed the quality appraisal using the Mixed Methods Appraisal Tool. Subsequently, data extraction was completed, and findings were summarised through narrative synthesis. The way racism was conceptualised impacted how data was collected, reported and interpreted; racism was silenced or exposed depending on how studies were undertaken. If exposed, evidence indicates racism is a problem but is not always acknowledged or acted upon. Some evidence determined racism led to negative work-related outcomes. The literature provided limited examples of interventions. These included changing education/orientation for staff, openly discussing racist events and better planning for patients among colleagues and management. Increasing diversity within the workforce requires more research exploring and addressing issues related to racism towards nurses. Narratives of racism being normalised and embedded in mental health/forensic settings need to be challenged.

Managing Aggressive Behaviour in Healthcare: Balancing of Patients and Staff Interests

The incidence of aggression within healthcare environments has exhibited a discernible rise. As a response, restrictive measures, including restraints, are enforced. Due to the safety and ethical concerns associated with using restraint, de-escalation measures are regarded as the most efficient course of action. The paper posits that it is critical to identify the causes of aggression before employing restraint through a multidisciplinary risk assessment. In addition, the reasonableness and proportionality of administering restraint must be carefully measured. The significance of cultivating a therapeutic and compassionate environment is emphasised. The paper will exclusively examine physical restraint as a form of restriction intervention.

Same job, same working conditions? A cross-sectional study to examine the similarities and differences of the working situation in ambulatory and residential youth welfare workers

BACKGROUND

Employees in social work exhibit high rates of sick leave due to mental health issues. Additionally, work-related demands in youth welfare have increased in recent years. Particularly in light of the escalating shortage of skilled professionals in this field, this trend becomes especially critical. The aim of this study is to systematically examine health-relevant working conditions, coping strategies, and health indicators in youth welfare. A special focus is placed on a differentiated analysis of job-related characteristics in the context of outpatient and residential youth welfare.

METHODS

Mean values, standard deviations and the reliability of scales are measured. In addition to descriptive statistics, t-tests for analyzing mean differences, as well as correlation analyses and odds ratios as measures of association, are computed.

RESULTS

A total of N = 1044 employees in youth welfare participated in the online survey. Among them, 671 individuals belonged to the field of residential youth welfare, and 373 to outpatient youth welfare. The results indicate that, in youth welfare in general, a variety of emotional, social, qualitative, and quantitative demands exhibit high levels. The comparison between outpatient and residential youth welfare reveals differences in half of the demands. The significant differences are observed for social demands and aggression from clients, which are statistically significant higher in the residential setting. Regarding resources, the most significant difference is observed for autonomy, which is higher in the outpatient setting. Overall, the association patterns reveals more similarities than differences between outpatient and residential settings. In both settings working conditions seem to have deteriorated during the pandemic.

CONCLUSIONS

In conclusion, the identified job-related characteristics in outpatient and residential youth welfare exhibit more similarities than differences. Nevertheless, the identified differences provide insights into the specific features of each work context, offering valuable starting points for targeted health promotion in practice.

TRIAL REGISTRATION

This trial is recorded at the Hamburg University Ethics Committee (AZ 2022_027).

Humanised care in acute psychiatric hospitalisation units: Definition, values and strategic initiatives from the perspective of persons with mental health problems, primary carers and professionals

INTRODUCTION

Humanised care refers to the holistic approach to the person, considering their bio-psycho-social and behavioural dimensions. It becomes more complex when the person has mental health problems that may affect his or her will, cognition and relationship to the world. The literature on the humanisation of mental health is scarce and only offers the view of professionals.

AIM

To analyse the concept, values and strategic initiatives of humanised care in acute psychiatric units from the perspective of persons with mental health problems, carers and professionals.

METHOD

Qualitative grounded-theory approach. Data were collected through focus groups and in-depth interviews among persons with mental health problems, carers and professionals.

RESULTS

Thirteen focus groups and three in-depth staff interviews were performed, with a total of 61 participants. Humanised care is defined as quality care of an individualised, ethical and safe nature, empowering persons/carers to involve them in their health process, helping them resist the stigma of mental illness through a therapeutic relationship, bond and communication. Formal training, teamwork and effective communication are required. Six values and strategic initiatives were identified.

DISCUSSION

Each value and strategic initiatives acquires full meaning when connected with the rest. Without this interconnection, humanised care would be impossible.

Workplace Violence against Nurses Working at Private Teaching Hospitals of Kathmandu: A Descriptive Cross-sectional Study

INTRODUCTION

Workplace violence in hospitals is a global concern and is considered as a major occupational hazard for all health care providers including the nurses. The aim of this study was to assess the status of workplace violence against nurses at hospitals in Kathmandu and determine the actions taken to investigate its cause.

METHODS

A descriptive cross-sectional study was conducted among a convenient sample of 100 registered nurses employed in Nepal Medical College and Teaching Hospital, and Kathmandu Medical College and Teaching Hospital. All eligible nurses who were willing to participate irrespective of their academic fulfilment, from all different shifts and of age below 45 years were included. Data were collected using a structured questionnaire and analysed using SPSS software. Ethical approval was taken from the Institutional Review Committee (IRC) of Nepal Medical College and Kathmandu Medical College.

RESULTS

Among 100 participants, the prevalence of workplace violence was 72 (72%) (62.13-80.52, 95% Confidence Interval). Verbal abuse accounted to 50 (69.44%), followed by physical violence accounting 17 (23.61%). Action was taken to investigate the causes of both physical violence 5 (29.41%) and verbal abuse 2 (4%) by the hospital administration 3 (60%) in physical violence and 2 (100%) in verbal abuse and police 2 (40%) in physical violence.

CONCLUSIONS

The study reveals a troubling reality, as the vast majority of nurses reported experiencing various forms of violence in their workplace. So, addressing this issue immediately could protect nurses' well-being and ensure quality care which benefits both healthcare professionals and patients.

Testing a recovery-oriented nursing communication framework to encourage collaboration and discussion about aggression prevention: A mixed methods study

Recovery-oriented practice is essential in healthcare, yet research exploring methods for integrating recovery-oriented principles in forensic mental health settings is limited. This study involved the co-development, with mental health care nurses and a lived experience expert, and testing of a recovery-oriented script for forensic mental health nurses to use when communicating with consumers at high-risk of imminent aggression. The aim was to examine whether nurses perceived the script as more empathic when the script included specific references to empathy, compared to an equivalent script that did not include empathic statements, and to explore nurses' perspectives on whether the script could help prevent aggression. Nurses (n = 54) working in a secure forensic mental health hospital were randomly allocated to read a script containing statements representing nine recovery-oriented principles that also included empathic statements, or an equivalent script that did not include empathic statements. After reading the script, the participants completed a questionnaire involving a recovery-oriented practice scale developed by the authors, measuring the extent to which the scripts reflected recovery-oriented principles, and open-ended questions about the script's potential to prevent aggression. Results revealed no significant difference in nurse perceptions of empathy between the two scripts. Content analysis indicated that nurses perceived the scripts could help prevent aggression.

Workplace trauma and professional quality of Life in clinical and forensic psychiatry: the CRITIC study

Background

Frontline staff in psychiatry need to perform at a very high professional level in order to ensure patient and community safety. At the same time they are exposed to high levels of stress and workplace trauma. This may have severe consequences for their professional quality of life. In addition, health care workers in general have higher incidence levels of childhood adversity than the general population. The CRITIC (CRITical Incidents and aggression in Caregivers) Study aims to improve increased understanding of the interaction between personal life history (childhood adversity and benevolence), individual capabilities, exposure to trauma and violence at work and Professional Quality of Life (ProQOL).

Method

The Critic Study is a cross-sectional survey of these aspects in frontline, treatment and administrative staff in clinical and forensic psychiatry. We aim to include 360 participants. Participants will be asked to complete questionnaires on childhood adversity and childhood benevolence (assessing personal life history), professional quality of life, current trauma and violence exposure, current mental health (depression, anxiety and stress), coping, social support, work engagement and resilience. In this study we will examine the moderating role of adverse and benevolent childhood experiences in the association between workplace trauma exposure and professional quality of life. Finally, a theoretical model on the relationships between trauma, stress and coping in the context of professional functioning will be tested using structural equation modelling.

Discussion

The CRITIC study examines which factors influence the complex relationship between childhood adversity and benevolence, and ProQOL in healthcare workers. It also aims to provide insight into the complex relationship between personal life history, individual characteristics, exposure to trauma and violence at work and ProQOL. The results can be used for designing interventions to increase resilience to trauma and to improve professional quality of life among health care professionals.

Trial registration

The CRITIC study has been approved by the Medical Ethical Committee of the Erasmus Medical Centre, under trial registration number NL73417.078.20.

Staff Turnover Intention at Long-Term Care Facilities: Implications of Resident Aggression, Burnout, and Fatigue

OBJECTIVES

Staff shortages and the high turnover rate of nursing assistants pose great challenges to long-term care. This study examined the effects of aggression from residents of long-term care facilities, burnout, and fatigue on staff turnover intention. The findings will help managers to devise effective measures to retain their staff.

DESIGN

Cross-sectional descriptive study design.

SETTING AND PARTICIPANTS

A total of 800 nursing assistants were recruited from 70 long-term care facilities using convenience sampling.

METHODS

The participants were individually interviewed and provided information about their turnover intention, resident aggression witnessed and experienced, self-efficacy, neuroticism, burnout, fatigue, and personal and facility characteristics.

RESULTS

Hierarchical multiple regression analysis revealed that the size and organizational practices of long-term care facilities were not associated with staff turnover intention. Staff who spent less time in the industry reported witnessing resident-to-resident aggression, experienced resident-to-staff aggression, reported high levels of burnout, had acute or chronic fatigue, and had low levels of inter-shift recovery were more likely than others to report a high turnover intention.

CONCLUSIONS AND IMPLICATIONS

Staff turnover poses great challenges to staff, residents, and organizations. This study identified important factors that may help support staff in long-term care facilities. Specific measures, such as person-centered care to diminish resident aggression by addressing residents' unmet needs, work-directed programs to mitigate burnout and improve staff mental health, and flexible schedules to prevent fatigue should also be advocated to prevent staff turnover.

Patient aggression experienced by professional nurses in acute psychiatric ward: South Africa

Background

Aggression of patients in hospital wards has become an endemic problem and professional nurses are particularly at high risk.

Aim

This article presents the types of patient aggression experienced by professional nurses working in an acute psychiatric ward in Vhembe District, South Africa.

Setting

Vhembe District, South Africa.

Methods

A qualitative approach using exploratory, descriptive and contextual research design was used. Four hospitals were purposively selected and 10 professional nurses were conveniently sampled to participate in the study. Individual interviews were used to collect data, which were then analysed through Tesch Open Coding Method. Measures to ensure trustworthiness and ethical considerations were adhered to throughout the study.

Results

This study shed some light on the professional nurses' lived experiences regarding the types of aggression from patients in an acute psychiatric ward in Vhembe District. The types of aggression are physical aggression, destructive behaviour and verbal aggression.

Conclusion

The findings show that the types of aggression to which professional nurses are exposed are overwhelming and the consequences are shocking. As a result, the health of professional nurses is compromised. Therefore, this study recommends further studies to determine the kind of support needed by professional nurses working in an acute psychiatric ward and to investigate the impact of aggression from patients in acute psychiatric ward with regard to the quality of care.

Contribution

This article contributes to the body of knowledge regarding patients' aggression in acute wards in Vhembe District, South Africa.

Experiences of workplace violence among healthcare workers in home care settings: A qualitative systematic review

AIMS

The aims of this systematic review were to obtain a comprehensive understanding of healthcare workers' experiences who were subjected to workplace violence in the home care environment and identify their specific support needs.

BACKGROUND

Workplace violence toward healthcare workers has been a prevalent and ongoing issue. With the expansion of home care services, more emphasis should be placed on maintaining a safe in-home care environment for healthcare workers. Understanding healthcare workers' experience of workplace violence is crucial for developing effective interventions.

METHODS

A systematic search was conducted in 10 databases from their inception date until January 2022. Primary qualitative studies were included. Two reviewers performed screening of studies, methodological quality assessment, and data extraction and analysis independently. The two-step approach by Sandelowski and Barroso on meta-summary and meta-synthesis was used. This qualitative systematic review was reported according to the PRISMA guidelines.

RESULTS

Eight studies were included. Three themes were identified: (1) impact of workplace violence, (2) reasons behind tolerating violence, and (3) way forward to prevent violence.

CONCLUSION

Workplace violence is common among healthcare workers in home care settings, yet the support provided to healthcare workers is inadequate. The findings suggest the need for effective interventions and policies to address this grave issue in order to improve the well-being of healthcare workers as it may indirectly affect the care quality provided to patients.

IMPLICATIONS FOR NURSING

Due to the unique nature of home care services, interventions preventing workplace violence must be tailored to the specific home care settings and needs of healthcare workers. Future research should develop and evaluate different interventions to prevent workplace violence in home care settings.

Incidence, Severity and Characteristics of Patients' Aggression in Acute Psychiatric Wards: Data from a Slovenian National Survey

Aim

To evaluate the incidence, severity and characteristics of aggressive behaviour in patients hospitalized in acute psychiatric wards, as well as the association between patient characteristics and the incidence of recurrent aggressive behaviour.

Methods

A multicentre prospective study included all twelve acute wards in Slovenian psychiatric hospitals with a total capacity of 232 beds. Over five consecutive months, data on the number of treatment episodes involving aggressive behaviour and the number of aggressive incidents, their severity and characteristics were obtained using the Staff Observation Aggression Scale-Revised (SOAS-R). Patient- and event-based incident rates of verbal and physical aggression were calculated. The association between patient characteristics and recurrent aggressive behaviour was analysed. Patient characteristics data were extracted from hospital databases.

Results

3,190 treatment episodes were included during a 5-month period. Aggressive behaviour was observed in 13.4% of treatment episodes, and 922 aggressive incidents were recorded, which resulted in 3.98 incidents per 100 occupied bed days and 9.48 incidents per bed per year. 74.1% of incidents were severe, and more than half of incidents included physical aggression. 75.5% of incidents were directed against medical staff. 5.9% of treatment episodes were involved in multiple aggressive incidents. Compared to patients with single incidents, patients with recurrent aggression had a less frequent main diagnosis of substance use disorders and a longer duration of hospitalization.

Conclusion

Monitoring the frequency and characteristics of aggressive behaviour allows comparisons with other studies and, more importantly, it is necessary for planning and assessing the effectiveness of preventative aggression management strategies.

Evaluating the impact of an information-based education and training platform on the incidence, severity, and coping resources status of workplace violence among nurses: a quasi-experimental study

BACKGROUND

Workplace violence among nurses has emerged as a critical issue, posing a significant threat to their occupational safety. Education and training are the primary measures employed to prevent and respond to workplace violence. However, the current approaches have proven ineffective, possibly due to a lack of consideration for the specific needs of clinical nurses. Therefore, it is essential to explore the effectiveness of an informational education and training platform tailored to nurses' requirements. This study aimed to investigate the impact of such a platform on the incidence, severity, and coping resources of WPV in nurses.

METHODS

This research was a quasi-experimental study. An information-based education and training platform focused on nurse workplace violence was developed through literature reviews, expert meetings, consultations with software development companies, and a trial run. A tertiary general hospital in Suzhou was selected, in which hospital district A was the intervention group and hospital district B was the control group. A total of 276 nurses were recruited, 140 in the intervention group and 136 in the control group. The nurses' incidence, severity, coping resources status, and evaluation of the application were measured before the intervention and at 1, 3, and 6 months after the intervention.

RESULTS

The overall incidence of workplace violence, verbal aggression, and verbal threat among nurses showed statistically significant differences (P < 0.05) for the time effect, while the incidence of physical aggression demonstrated statistically significant differences (P < 0.05) for the between-group effect and the time effect. The severity of physical violence among nurses exhibited statistically significant differences (P < 0.05) for the between-group effect and time effect, and the severity of psychological violence showed statistically significant differences (P < 0.05) for the time effect. Nurses' total coping resources score and dimensions also showed statistically significant differences in terms of group, time, and interaction effects (P < 0.001). The evaluation questionnaire for the mobile application indicated usefulness scores of 2 (1, 2); ease of learning scores of 2 (1, 2); ease of use scores of 2 (1, 2); trust scores of 2 (1, 2.75); acceptance score of 1 (1, 2); and satisfaction scores of 2 (1, 2).

CONCLUSIONS

Implementing the nurse workplace violence information-based education and training platform proved beneficial in reducing the incidence and severity of workplace violence among nurses and enhancing their coping resources. This outcome suggested the platform's potential for further application and promotion in clinical settings.

'Fleeing' as a Strategy for Navigating Resistance in Patient Encounters within Forensic Care

The aim of this study was to describe the phenomenon of "fleeing the encounter when facing resistance" as experienced by carers working in forensic inpatient care. Qualitative analysis, namely reflective lifeworld research, was used to analyze data from open-ended questions with nine carers from a Swedish regional forensic clinic. The data revealed three meaning constituents that describe the phenomenon: shielding oneself from coming to harm or harming the other, finding one's emotional balance or being exposed, and offering the patient emotional space and finding patience. The carers described their approaches in the encounters with the patients as alternating between primitive instincts and expectant empathy in order to gain control and deal with the interaction for their own part, for that of the patient, and for that of their colleagues. The phenomenon of fleeing the encounter when facing resistance was intertwined with carers' self-perception as professional carers. Negative encounters with patients evoked feelings of shame and self-blame. A carer is a key person tasked with shaping the care relationship, which requires an attitude on the part of the carer that recognizes not only the patient's lifeworld but also their own.

Aggression against Nursing Personnel during the First Wave of COVID-19 Pandemic: An Internet-Based Survey

(1) Background: health care workers, particularly nurses, have been regularly assaulted during the COVID-19 pandemic. Purpose: to evaluate the prevalence and location of assaults against nursing personnel in Latin America, and to determine predictor factors for aggression against nurses. (2) Methods: A cross-sectional online survey was answered by 374 nurses working in health care during the COVID-19 pandemic. The aggression against nurses was estimated using the Victimization Scale. (3) Results: A total of 288 nurses were included in this study. The victimization scale showed that 52.1% of nurses have suffered aggression by the general population during the COVID-19 pandemic. Males were more likely to be attacked than females (p < 0.05). Additionally, males were attacked more frequently on public transport (x2 = 6.72, p = 0.01). The home neighborhood and markets were other locations with a higher risk of being assaulted (OR: 3.39, CI: 1.53-7.50). (4) Conclusions: Our results indicate that nurses in Latin America who work during the COVID-19 pandemic and social isolation have been frequently assaulted by the general public. Males are more frequently attacked than females and the main places of aggression are public transportation, their home neighborhood and supermarkets. Implications for nursing practice: it is necessary to create and implement protocols and guidelines to support nursing personnel during the COVID-19 pandemic. This study was retrospectively registered at the Juarez Autonomous University of Tabasco (103/CIPDACS/2020) on the (08/2020).

Violence toward staff in the inpatient psychiatric setting: Nurses' perspectives: A qualitative study

BACKGROUND

Workplace violence is a universal phenomenon faced by employees in all industries but more so by employees working in sectors that require interpersonal contact, especially with individuals who may be violent, distressed, or vulnerable. Globally, healthcare professionals working in the emergency and psychiatric sectors are at the highest risk of workplace violence. In fact, healthcare professionals in the psychiatric setting have a higher risk rate of facing workplace violence opposed to other healthcare settings. Workplace violence can lead to adverse physical and psychological outcomes and impact the quality of care provided to patients.

OBJECTIVE

This study aims to explore nurses' experiences with workplace violence and the impact of violence on nurses. Whereas the objectives of this study are to explore and analyze mental health nurses' experiences with workplace violence in Brunei Darussalam, identify and explore the impact of violence on mental health nurses, and discuss nurses' coping mechanisms following a workplace violence experience.

DESIGN

Qualitative explorative study.

SETTING(S)

Mental Health Unit Kiarong of Raja Isteri Pengiran Anak Saleha Hospital, Brunei Darussalam.

PARTICIPANTS

Nurses (n = 12).

METHODS

Data was collected by conducting individual via online platforms. The interviews were carried out in English and/or Malay, the verbatim transcripts produced were transcribed in their source languages and only relevant excerpts were translated into English for the write-up. The data were analyzed utilizing thematic analysis by the researcher independently.

RESULTS

This study identified three themes: Violence as a norm in the psychiatric setting, perceived impact of workplace violence, and "Talk, Report and Accept" as Coping mechanisms.

CONCLUSIONS

In conclusion, it is apparent that globally workplace violence is normalized in the nursing industry, especially in the psychiatric setting. Workplace violence yields a plethora of negative long-term and short-term impacts on nurses. Despite this, workplace violence often goes unreported for numerous reasons but mainly due to the lack of changes after reporting. Nurses should be encouraged to report all instances of workplace violence by demonstrating effective changes and providing hazard pay. The management should actively attempt to reduce the risk of workplace violence by preemptively equipping nurses with the necessary training including identification of potential risks of workplace violence, effective de-escalation methods, and proper control and restraint methods.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Is mental health staff training in de-escalation techniques effective in reducing violent incidents in forensic psychiatric settings? - A systematic review of the literature

BACKGROUND

Inpatient violence is a relevant issue in forensic psychiatric settings. Relevant guidelines recommend that restrictive measures are to be used exclusively if de-escalation and other preventive strategies have failed and there is a risk of harm to patients or staff if no action is taken. However, restrictive measures are untherapeutic and can be harmful. In order to enable staff to intervene before inpatient violence or other serious incidents occur and thus to avoid restrictive measures, mental health staff training programs including de-escalation components are being adopted in general as well as forensic mental health settings. There is growing evidence for the efficacy of mental health staff training in de-escalation techniques in the field of general psychiatry. However, there are no reviews evaluating the effectiveness of these interventions in reducing violent incidents in forensic psychiatric settings. Here we present the first literature review on the effectiveness staff training in de-escalation techniques in the field of forensic psychiatry.

METHOD

We searched relevant databases for original research on the effectiveness of reducing violence in forensic psychiatric settings. Studies were included if they investigated staff training programs with de-escalation techniques in forensic mental health settings.

RESULTS

A total of 5 relevant studies were identified. None of the studies was a randomized controlled trial. Four studies were before and after comparisons without control group. A one group post-test-only design was used in one study. Methodological quality was low. The maximum sample size was 112 participants. Results indicated no relevant impact of mental health staff training in de-escalation techniques on the rate of violent incidents in forensic psychiatric wards. However, staff seemed to feel safer following the training. Results have to be interpreted cautiously due to several methodological and content-related limitations.

DISCUSSION

Evidence for the effectiveness of staff training in de-escalation techniques on reducing verbal and physical aggression in forensic settings remains very limited. The existing definitions of terms like de-escalation, de-escalation training and de-escalation techniques in the healthcare context appear rather vague. Although some positive changes are reported across a variety of outcome measures it remains unclear to what extent staff training in de-esclation techniques contributes to a reduction in aggressive incidents and restrictive measures in forensic psychiatry. The clinical implications of this review are therefore limited. Yet, an important implication for future research is that a more comprehensive approach might prove worthwhile. Conducting a further review integrating a wide range of complex interventions aimed at the reduction of inpatient violence rather than focusing on de-escalation only, might be a worthwhile approach.

Prevalence and correlates of workplace violence against medical assistants in Germany: a cross-sectional study

BACKGROUND

Workplace violence is widespread, but studies on workplace violence against health professions in outpatient settings are sparse. We aimed to examine, for the first time, the prevalence of workplace violence against medical assistants as well as potential sociodemographic, occupational and health-related correlates of the exposure to workplace violence.

METHODS

We used data from a survey (03-05/2021) among medical assistants in Germany (n = 424). We assessed the 12-month prevalence (yes/no) of verbal violence, physical violence, and sexual harassment as well as the types of perpetrators of workplace violence. Further, information was gathered on sociodemographic (e.g., age, educational level), occupational (e.g., years in job), and mental health-related factors (i.e., anxiety, depression). The 12-month prevalences of the different types of workplace violence were merged into a single variable ("any workplace violence" vs. none) for association analysis. We ran multivariable Poisson regression models to examine potential associations between sociodemographic and occupational correlates (i.e., independent variables) with any workplace violence as dependent variable and in addition between any workplace violence (independent variable) and dichotomized mental health as dependent variable.

RESULTS

Overall, 59.4% of the medical assistants reported verbal violence, 5.9% reported physical violence, 3.8% reported sexual harassment, and 60.1% reported any workplace violence in the previous 12 months. Patients were reported to be the main perpetrators, followed by patients' relatives. Younger age, being single, and working in a medical care center were sociodemographic and occupational correlates of workplace violence (PRs ≥ 1.27). Workplace violence was significantly associated with mental health variables (PRs ≥ 1.72).

CONCLUSION

Medical assistants experience workplace violence, in particular verbal violence. To devise preventive measures, prospective studies are needed to confirm the potential risk groups for workplace violence and the potential mental health sequels of workplace violence observed in our study.

A Literature Review: Violence and Aggression in Neuroscience Nursing

ABSTRACT

BACKGROUND: Violence and aggression is commonly encountered in nursing worldwide and is an increasing concern, although it is largely underreported by staff. Violence and aggression can take many forms, from verbal and physical abuse to sexual assault. This study aims to define agitation, violence, and aggression and to explore the prevalence of violence and aggression among neuroscience patients. This review also examines why violence and aggression occurs for neuroscience patients and to determine the effects on the patients, the environment, and the nursing staff. METHODS: A review of articles was conducted using CINAHL, PubMed, the Cochrane Database, and Google Scholar between 2012 and 2022. DISCUSSION: Agitation can escalate to violence and aggression. The reasons a neuroscience patient may become agitated are multifactorial. An injury to the brain may not cause agitation; however, the effect on the frontal lobe, hypothalamus, and hippocampus may cause a lack of self-control, impulsivity, an inability to control emotions, and an uncontrolled release of hormones, leading to a heightened sympathetic response. The effects of violence and aggression can be detrimental to the patient and include isolation, increased sedation, reduced observations, and even death. The effects on the nurse are profound including a decline in productivity at work, an increased risk of drug errors, and posttraumatic stress disorder or burnout as longer-term consequences. CONCLUSION: Violence and aggression is commonly experienced within neuroscience nursing, and the contributing factors are multifactorial. The effects for the patients and staff can be profound, and this is why prevention of agitation is fundamental to ensure the safety and retention of nursing staff.

Humane and Comprehensive Management of Challenging Behaviour in Health and Social Care: Cross-Sectional Study Testing Newly Developed Instrument

BACKGROUND

Management of challenging behaviour causes victimization and violates the human rights of service users in psychiatric and long-term settings for people having mental health issues and learning disabilities. The purpose of the research was to develop and test an instrument for measuring humane behaviour management (HCMCB). The research was guided by the following questions: (1) What is the structure and content of the Human and Comprehensive management of Challenging Behaviour (HCMCB) instrument, (2) What are the psychometric properties of the HCMCB instrument, and (3) How do Finnish health and social care professionals evaluate their humane and comprehensive management of challenging behaviour?

METHODS

A cross-sectional study design and STROBE checklist were applied. A convenience sample of health and social care professionals (n = 233) studying at the University of Applied Sciences (n = 13) was recruited.

RESULTS

The EFA revealed a 14-factor structure and included a total of 63 items. The Cronbach's alpha values for factors varied from 0.535 to 0.939. The participants rated their individual competence higher than leadership and organizational culture.

CONCLUSIONS

HCMCB is a useful tool for evaluating competencies, leadership, and organizational practices in the context of challenging behaviour. HCMCB should be further tested in various international contexts involving challenging behaviour with large samples and longitudinal design.

Influencing factors on the health of nurses-a regression analysis considering individual and organizational determinants in Germany

BACKGROUND

The care sector is characterized by high absenteeism of nursing care employees due to illness. Organizational determinants that can affect the mental health of nurses are known. Although nurses are confronted with different framework conditions in different care settings, there is a lack of comparative data in Germany.

METHODS

The purpose of this study was to examined the relationship between work demands and employee health in different care settings. This cross-sectional survey was conducted between June and October 2021 in four acute care hospitals, seven inpatient care facilities, and five outpatient care services in Germany. 528 nursing care employees (acute care hospitals n = 234; inpatient care facilities n = 152; outpatient care services n = 142) participated in the survey (participation rate: 22.6%-27.9%). For each care setting, data was collected via questionnaire on individual determinants (gender, age, profession, working time), organizational work demands (quantitative workload, qualitative workload, organization of work, social work climate, after work situation, verbal violence, threats, physical violence) and employee health (subjective health status and work ability). Descriptive statistics and binary logistic regressions were performed.

RESULTS

Increasing age (OR = 0.650, 95% CI = 0.424-0.996) as an individual determinant and organization of work (OR = 0.595, CI = 0.362-0.978) as an organizational determinant were negatively associated with subjective health. Furthermore, age (OR = 0.555, 95% CI = 0.353-0.875), a demanding organization of work (OR = 0.520, CI = 0.315-0.858), increasing quantitative workloads (OR = 0.565, CI = 0.343-0.930) and a poorer perceived social work climate (OR = 0.610, CI = 0.376-0.991) were associated with lower work ability.

CONCLUSIONS

Based on the study results, health programs should target both individual and organizational factors. The findings seem to support the importance to include nursing care employees in the planning process, as it can have an impact on their health.

TRIAL REGISTRATION

The project was registered in the German Clinical Trial Register (DRKS00024961, 09/04/2021).

Incidents related to safety in mental health facilities in Kenya

BACKGROUND

Both patients and health care providers working in mental health facilities witness high rates of incidents that have the potential to jeopardize their safety. Despite this, there are few studies that have documented the kind of incidents that are experienced, or explored the potential contributors to these incidents, and solutions that would result in better safety. This study explored various types of safety related incidents occurring in mental facilities in Kenya, perceived contributing factors, and recommendations for improve.

METHODS

This qualitative descriptive study was carried out between December 2019 - February 2020. It included 28 mental health staff across 14 mental health unit spread across the country.

RESULTS

All the participants reported having personally experienced an incident that threatened their safety or that of the patients. Most of the respondents (24/26. 91.67%) admitted to have experienced verbal aggression while 54.17%, (n = 24) had experienced physical assault. Participating health care workers attributed the safety incidents to poor infrastructure, limited human resources, and inadequate medication to calm down agitated patients. Suggested solutions to improve patient safety included; improving surveillance systems, hiring more specialized healthcare workers, and provision of adequate supplies such as short-acting injectable psychotropic.

CONCLUSION

Incidents that threaten patient and staff safety are common in mental health facilities in Kenya. There is need to strengthen staff capacity and reporting mechanisms, as well as invest in infrastructural improvements, to safeguard patient and staff safety in mental health facilities in Kenya.

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

Introduction

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

Objectives

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

Methods

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

Results

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

Conclusions

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

(Un)Broken: Lateral violence among hospital nurses, user violence, burnout, and general health: A structural equation modeling analysis

Introduction

Workplace violence is a social problem yet to be solved. Although it is present in virtually all work environments, its prevalence in healthcare settings stands out, being perceived as something inherent to the job. Most studies in this context have focused on user violence against professionals. However, it has been observed that violence among colleagues in these types of jobs is a risk factor for the health of workers and has rarely been studied as a whole. Among the main consequences of exposure to violence reported in the literature, burnout syndrome, depression, anxiety, or somatic problems have been among the most studied. On the one hand, some authors claim that being exposed to workplace violence can increase the associated physical and psychological pathology and lead to a picture congruent with burnout. On the other hand, it has been hypothesized that violence is associated with burnout, which can trigger physical and psychological symptoms. Taking into account this background, the aim of this study is to explore workplace violence in health personnel, symptomatology, and burnout syndrome through mediation models that allow us to know the interrelationships between the variables.

Methods

A cross-sectional design with a double descriptive-associative strategy was used. The sample was composed of 950 nursing professionals from public hospitals. The scales of physical and non-physical violence from users to professionals HABS-U, personal, social, and occupational violence among co-workers using the Health Aggressive Behavior Scale - Co-workers and Superiors (HABS-CS) scale, the burnout scale Maslach Burnout Inventory - General Survey (MBI-GS) which evaluates professional exhaustion, efficacy and cynicism, and the factors referring to depression, anxiety, somatization, and dysfunction of the GHQ-28 scale were applied. In order to calculate the models, workplace violence was used as a predictor of symptomatology, using the burnout variables as mediators. Regression coefficients with and without mediation model, direct and standardized estimates were obtained. For statistical power, Bootstrap analysis was used to calculate direct mediation effects.

Results

After controlling the mediation effects of burnout and cynicism, physical and non-physical user violence toward healthcare personnel were significant predictors of the GHQ-28 scores. These same results were obtained when assessing the relationship between social, occupational, and personal violence among co-workers and GHQ-28 scores.

Conclusion

Our results contribute to increase the evidence about the effects of violence on the health of professionals and to advance in the characterization of the possible consequent psychological damage. Regardless of the type of violence experienced, exposure to violence can lead to anxious, depressive or somatization symptoms, among others. Violence is also a predictor of burnout syndrome, which in turn accentuates the rest of the consequences studied. Despite the limitations of the proposed model, these results serve to highlight the complexity of the situation experienced by healthcare professionals. Moreover, it serves as a basis for proposing intervention/prevention programs to raise awareness and protect professionals from these risks. To this end, self-care tools should be proposed with which professionals take care of their own health through the management of violent situations and/or the improvement of occupational health.

Dental Students' Experience, Impact, and Response to Patient Aggression in Saudi Arabia: A Nationwide Study

Patient aggression and violence comprise a wide range of behaviors and actions that may include verbal aggression and physical aggression. The aim of this study is to report dental students' experience with, impact from, and response to patient aggression in Saudi Arabia. A cross-sectional analytical study was conducted among dental students from various health universities representing each region of Saudi Arabia. Data were collected using a self-administered, structured and validated questionnaire. A total of 375 participants responded to the questionnaire and 121 (32.3%) study participants reported experiencing patient aggression. Out of those, 91 (75.21%) experienced patients displaying anger or raising their voice toward them, 37 (30.58%) reported being insulted by a patient, 22 (18.18%) reported being threatened, 12 (6.2%) had experienced sexual harassment, and 65 (50.41%) had experienced verbal harassment. Furthermore, 91 (75.21%) participants reported being abandoned by patients because they were students. A total of 55 (45.45%) participants stated that aggressive patient behavior had an impact on their clinical performance, and 44 (36.36%) considered themselves stressed out. A total of 24 (19.83%) participants took time off due to incidents and 22 (18.18%) thought about quitting dentistry. Prevalence of patient aggression was significant among dental students in Saudi Arabia. These episodes of patient aggression negatively impacted students' academic performance and wellbeing, necessitating urgent attention. Educational institutions should conduct periodic workshops for students in order to address these issues. Policymakers should develop better policies in order to reduce violence and aggression against health care providers.

Iranian nursing students' experiences of workplace violence: a qualitative study

BACKGROUND

Workplace violence against nursing students is a common phenomenon. This study aimed to investigate Iranian nursing students' experiences of workplace violence, including their reaction to violence and the consequences and the effects of such violence on the students.

METHODS

The study participants were undergraduate nursing students. The data were collected using semi-structured, in-depth face-to-face interviews. Data analysis was carried out with qualitative approach using conventional content analysis.

RESULTS

Four categories were extracted from the analysis of the interview transcriptions: vertical violence, horizontal violence, reaction to violence and consequences of violence. Nurses were the major imposers of violence against students and psychological and verbal violations were the most of used forms of violence. The students reacted to violence in the forms of counteracting, reporting, disregarding and considering as commonplace.

CONCLUSIONS

Workplace violence is a common phenomenon experienced by nursing students in this study, which causes devastating individual, educational, and professional impacts. Action plans including providing safe environment and appropriate support from nurses and educators should be developed in clinical settings to intervene and to prevent workplace violence.

Factors related to work ability among nursing professionals from urgent and emergency care units: A cross-sectional study

BACKGROUND

Nursing professionals are on the front line of health systems in Brazil as well as worldwide. Studies on the work ability of nursing professionals are especially relevant as care demands increase and health care workforce shortages are expected. As the population of Brazil ages, the need for nursing care will increase.

OBJECTIVE

To identify levels and predictors of work ability among Brazilian nursing professionals.

METHODS

A cross-sectional study with 267 nursing professionals (72 nurses and 195 nursing technicians and nursing auxiliary) from public emergency and urgent care units was conducted. Measures included the following: Work Ability Index; Questionnaire of Socio-demographics, Lifestyle and Work and Health Aspects; and Violence at Work questionnaire. Generalized linear regression and Poisson models were used for data analysis.

RESULTS

The mean work ability was 40.4 (range: 22 to 49). Almost 79.6% (n = 211) of participants reported good or excellent work ability, and 20.4% (n = 54) reported moderate or poor work ability. Better perceptions of health and job satisfaction, absence of health issues (past 15 days), lower stress levels, and having a partner were associated with better work ability. Victims of workplace violence were less likely to have good or excellent work ability than non-victims (prevalence ratio = 0.80; 95% CI 0.72 to 0.90). Professionals with cumulative experiences of workplace violence were less likely to report better work ability.

CONCLUSIONS

The prevalence of good or excellent work ability was 79.6%. Our findings indicate that the following factors are predictors of work ability: self-reported perception of health, health issues in the last 15 days, workplace violence, job satisfaction, stress, and marital status.

Identifying Predictors of Workplace Violence Against Healthcare Professionals: A Systematic Review

Understanding the predictors of workplace violence amongst healthcare professionals is important to develop and implement prevention and mitigation strategies. We conducted a systematic review to synthesize the recent evidence on predictors of workplace violence across healthcare settings. The review has been done as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two electronic databases (PubMed and Google Scholar) were used to search peer-reviewed studies published for the year 2009-2020 to identify studies reporting predictors of workplace violence. The significant predictors were analyzed using descriptive statistics such as proportions in most of the studies and some studies used inferential statistics such as logistic regression analysis, Chi-square test, ANOVA and Student's t-test. A total of 46 studies were identified and overall evidence was graded using an adapted GRADE approach. Some of the moderate quality predictors associated with workplace violence were the patient with a history of mental health disease, psychiatric setting, professional's gender and work experience and evening shift workers. Being a nurse was the only high-quality predictor. Healthcare professionals and administration can identify the predictors relevant to their setting to mitigate episodes of violence against healthcare personnel.

Aggressive incidents in home care services and organizational support: A cross-sectional survey in Switzerland

AIMS

To explore the available organizational structures addressing aggressive incidents towards home care services staff.

BACKGROUND

Organizational structures how professional caregivers deal with care recipients' aggressive incidents.

METHODS

An explorative cross-sectional survey using the Violence Experienced by Staff (German version revised) and the Impact of Patient Aggression on Carers Scale was conducted. Data from 852 health care professionals in the German-speaking part of Switzerland were collected between July and October 2019. Multiple logistic regression models were used to investigate associations. The STROBE-Checklist was used as the reporting guideline.

RESULTS

Organizational support and management support in home care services were generally rated high and found to cause a significant decrease in negative feelings. Some self-rated skills regarding aggression management were linked to a decrease in perceived burden after aggressive incidents, whereas others increased the perceived burden.

CONCLUSION

Organizational structures including official procedures for affected professional caregivers should be established in home care services. This should contain efficient reporting systems and aggression management training for the specific setting.

IMPLICATIONS FOR NURSING MANAGEMENT

The study highlights the importance of organizational support regarding aggressive incidents in the home care setting as well as of aggression management training.

The moderating role of social support on workplace violence and stress among psychiatric nurses

Exposure to violent acts is considered one of the major stressful events psychiatric nurses are exposed to. Social support has been found to reduce nurses' stress and alleviate their experience of workplace violence; however, no accounts are available on whether social support moderates the relationship between workplace violence and stress. Therefore, the aim of this study was to examine the moderating role of social support on workplace violence and stress among psychiatric nurses. A cross-sectional descriptive and predictive design was utilized. A total of 195 psychiatric nurses were recruited from two governmental mental health hospitals. The results showed that psychiatric nurses were frequently exposed to violence, both verbally and physically, whether during their entire career or within the past 12 months. Verbal violence was more common among participants than physical abuse. Male nurses and nurses working mix-shift were more likely to experience violent acts. Regression analysis showed that only workplace violence and social support predicted psychiatric nurses' stress. On the other hand, social support did not moderate the relationship between workplace violence and stress. Further research is needed to investigate whether similar findings will conform with the results of this study. Meanwhile, healthcare institutions need to implement strategies to reduce or prevent nurses' exposure to workplace violence and lower their stress levels. Mobilizing and activating social support resources at work are considered other avenues to reduce stress experienced by psychiatric nurses.

Violence by clients and patients against social and healthcare staff - An integrative review of staff's well-being at work, implementation of work and leaders' activities

AIM

The aim of this study was to compile, assess and synthesise empirical research on violence by social and healthcare clients or patients against staff and its connections to staff's well-being at work, implementation of work and activities of leaders related to it.

BACKGROUND

Workplace violence against social and healthcare staff is a global and daily problem. One in three employees encounters violence from patients or clients and the risk of this is 16 times higher compared to other professions. None of the recent reviews on this topic were focused on the well-being at work, implementation of work or leaders' role in the cases of violence of clients or patients against the staff.

DESIGN

An integrative review reported according to PRISMA Checklist.

METHODS

The search was conducted to CINAHL, PubMed, PsychINFO and Scopus databases resulting in 21 articles. The quality of the articles was evaluated, and the data were analysed narratively.

RESULTS

The workplace violence committed by clients and patients was negatively connected to staff's psychological, emotional and physical well-being at work and to their work performance and commitment. The leaders found this form of workplace violence challenging and ethically conflicted and felt that they were left alone without training and support. The employees expressed disappointment with their leaders' activities and suggested many measures to make environment safer to staff and patients.

CONCLUSIONS

In future, intervention studies are needed for prevention of workplace violence by patients and clients against staff and for supporting the well-being at work of staff in relation to violent incidents.

RELEVANCE TO CLINICAL PRACTICE

Workplaces should introduce uniform protocols for reporting, preventing and processing workplace violence committed by clients and patients. An open dialogue with leaders and co-workers of the cases is of high importance. Leaders and staff need training that ensure patient and work safety.

Risk of Burnout among Emergency Department Staff as a Result of Violence and Aggression from Patients and Their Relatives

Emergency department staff are often affected by incidents of violence. The aim of the study was to generate data on the frequency of violence by patients and accompanying relatives and the correlation between experienced aggression, a possible risk of burnout and a high sense of stress. Additionally, the buffering effect of good preventive preparation of care staff by the facility on aggressive visitors and patients was examined. In this cross-sectional study, members of the German Society for Interdisciplinary Emergency and Acute Medicine were surveyed. The investigation of risk factors, particularly experiences of verbal and physical violence, as well as exhaustion and stress, was carried out using ordinal regression models. A total of 349 staff from German emergency departments took part in the survey, 87% of whom had experienced physical violence by patients and 64% by relatives. 97% had been confronted with verbal violence by patients and 94% by relatives. Violence by relatives had a negative effect on perceived stress. High resilience or effective preparation of employees for potential attacks was shown to have a protective effect with regard to the burnout risk and perceived stress. Therefore, management staff play a major role in preventing violence and its impact on employees.

Workplace health promotion interventions for nurses in Germany: a systematic review based on the RE-AIM framework

Background

The German health care system is faced with a serious shortage of nurses. This is associated, amongst other things, with difficult working conditions and work-related health burdens. Workplace health promotion (WHP) is considered a promising approach to promote the health of nurses. The present review aims to give an overview on existing interventions in different nursing settings (acute care hospitals, long-term care (LTC) facilities and home-based long-term care) in Germany.

Methods

A systematic literature search was conducted in PubMed and PubPsych. Studies were included if published after 2010 and provided data of intervention studies on workplace health promotion among nurses in Germany (RCTs, non-RCTs, non-controlled intervention studies and pilot studies). The setting in which the study was conducted (acute medical care hospital, inpatient LTC facilities, home-based LTC, cross-setting) as well as the health issue assessed (physical health, mental health and/or violence experience) were extracted. The intervention was reported against the background of the quality criteria for prevention measures of the statutory health insurers in Germany. The results of the studies were presented according to the RE-AIM framework.

Results

Eleven studies on WHP for nurses were included, whereof seven studies were conducted in acute medical care hospitals and four in LTC facilities. No study reported results on WHP for nurses working in the setting of home-based LTC. Most studies aimed at improving mental health. The intervention contents and forms of implementation were heterogeneous. According to the RE-AIM criteria, the reporting of most studies showed several limitations, especially a lack of reporting on Implementation and Adoption. Most studies showed no statistically significant effect on the respective outcomes (Effectiveness). Four studies reported results on Maintenance indicating a sustained effectiveness.

Conclusion

Despite the high relevance for health promotion for nurses, our review showed a striking lack of intervention studies in this field. From this we derive a high need of tailored interventions, taking into account the setting-specific development, implementation of WHP interventions for nurses. With regard to the evaluation, the RE-AIM criteria should be taken more into account in order to meet the requirements of evaluating complex interventions and thus contribute to evidence development of WHP in nursing. In terms of content, the topic of violence prevention and dealing with experiences of violence should also be taken into account. Regarding the settings, the working conditions and health burdens in LTC facilities, home-based LTC and acute medical hospitals must be considered.

Trial registration

PROSPERO registration number: CRD42021231891

Organizational Framework Conditions for Workplace Health Management in Different Settings of Nursing—A Cross-Sectional Analysis in Germany

Studies show that workplace health promotion (WHP) can reduce sickness-related absenteeism among employees and secure long-term workability. Embedding WHP in workplace health management (WHM) can contribute to sustainability and holism. This study aimed to investigate organizational framework conditions for WHM in different settings of nursing in Germany (acute care hospital, long-term care (LTC) facilities and home-based LTC). In a project on WHM implementation, managers with personnel responsibility for nurses (n = 16) were surveyed. In total, 46 close-ended questions on organizational framework conditions of WHM in their care facility were answered at the beginning of the project. No significant differences were found for the indexes of health promoting willingness, health promoting management, social capital and workplace health activity. Descriptive analysis showed that home-based LTC performed slightly better on average. Home-based LTC and LTC facilities had higher ratings in health promoting willingness than in actually managing the process (health promoting management), while the results for acute care hospitals were reversed. Acute care hospitals showed the lowest values for the topics of health as a leadership topic and evaluation of incidents of violence, which were generally rated lower among all settings. Need for action can be identified in improving personal, financial and time resources, evaluation and information on WHM.

Formally reporting incidents of workplace violence among nurses: A scoping review

AIM

To describe and synthesise the scientific literature on nurses' formal reporting of workplace violence.

BACKGROUND

Research on reporting workplace violence among nurses is increasing annually, but the evidence from such reports has not been summarised or analysed.

EVALUATION

A scoping review was conducted using electronic databases including PubMed, Web of Science, Scopus, CINAHL and Ovid-Embase.

KEY ISSUES

Forty-nine studies were included in this review, and four significant issues pertinent to reporting of workplace violence was identified: (1) the reporting rate is generally low, and oral report is the most popular medium (2) nurses are often not satisfied with how the organisation handles their report, (3) the reasons affecting reporting are complex and diverse, (4) few studies have proposed countermeasures to promote reporting formally.

CONCLUSION

Scholars are paying increasing attention to workplace violence, however, the reporting of workplace violence in real world situations is not being facilitated to inform improvements in managing violence in the workplace. Therefore, more countermeasures conducive to reporting urgently need to be put forward.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers are in a pivotal position to encourage reporting by their staff, respond pro-actively and advocate for more streamlined and accessible processes. The findings of this review can provide a basis for nursing managers to better manage workplace violence and improve the reporting rate among nurses.

Sensitivity and specificity of a brief scale to evaluate psychological violence at work in Peruvian health professionals

Objective

Most studies in Latin America that evaluate psychological violence at work (PVW) focus on measuring occurrences of PVW. However, the discriminative validity and randomness of instruments used for evaluating incidents of PVW that are generated by agents internal to the workplace in the Peruvian health sector have not yet been studied. The objective of this study was to determine the sensitivity and specificity of the Scale of Psychological Violence in Health Professionals (SVP-Health) in the Peruvian population. For this purpose, a cross-sectional study based on the two-stage administration of guided surveys and ROC (receiver operating characteristic) curve analysis was performed.

Results

The study included 188 professionals from ten care centres in Peru. The professionals were divided into two groups of 94 subjects: those who had experienced PVW and those who had not. The average age of the participants was 36.8 ± 10.5 years; their work experience ranged between one and 35 years; and 59% of the sample were women. According to an analysis based on the ROC curve, (a) there was a significant area under the curve (AUC = 0.899) with adequate randomness; and (b) the SPV-Health adequately distinguished subjects with PVW from those without PVW (89% versus 94%).

Supplementary Information

The online version contains supplementary material available at 10.1186/s13104-022-05959-8.

Work-Related Health Burdens of Nurses in Germany: A Qualitative Interview Study in Different Care Settings

Background: The growing need for nursing care is offset by a shortage of nurses, who are exposed to high physical and psychological demands in their daily work and have above-average absences that vary between different care settings. Based on the data on sick days, the question arises: What are the subjective work-related health burdens of nurses in acute care hospitals, inpatient care facilities, and outpatient care services? Methods: Sixteen semi-structured interviews were conducted in different care settings between May and September 2021. Questions about the professional career, everyday working life and personal health, violence in the workplace, and organizational framework conditions were asked. Results: The experiences of the nurses highlighted that health-related burdens have varying manifestations in different care settings. This was reflected in three main categories: health, everyday working life, and experiences of violence. In particular, the different structural framework conditions that trigger stress and the occurrence of violence are important from the perspective of the nurses. Conclusions: The results of this exploratory study can serve as a baseline for obtaining further setting-specific quantitative data that can contribute to the development, implementation, and evaluation of target group-specific health promotion programs.

The Seniority Swoop: Young Nurse Burnout, Violence, and Turnover Intention in an 11-Hospital Sample

We sought to understand whether nurses aged 20 to 29 years burnout and intend to turnover in higher proportions than more senior nurses, and if so, why. Guided by Maslow's hierarchy, we used brief inventories to assess hospital-based bedside nurses at 11 hospitals in Pennsylvania and Rhode Island (n = 3549/9520) prior to the pandemic. In a second study, we compared scheduling policies, bargaining, and Magnet status to see whether these variables predicted worsened burnout rates in young nurses. In a pattern that appears like a swooping line when graphed, nurses aged 20 to 29 years reported higher burnout and intention to leave than more senior nurses. They also reported being punched, bitten, spit on, kicked, or otherwise physically struck more often, worked more long shifts, worked more nights, and reported more dehydration and poorer sleep. Notably, age alone was not a strong predictor of turnover until burnout was added to the model, indicating that there is no inherent millennial trait resulting in higher turnover. Instead, preventing and addressing burnout is key to retention. When comparing hospital characteristics, only scheduling perks for senior nurses predicted the seniority swoop pattern. We offer 9 recommendations to reduce burnout and turnover in young nurses.

[Risk assessment for mental stress]

Hintergrund

Die Gefährdungsbeurteilung psychischer Belastung hat zum Ziel, die durch die Arbeit verbundenen Gefährdungen zu beurteilen, um Maßnahmen zur gesundheitsgerechten Gestaltung der Arbeit abzuleiten. Allerdings ist das Angebot an Verfahren für die Ermittlung der psychischen Belastung umfangreich und unübersichtlich. Vor diesem Hintergrund wird für das Sozial- und Gesundheitswesen ein reduzierter und strukturierter Überblick an Instrumenten vorgestellt.

Methode

Für die Identifizierung geeigneter Instrumente wurde eine umfangreiche Suche durchgeführt. Vor Recherchebeginn wurden Kriterien definiert, um die identifizierten Instrumente auf Eignung zu prüfen. Zum einen gab es Mindestanforderungen, die erfüllt sein mussten, damit das Instrument in den Review-Prozess aufgenommen wurde, und zum anderen Strukturierungskriterien, die sich in beschreibende und bewertende Aspekte unterteilten.

Ergebnisse

Die Recherche identifizierte insgesamt 83 Instrumente für die Gefährdungsbeurteilung psychischer Belastung (GBU Psyche); nach der ersten Sichtung wurden 58 von diesen zur weiteren Eignung im Review-Prozess übernommen. Abgeschlossen wurde das Gesamtreview bisher für 44 Verfahren aus der unsystematischen Suche. Davon wurden 19 Verfahren als geeignet eingestuft und in einer Übersichtsmatrix strukturiert dargestellt. Das Review für die 14 Verfahren aus der systematischen Recherche erfolgt voraussichtlich bis Mitte 2022 und ist Teil eines kontinuierlichen Review-Prozesses.

Diskussion

Die Vielzahl an identifizierten Verfahren für die GBU Psyche (Gefährdungsbeurteilung psychischer Belastung) zeigt deutlich die Sinnhaftigkeit und Relevanz, eine begrenzte, praxiserprobte sowie qualitätsgesicherte Auswahl an Instrumenten zu treffen. Die ebenfalls in diesem Artikel dargestellten Kriterien zur Bewertung der Instrumente, machen die getroffene Auswahl transparent.

Health problems and violence experiences of nurses working in acute care hospitals, long-term care facilities, and home-based long-term care in Germany: A systematic review

Background

Working in the nursing sector is accompanied by great physical and mental health burdens. Consequently, it is necessary to develop target-oriented, sustainable profession-specific support and health promotion measures for nurses.

Objectives

The present review aims to give an overview of existing major health problems and violence experiences of nurses in different settings (acute care hospitals, long-term care facilities, and home-based long-term care) in Germany.

Methods

A systematic literature search was conducted in PubMed and PubPsych and completed by a manual search upon included studies’ references and health insurance reports. Articles were included if they had been published after 2010 and provided data on health problems or violence experiences of nurses in at least one care setting.

Results

A total of 29 studies providing data on nurses health problems and/or violence experience were included. Of these, five studies allowed for direct comparison of nurses in the settings. In addition, 14 studies provided data on nursing working in acute care hospitals, ten on nurses working in long-term care facilities, and four studies on home-based long-term care. The studies either conducted a setting-specific approach or provided subgroup data from setting-unspecific studies. The remaining studies did not allow setting-related differentiation of the results. The available results indicate that mental health problems are the highest for nurses in acute care hospitals. Regarding violence experience, nurses working in long-term care facilities appear to be most frequently affected.

Conclusion

The state of research on setting-specific differences of nurses’ health problems and violence experiences is insufficient. Setting-specific data are necessesary to develop target-group specific and feasible interventions to support the nurses’ health and prevention of violence, as well as dealing with violence experiences of nurses.

[Emotional and psychological status of nursing staff attacked during the COVID-19 pandemic in Latin America]

INTRODUCTION

The new COVID-19 disease is worldwide. During the pandemic, attacks on healthcare staff have increased. The objective of the study was to know the incidence of aggression towards nursing staff and to evaluate the main emotional and psychological symptoms experienced during the COVID-19 pandemic in Latin America.

METHOD

A cross-sectional survey was applied to nursing staff of Spanish-speaking Latin American countries. Sociodemographic information was obtained concerning aggression, psychological symptoms, and emotional state. Descriptive statistics were applied in frequencies and percentages, means and standard deviation.

RESULTS

310 people from Mexico (65.2%), Argentina (5.8%), Colombia (5.2%), Honduras (5.2%), Costa Rica (4.5%) and other Latin American countries (14.1%) participated. 78.1% were women, with an average age of 35.2 years. 79.6% of the sample reported being attacked or discriminated against. The most common emotions were fear of getting sick (73.7%), sleep disturbances (33.4%), fear of infecting their relatives (33.4%). The mental health disorders reported were anxiety (29.2%), sadness (10.4%) and increased appetite (8.8%). The most frequent locations of aggression were the street and public transport. Our results suggest a high incidence of aggression against nursing staff during the pandemic; in any case, the staff present emotional and mental disturbances. It is necessary to develop safety and security policies for nursing staff and provide mental health care to staff who are on the first line of defence against COVID-19.

[Violence Against Staff in Delivery Rooms - Results of an Online-Survey and Structured Interviews in Obstetric Clinics in Berlin]

INTRODUCTION

Violence against medical staff is a known problem in emergency departments. Nevertheless, there is little empirical data about physical and verbal violence against staff members in delivery rooms in Germany.

METHODS

This study comprises both quantitative and qualitative analyses. For the quantitative part, midwives and doctors working in delivery rooms in Berlin were asked to fill out a questionnaire about their experiences with violence within the last 6 months; this survey was completed between 15 November 2019 and 15 February 2020. For the qualitative part, structured interviews were conducted to investigate individual experiences of violence in more detail.

RESULTS

Out of 173 participants in total, 148 (86%) reported to have experienced verbal violence and 82 (47%) reported to have experienced physical violence. Midwives and younger staff seem to be more often affected by violence. 70% of the participants did not feel sufficiently prepared for situations of violence. In a total of 36 interviews, the participants specifically named communicative problems, too high expectations of the pregnant women and their companion, as well as language barrier and cultural differences as reasons for furthering violence.

CONCLUSION

Violence against staff is a relevant problem in delivery rooms in Berlin. Participants would welcome training to deal with violence and professional help for coming to terms with experiences of violence. Improved information about pregnancy and delivery, institutionalized translation, and more staff could possibly help to decrease frequency of violence.

Impact of STAR-VA on Staff Injury and Disruptive Behavior Reports in VA Nursing Homes

OBJECTIVES

Workplace disruptive behavior incidents can be costly for organizations, employees, and customers. Persons with dementia living in long-term care settings have a high risk of exhibiting distressed behaviors. We examined whether a resident-centered, behavioral intervention for residents with dementia led to a reduction in reported workplace disruptive behaviors and staff injury rate due to assault. Impactful interventions are important for quality of care.

DESIGN

We examined whether a team-based behavioral program in community living centers (CLCs), where a nurse champion and behavioral coordinator were trained to work with the clinical team to understand and manage distressed behaviors commonly associated with dementia, was associated with reductions in behavior incidents.

SETTING AND PARTICIPANTS

The setting was Veterans Health Administration CLCs. The sample consisted of 120 aggregated CLCs operating between 2012 and 2017 with 62 completing training. CLCs were distributed across the United States.

METHODS

Outcomes included CLC-level rates of staff injury and number of workplace disruptive behavior incidents. Outcomes were regressed on measures of intervention completion, time since intervention, and several CLC characteristics.

RESULTS

The intervention was significantly associated with lower incidence of assault with staff injury rates overall, particularly following the first year of training, but not with other reported workplace disruptive behavior incident rates.

CONCLUSIONS AND IMPLICATIONS

A team-based behavioral intervention was associated with reduction of employee assaults, a critical repercussion of distressed behavior in dementia. Given rapid growth in patients with dementia in nursing homes, effective treatment practices, such as interdisciplinary behavioral management approaches may be impactful and valuable to implement.

Gewalt und Gewaltprävention in der stationären Altenpflege während der COVID-19-Pandemie

Violence and Violence Prevention in Nursing Homes during the COVID-19 Pandemic - A partial analysis of Interviews with Managers or Team Leaders Abstract. Background: During the first wave of the COVID-19 pandemic, strict infection control measures were in force in long-term residential care in Germany that burdened staff and isolated residents socially. Both are considered risk factors for violence in long-term residential care. Questions: How does violence develop in nursing homes under pandemic conditions from the point of view of managers and how do strategies for preventing violence change? Methods: Semi-structured telephone interviews were conducted with staff in 43 nursing homes: 25 with service managers, 15 with nurse managers, 28 with nursing team leaders and 10 with registered nurses with extended tasks. The interviews were recorded as audio, transcribed and analysed in five steps following the "Thematic Framework Analysis". Results: The infection control measures were partly perceived as deprivation of freedom. Residents, relatives and staff partly reacted most with verbal violence. Nevertheless, the issue of violence was not a major concern for management and preventive measures were not carried out. Conclusions: The results show that strategies to prevent violence might not be sufficiently established in the institutions involved and would have to be adapted to the conditions of the pandemic. Further research is needed to evaluate infection control measures in their potential to increase the incidence of violence.

Incidence of type II workplace violence in Catalan nursing homes

BACKGROUND

Nursing home professionals belong to one of the most vulnerable occupational groups when it comes to type II workplace violence. Cared-for elders carry out violent actions that affect both the health of professionals and the organisation and services provided in nursing homes. Taking notice of this phenomenon and getting to know its magnitude is the first step for preventive action and intervention to take place. In Catalonia, it was the medical community that started to notice workplace violence. However, the frequency of this phenomenon had not been investigated.

OBJECTIVE

This study was carried out with the main goal of learning about the phenomenon of type II workplace violence in nursing homes.

METHODS

433 nursing home professionals of Catalonia volunteered to take part in this study. They remained anonymous and their data was treated confidentially.

RESULTS

68.6%(IC 95%: 64.1-73.1) of the nursing home professionals admitted to having been attacked by the senior citizens residing in these nursing homes. The occupation and self-perceived stress level of the professionals were related to the consideration of aggression. Verbal abuse was the type of aggression that targeted professionals reported the most. In 61.3 %of the cases, they were attacked by both male and female patients.

CONCLUSION

The results of the study reveal that nursing home professionals are assaulted and/or attacked by the residents they tend to.