Workplace Violence in Chinese Hospitals: The Effects of Healthcare Disturbance on the Psychological Well-Being of Chinese Healthcare Workers

Association between occupational burnout and psychological symptoms among Chinese medical staff: moderating role of social support

This study aimed to examine the association between occupational burnout and psychological symptoms among Chinese medical staff, assuming social support to play a moderating role in the aforementioned relationship. The survey was conducted online from May 1 to June 28, 2022, and the questionnaires were distributed and retrieved through a web-based platform. The final sample was comprised of 1461 Chinese medical staff in this cross-sectional study. Several multiple linear regressions were performed to analyze the data. After controlling for potential confounding factors, all three dimensions of occupational burnout were associated with poorer psychological symptoms. Emotional exhaustion (β = 0.33; 95% confidence interval [CI], 1.018, 1.479) had the strongest association with psychological symptoms, followed by depersonalization and diminished personal accomplishment. Moreover, medical staff with higher levels of friend support (β =  -0.11; 95% CI, -4.063, -0.573) and significant other support (β =  -0.10; 95% CI, -3.965, -0.168) were less likely to suffer from psychological symptoms when faced with occupational burnout. The results suggested that interventions aimed at lessening occupational burnout and boosting social support can be an effective way to promote the psychological health of medical staff.

Depression in nursing students during the COVID-19 pandemic: Systematic review and meta-analysis

The pandemic meant a change in academic approach. This had an impact on the mental health of students, leading to, among other problems, depressive disorders. The aim of this study was to find out the prevalence and factors that favoured the development of depression in nursing students during the COVID-19 pandemic. A systematic review with meta-analysis of prevalence was conducted in October 2023, using Pubmed, CINAHL and Scopus as the data sources used for the search. This review followed the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Search equation was: "(undergraduate nurses OR nursing students) AND depression AND (COVID-19 OR Sars-CoV-2)". The final set of articles was N = 12. Quantitative primary studies using anonymous scales and surveys to assess the prevalence of depression in nursing students in the last 3 years were included. Studies show a high prevalence of depression among young university students with figures above 50%. The total sample of students in the meta-analysis was n = 4,479 with a prevalence value of 32% (CI95% 22%-42%). Affected students are characterised by young, female students. Concerns included generalised academic uncertainty, social isolation, work overload, fear of contagion and concern about teaching delivery. Coping mechanisms were generally resilience, spiritual support, laughter therapy, seeking information about COVID-19 and eating food. In conclusion, students, especially female students, are at high risk of depression due to social isolation. In addition, coping techniques were inadequate and future strategies to prevent this situation should be considered.

Improvement of violence management among nurses in Iran: The best practice implementation project in a health promoting hospital

BACKGROUND

This project aimed to assess compliance with evidence-based criteria' for the prevention and management of workplace violence against nursing staff in Shahid-Beheshti hospital, Maragheh, Iran. Workplace violence is a managerial and workplace occupational health and safety issue that can affect the performance of an institution. Further, it might turn the work environment into an insecure and hostile one which can influence the performance of employees and their professional relationships negatively. Nevertheless, staff have their own legal rights, and their organizations are legally and ethically in charge of providing them with safe work environments.

METHODS

Following the JBI Practical Application of Clinical Evidence System and Getting Research into Practice audit and feedback tool with three phases of activities, this project utilized an implementation framework incorporating quality improvement. Furthermore, the audit tool was used to establish the project and set up the measurement and evaluation of three evidence-based criteria.

RESULTS

The post-implementation audit results indicated a significant improvement in violence management and prevention. The compliance rate on the first criterion, i.e. aggression management training, increased from 49% at baseline to 81% at the end. The second criterion, i.e. timely support and assistance following an incident, exhibited greater increase from eight to 73%. Finally, an increased compliance was noted on the third criterion, i.e. policy for risk management and safe environment, from 22 to 77%.

CONCLUSIONS

The current project successfully implements evidence-based violence management in Shahid-Beheshti hospital. It reveals significant results on compliance and the increasing knowledge of nurses on evidence-based stress management, communication skills and self-companion.

Association between Workplace Violence and Depressive Symptoms among Primary Healthcare Professionals in Shandong, China: Meaning in Life as a Moderator

BACKGROUND

Workplace violence (WPV) is common in healthcare settings. However, the association between WPV and depressive symptoms has not been explored among primary healthcare professionals, especially in China. The assumption of the moderating effort of meaning in life on the association has also not been tested. The purposes of the study are to investigate the relationship between WPV and depressive symptoms and identify the moderating role of meaning in life among primary healthcare professionals in China.

METHODS

In this study, we collected 2530 valid questionnaires. The participants were composed of primary healthcare professionals in Shandong province, China. WPV, meaning in life (including presence of life and search for life), depressive symptoms, and some social-demographic variables were evaluated. The SPSS macro was used to build the moderating relationship.

RESULTS

WPV was positively correlated with depressive symptoms (β = 9.09, p < 0.001), and meaning in life was negatively associated with WPV and depressive symptoms (β = -0.13, p < 0.05) among primary healthcare professionals in China. For primary healthcare professionals with low presence of life, presence of life aggravated the relationship.

CONCLUSIONS

The current study has verified the association between WPV and meaning in life, and the relationship between WPV and depressive symptoms has been supported among primary healthcare professionals in China. Meaning in life and presence of life as moderators play crucial roles in the relationship between WPV and depressive symptoms.

Association between high burn-out and workplace violence among healthcare workers in China: a WeChat-based survey

OBJECTIVES

This study is conducted to examine whether overall workplace violence (WPV) and its five types are associated with high burn-out among healthcare workers in China.

DESIGN

A WeChat-based cross-sectional survey. Snowball sampling was used in this study.

PARTICIPANTS

Front-line healthcare workers (N=3706) from 149 cities across 23 provinces in China responded to the survey, and 22 questionnaires were excluded because of incomplete data.

PRIMARY AND SECONDARY OUTCOME MEASURES

(1) The Chinese Maslach Burnout Inventory-General Survey was used to measure high burn-out. (2) WPV was assessed using the Chinese version of the Workplace Violence Scale. (3) An anonymous self-designed web-based questionnaire consisting of demographic, behavioural and occupational information was used to identify covariates.

RESULTS

A total of 3684 front-line healthcare workers (934 physicians and 2750 nurses) were included. Of all participants, 13.3% (491/3193) experienced high burn-out. Adjusted logistic regression revealed that experience of WPV in the past year was associated with high burn-out (OR 2.10, 95% CI 1.69 to 2.62). Healthcare workers who had suffered emotional abuse, threat or verbal sexual harassment were more vulnerable to high burn-out.

CONCLUSION

This study finds that healthcare workers with WPV, especially emotional abuse, threat and verbal sexual harassment, are more likely to experience burn-out. These types of WPV should be considered in interventions to reduce and prevent burn-out for healthcare workers.

Psychological stress responses of medical staff after workplace violence: a longitudinal study

OBJECTIVE

To explore the occurrence and dynamic trends of psychological stress responses of medical staff experiencing workplace violence at different time points.

METHODS

A longitudinal study of 23 medical workers who experienced workplace violence was conducted. The perceived stress scale (PSS-4), posttraumatic stress disorder checklist for DSM-5 (PCL-5), and hospital anxiety and depression scale (HADS) were used to measure the medical workers' psychological perception of pressure, posttraumatic stress symptoms, anxiety, and depression at the time of exposure to violence, at 1 month, 2 months, and 4 months after exposure in the workplace, respectively. Repeated measures analysis of variance was applied to analyze psychological stress response and temporal effect. Factors influencing psychological stress responses were analyzed.

RESULTS

The scores of PSS-4, PCL-5, HADS-anxiety, and HADS-depression of medical staff exposed to violence began to increase at the time of exposure, peaked 1 month after exposure, and gradually decreased 2 months and 4 months after exposure (all P<0.05). The main influencing factors were being nurses, physical violence, working years ≤5, and being female.

CONCLUSION

Effective interventions for medical staff should be made up to 1 month after exposure to workplace violence when the psychological stress responses are the highest.

Exploring Experiences of Workplace Violence and Attempts to Address Violence Among Mental Health Nurses in the Kingdom of Saudi Arabia

INTRODUCTION

Workplace violence has emerged as a global phenomenon requiring immediate attention. The nursing profession is primarily affected, and the unique vulnerability of nurses to workplace violence is particularly evident in the field of mental health nursing.

AIMS

This study explores the experiences of mental health nurses with work-related violence and attempts to combat this violence in the context of inpatient mental health facilities in Saudi Arabia.

METHODS

This research comprises a qualitative exploratory study consisting of semistructured interviews with 16 participants using open-ended questions. The participants are psychiatric/mental health nurses with experience in the field, so this methodological approach facilitates a detailed investigation of their encounters with workplace violence.

RESULTS

This study reveals that nurses experience violence in accordance with two main themes and subthemes: experiences of workplace violence, the influence of violence on work settings, and efforts required to combat violence. Data show that these participants consider of prime importance access to training to increase safety through knowledge, improved communication, and protective skills, along with adequate staffing and a safe built environment.

CONCLUSION

The research findings confirm the urgency of addressing the needs of mental health nurses in inpatient psychiatric hospitals. Policymakers in the healthcare field must be aware of the inpatient psychiatric care climate and the need for support from those who staff these areas of practice. Training in specialized knowledge and skills is required to ensure a safe work environment as well as appropriate staffing levels, and a safe built environment. These conditions may be required to recruit and retain mental health nurses capable of providing best-practice care.

Protecting Nurses from Mistreatment by Patients: A Cross-Sectional Study on the Roles of Emotional Contagion Susceptibility and Emotional Regulation Ability

In recent years, patient mistreatment of healthcare workers, especially nurses, has been frequent, endangering the interests of organizations while also threatening nurses’ own development. This study aims to examine from the perspective of nurses’ personal interests whether mistreatment by patients decreases nurses’ workplace well-being and career commitment, and how their susceptibility to emotional contagion and emotional regulation ability might mitigate these negative effects. This study adopted a cross-sectional study design (data were collected through self-reported questionnaires with a two-month time lag between the months of August–October 2017). A total of 289 nurses from three hospitals in Shandong province, China, were recruited to participate in our study. The results reveal that mistreatment by patients is negatively related to nurses’ workplace well-being and career commitment. Emotional contagion susceptibility moderates the relationships between mistreatment by patients and career commitment, while there is no significant buffering effect of mistreatment by patients on workplace well-being. Emotional regulation ability moderates the relationships between mistreatment by patients and both workplace well-being and career commitment. These results suggest that improvements in nurses’ emotional regulation ability and susceptibility to emotional contagion can alleviate the harmful impacts of mistreatment by patients.

Knowledge, Attitudes, and Social Responsiveness Toward Corona Virus Disease 2019 (COVID-19) Among Chinese Medical Students-Thoughts on Medical Education

Purpose: To assess knowledge, attitudes, and social responsiveness toward COVID-19 among Chinese medical students.

Methods: Self-administered questionnaires were used to collect data from 889 medical students in three well-known Chinese medical universities. The questionnaire was comprised of three domains which consisted of demographic characteristic collection, seven items for knowledge, and eight items for attitudes and social responsiveness toward COVID-19. Data from different universities were lumped together and were divided into different groups to compare the differences, including (1) students at the clinical learning stage (Group A) or those at the basic-medicine stage (Group B) and (2) students who have graduated and worked (Group C) or those newly enrolled (Group D).

Results: Medical students at group B had a weaker knowledge toward COVID-19 than did students at group A, especially in the question of clinical manifestations (p < 0.001). The percentage of totally correct answers of COVID-19 knowledge in group C was higher than that in Group D (p < 0.001). There were significant differences between groups C and D in the attitudes and social responsiveness toward COVID-19. Surprisingly, we found that the idea of newly enrolled medical students could be easily affected by interventions.

Conclusions: In light of this information, medical education should pay attention not only to the cultivation of professional knowledge and clinical skills but also to the positive interventions to better the comprehensive qualities including communicative abilities and empathy.

Emotional Intelligence Profiles and Mobbing in Nursing: The Mediating Role of Social Support and Sensitivity to Anxiety

The prevalence of mobbing among nurses in various countries is around 17–20%. Some researchers have attempted to explain the success or failure of adaptation to the work environment and teamwork and to buffer the effects of psychological harassment in the workplace by incorporating emotional intelligence into the mobbing context. As its main objectives, this quantitative, observational, cross-sectional study analyzed the relationship between emotional intelligence and mobbing as perceived by nurses and sought to establish the mediating roles of other variables involved, such as social support and sensitivity to anxiety. The final sample consisted of 1357 Spanish, self-selected nurses aged 22–58 from multiple healthcare institutions. The questionnaires (Perceived Psychological Harassment Questionnaire, The Brief Emotional Intelligence Inventory, Brief Perceived Social Support Questionnaire, Anxiety Sensitivity Index-3) were implemented on a web platform, which enabled the participants to complete them online. Descriptive analyses and mediation models were estimated. Personal characteristics related to high sensitivity to anxiety and low emotional intelligence implied greater presence of mobbing at work. This mobbing may be buffered if the person perceives enough support from family, friends or significant others. Our results recommend reinforcing the social support network of nursing personnel to improve the work climate and training them in emotional intelligence in university and on-the-job programs.

Risk assessment of workplace violence towards health workers in a Chinese hospital: a cross-sectional study

OBJECTIVE

This study aimed to assess the risk factors associated with workplace violence towards health workers (HWs) in a Chinese hospital.

METHODS

We conducted a cross-sectional survey in a Chinese secondary hospital in 2019 using an international survey questionnaire, and collected valid data from 1028 HW respondents via mobile phone. Alongside analysing the potential association between exposure to violence and respondents' characteristics, we compared the workplace violence between this survey and a baseline survey in the same hospital using the same questionnaire in 2018, and investigated the existing measures.

RESULTS

A total of 5.45% of respondents had encountered physical violence while 41.63% had experienced psychological violence. Women (OR=3.45, 95% CI 1.87 to 6.38), those working in outpatient and emergency departments (OR=7.96, 95% CI 2.27 to 27.95), and those with extremely high concern about workplace violence (OR=7.94, 95% CI 1.04 to 60.85) were significantly more likely to suffer physical violence. Working in the outpatient and emergency department (OR=2.03, 95% CI 1.23 to 3.34), having direct physical contact/interaction with patients (OR=2.98, 95% CI 1.62 to 5.49), and extremely high worry about workplace violence (OR=6.47 95% CI 3.38 to 12.40) significantly increased the risk of psychological violence. When the results of the baseline survey were compared with those in this survey, it was shown that physical violence declined significantly from 8.79% in 2018 to 5.45% in 2019, while psychological violence declined significantly from 47.14% in 2018 to 41.63% in 2019. The most recognised measures were security measures (81.03%) while the least recognised measures were check-in procedures for staff (11.19%).

CONCLUSION

Workplace violence towards HWs is a global problem with country-specific features. In our study, workplace violence in the hospital is of great concern. While demonstrating the effectiveness of measures in some degree, there is significant room for improvement. To achieve the vision of 'zero violence' in the health sector, aligned comprehensive measures should be systematically adopted.

The Mediating Role of Perceived Stress in Associations Between Self-Compassion and Anxiety and Depression: Further Evidence from Chinese Medical Workers

Objective

Medical workers report high rates of stress, anxiety and depression, which need urgent attention. Providing evidence for intervention measures in the face of a mental health crisis, the present study validates the relation between self-compassion and anxiety and depression mediated by perceived stress amongst medical workers. The goal is also to replicate a similar mediation model though multigroup analysis.

Methods

Medical workers were randomly selected to investigate by paper-and-pencil survey among 1,223 medical workers from three hospitals in Shiyan, China. The measures were comprised of four parts: the Chinese version of the Goldberg Anxiety and Depression Scale (GADS), the Self-Compassion Scale-Short Form (SCS-SF), the Perceived Stress Questionnaire (PSQ) and a socio-demographic questionnaire. Applying structural equation modeling (SEM, single-group analysis), we estimated the effects of self-compassion on anxiety/depression through perceived stress. Furthermore, based on multigroup analysis, we used two sets of internal samples (gender groups, medical groups) and an external sample (nursing students) for testing multigroup invariance.

Results

The average scores of anxiety, depression, self-compassion and perceived stress in medical workers were 5.93 ± 2.46, 4.91 ± 2.62, 38.87 ± 4.66 and 71.96 ± 15.14, respectively. In some departments engaged in the research, the medical workers showed higher levels of anxiety and depression. The SEM results indicated that the original relationship between self-compassion and anxiety and depression was beta = -0.42 (P < 0.001) and reduced to beta = -0.17 (P < 0.001) while introducing perceived stress as a mediating variable. Perceived stress was positively associated with anxiety and depression (beta = 0.60, P < 0.001), and self-compassion was negatively associated with perceived stress (beta = -0.56, P < 0.001). Multigroup analysis showed acceptable changes in fit indices across gender (male and female), medical (clinician and non-clinician), and population (medical workers and nursing students) groups.

Conclusion

Medical workers were experiencing high levels of anxiety and depression and perceived stress. Perceived stress might have a partial mediating effect on self-compassion and anxiety and depression amongst medical workers, which was similar to a previous study in nursing students. The findings supported multigroup invariance across gender, medical and population groups. The study concluded that the mediation model may be generalized across these multiple samples. Psychological intervention could be used to improve levels of self-compassion of medical workers.

A worldwide bibliometric analysis of published literature on workplace violence in healthcare personnel

Background

Workplace violence in healthcare professionals has become a worldwide public health problem and has been the focus of numerous publications; however, currently, no macroscopic overviews of this research based on bibliometric analysis have been carried out. Therefore, the main aim of this study was to analyse the research trends focusing on workplace violence in healthcare personnel over the last 27 years.

Materials and methods

A bibliometric study was conducted from 1992 to 2019 in the field of workplace violence in healthcare personnel using the Scopus database. The author co-citation analysis was carried out using VOSviewer software. A worldwide map was created with Mapchart and word cloud image was created using Wordart. Descriptive and inferential statistics were applied.

Findings

1791 records were analysed, 1376 of which (76.83%) were articles, with “Medicine” the most frequent subject category (58.91%). English was the predominant language (93.41%). From 2004 onwards, there was an exponential rise in the number of publications (R² coefficient = 0.89; p < 0.0001) and the number of annual citations gradually increased from 1995 (R² coefficient = 0.73; p < 0.0001). The University of Cincinnati (United States) was the institution (and country) with the highest number of publications (n = 30; n = 549), with D. M. Gates leading the ranking of the most productive authors (n = 21). Journal of Nursing Management was the most active journal publishing on the topic (n = 34) and the commonest keyword was “human/s” (16.43%).

Conclusion

From 1992 to 2019, worldwide research into the published literature on workplace violence in healthcare personnel has grown steadily year by year, both in the number of documents and the number of citations. United States and their institutions and researchers dominates this research output.

Anxiety symptoms and burnout among Chinese medical staff of intensive care unit: the moderating effect of social support

BACKGROUND

Social support can be a critical resource to help medical staff cope with stressful events; however, the moderating effect of social support on the relationship between burnout and anxiety symptoms has not yet been explored.

METHODS

The final sample was comprised of 514 intensive care unit physicians and nurses in this cross-sectional study. Questionnaires were used to collect data. A moderated model was used to test the effect of social support.

RESULTS

The moderating effect of social support was found to be significant (b = - 0.06, p = 0.04, 95%CI [- 0.12, - 0.01]). The Johnson-Neyman technique indicated that when social support scores were above 4.26 among intensive care unit medical staff, burnout was not related to anxiety symptoms.

CONCLUSIONS

This is the first study to test the moderating effect of social support on the relationship between burnout and anxiety symptoms among intensive care unit staff.