Doctors and Nurses: A Systematic Review of the Risk and Protective Factors in Workplace Violence and Burnout

Workplace violence in trauma centers: an American Trauma Society Position Statement

In 1966, the National Academy of Sciences and National Research Council published 'Accidental Death and Disability: the Neglected Disease of Modern Society' which served as a national call to action to address the apparent public apathy towards the devastating and unnecessary toll that injury was taking on America. This white paper recommended the establishment of a National Trauma Association to drive public demand for injury prevention and mitigation. The American Association for the Surgery of Trauma heeding that call, founded the American Trauma Society (ATS) in 1968. Since its founding and with a mission of 'Save Lives. Improve Care. Empowering Survivors', the ATS has had a 56-year legacy of service to improve trauma care by providing professional and public education, advocacy for injury and violence prevention, and attending to the unique needs of trauma survivors and their families. As a focus of the ATS's advocacy efforts, the ATS's Legislative and Policy Committee (LPC) formulates the organization's legislative goals and strategy by reviewing proposed legislation and regulations that may favorably or adversely affect trauma professionals, and disseminating key information as position statements to the membership and public for edification and/or action. In accordance with this effort, the ATS has partnered with the Trauma Surgery and Acute Care Open to publish these important collaborative endeavors. For this inaugural publication of an ATS position statement, the topic we chose is workplace violence (WPV) in trauma centers. A work group of the ATS's LPC reviewed current literature gathered from a variety of organizational and agency sources addressing safety and protection of healthcare providers from WPV including federal and state legislative and regulatory initiatives. Based on the work groups review, we provide eight recommendations regarding the prevention, mitigation, or handling of WPV. We also review and discuss best practices and risk mitigation strategies, providing a listing of them in an accompanying appendix.

Training Nurses in Trauma-Informed Care to Address Workplace Violence in Inpatient Settings

BACKGROUND

Frontline workers in psychiatric facilities are exposed to considerable risks of verbal and physical assaults, with 40% to 65% of mental health nurses experiencing violence in the workplace. The goal of this pilot study was to assess the readiness and motivation for adopting trauma-informed care (TIC) to address workplace violence in an acute care psychiatric hospital.

METHOD

A pre-post quality improvement study was conducted in two pilot units of a 274-bed acute care psychiatric hospital, involving a discussion-based seminar and a practical exercise. Surveys assessed participants' readiness and motivation posttraining.

RESULTS

Sixty-eight staff members completed part 1 training, with 63 (92.6%) reporting being prepared to use TIC principles afterward. All 14 staff members (100%) who completed part 1 and part 2 training reported being motivated to apply the TIC model after the intervention.

CONCLUSION

The results show that TIC training may impact self-reported strategies for reducing workplace violence. Education in trauma-informed care may prove to be beneficial in providing nurses with the necessary skills to effectively implement TIC principles in their daily practices. [J Contin Educ Nurs. 2024;55(10):472-478.].

The Relationship Between Individual Social Responsibility and the Public's Intention to Act Violently Toward Nurses-A Cross-Sectional Study

AIMS

To explore (a) the associations between individual social responsibility and the public intention to use violence against nurses; and (b) the relationship between individual social responsibility, personal variables and the public's intention to employ violence against nurses.

BACKGROUND

Workplace violence against nurses is a significant widespread occupational health issue. To date, no reference has been found to the association between personality traits such as individual social responsibility and the public's intention to use violence against nurses.

DESIGN AND METHODS

A cross-sectional survey design with a convenience sample of 667 Israeli participants from among the public. A structured self-report questionnaire was distributed, including socioeconomic variables, individual social responsibility and responses to four vignettes describing incidents of violence directed at nurses. Multiple linear regressions were calculated for intention to employ violence, with demographic variables and individual social responsibility as independent variables. The STROBE checklist for cross-sectional studies was used for reporting.

RESULTS

Negative correlations were found between individual social responsibility and the intention to employ violence against nurses. Gender, having witnessed physical violence and individual social responsibility explained 19% of the variance in the intention to employ violence against nurses. Demographic variables and having witnessed verbal or physical violence were found to moderate the association between individual social responsibility and the intention to employ violence against nurses.

CONCLUSIONS

Witnessing a violent incident in a healthcare setting is a risk factor for the intention to employ violence against nurses. Our findings point to the role of individual social responsibility as one of the strategies to help reduce violent events.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Educating and promoting values of social responsibility among the public can reduce incidents of violence in healthcare settings, thus contributing to the safety and quality of care provided.

PATIENT OR PUBLIC CONTRIBUTION

The public contributed via study participation.

Work-related stressors and psychological distress predict career change ideation among Lithuanian healthcare workers

OBJECTIVES

The study aimed to assess the mental health and well-being of Lithuanian healthcare workers by gathering demographic information, identifying common stressors affecting the work environment, evaluating mental health, and exploring directions for psychosocial care. Additionally, the research explored the prevalence of considering a career change among respondents.

MATERIAL AND METHODS

The study included 1618 responders who completed an online survey in December 2021 - January 2022. Participants included in this study: physicians, nurses, residents and other healthcare workers. It evaluated their demographics, most common stressors affecting their work environment and mental health on the Depression, Anxiety and Stress Scale - 21 (DASS-21) scale. Lastly, all responders asked if they had considered changing their occupation to a non-medical job. Univariate analysis was performed using χ2 and Student's t test, and binary logistic regression evaluated career change predictors.

RESULTS

Career change was considered by 1081 (66.8%) responders. The main career change predictors were poor working conditions (OR 1.91, p < 0.001), direct contact with patients (OR 1.84, p < 0.001), lack of career perspectives (OR 1.95, p < 0.001), mobbing (OR 1.67, p = 0.001) and exhaustion (OR 1.51, p = 0.005). After evaluating DASS-21 scores, it was found that 23% of respondents had severe and extremely severe depression symptoms, 27.4% severe and extremely severe anxiety, and 21.4% had severe and extremely severe stress levels.

CONCLUSIONS

Lithuanian healthcare workers are in high distress and have poor mental health. They are in need psychosocial assistance to avoid burnout and staff loss. Int J Occup Med Environ Health. 2024;37(3):287-99.

Italian Version of the Hospital Aggressive Behaviour Scale-Users: Initial Psychometric Evaluation among Hospital Healthcare Professionals

BACKGROUND

Healthcare professionals frequently encounter various forms of aggression, ranging from verbal abuse to physical assaults, which can compromise both their occupational well-being and patient-care quality. Despite its prevalence and serious consequences, workplace aggression is often underreported due to a lack of standardized assessment tools. This study aims to develop a valid Italian version of the Hospital Aggressive Behaviour Scale-Users.

METHODS

The scale's structure was evaluated using exploratory (EFA) and confirmatory (CFA) factor analyses on two samples of healthcare professionals during and after the pandemic. Reliability, measurement invariance, and nomological validity were examined.

RESULTS

EFA revealed a two-factor structure comprising eight items (χ2 = 59.651, df = 13, p = 0.00; CFI = 0.98; TLI = 0.95; RMSEA = 0.07; SRMR = 0.02), distinguishing non-physical and physical aggression, and meeting all recommended criteria. CFA confirmed this structure, demonstrating good reliability and outperforming alternative models. The same factor structure was confirmed in standard (χ2 = 35.01, df = 19, p = 0.00; CFI = 0.99; TLI = 0.99; RMSEA = 0.03; SRMR = 0.02) and emergency (χ2 = 30.65, df = 19, p = 0.04; CFI = 0.98; TLI = 0.97; RMSEA = 0.06; SRMR = 0.04) contexts. Full residual invariance was found across job tenure groups. Aggression was positively associated with emotional exhaustion, psychological distance, psychosomatic symptoms, post-traumatic stress symptoms, and turnover intentions while negatively related to job satisfaction. Nurses and healthcare assistants reported higher levels of aggression than doctors.

CONCLUSIONS

This study provides a reliable, context-specific instrument for documenting and analysing outsider aggression. The insights can inform targeted interventions, contributing to a healthier hospital environment.

'On the slope of an erupting volcano': A qualitative study on the workplace violence experiences of psychiatric nurses

WHAT IS KNOWN ON THE SUBJECT?: Workplace violence is common in healthcare. Workplace violence remains a complex and serious occupational hazard in healthcare. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Since there is no study examining detailed explanations of experiences and perspectives of workplace violence among psychiatric nurses, this study will act as a guide for psychiatric nurses. This study provides information about how psychiatric nurses evaluate the concept of workplace violence from their perspective, what it means to them and the effects of workplace violence. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Considering the effects of workplace violence, a preventive, systematic and holistic approach should be used in psychiatry and community mental health centres. Supportive interventions should be used to improve the health and safety of psychiatric nurses and patients.

ABSTRACT

INTRODUCTION: Workplace violence is common in healthcare and remains a complex and serious occupational hazard.

AIM

This research was conducted to assess the workplace violence experiences and perspectives of psychiatric nurses.

METHOD

This study was a qualitative study conducted using a grounded theory approach method. The study was conducted between November 2022 and January 2023. The purposeful sampling method was used, and 11 psychiatric nurses were interviewed. Data were collected with an information form and a semi-structured interview form. The data were analysed using content analysis, and themes were created.

FINDINGS

The ages of the psychiatric nurses ranged from 38 to 57 years. Themes and sub-themes related to the workplace violence experiences and perspectives of psychiatric nurses included the way of violence (rising tension, eruption of the volcano, unintentional violence and turning to ash) and empowerment (ash cloud and ring of fire).

CONCLUSION

Psychiatric nurses stated that they were exposed to verbal and physical violence for many reasons, that this situation seriously affected their physical, mental and social health and that in addition to the devastating effects of violence, they became stronger by developing various skills to protect against violence.

IMPLICATIONS FOR PRACTICE

Supportive interventions should be used to improve the health and safety of psychiatric nurses and patients. Strategies can be developed to include psychiatric nurses in occupational health nursing courses.

Effects of perceived risk of COVID-19 on fear among visiting workers: Mediating role of perceived stress

With the creation of a social distancing policy due to coronavirus disease 2019 (COVID-19), home visit workers are under mental stress as they are treated as the source of infection for COVID-19. Since door-to-door rental equipment examiners and gas inspectors must perform their duties even in the COVID-19 situation, they are being discriminated against so severely. The purpose of study was to examine the mediating role of perceived stress on the relationship between risk perception and fear. Data was collected data through labor unions among 275 home visiting workers who examine rental home appliance equipment or inspecting gas. On-line survey was conducted to assess COVID-19 risk perception, fear, perceived stress, and demographic characteristics. The data was analyzed using PROCESS Macro (Model 4). The results of the study showed that stress plays an important role in increasing COVID-19 fears when COVID-19 risk perception increases. Meanwhile, it was found that COVID-19 fear decreased when the level of perceived stress decreased. To reduce the impact of COVID-19 risk perception on COVID-19 fears, appropriate educational programs to reduce stress should be developed for home visit workers. Policymakers need to develop online or mobile Infectious disease education programs for COVID-19 risk at work and establish policies to apply legal education.

Eliciting psychiatric nurses' preferences for workplace violence prevention: a protocol for discrete choice experiment

Introduction

Workplace violence against healthcare workers has become a serious global public health problem. The incidence of workplace violence towards Psychiatric nurses is higher than in all other medical institutions, up to 84.2% per year. It not only negatively affects many aspects of healthcare workers' lives, but also destroys the harmony of the nurse-patient relationship and reduces the quality of nursing care. The number of psychiatric nurses in China was approximately 96,000, far lower than most other countries and unable to meet the growing demand for mental health. However, the increase in workplace violence has future exacerbates the current shortage of nurses. Therefore, it is necessary to develop effective strategies to prevent psychiatric nurses from suffering from workplace violence, thereby to reduce nurse turnover and improve the quality of nursing care. A comprehensive understanding of psychiatric nurses' preferences and priorities for preventing workplace violence is an important prerequisite before formulating strategies and taking measures. Unfortunately, to date, no research has investigated the psychiatric nurses' preferences. Therefore, a discrete choice experiment (DCE) is conducting to explore the psychiatric nurses' preferences for workplace violence prevention. This article reports on methodological details of the DCE.

Methods and analysis

Six attributes were developed through a literature review, one-on-one interviews and focus group discussions. D-efficient design in NGENE was used to generate choice sets. SPSS 24.0 will be used for descriptive analysis of social Demography, and Stata 16.0 will be used for analysis of DCE data. A multinomial logit model will be used to preliminarily explore trade-offs between workplace violence prevention characteristics included in the choice tasks. Then, in a mixed logit model, we plan to choose some arbitrarily defined base violence prevention program and will use the nlcom command to evaluate the probability of an alternative violence prevention program.

Ethics and dissemination

The study was approved by the relevant ethics committees. Our findings will emphasize priority intervention areas based on the preferences of psychiatric nurses and provide references for hospitals to develop and improve workplace violence prevention strategies. The results will be shared through seminars, policy briefs, peer-reviewed journal articles and online blogs.

The growing burden of workplace violence against healthcare workers: trends in prevalence, risk factors, consequences, and prevention - a narrative review

Workplace violence (WPV) against healthcare workers (HCW) is a globally growing problem in healthcare systems. Despite decades of research and interventions violent incidents are rising in their severity and frequency. A structured review of PubMed and Scopus databases and supplementary internet searches, resulted in a synthesis of evidence covering multiple countries and healthcare worker populations. High rates of WPV are increasingly common due to unmet patient expectations, poor communication, long wait times and organizational factors such as resourcing and infrastructure. We highlight links between WPV and poor worker health outcomes, staff turnover, reduced patient safety and medical errors. Few prevention and mitigation activities have shown sustained effects, highlighting the challenges in understanding and addressing the complex interplay of factors that drive violence against HCWs. The rapidly rising incidence of WPV requires special consideration and action from multiple stakeholders including patients and visitors, healthcare providers, law enforcement, media and policy makers.

Workplace violence, work-related exhaustion, and workplace cognitive failure among nurses: A cross-sectional study

AIM

To examine the relationships between nurses' exposure to workplace violence and self-reports of workplace cognitive failure.

DESIGN

A cross-sectional study.

METHODS

An online questionnaire was administered in April 2023 to nurses in Michigan, US. Structural equation modelling was used to examine effects of physical and non-physical workplace violence (occupational stressors) and work efficiency and competence development (occupational protective factors) on workplace cognitive failure.

RESULTS

Physical violence was a significant predictor of the action subscale of cognitive failure. There were no direct effects of non-physical violence, workplace efficiency, or competence development on any of the workplace cognitive failure dimensions. Both types of violence and efficiency had significant indirect effects on workplace cognitive failure via work-related exhaustion. Work-related exhaustion predicted significantly higher scores for workplace cognitive failure.

CONCLUSION

Workplace violence and work efficiency exhibited primarily indirect effects on workplace cognitive failure among nurses via work-related exhaustion.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Nurses experiencing workplace violence may be at increased risk for workplace cognitive failure, especially if they are also experiencing work-related exhaustion. Workplaces that nurses perceive as more efficient can help to mitigate the effects of violence on nurses' cognitive failure.

IMPACT

This study addressed the possible effects of workplace violence as well as work efficiency and competence development on nurses' cognitive failure at work. Analyses revealed primarily indirect effects of workplace violence, and indirect protective effects of work efficiency, on nurses' cognitive failure via work-related exhaustion. This research has implications for healthcare organizations and suggests that efforts made by healthcare workplaces to prevent violence and work-related exhaustion, and to enhance work efficiency, may help to mitigate workplace cognitive failure among nurses.

REPORTING METHOD

We have followed the STROBE checklist in reporting this study.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or public contribution.

Requesting That Delirium Achieve Parity With Acute Encephalopathy in the MS-DRG System

Since 2007, the Medicare Severity Diagnosis Related Groups classification system has favored billing codes for acute encephalopathy over delirium codes in determining hospital reimbursement and several quality-of-care value metrics, despite broad overlap between these sets of diagnostic codes. Toxic and metabolic encephalopathy codes are designated as major complication or comorbidity, whereas causally specified delirium codes are designated as complication or comorbidity and thus associated with a lower reimbursement and lesser impact on value metrics. The authors led a submission to the U.S. Centers for Medicare and Medicaid Services requesting that causally specified delirium be designated major complication or comorbidity alongside toxic and metabolic encephalopathy. Delirium warrants reclassification because it satisfies U.S. Centers for Medicare and Medicaid Services' guiding principles for re-evaluating Medicare Severity Diagnosis Related Group severity levels. Delirium: (1) has a bidirectional relationship with the permanent condition of dementia (major neurocognitive disorder per DSM-5-TR), (2) indexes vulnerability across populations, (3) impacts healthcare systems across levels of care, (4) complicates postoperative recovery, (5) consigns patients to higher levels of care, (6) impedes patient engagement in care, (7) has several recent treatment guidelines, (8) often indicates neuronal/brain injury, and (9) represents a common expression of terminal illness. The proposal's impact was explored using the 2019 National Inpatient Sample, which suggested that increasing delirium's complexity designation would lead to an upcoding of less than 1% of eligible discharges. Parity for delirium is essential to enhancing awareness of delirium's clinical and economic costs. Appreciating delirium's impact would encourage delirium prevention and screening efforts, thereby mitigating its dire outcomes for patients, families, and healthcare systems.

Development and validation of burnout factors questionnaire in the operating room nurses

Nurses may experience burnout more than other professions. Occupational burnout is a serious concern considering the importance of nurses' jobs in patient care. This study was carried out with the aim of designing and validating the questionnaire of burnout factors in the operating room nurses. Mixed method study was done in two qualitative and quantitative phases in 2022 on Iranian operating room nurses. In the first stage, the concept of operating room nurses' burnout was explained using interviews and literature review, and items were generated. In the second stage, the face validity, content and construct validity of the questionnaire was examined with 342 operating room nurses, and also the reliability of the questionnaire was tested using internal consistency (Cronbach's alpha) and stability (test-retest). After conducting the interview and literature review, 65 questions were extracted. Based on face validity, 4 items were modified. After content validity, 40 items remained. In construct validity, after exploratory factor analysis, 34 items with 5 dimensions were extracted. These dimensions included Organizational, Individual, Interpersonal, Occupational Nature and Managerial factors. Cronbach's alpha and intra-class correlation coefficient were equal to 0.937 and 0.946, respectively. The designed tool based on understanding the concept of burnout in operating room nurses has appropriate and acceptable validity and reliability. Therefore, it can be used to measure burnout in operating room nurses.

The Professional Quality of Life of Domestic and Sexual Violence Advocates: A Systematic Review of Possible Risk and Protective Factors

Professionals employed within the field of domestic and sexual violence (DV/SV) are known to experience both positive and negative psychological impacts because of the nature of their work. This review aims to establish which factors influence the professional quality of life (ProQOL) of DV/SV advocates. This group is known to face challenges that are specific to their working practices including scarce resources and frequent exposure to traumatic material. The systematic review protocol was designed based upon Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidance. Following a mixed-methods convergent segregated approach, a systematic search for qualitative and quantitative research within PsycINFO, Academic Search Complete, CINAHL, MEDLINE, Sage, Taylor & Francis, Wiley Online Library, and BASE was undertaken. Peer-reviewed empirical research and relevant gray literature, published in English, were considered for inclusion. Thirty articles were identified (16 quantitative, 13 qualitative, and 1 mixed-methods study), and assessed for methodological quality and risk of bias using established quality appraisal tools. An array of risk and protective factors emerged including communication competence, support from co-workers, office resources, and occupational stigma. A gap in the current evidence base was identified regarding the role that personal strengths may play in the well-being of those employed within the DV/SV sector. The ProQOL of DV/SV advocates is complex and dependent upon a variety of factors specific to their situation at the time. However, the findings of this review provide an important evidence base for future research avenues as well as policies and procedures for this workforce specifically.

Workplace Violence in the Pediatric Emergency Department: A National Survey of Physicians in the United States

OBJECTIVES

Previous work shows that health care workers, and particularly emergency department (ED) staff, are at an above average risk of workplace violence (WPV), defined as verbal threats or physical violence in the workplace. Previous data suggest that staff of a single pediatric ED frequently feel unsafe. The objective of this study was to conduct the first national survey study to assess the prevalence and incidence of WPV in the pediatric ED.

METHODS

In this cross-sectional survey study, a representative sample of US pediatric emergency medicine physicians were invited to participate in a national survey adapted from the previously validated Workplace Violence in the Health Sector questionnaire from the World Health Organization. The primary outcome measure was the proportion of physicians who have been exposed to WPV. Rates of exposure to violence, reporting habits, and physician perception of various violence prevention strategies were studied secondarily.

RESULTS

Surveys were completed by 207 (45%) invited participants, representing 31 US children's hospitals. The prevalence of WPV exposure was 96%. Physical violence with a weapon was witnessed by 20% of participants. Injuries requiring medical attention or time off work were experienced by 10% of participants. Half of participants never reported violent events. Security guards were welcome by 99%, armed law enforcement officers by 70%, and metal detectors by 81% of physicians. Self-arming was opposed by 85% of respondents.

CONCLUSIONS

Exposure to WPV is frequent among pediatric emergency medicine physicians with a prevalence similar to that of general emergency departments. Workplace violence remains underreported. This national survey contributes to the objective evaluation of individual- and systems-level violence prevention interventions.

Factors associated with burnout among frontline nurses in the post-COVID-19 epidemic era: a multicenter cross-sectional study

BACKGROUND

The COVID-19 pandemic has significantly increased the risk of burnout among frontline nurses. However, the prevalence of burnout and its associated factors in the post-pandemic era remain unclear. This research aims to investigate burnout prevalence among frontline nurses in the post-pandemic period and pinpoint associated determinants in China.

METHODS

From April to July 2023, a cross-sectional study was carried out across multiple centers, focusing on frontline nurses who had been actively involved in the COVID-19 pandemic. The data collection was done via an online platform. The Maslach Burnout Inventory-Human Services Survey was utilized to evaluate symptoms of burnout. A multivariable logistic regression analysis was used to pinpoint factors associated with burnout.

RESULTS

Of the 2210 frontline nurses who participated, 75.38% scored over the cut-off for burnout. Multivariable logistic regression revealed that factors like being female [odds ratio (OR) = 0.41, 95%CI = 0.29-0.58] and exercising 1-2 times weekly[OR = 0.53, 95%CI = 0.42-0.67] were protective factors against burnout. Conversely, having 10 or more night shifts per month[OR = 1.99, 95%CI = 1.39-2.84], holding a master's degree or higher[OR = 2.86, 95% CI = 1.59-5.15], poor health status[OR = 2.43, 95% CI = 1.93-3.08] and [OR = 2.82, 95%CI = 1.80-4.43], under virus infection[OR = 7.12, 95%CI = 2.10-24.17], and elevated work-related stress[OR = 1.53, 95% CI = 1.17-2.00] were all associated with an elevated risk of burnout.

CONCLUSION

Our findings indicate that post-pandemic burnout among frontline nurses is influenced by several factors, including gender, monthly night shift frequency, academic qualifications, weekly exercise frequency, health condition, and viral infection history. These insights can inform interventions aimed at safeguarding the mental well-being of frontline nurses in the post-pandemic period.

Assessing Workplace Violence: Methodological Considerations

The risk of violence is present in all workplaces. It must be accurately assessed to establish prevention and protection measures tailored to the features of each situation. The risk management process requires compliance in a sequential order: 1) risk identification, 2) quantitative risk assessment, and 3) impact assessment. Gathering workers' experiences using lists, focus groups, or participatory ergonomics groups is necessary to identify the phenomenon. For risk assessment, spontaneous reporting of events is often insufficient. It may be complemented with two methods: systematic recording of violent events that occurred in the past year during periodic medical examinations of workers and targeted surveys. The epidemiological analysis of data from individual interviews and surveys provides the phenomenon's prevalence, incidence, and evolution. Moreover, reporting the harm suffered by victims of violence allows constructing impact matrices to allocate resources where they are most needed.

A Model of Burnout Among Healthcare Professionals

BACKGROUND

Burnout is common and can lead to worse outcomes for both healthcare workers and patients. Our study purpose was to assess the structural relationship among factors that protect against or worsen burnout.

DATA SOURCES AND STUDY SETTING

We surveyed healthcare professionals in 15 different Japanese intensive care units during the 3rd wave of the COVID-19 pandemic (March 2021). Surveys assessed burnout (Mini Z 2.0), resilience (Brief Resilience Scale), depressive (PHQ-9) and anxiety (GAD-7) symptoms, job and work environment characteristics, and personal experience with COVID. We explored survey domains with principal component factor analysis and modeled our results using structural equation modeling.

PRINCIPAL FINDINGS

Among 936 ICU professionals, 24.3% met criteria for burnout. Our model suggested that resilience (β =  - 0.26, 95% CI - 0.32 to - 0.20), teamwork (β =  - 0.23, 95% CI - 0.30 to - 0.16), and feeling safe (β =  - 0.11, 95% CI - 0.18 to - 0.04) reduced burnout. Depression (β =  - 0.32, 95% CI - 0.41 to - 0.23) and anxiety (β =  - 0.20, 95% CI - 0.29 to - 0.10) both decreased resilience as did COVID fear (β = 0.08, 95% CI - 0.14 to - 0.02). In addition to directly reducing resilience, anxiety also indirectly reduced resilience by increasing COVID fear (0.23, 95% CI 0.17 to 0.23), which decreased resilience (β - 0.08, 95% CI - 0.14 to - 0.02).

CONCLUSIONS

Burnout is common among Japanese ICU professionals. Resilience, teamwork, and safety are all correlated with reduced burnout. Those who had depression or anxiety or COVID fear had higher degrees of burnout, an effect that appears to be mediated by reduced resilience. These are potential targets for interventions to reduce burnout.

Workplace Violence Against Nurses: Challenges and Solutions for Europe

We report the results of a mapping exercise by the European Federation of Nurses (EFN) on challenges and solutions related to violence against nurses. This is an issue of growing international concern, with the problem accentuated during and following the COVID-19 pandemic. Following a cross-sectional observational design, an online questionnaire was distributed among 35 national nurses' associations across Europe in March 2021. Face validity was achieved through an expert panel. Descriptive statistics were used for data analysis, including counts, percentages, and tabulation. Qualitative data analysis followed thematic synthesis techniques. Three main findings are noted. First, violent incidents against nurses are under-reported due to fear of victimization, employer discouragement, and the perception that reporting will not make any difference. Second, perpetrators of violent acts extend beyond patients and families to include health professionals of different ranks. Third, violent incidences have a significant adverse effect on nurses' health and retention, leading to nurses reducing their working hours or opting for part-time work. Violence against nurses is an expression of a broader problem that is rooted in the failure to recognize and manage violence at the level of the healthcare organization, and the absence of appropriate legislation to maintain minimum standards of safe working environments. This is partly the result of inadequate European Union-wide legislation targeting workplace violence in the health professions. Nurses need more institutional support through dedicated funding aimed at targeted interventions, more legislative commitment to ratify policies against discrimination, and an opportunity to voice the needs to the appropriate policymakers with the ability to bring significant change to existing conditions. Given the severity of the situation, inaction could lead to irreplaceable damage to the nursing workforce, compounding pressures resulting from the COVID-19 pandemic. Ultimately, this situation can further drive existing nurses out of the profession, weakening health systems worldwide.

Violence and Clinical Learning Environments in Medical Residencies

INTRODUCTION

The objective of this study was to describe and analyze residents' perceptions of characteristics on the expansive/restrictive continuum of their clinical learning environment.

METHODS

We conducted a quantitative, descriptive and cross-sectional study. A self-administered questionnaire was designed, programmed and applied to residents at the Faculty of Medicine of the National Autonomous University of Mexico. The instrument was structured in eight sections, and for this article, Section 3, which referred to clinical environments and violence was considered. The questionnaire had an 85% response rate, with 12,612 residents from 113 medical units and 78 specialties participating. The reliability and internal consistency measured with alpha omega obtained a value of ω 0.835 (CI; 0.828-0.843).

RESULTS

Unpleasant, competitive, tense and conflictive contexts were related to restrictive environments. Sexual orientation influenced the perception of intolerance in the clinical setting with respect to discriminatory comments, such that for gender minorities, the environment was experienced as exclusionary. First-year residents perceived environments as more aggressive, a perception that tended to decrease in later years of residency.

DISCUSSION

Abuses in power relations, rigid hierarchical positions and offensive clinical interactions may foster restrictive environments. In such settings, the reproduction of socio-culturally learned violence is feasible; however, asymmetrical relationships may be deconstructed and transformed.

Mental Health Status, Risk and Protective Factors for Healthcare Staff Prior to the First Major COVID-19 Outbreak in Western Australia

Objectives: Western Australia's unique public health response delayed the first wave of community COVID-19 transmission for 2 years. We aimed to determine the status of post-traumatic stress (PTSS), depressive, and anxiety symptoms among healthcare staff in major tertiary hospitals, together with associated risk and protective factors prior to the first substantial outbreak of COVID-19. Methods: A cross-sectional study was conducted with 431 healthcare staff immediately prior to the Western Australian border re-opening in 2022. Staff were recruited via notices in email newsletters, at four tertiary hospitals and a public mental health clinic in metropolitan Perth. Validated and original questionnaires were administered via Qualtrics. Results: Moderate levels of PTSS (22.3%), depression (21.9%), and anxiety (25.9%) were reported. Pathway analyses indicated that sleep difficulties, workplace stressors, and infectious disease training were associated with higher PTSS, depression and anxiety symptoms, and younger age was associated with higher levels of depression and anxiety. Nursing roles were associated with higher PTSS. Social support and workplace support were associated with lower levels of depression and anxiety but were not associated with PTSS. Conclusion: The findings illustrate high levels of resilience, but indicate a need for structural supports within the health system to foster staff mental health prior to the onset of emergencies.

Organization-Level Factors Associated With Burnout: Guided Discussions With Micropolitan Public Health Workers During COVID-19

OBJECTIVE

To understand how micropolitan public health workers (PHWs) experienced burnout antecedents during the COVID-19 pandemic.

METHODS

We conducted in-depth guided discussions with 34 representatives from 16 micropolitan public health departments using semistructured, open-ended questions about departments' experiences during the COVID-19 pandemic. We coded discussion transcripts to develop themes according to the Six Areas of Worklife model.

RESULTS

PHWs described antecedents of burnout that stemmed from organizational and external forces, most notably within the workload, control, reward, and values dimensions of the Six Areas of Worklife model, as well as instances of workplace violence.

CONCLUSIONS

Our findings support organization-level approaches to reducing and preventing burnout in the micropolitan public health workforce. We discuss addressing specific dimensions of the Six Areas of Worklife model when designing burnout solutions for this essential workforce.

Incidence and trends in workplace violence within emergency departments in the United Kingdom 2017-2022: an observational time series analysis

Background

Workplace violence (WPV) is a notable issue facing healthcare services and workers globally. WPV impacts upon the well-being of staff and can put healthcare provision at risk with detrimental effects on patient care. This study aims to investigate and quantify, at national and regional levels, the incidence and trends of WPV within emergency departments (EDs).

Methods

We requested data relating to WPV from all 152 trusts with an ED in the United Kingdom from January 2017-March 2022. We applied interrupted time series and trend analysis to check for significant differences in WPV across the COVID-19 pandemic.

Results

We conducted time series analysis on 58 million attendances and detected statistically significant increases in WPV in March 2020-5.06/100,000 attendances (95% CI 1.59/100,000-8.53/100,000 p < 0.01) and May 2020-20.63/100,000 attendances (95% CI 9.39-31.87 p < 0.01). Rises in incidents of 0.37/100,000 attendances per month (95% CI 0.21-0.53 p < 0.0001) were found January 2017-March 2020. We analyzed 96 million attendances for yearly trends, which revealed statistically significant increasing trends of WPV in London and North-West England (p < 0.05), and physical WPV in the North West England (p < 0.05).

Conclusion

There have been dramatic increases in incidents of WPV in United Kingdom EDs over the last 5 years with concerning rises during the COVID-19 period. Our findings highlight the potential to further demoralize a workforce already under significant strain, resulting in increased absences for physical or mental health and an exodus of staff. Therefore, trusts should ensure there are robust systems in place to protect and safeguard staff.

Implementation of a workplace protection system and its correlation with experiences of workplace violence: a cross-sectional study

BACKGROUND

While customer interactions are inherent and essential aspects of the service industry, instances of violence against service workers have brought social attention to the need for a system to ensure their protection. In South Korea, a protection system for the health of service workers has been implemented to prevent this type of violence and its negative consequences. This study conducted a comparative analysis to clarify the impacts of this protection system across a sample of service workers. We collected data on their general characteristics, occupational characteristics, and experiences with the service protection system to determine how those factors were related to workplace violence, with a focus on whether the system has reduced such occurrences.

METHODS

We collected self-reported survey data over 28 days (March 2 to March 30, 2020), resulting in 1,349 (99.3%) responses for our final analysis. We conducted a chi-square test and logistic regression analysis to investigate the general and occupational characteristics, experiences of violence, and experiences with the worker protection system.

RESULTS

We found workplace violence is more observed among males, older workers, electronic equipment repairers, irregular workers, and those who worked for extended periods. On the other hand, we found a reduction in the occurrence of workplace violence in businesses that provided service workers with regular counseling from professional counselors, had designated persons responsible for grievance procedures, and/or had grievance procedure committees. We found the lowest likelihood of workplace violence in businesses that operated stress relaxation programs (all p < 0.01).

CONCLUSIONS

This study identified a correlation between the adoption of the protection system for service workers and the prevalence of workplace violence. We also clarified the effects of the service protection system and developed a plan for its expansion.

KEY POINTS

This study clarified the correlation between the adoption of the protection system for service workers and the occurrence of workplace violence. Along with our investigation of the protection system's effects, these findings provide a basis for expanding Korea's existing worker protection system.

Developing a model for predicting safety performance of nurses based on psychosocial safety climate and role of job demands and resources, job satisfaction, and emotional exhaustion as mediators

BACKGROUND

The present study aimed to develop a model for predicting the safety performance of nurses based on psychosocial safety climate (PSC) and the role of job demands and resources, job satisfaction, and emotional exhaustion as mediators.

METHODS

A cross-sectional study using structural equation modeling (SEM) was carried out among nurses in Iran. Data were collected using the Psychosocial Safety Climate questionnaire, Neal and Griffin's Safety Performance Scale, the Management Standards Indicator Tool, the Effort-Reward Imbalance questionnaire, the Michigan Organizational Assessment Job Satisfaction subscale and the Maslach Burnout Inventory.

RESULTS

Surveys were distributed to 340 nurses provided informed consent. After removing incplete surveys, data from 280 partipants were analysed. The completion rate was 82.35%. The SEM results indicated that PSC can directly and indirectly predict nurses' safety performance. The final model showed an acceptable goodness of fit (p = 0.023). It indicated that PSC, job demands, and job satisfaction were directly related to safety performance, and also that PSC, emotional exhaustion, job resources, and job demands were all indirectly related to safety performance. Also, PSC had a significant relationship with all mediator variables, and job demands had direct effect on emotional exhaustion.

CONCLUSIONS

The current study presented a new model for predicting safety performance in nurses in which PSC, both directly and indirectly, plays an important role. In addition to paying attention to the physical aspects of the workplace, healthcare organizations should also take into account PSC to improve safety. Next steps in reducing safety issues in nursing is to develop intervention studies using this new evidence-based model as a framework.

Kindness Isn't Just about Being Nice: The Value Proposition of Kindness as Viewed through the Lens of Incivility in the Healthcare Workplace

The healthcare workplace is a high-stress environment. All stakeholders, including patients and providers, display evidence of that stress. High stress has several effects. Even acutely, stress can negatively affect cognitive function, worsening diagnostic acumen, decision-making, and problem-solving. It decreases helpfulness. As stress increases, it can progress to burnout and more severe mental health consequences, including depression and suicide. One of the consequences (and causes) of stress is incivility. Both patients and staff can manifest these unkind behaviors, which in turn have been shown to cause medical errors. The human cost of errors is enormous, reflected in thousands of lives impacted every year. The economic cost is also enormous, costing at least several billion dollars annually. The warrant for promoting kindness, therefore, is enormous. Kindness creates positive interpersonal connections, which, in turn, buffers stress and fosters resilience. Kindness, therefore, is not just a nice thing to do: it is critically important in the workplace. Ways to promote kindness, including leadership modeling positive behaviors as well as the deterrence of negative behaviors, are essential. A new approach using kindness media is described. It uplifts patients and staff, decreases irritation and stress, and increases happiness, calmness, and feeling connected to others.

Student nurses' experiences of workplace violence: A mixed methods systematic review and meta-analysis

OBJECTIVES

To identify the prevalence of student-directed violence on clinical placement and description of their related experience during clinical placements.

DESIGN

Mixed methods systematic review and meta-analysis conducted following Joanna Briggs Institute guidelines and reported according to Preferred Reporting of Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

DATA SOURCES

CINAHL, Embase, Medline, Proquest, PsycINFO and Google Scholar.

REVIEW METHODS

Included studies were peer reviewed, published primary studies where pre-registration nursing students were surveyed about their experiences of physical, verbal, or sexual aggression, bullying or racism during clinical placement. Studies were quality assessed but not excluded based on the result. A convergent segregated approach to synthesis and integration was undertaken. Prevalence data were extracted and pooled using both random and quality effects models; separate analyses were conducted by violence type, source, and region. Qualitative data were thematically analysed.

RESULTS

14,894 student nurses from 42 studies were included across the meta-analyses. There was substantial heterogeneity in the included data. Pooled prevalence rates ranged from racism 12.2 % to bullying 58.2 %. Bullying (38.8 %) and physical aggression (10.2 %) were most perpetrated by nurses whereas sexual aggression was perpetrated mostly by patients (64.2 %) and physicians (18.6 %). Qualitative findings identified students' descriptions of reasons for, effects of, strategies for dealing with and higher education establishments' responsibilities with regards to workplace violence.

CONCLUSIONS

Student nurses commonly experience violence during their clinical placements. Given the potential debilitating physical and psychological sequelae of all forms of violence then this study further emphasises the need to use multiple strategies to prevent violence and to better equip student nurses to manage potentially violent incidents, their responses to violence, and to whistle blow or report when they are subject to violence.

American Academy of Nursing Expert Panel Consensus Statement on leveraging equity in policy to improve recognition and treatment of mental health, substance use disorders, and nurse suicide

Rates of nurse mental health and substance use disorders are high. Heightened by the COVID-19 pandemic, nurses are challenged to care for patients in ways that often jeopardize their own health and increase risks for their families. These trends exacerbate the epidemic of suicide in nursing underscored by several professional organization clarion calls to nurses' risk. Principles of health equity and trauma-informed care dictate urgent action. The purpose of this paper is to establish consensus among clinical and policy leaders from Expert Panels of the American Academy of Nursing about actions to address risks to mental health and factors contributing to nurse suicide. Recommendations for mitigating barriers drew from the CDC's 2022 Suicide Prevention Resource for Action strategies to guide the nursing community to inform policy, education, research, and clinical practice with the goals of greater health promotion, risk reduction, and sustainment of nurses' health and well-being are provided.

The Management of Workplace Violence against Healthcare Workers: A Multidisciplinary Team for Total Worker Health® Approach in a Hospital

The risk of aggression against healthcare workers (HCWs) is a globally well-known topic. However, workplace violence (WV) is often considered as part of HCW’s job, leading to a general underreporting. This cross-sectional study aims at providing a descriptive analysis of aggressive acts against HCWs registered in a 34-month period in a pediatric hospital. According to a specific protocol, each aggressive act was analyzed by a multidisciplinary team using the “Modified Overt Aggression Scale” (MOAS), the “General Health Questionnaire-12” (GHQ-12), and the “Short Form-36 Health Survey” (SF-36) to build a report addressing improvement measures. A three-domain model of WV was also developed considering: (1) assaulted HCWs, (2) attacker-related issues, and (3) environmental context. Contributing factors to overt aggression were outlined and tested using univariate analyses. Statistically significant factors were then included in a multiple linear regression model. A total of 82 aggressive acts were registered in the period. MOAS scores registered a mean value of 3.71 (SD: 4.09). Verbal abuse was the most common form of WV. HCWs professional category, minor psychiatric disorder, emotional role limitation, type of containment used, and emotion intensity were significantly associated with overt aggression (p < 0.05), as well as the attacker’s role in the hospital (p < 0.05). The multiple regression analysis confirmed these findings (p < 0.001). Raising awareness on the aggression risk and contributing factors may lead to a relevant improvement of workplace environment, individual workers’ health, and organizational well-being.

More exposure to medical injury news, better doctor-patient communication, but less doctors' professional identity: A moderated chain mediation model

Objectives

In recent years, news of medical malignant injury events has become common in China. However, it is unclear how exposure to this news affects medical staff.

Methods

The present study collected data from a sample of 311 medical staff in China. It explored the effect of exposure to such news on medical staff's communication and willingness to let their children be doctors, which was an attitude that reflects their professional identity well. In addition, this study also examined the mediating roles of outgroup attribution and anxiety, and the moderating role of social support.

Results

The results showed that exposure to news of medical injury could positively and directly predict the quality of doctor-patient communication, but negatively and indirectly predict medical staff's willingness to let their children become doctors. These effects existed through the mediating role of anxiety and the chain mediating role of both outgroup attribution and anxiety. In addition, social support could mitigate the negative correlation between news exposure and outgroup attribution.

Conclusions

These results suggest that news of medical malignant injury events may incentivize medical staff to improve the quality of communication in the short term, but it is not conducive to medical staff's long-term mental health. That is, exposure to news of medical injury is likely to lead to a negative influence on their professional identity, although social support can alleviate this negative influence.

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.

Status and related factors of burnout among palliative nurses in China: a cross-sectional study

Background

Burnout occurs frequently in nurses and seems more common in nurses providing palliative care. However, to our knowledge, there is a lack of understanding regarding the factors influencing burnout among palliative nurses in China.

Methods

A cross-sectional design was conducted. A total of 331 palliative nurses from 25 hospitals participated in this study. Anonymous data were collected through a self-designed social-demographic questionnaire, the Nursing Burnout Scale, the Perceived Social Support Scale, the General Self-Efficacy Scale, the Connor-Davidson Resilience Scale, and the Simplified Coping Style Questionnaire. Independent sample t tests, one-way ANOVA, Pearson correlations, and multiple linear regressions were performed to identify the related factors of the three dimensions of burnout.

Results

In the results of multiple linear regression, resilience, health condition, coping style, and pessimistic personality were common related factors; in addition, end-of-life care training, social support, and income satisfaction were statistically significantly associated with burnout. These factors could explain 38.6%, 27.8%, and 34.5% of the total variance in emotional exhaustion, depersonalization, and reduced personal accomplishment, respectively.

Conclusions

The findings of this study help policy makers and nurse managers better understand burnout among palliative nurses in China. The results highlighted the importance of implementing culture-oriented training programs, providing perceived organizational support, and building a reasonable salary system to decrease burnout among palliative nurses, increase the quality of nursing and promote the development of Chinese palliative care.

Association between characteristics of nursing teams and patients' aggressive behavior in closed psychiatric wards

PURPOSE

Estimate the effect of nursing, shift, and patient characteristics on patients' aggression.

DESIGN AND METHODS

Follow-up study on a closed psychiatric ward was performed to estimate the effect of nursing team characteristics and patient characteristics on the incidence of aggression.

FINDINGS

The incidence of aggression (n = 802 in sample) was lower in teams with >75% male nurses. Teams scoring high on extraversion experienced more verbal aggression and teams scoring high on neuroticism experienced more physical aggression. Younger patients and/or involuntarily admitted patients were more frequently aggressive.

PRACTICE IMPLICATIONS

These findings could stimulate support for nurses to prevent aggression.

Workplace violence against nurses working in the public hospitals in Giresun, Turkey: Prevalence, risk factors, and quality of life consequences

PURPOSE

The aim of this study is to determine the prevalence and risk factors of workplace violence (WPV) against nurses working in public hospitals and to evaluate for associations between WPV with the quality of life (QOL).

DESIGN AND METHODS

A cross-sectional study design was carried out from April to May 2021. The study population consisted of 890 nurses working in public hospitals in Giresun, Turkey.

FINDINGS

The prevalence of WPV was found to be 54.8%, consisting of verbal abuse (38.4%), followed by bullying/mobbing (37.5%), physical violence (6.2%), and sexual harassment (1.7%). Moreover, the WPV was found to be related to poor QOL among the nurses.

PRACTICE IMPLICATIONS

Violence prevention, preparedness, and response arrangements should be established and maintained in all hospitals.

Nurse, Provider, and Emergency Department Technician: Perceptions and Experiences of Violence and Aggression in the Emergency Department

INTRODUCTION

Patient/visitor violence and aggression (V&A) in the emergency department occurs daily. Few interventions exist to decrease V&A. Research describing prevalence, severity, and perceived safety among ED clinicians is limited.

METHODS

A descriptive survey explored V&A against ED clinicians in one urban emergency department. A sample of nurses, ED technicians, physicians and advanced practice providers participated. Participants completed a demographic survey, Personal Workplace Safety Instrument for Emergency Nurses (PWSI-EN), and ENA V&A frequency checklist. Analysis of Variance (ANOVA) for unadjusted and Analysis of Covariance (ANCOVA) for adjusted associations were used to assess differences in the PWSI-EN survey composite score and "feeling safe in the ED" among ED roles. ANCOVA was adjusted for potential confounders: sex, race, years working in emergency department, and shift worked.

RESULTS

Sixty-five (46.4%) of the 140 ED clinicians returned surveys, which were almost evenly distributed between ED clinician roles and sex. Mean age was 37.2 (range: 21-64) years. All (100%) nurses and providers reported being verbally abused. More nurses reported physical violence (n = 21, 87.5%) than providers (n = 7, 36.8%) and ED technicians (n = 11, 55%). Nurses and ED technicians reported experiencing greater prevalence of physical violence than providers (p < .05). Nurses (mean 3.29, range 2.95 to 3.63) were more fearful for their personal safety than ED technicians (mean 3.88, range 3.48 to 4.28) (p < .03).

DISCUSSION

V&A are common creating a fearful environment. However, little research regarding clinician perceptions exists. Our study aids in identifying areas for clinician-targeted strategies to prevent ED V&A.

Burnout, quality of life and perceived patient adverse events among paediatric nurses during the COVID-19 pandemic

PURPOSE

This cross-sectional, descriptive, correlational study aimed to measure burnout, quality of life (QOL) and perceptions of patient-related adverse events among paediatric nurses amid the COVID-19 pandemic and assess the relationships between these scores and participants' demographic and work-related characteristics.

BACKGROUND

The mental health of most nurses may severely suffer due to the significant adversities that they struggle with while they care for their patients amid the COVID-19 pandemic. Mental distress negatively affects nurses' relationships and work performance, which may adversely influence the quality of care and patient safety.

METHODS

A convenient sample of 225 Jordanian paediatric nurses completed a test batter comprising the Copenhagen Burnout Inventory, the Brief Version of the World Health Organisation's Quality of Life questionnaire and the nurse-perceived patient adverse events' questionnaire. This study was prepared and is reported according to the STROBE checklist.

RESULTS

Paediatric nurses reported high levels of burnout, low QOL and high occurrence of hospital-acquired infections. Participants' age and hospital/unit capacity were significantly associated with burnout and QOL.

CONCLUSION

Personal traits, perceived salary insufficiency and hospital/unit capacity represent factors that aggravate burnout, lower quality of life and worsen perceived patient safety among paediatric nurses.

RELEVANCE TO CLINICAL PRACTICE

Policymakers should promote nurses' mental integrity and patient safety by addressing issues of workload and financial sufficiency and by provide interventions aimed to increase nurses' resilience.

PATIENT OR PUBLIC CONTRIBUTION

Patients or public were not involved in setting the research question, the outcome measures, the design or implementation of the study. However, paediatric nurses responded to the research questionnaires.

Workplace violence and the risk of post-traumatic stress disorder and burnout among nurses: a systematic review and meta-analysis

AIM

This review examined the association between workplace violence and the risk of post-traumatic stress disorder (PTSD) and burnout among nurses.

BACKGROUND

The extent to which workplace violence is associated with an increased risk of PTSD and burnout in nurses remains unclear.

EVALUATION

We searched nine electronic databases (PubMed, Cochrane, Embase, Web of Science, CINAHL, PsycINFO, Chinese Biomedical, China National Knowledge Internet, and WANFANG).

KEY ISSUES

Overall, 114 full-text studies were identified; 43 met the inclusion criteria, of which 10 were included in the meta-analysis. Compared to their counterparts with non-exposure to workplace violence, nurses experiencing it had 2.13 and 2.25 times higher odds of reporting PTSD and burnout after adjusting the confounding factors. Additionally, the moderator and mediator factors might help reduce the risk of both in this population.

CONCLUSION

This study indicated that workplace violence increases the risk of PTSD and burnout.

IMPLICATIONS FOR NURSING MANAGEMENT

Our review identified the magnitude of the association between exposure to workplace violence and the reported symptoms of PTSD and burnout in nurses. Furthermore, multi-targeted efforts directed at the identified social/organisational, task-related, and individual resources might help mitigate their harmful impact in the aforementioned population.

Workplace Violence in Healthcare Settings: Work-Related Predictors of Violence Behaviours

Healthcare workers are exposed to workplace violence such as physical assaults, psychological violence and threats of violence. It is crucial to understand factors associated with workplace violence to prevent and mitigate its consequences. This study aims to identify work-related factors that might influence workplace violence in healthcare settings. A cross-sectional study was developed between March and April of 2022 with healthcare workers. The Aggression and Violence at Work Scale was used to assess workplace violence, and psychosocial risks were assessed through the Health and Work Survey—INSAT. Statistical analysis using bivariate analysis was performed to identify the psychosocial risk factors related to physical violence, psychological violence and vicarious violence. Subsequently, a multiple linear regression was performed to identify the models that better explained the relationship between psychosocial risk factors and the three dimensions of violence. Psychological violence was frequently experienced by the healthcare workers. Significant associations were found between psychosocial risk factors and physical, psychological and vicarious violence, namely working hours, work relationships, employment relations, high demands and work intensity. These findings highlight the importance of taking into consideration work-related factors when designing interventions to prevent and address workplace violence in healthcare settings.

Burnout in hospital healthcare workers after the second COVID-19 wave: Job tenure as a potential protective factor

Burnout is an impactful occupational health phenomenon to which doctors and nurses have been more exposed during the COVID-19 pandemic. The objectives of this study were to measure the dimensions of burnout-emotional exhaustion, depersonalization and personal accomplishment-in a hospital healthcare population after the second COVID-19 wave and to study their association with sociodemographic variables and previous COVID-19 infection. We invited 112 healthcare professionals (doctors and nurses) who attended the occupational health department of a tertiary hospital in March-July 2021. Emotional exhaustion, depersonalization and personal accomplishment were measured by the Maslach Burnout Inventory. Linear-regression analyses were conducted to explore relationships between burnout dimensions and sociodemographic variables. Differences between groups according to previous COVID-19 infection were verified using the t-test and when appropriate the Mann-Whitney test (for continuous variables), the chi-square test and when appropriate the Fisher exact test (for categorical variables). We surveyed 106 subjects (95% response rate). High emotional exhaustion and depersonalization were reported by 33.0 and 18.4% of participants, respectively; 21.4% reported low personal accomplishment. Job tenure was associated with depersonalization and personal accomplishment. For each 1-year increase in job tenure, depersonalization decreases 0.14 (95% CI [-0.23, -0.04]) and personal accomplishment increases 0.16 (95% CI [0.06, 0.25]). Gender was associated with emotional exhaustion (being male increases emotional exhaustion 5.62-fold [95% CI: 1.33; 9.92]). The prevalence of high emotional exhaustion, high depersonalization and low personal accomplishment after the second COVID-19 wave was relevant and should not be overlooked. Our findings suggest that job tenure may play a protective role in healthcare workers' burnout.

Study on the Current Status and Influencing Factors of Workplace Violence to Medical Staff in Intensive Care Units

Objective

To explore the current status and influencing factors of workplace violence to medical staff in intensive care unit (ICU).

Methods

A total of 230 medical staff in the ICU of Hengyang city were enrolled as the research subjects between October 2021 and January 2022. The situations and characteristics of workplace violence were collected with questionnaires. The influencing factors of workplace violence were analyzed by univariate and multivariate logistic regression analyses.

Results

The incidence of workplace violence to ICU medical staff was 40.43%. There were 18.70% of them threatened, 13.48% with verbal violence, 10.00% with physical violence, and 7.39% with sexual harassment. Of the 114 workplace violence incidents, there were 69 (59.65%) during the day, 101 (88.60%) only with medical staff on the spot, and 91 (79.82%) with male perpetrators (mainly on patients and their families). The main reasons for violence were verbal miscommunication (15.79%), too long waiting time for treatment (27.19%), and unsatisfactory treatment effect (38.60%). The main coping style of medical staff after suffering violence was patient explanation (64.04%). Multivariate regression analysis showed that working years ≤5 years (OR = 2.093, P=0.009) and weekly working time >45 h (OR = 2.127, P=0.022) were independent risk factors of workplace violence to ICU medical staff.

Conclusion

The working years ≤5 years and weekly working time >45 h are high-risk factors of workplace violence to ICU medical staff. The hospital can prevent and control workplace violence based on the high-risk factors to reduce the incidence of workplace violence.

Prevalence, associated factors and adverse outcomes of workplace violence towards nurses in psychiatric settings: A systematic review

Workplace violence towards psychiatric nurses by psychiatric patients is common, which can potentially affect care quality as well as nurses' health. This study aimed to synthesize the literature on workplace violence towards psychiatric nurses and identify the prevalence and factors influencing workplace violence and related outcomes. PubMed, Cochrane Library, CINAHL, EMBASE and PsychINFO were searched for English articles on workplace violence against psychiatric nurses published from January 2011 to December 2020. Sixteen articles were selected for the systematic review. This was followed by quality assessment and data extraction. The workplace violence prevalence ranged 11.4-97.6%. Diagnosis of the patient; nurse-related factors such as age, sex, marital status, education, emotional intelligence level and personality; and work shift were associated with the occurrence of workplace violence. Psychiatric nurses who experienced workplace violence had primarily poor mental health such as depressive symptoms and negative work-related outcomes such as turnover intention. The results revealed that there were relatively few patient-related factors associated with workplace violence and few reports on workplace violence-related to nurses' physical health, suggesting the need for a multi-dimensional approach. Future studies are needed to develop standardized instruments for workplace violence investigation considering inpatients psychiatric settings. Effective workplace violence prevention strategies should consider comprehensive patient-, nurse- and occupation-related factors.

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.

Exploring Inequality Through Service Learning in Higher Education: A Bibliometric Review Study

Service learning (S-L) is an innovative methodology, which is extensively known worldwide. The implementation of this methodology involves classroom learning and real practice. It is based on a cooperative methodology, integrating community service and learning in a connected way. Its main strength lies in its great potential as a transformative social movement to reduce inequality. The main aim of this study was to understand and describe the field of S-L and inequality in higher education through a bibliometric analysis. A descriptive, retrospective, and cross-sectional methodology is used to describe the information obtained from the 20 references on the topic registered in the Scopus and Web of Science (WoS) databases using a mixed methodology. The quantitative and qualitative results show that most of the publications are concentrated in 2016, with the United States being the country with the largest amount of scientific production on this subject. It is also worth noting that most of the authors reported this approach as a powerful tool to develop consciousness, commitment, and responsibility toward inequality and social problems.

Violence Against Physicians in the Workplace: Trends, Causes, Consequences, and Strategies for Intervention

PURPOSE

Violence against healthcare professionals has become an emergency in many countries. Literature in this area has mainly focused on nurses while there are less studies on physicians, whose alterations in mental health and burnout have been linked to higher rates of medical errors and poorer quality of care. We summarized peer-reviewed literature and examined the epidemiology, main causes, consequences, and areas of intervention associated with workplace violence perpetrated against physicians.

RECENT FINDINGS

We performed a review utilizing several databases, by including the most relevant studies in full journal articles investigating the problem. Workplace violence against doctors is a widespread phenomenon, present all over the world and related to a number of variables, including individual, socio-cultural, and contextual variables. During the COVID-19 pandemic, incidence of violence has increased. Data also show the possible consequences in physicians' deterioration of quality of life, burnout, and traumatic stress which are linked to physical and mental health problems, which, in a domino effect, fall on patients' quality of care. Violence against doctors is an urgent global problem with consequences on an individual and societal level. This review highlights the need to undertake initiatives aimed at enhancing understanding, prevention, and management of workplace violence in healthcare settings.