Workplace Violence in Outpatient Physician Clinics: A Systematic Review

Impact of Workplace Bullying on Nursing Care Quality: A Comprehensive Review

Workplace bullying, commonly known as mobbing, persists as a significant problem across various industries, including the healthcare sector. To establish effective interventions and protocols for enhancing the well-being of healthcare workers and patients, it is vital to fully grasp the link between workplace bullying and the quality of nursing care. The analysis highlights the complex link between workplace bullying and nursing care quality, stressing the urgency of addressing this issue due to its wide-reaching impact on individuals and healthcare organizations, ultimately affecting patient safety. Emphasizing the significance of addressing workplace bullying across different professional settings is crucial for protecting the mental health and well-being of employees. The research identifies various forms of aggression and emphasizes the need to understand how these behaviors affect patient outcomes. Further investigation is needed to clarify nurses' responses to workplace violence, particularly in specialized settings like mental health facilities. The studies underscore the numerous challenges nurses encounter when trying to report incidents of workplace bullying. This insight is vital for developing effective reporting mechanisms and targeted interventions to combat bullying behaviors in medical environments. Ultimately, establishing a safer working environment for nurses is paramount. This article aims to review the associations between workplace bullying and the quality of nursing care.

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

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

Restoring Well-Being for Physicians Through Lifestyle Medicine

In the wake of the COVID-19 pandemic, physician burnout is a more relevant concern than ever. Pre-existing stressors in health care, such as poor work-life balance, perfectionism, and inadequate social support, have been exacerbated by uncertainty, increased risk exposure, and general anxiety. Burnout places not only physicians, but also patients, systems, and communities at risk. The promotion of physician well-being is critical to sustaining the health care system. Actions to reduce burnout and increase well-being can and should occur on multiple levels. Organizations and leaders must take steps to create a culture of support and respect for health care providers. Such steps may include improved time-off policies, destigmatizing the use of mental health services, and reducing administrative burden. Physician well-being may benefit from action on an individual level as well. The pillars of Lifestyle Medicine provide a framework for engaging in behaviors compatible with overall well-being, such as physical activity, social connection, and sleep. Lifestyle Medicine plays a key role in mitigating the impact of physician burnout, and will be essential to the success of the health care system moving forward.

Prevalence and associated factors of sexual, psychological, and physical violence among physical therapists in their clinical role in Spain: a national web-based cross-sectional survey

OBJECTIVES

To determine the extent of career-long and 12-month exposure to sexual, physical, and psychological/verbal violence committed by patients or their companions among physical therapists in Spain. Additionally, to identify the factors associated with such exposure.

METHODS

This study employed an observational cross-sectional approach. Initially, a questionnaire was developed and validated using a convenience sample. Subsequently, it was distributed via email to all physical therapists registered in Spain in the first quarter of 2022. Individual risk models were created for each type of violence experienced within the past 12 months.

RESULTS

The prevalence of violence encountered by physical therapists throughout their careers was 47.9% for sexual violence, 42.7% for psychological/verbal abuse, and 17.6% for physical abuse. Lower values were observed within the last 12 months (13.4%, 15.8%, and 5.2%, respectively). Statistical risk modeling for each type of violence experienced in the past 12 months indicated that the common precipitating factor for all forms of violence was working with patients with cognitive impairment. Working part-time appeared to be a protective factor. Other factors, such as the practitioners' gender, practice setting, or clinic location showed variations among the diverse types of violence.

CONCLUSIONS

The exposure to type II workplace violence within the last 12 months among physical therapists in Spain (Europe) is not so high as in some other world regions. Various individual, clinical, and professional/organizational risk factors have been identified in connection with type II workplace violence. Further research is warranted to compare the violence experienced once the COVID pandemic has subsided.

Evaluation of violence against primary care healthcare professionals through different dimensions

BACKGROUND

Violence is common in emergency departments and is also increasing in primary care settings. It is important to research the factors that cause violence to prevent incidents.

OBJECTIVE

The aim of this study is to determine the frequency, causes, and effects of violence in the workplace of primary care physicians in a province in Turkey.

METHODS

This cross-sectional study was conducted among 303 family physicians working in Family Health Centers. The subjects completed a questionnaire consisting of questions designed to elicit healthcare professionals' perspectives on violence. The analysis was performed using SPSS 15.0 software, with p < 0.05 considered significant.

RESULTS

The participants' mean age was 48.05±6.11. The majority (82%) stated that they had been subjected to violence throughout their professional life. Although the rate of exposure to violence was 56.4% in the previous year, they did not report these incidents to the appropriate authorities. The main reason for failing to report violent acts was "not caring" (40.1%). Respondents who believed "violent incidents should be reported" were under 50 years old (p = 0.045). The impact of violence on their lives was expressed as "losing interest in their profession" (40.8%). The most commonly cited cause of violence was "educational problems" (74.9%).

CONCLUSION

Violence is prevalent in primary healthcare settings. It is suggested that there can be numerous reasons for violence, primarily a lack of education, and its effects, such as professional disengagement, are notable. Measures should be implemented to provide physicians with safe working conditions and reduce the risk of violence.

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.

Workplace Violence in Healthcare Settings: A Scoping Review of Guidelines and Systematic Reviews

Workplace violence in healthcare settings is alarmingly common and represents significant financial and human cost. The aim of this scoping review was to identify and summarize evidence on strategies to prevent and/or manage workplace violence in healthcare settings. Searches were limited to evidence-based clinical practice guidelines and systematic reviews published between 2015 and 2021. Multiple databases were searched and screened. Quality of the included guidelines and reviews was also assessed. Three guidelines and 33 systematic reviews were included. Both the Occupational Safety and Health Administration 2015 and Registered Nurses' Association of Ontario 2019 guidelines provided useful recommendations for building a comprehensive prevention program. Evidence-based risk assessment, prevention and management, and education and training are all central components. Regular reassessment and adjustment is required. Included reviews (n = 33) were grouped into five main categories: violence toward nurses (n = 10); violence toward healthcare workers in general (n = 8); violence in the emergency department (n = 5); violence related to mental health (n = 5); and measurement related to workplace violence (n = 5). Multicomponent interventions were often more effective than those applied in isolation. We found consistent support for certain strategies including education and training, post-incident debriefing, multidisciplinary rapid response teams, and environmental modifications; however, the strength of evidence and certainty of conclusions were limited across reviews. This scoping review found that strong leadership that cultivates and enforces a culture of inclusivity, support, and respect is a prerequisite for a successful workplace violence prevention program. Rigorous comparative effectiveness research testing interventions are needed.

Nursing students' experiences of sexual harassment - A qualitative study from feminist identity perspective

AIM

To explore experiences of sexual harassment among nursing students in an East Asian region and to gain knowledge of the underlying factors influencing nursing students' conceptualization of and response to sexual harassment.

BACKGROUND

Nursing students are susceptible to sexual harassment due to gender and power inequality in healthcare systems. Sexual harassment has an adverse impact on the students' physical and mental health. Studies on sexual harassment among nursing students are limited and reported significantly varied occurrence prevalence in different cultures. Feminist identity theory can provide a framework to examine social-culturally constructed perceptions of sexual harassment.

DESIGN

A qualitative descriptive study.

METHODS

The study was conducted in Macau, a Special Administrative Region of China. Purposive sampling was applied. Twenty-six nursing students and five nursing educators participated in the study. Semi-structured interviews were conducted. Thematic analysis was used to analyze the interview data. A series of measures were applied to enhance the trustworthiness of the study.

RESULTS

While most of the students had not experienced or heard of sexual harassment, a limited number claimed sexual harassment as a frequently encountered instance. The students expressed uncertainty about what constituted sexual harassment, mainly due to a lack of exposure to information on sexual harassment. They were caught in a dilemma between exerting nursing professional virtues and exposing the misconduct of the suspected perpetrators, leading to taking passive approaches of ignoring and avoiding as the primary coping strategies. In contrast, nursing educators advocated proactive approaches as coping strategies to address sexual harassment.

CONCLUSIONS

A conflict between nursing professional identity and feminist identity is observed among nursing students. Healthcare institutions and nursing schools should develop interventions to enhance nursing students' assertiveness to sexual harassment.

Contemporary evidence of workplace violence against the primary healthcare workforce worldwide: a systematic review

Violence against healthcare workers recently became a growing public health concern and has been intensively investigated, particularly in the tertiary setting. Nevertheless, little is known of workplace violence against healthcare workers in the primary setting. Given the nature of primary healthcare, which delivers essential healthcare services to the community, many primary healthcare workers are vulnerable to violent events. Since the Alma-Ata Declaration of 1978, the number of epidemiological studies on workplace violence against primary healthcare workers has increased globally. Nevertheless, a comprehensive review summarising the significant results from previous studies has not been published. Thus, this systematic review was conducted to collect and analyse recent evidence from previous workplace violence studies in primary healthcare settings. Eligible articles published in 2013-2023 were searched from the Web of Science, Scopus, and PubMed literature databases. Of 23 included studies, 16 were quantitative, four were qualitative, and three were mixed method. The extracted information was analysed and grouped into four main themes: prevalence and typology, predisposing factors, implications, and coping mechanisms or preventive measures. The prevalence of violence ranged from 45.6% to 90%. The most commonly reported form of violence was verbal abuse (46.9-90.3%), while the least commonly reported was sexual assault (2-17%). Most primary healthcare workers were at higher risk of patient- and family-perpetrated violence (Type II). Three sub-themes of predisposing factors were identified: individual factors (victims' and perpetrators' characteristics), community or geographical factors, and workplace factors. There were considerable negative consequences of violence on both the victims and organisations. Under-reporting remained the key issue, which was mainly due to the negative perception of the effectiveness of existing workplace policies for managing violence. Workplace violence is a complex issue that indicates a need for more serious consideration of a resolution on par with that in other healthcare settings. Several research gaps and limitations require additional rigorous analytical and interventional research. Information pertaining to violent events must be comprehensively collected to delineate the complete scope of the issue and formulate prevention strategies based on potentially modifiable risk factors to minimise the negative implications caused by workplace violence.

Associations among the workplace violence, burnout, depressive symptoms, suicidality, and turnover intention in training physicians: a network analysis of nationwide survey

Depression and anxiety are the most common mental disorders among physicians, who have a greater risk of suicide than those in other professional occupations. Relationships among a demanding workload, workplace violence, burnout, and intention to turnover have also been reported. The current study examined the principal components and propagating patterns of mental health and working environment interactions in training physicians. A total of 1981 training physicians completed online self-report questionnaires during September-October (midpoint of the training year) 2020. Regularized partial correlations in a mixed graphical model (MGM) and joint probability distributions (directed acyclic graph; DAG) were estimated for four subtypes of workplace violence (verbal abuse/physical violence perpetrated by clients/hospital staff), three burnout subdomains (Maslach Burnout Inventory), thoughts about quitting, and nine depressive symptoms, including suicidality, comprising the DSM-5 diagnostic criteria for major depressive disorder (assessed using the Patient Health Questionnaire-9). Thoughts of death/self-harm showed directional dependencies on the joint probability distributions of psychomotor agitation/retardation, concentration difficulty, self-reproach, and sadness in the DAG. In the MGM, a partial correlation with psychomotor agitation/retardation (r = 0.196) accounted for 56.5% of the variance in thoughts of death/self-harm. Partial correlations with concentration difficulties (r = 0.294), self-reproach (r = 0.257), changes in appetite (r = 0.184), and worker-on-worker physical violence (r = 0.240) in the MGM accounted for 54.4% of the variance in psychomotor agitation/retardation. Thoughts about quitting were partially correlated with and dependent upon the joint probability distributions of emotional exhaustion (r = 0.222), fatigue (r = 0.142), anhedonia (r = 0.178), and sadness (r = 0.237). In contrast, worker-on-worker (r = 0.417) and client-on-physician (r = 0.167) verbal abuse had regularized partial correlations with directional dependencies on thoughts about quitting. Organization-level interventions aiming to reduce the worker-on-worker violence and individual-level approaches of clinical screening program and psychiatric counseling clinic are required. Follow-up studies to verify the effectiveness of these interventions for training physicians are needed.

Anger: an underappreciated destructive force in healthcare

Anger is an emotional state that occurs when unexpected things happen to or around oneself and is "an emotional state that varies in intensity from mild irritation to intense fury and rage." It is defined as "a strong feeling of displeasure and usually of antagonism," an emotion characterized by tension and hostility arising from frustration, real or imagined injury by another, or perceived injustice. It can manifest itself in behaviors designed to remove the object of the anger (e.g., determined action) or behaviors designed merely to express the emotion. For the Roman philosopher Seneca anger is not an uncontrollable, impulsive, or instinctive reaction. It is, rather, the cognitive assent that such initial reactions to the offending action or words are in fact unjustified. It is, rather, the cognitive assent that such initial reactions to the offending action or words are in fact unjustified. It seems that the year 2022 was a year when many Americans were plainly angry. "Why is everyone so angry?" the New York Times asked in the article "The Year We Lost It." We believe that Seneca is correct in that anger is unacceptable. Anger is a negative emotion that must be controlled, and Seneca provides us with the tools to avoid and destroy anger. Health care professionals will be more effective, content, and happier if they learn more about Seneca's writings about anger and implement his wisdom on anger from over 2000 years ago.

Workplace violence against physicians in intensive care units in Turkey: A cross-sectional study

Background Although there are many studies on violence against physicians in the literature, there are few studies on violence against physicians working in intensive care units (ICUs). We aimed to investigate the frequency, type and underlying factors of violence against physicians working in ICUs in Turkey in the past 1 year. Methods We collected data by sending a questionnaire about violence against physicians working in ICUs via e-mail and WhatsApp between 1 and 15 May 2022. IBM SPSS Statistics V.24.0 was used for data analysis. The chi-square test and Fisher precision test were used to compare categorical data. Results Over one-third (38.6%) of the 354 physicians participating in our study reported that they had been exposed to violence in the past year, while 20.7% reported that they had been exposed to violence more than once in the past year. There was a significant relationship between the frequency of exposure to violence, female gender, age group, title, subspecialization status, working style and duration of working in the ICU (p<0.05). There was no relationship between the working area, type of hospital and ICU and exposure to violence (p>0.05). The presence of restriction and control points at the entrance to ICUs prevented violence (p<0.05). Conclusion Physicians working in ICUs encounter violence against them. The frequency of violence increased after the Covid-19 pandemic. A significant relationship was found between the frequency of violence and female gender, age group, title, subspecialization status, working style and duration of working in ICUs.

Development and Validation of Questionnaires to Assess Workplace Violence Risk Factors (QAWRF): A Tripartite Perspective of Worksite-Specific Determinants in Healthcare Settings

Introduction

Workplace violence (WPV) incidences are prevalent in healthcare, and existing WPV interventions have only moderate evidence for effectiveness. This study aimed to develop and validate an instrument to assess worksite-specific WPV risk factors in healthcare settings based on a tripartite perspective of key stakeholders to facilitate improved interventions.

Methods

Three questionnaires were developed to get the responses from healthcare administrators, workers, and clients, representing the three components of Questionnaires to Assess Workplace Violence Risk Factors (QAWRF). The domains of the questionnaires were developed based on The Chappell and Di Martino's Interactive Model of Workplace Violence, and the items were generated from 28 studies identified from a systematic review of the literature. Six experts, 36 raters, and 90 respondents were recruited to assess the content validity, face validity, and usability and reliability of the QAWRF respectively. Item and Scale Level Content Validity Index, Item and Scale Level Face Validity Index, and Cronbach's alpha values were determined for QAWRF-administrator, QAWRF-worker, and QAWRF-client.

Results

The psychometric indices for QAWRF are satisfactory.

Conclusion

QAWRF holds good content validity, face validity, and reliability, and findings from QAWRF can contribute towards worksite-specific interventions that are expected to be resource efficient and more effective than general WPV interventions.

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.

Patient Safety Culture: The Impact on Workplace Violence and Health Worker Burnout

BACKGROUND

Patient and health care worker safety is an interconnected phenomenon. To date, few studies have examined the relationship between patient and worker safety, specifically with respect to work safety culture. Therefore, we examined patient safety culture, workplace violence (WPV), and burnout in health care workers to identify whether patient safety culture factors influence worker burnout and WPV.

METHODS

This cross-sectional study used secondary survey data sent to approximately 7,100 health care workers at a large academic medical center in the United States. Instruments included the Hospital Survey on Patient Safety Culture, a WPV scale measuring physical and verbal violence perpetrated by patients or visitors, and the Emotional Exhaustion scale from the Maslach Burnout Inventory.

FINDINGS

These analyses included 3,312 (47%) hospital staff who directly interacted with patients. Over half of nurse (62%), physician (53%), and allied health professional respondents (52%) reported experiencing verbal violence from a patient, and 39% of nurses and 14% of physicians reported experiencing physical violence from a patient. Burnout levels for nurses (2.67 ± 1.02) and physicians (2.65 ± 0.93) were higher than the overall average for all staff (2.61 ± 1.0). Higher levels of worker-reported patient safety culture were associated with lower odds of WPV (0.47) and lower burnout scores among workers (B = -1.02). Teamwork across units, handoffs, and transitions were dimensions of patient safety culture that also influenced WPV and burnout.

CONCLUSIONS/APPLICATION TO PRACTICE

Our findings suggest that improvements in hospital strategies aimed at patient safety culture, including team cohesion with handoffs and transitions, could positively influence a reduction in WPV and burnout among health care workers.

Associations between work-related variables and workplace violence among Chinese medical staff: A comparison between physical and verbal violence

Background

Workplace violence (WPV) against medical staff has been an important public health and societal problem worldwide. Although numerous studies have implied the differences between physical violence (PV) and verbal violence (VV) against medical staff, few studies were conducted to analyze the different associations between work-related variables, PV, and VV, especially in China.

Methods

A cross-sectional study was conducted among Chinese medical staff in public hospitals, and 3,426 medical staff were interviewed and analyzed. WPV, including PV and VV, were evaluated by the self-report of the medical staff. Work-related variables, physical disease, depression, and social-demographic variables were also measured. The work-related variables included types of medical staff, professional titles, hospital levels, managers, working years, job changing, working hours/week, night duty times/week, monthly income, self-reported working environment, and social position. Logistic regressions were conducted to examine the factors associated with PV and VV.

Results

A total of 489 medical staff (23.0%) reported the experience of PV and 1,744 (50.9%) reported the experience of VV. Several work-related variables were associated with PV and VV, including nurse (OR = 0.56 for PV, p < 0.01; OR = 0.76 for VV, p < 0.05), manager (OR = 1.86 for PV, p < 0.01; OR = 1.56 for VV, p < 0.001), night duty frequency/week (OR = 1.06 for PV, p < 0.01; OR = 1.03 for VV, p < 0.01), bad working environment (OR = 2.73 for PV, p < 0.001; OR = 3.52 for VV, p < 0.001), averaged working environment (OR = 1.51 for PV, p < 0.05; OR = 1.55 for VV, p < 0.001), and bad social position (OR = 4.21 for PV, p < 0.001; OR = 3.32 for VV, p < 0.001). Working years (OR = 1.02, p < 0.05), job changing (OR = 1.33, p < 0.05), and L2 income level (OR = 1.33, p < 0.01) were positively associated with VV, but the associations were not supported for PV (all p>0.05). The other associated factors were male gender (OR = 1.97 for PV, p < 0.001; OR = 1.28 for VV, p < 0.05) and depression (OR = 1.05 for PV, p < 0.001; OR = 1.04 for VV, p < 0.001).

Conclusion

Both PV and VV were positively associated with work-related variables, such as doctor, manager, more night duty frequency, perceived bad working environment, or social position. Some variables were only associated with VV, such as working years, job changing, and monthly income. Some special strategies for the work-related variables should be applied for controlling PV and VV.

Taking Prior Sick Leave Patterns Into Account When Estimating Health Consequences of Violence on the Job

BACKGROUND

Violence on the job has been shown to harm both physical and psychosocial health, but the results presented in existing studies might be biased because they have not considered prior indicators of such health.

METHODS

Physical violence and threats were pooled into a measure of workplace violence for 77,388 randomly sampled respondents from the working population in Denmark in 2012, 2014, and 2016. Longitudinal analyses of these survey data merged with administrative records on sick leave (exceeding 30 days, implying that the consequences of the violence were more serious) were performed. Separate analyses were conducted by sector, gender, and by gender within sectors.

FINDINGS

Experiencing violence increased sick leave +36% from before to after the violence relative to the general trend among other respondents that did not experience a violent event.

CONCLUSIONS/APPLICATION TO PRACTICE

Work-related violence is a serious health issue, especially in health care, even when we meticulously took prior use of sick leave into account to obtain less biased results.

Gender Differences for the Prevalence and Risk Factors of Workplace Violence Among Healthcare Professionals in Shandong, China

Background

Workplace violence (WPV) against healthcare professionals (HPs) has been recognized as important occupational health and societal problem in the world. Many studies were also conducted to explore the prevalence, risk factors, and adverse outcomes of WPV against HPs. Although the gender differences in the prevalence and risk factors of WPV against HPs have been implied in many studies, fewer studies were conducted to explore the gender differences for WPV against HPs, especially in China. In this study, we aim to analyze the gender differences in the prevalence and risk factors of WPV against HPs in Shandong, China.

Methods

This study was conducted among HPs with a cross-sectional design. WPV, social-demographic variables, occupational characteristics, physical disease, social support, and depression were evaluated for the participated HPs. The prevalence and risk factors of WPV among male healthcare professionals (MHPs) and female healthcare professionals (FHPs) were analyzed in this study. Student's t-tests, one-way ANOVA, and logistic regressions were performed to test the associated factors of WPV among MHPs and FHPs.

Results

The prevalence of WPV among MHPs and FHPs was 61.4 and 48.8%, respectively. Being silent was the most common method of response to WPV among MHPs (52.3%) and FHPs (59.2%). For MHPs, the associated factors of WPV were master's degree (odds ratio (OR) =2.20, P < 0.05), bachelor's degree (OR = 2.49, P < 0.001), lower income level (OR = 1.81, P < 0.05), manager (OR = 1.81, P < 0.05), and depression (OR = 1.05, P < 0.001). For FHPs, the associated factors of WPV were a master's degree (OR = 1.58, P < 0.05), more working hours per week (OR = 1.02, P < 0.001), and depression (OR = 1.05, P < 0.001).

Conclusion

The prevalence of WPV among MHPs was higher than FHPs, and the associated factors for WPV against HPs were also different among MHPs and FHPs. The findings remind us that some gender-specific interventions are needed to control WPV against HPs.

The Effect of Abuse and Mistreatment on Healthcare Providers (TEAM): A Survey Assessing the Prevalence of Aggression From Patients and Their Families and Its Impact

OBJECTIVE

Aggression from patients and families on health care providers (HCP) is common yet understudied. We measured its prevalence and impact on HCPs in inpatient and outpatient settings.

METHODS

Four thousand six hundred seven HCPs employed by a community teaching hospital received an anonymous survey with results analyzed.

RESULTS

Of 1609 HCPs (35%) completing the survey, 88% of inpatient staff reported experiencing different types of aggression compared to 82% in outpatient setting. Almost half did not report it to their supervisor. Younger staff were more likely to report abuse. Negative impacts on productivity and patient care were reported. A third of all responders' indicated negative effects on mental health.

CONCLUSIONS

Despite negative impacts on staff wellbeing and productivity, patient/family aggression toward HCPs is highly prevalent and underreported. Our healthcare system needs measures to address staff security and wellness.

From Florence to fossil fuels: Nursing has always been about environmental health

BACKGROUND

Since its founding, professional nursing has applied an environmental lens to healing.

METHODS

This CANS 2020 Keynote article describes the history of nursing environmental science and nurses important contributions to the US Environmental Justice Movement. Starting with Florence Nightingale's Notes on Nursing, which established Environmental Theory, the paper introduces key figures throughout nursing history who have studied and advocated for environmental health and justice.

FINDINGS

The paper emphasizes that nursing has always been about environmental health and that, regardless of specialty or practice setting, all nurses are called to incorporate environmental science and translation into their research and practice.

CONCLUSION

This call to action is especially critical today in the context of urgent issues like climate change, environmental racism and racial health disparities, emerging infectious diseases like COVID-19, and chemical exposures in the home and workplace (among others).

Serious Workplace Violence Against Healthcare Providers in China Between 2004 and 2018

Introduction: Workplace violence (WPV) against healthcare providers has severe consequences and is underreported worldwide. The aim of this study was to present the features, causes, and outcomes of serious WPV against healthcare providers in China. Method: We searched for serious WPV events reported online and analyzed information about time, location, people, methods, motivations, and outcomes related to the incident. Result: Serious WPV reported online in China (n = 379) were mainly physical (97%) and often involved the use of weapons (34.5%). Doctors were victims in most instances (81.1%). Serious WPV mostly happened in cities (90.2%), teaching hospitals (87.4%), and tertiary hospitals (67.9%) and frequently in Emergency Department (ED), Obstetrics and Gynecology Department (OB-GYN), and pediatric departments; it was most prevalent in the months of June, May, and February. Rates of serious WPV increased dramatically in 2014 and decreased after 2015, with death (12.8%), severe injury (6%), and hospitalization (24.2%) being the major outcomes. A law protecting healthcare providers implemented in 2015 may have helped curb the violence. Conclusion: Serious WPV in China may stem from poor patient-doctor relationships, overly stressed health providers in highly demanding hospitals, poorly educated/informed patients, insufficient legal protection, and poor communication. Furthering knowledge about WPV and working toward curtailing its presence in healthcare settings are crucial to increasing the safety and well-being of healthcare workers.