Effects of Integrated Workplace Violence Management Intervention on Occupational Coping Self-Efficacy, Goal Commitment, Attitudes, and Confidence in Emergency Department Nurses: A Cluster-Randomized Controlled Trial

Exploring staff experiences and perceptions of patient-perpetrated violence in hospital settings: A qualitative study

AIMS

To explore hospital staff experiences and perceptions of patient-perpetrated violence.

DESIGN

Descriptive qualitative study.

METHODS

Twelve semi-structured interviews (June-August 2022) were held with a diverse sample of hospital nurses, doctors, allied health professionals, security and a non-clinical manager. The framework approach was used to organise and analyse data, using Attribution Theory as a theoretical lens.

RESULTS

Three themes were identified: violence as (un)predictable, violence as (un)preventable and the cumulative toll of violence. In making sense of why patients become violent, participants described different 'types' of aggressive patients and variably attributed behaviours to situation, disposition or a combination of both. Regardless of perceived causal factors, staff overwhelmingly appeared to view violence as predictable. Participants also reflected on the wider structural problems underpinning violence, frequently alluding to their sense of relative powerlessness to initiate change. The cumulative toll of violence was a common thread, with staff describing their acquisition of 'resilience' and reflecting on its role in their responses to escalating situations.

CONCLUSIONS

Many hospital staff are resigned to the inevitability of violence. The concept of staff 'resilience' following violence is not unproblematic, having the potential to serve as a guise for acceptance and as an additional variable for which staff are held accountable. When designing strategies, organisations should ensure that accountability for violence reduction is distributed across multiple levels. This study makes a novel contribution by exploring the perspectives of multiple staff groups working across diverse hospital settings, and adds to a sparse literature on this subject in the UK.

IMPLICATIONS FOR THE PROFESSION

Efforts to address violence against healthcare staff need to be power-conscious, ensuring that accountability is distributed across multiple levels.

REPORTING METHOD

This study is reported in line with the Consolidated Criteria for Reporting Qualitative Studies (COREQ).

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Associations between traumatic dental injuries due to violence and various drinking behaviors in Korea: A cross-sectional study

BACKGROUND AND AIM

Various patterns of alcohol consumption are associated with trauma and violence. The aim of this study was to assess the association between traumatic dental injuries (TDI) due to violence and different patterns of alcohol consumption in Korean adults.

MATERIALS AND METHODS

A cross-sectional study was conducted with representative sample of Korean adults. Among the total participants, 11.8% (6489/58,999) experienced TDI, and 0.9% (520/58,999) experienced TDI due to violence. The associations between various types of alcohol consumption (frequency of drinking, frequency of binge drinking, age of first drinking) and TDI due to violence were assessed using logistic regression analyses. We confirmed differences in the prevalence experience of TDI due to violence with various types of alcohol consumption by confounders (socioeconomic status).

RESULTS

All types of drinking (frequency of drinking, frequency of binge drinking, age of first drinking) were strongly associated with TDI due to violence. After adjusting for confounders, those who started drinking at the age of 18 or younger and drank 4 or more days a week (OR: 2.86, 95% CI: 1.68-4.88), those who started drinking at the age of 18 or younger and drank 3 days or less a week (OR: 2.37, 95% CI: 1.40-4.02), and those who started drinking at the age of 18 or younger and binge drinking at least once a week (OR: 3.18, 95% CI: 1.79-5.65) had higher prevalence of TDI due to violence compared to those with no alcohol drinking.

CONCLUSIONS

This study presents evidence of an association between various types of alcohol consumption and TDI due to violence in Korean adults. These findings suggest the necessity for policies aimed at reducing alcohol consumption, frequency of drinking, and access to drinking especially in adolescent to reduce the prevalence experience of TDI due to violence.

Defining Research Funding Priorities: Emergency Nurses Association Foundation

INTRODUCTION

Establishing research priorities provides focus and direction for limited resources among organizations and increasing impact in a focused area. The Emergency Nurses Association (ENA) Foundation sought to identify research priorities to guide funding decisions in its extramural grants program.

METHODS

A modified Delphi research strategy was used to build consensus among ENA members and key leaders to determine research focus areas. Two Delphi rounds were conducted. In the first round, 81 emergency nurses participated in providing a list of potential research foci. In the second round, 221 emergency nurse leaders recommended which research topics should be prioritized. Descriptive statistics (frequencies, percentages) were calculated for each research topic. The topics were clustered together and rank ordered by frequency/percentage.

RESULTS

Eight research priorities were identified: emergency department overcrowding, workplace violence, nurse well-being, appropriate use of the emergency department, new graduate training, mental health care, disaster training, and diversity, equity, and inclusion research.

DISCUSSION

These identified research priorities offer direction for determining ENA Foundation funding priorities. In addition, the research priorities provide strategic direction to emergency nurse researchers to promote a rich depth of research that can make a meaningful impact to science and emergency nursing practice.

Standardized training nurses's humanistic care practice ability: A cross-sectional survey in western China during COVID-19

AIM

This study aims to investigate the current status and determinants of humanistic care practice abilities among standardized training nurses in China during the post-COVID-19 era, as well as to propose management strategies.

DESIGN

A cross-sectional study.

METHODS

Deliberately chosen were 517 standardized training nursing students from a provincial-level training facility in western China.

RESULTS

The respondents had a mean ± SD age of 21.23 ± 1.34 years, and 92.0% of them voluntarily opted for the nursing profession. Almost all (99.8%) respondents had at least a college degree. The standardized training nurses scored an average of (130.31 ± 14.18) on humanistic care ability, which was significantly related to some sociodemographic variables. The average scores for the five dimensions of nursing communication ability, psychological adjustment ability, moral and legal application ability, nursing aesthetic ability, and care practice ability were 30.78, 17.61, 32.23, 18 and 31.67, respectively. All these dimensions showed positive correlations with the overall score of humanistic care practice ability.

Impacts for health and care workers of Covid-19 and other public health emergencies of international concern: living systematic review, meta-analysis and policy recommendations

BACKGROUND

Health and care workers (HCW) faced the double burden of the SARS-CoV-2 pandemic: as members of a society affected by a public health emergency and as HWC who experienced fear of becoming infected and of infecting others, stigma, violence, increased workloads, changes in scope of practice, among others. To understand the short and long-term impacts in terms of the COVID-19 pandemic and other public health emergencies of international concern (PHEICs) on HCW and relevant interventions to address them, we designed and conducted a living systematic review (LSR).

METHODS

We reviewed literature retrieved from MEDLINE-PubMed, Embase, SCOPUS, LILACS, the World Health Organization COVID-19 database, the ClinicalTrials.org and the ILO database, published from January 2000 until December 2021. We included quantitative observational studies, experimental studies, quasi-experimental, mixed methods or qualitative studies; addressing mental, physical health and well-being and quality of life. The review targeted HCW; and interventions and exposures, implemented during the COVID-19 pandemic or other PHEICs. To assess the risk of bias of included studies, we used the Johanna Briggs Institute (JBI) Critical Appraisal Tools. Data were qualitatively synthetized using meta-aggregation and meta-analysis was performed to estimate pooled prevalence of some of the outcomes.

RESULTS

The 1013 studies included in the review were mainly quantitative research, cross-sectional, with medium risk of bias/quality, addressing at least one of the following: mental health issue, violence, physical health and well-being, and quality of life. Additionally, interventions to address short- and long-term impact of PHEICs on HCW included in the review, although scarce, were mainly behavioral and individual oriented, aimed at improving mental health through the development of individual interventions. A lack of interventions addressing organizational or systemic bottlenecks was noted.

DISCUSSION

PHEICs impacted the mental and physical health of HCW with the greatest toll on mental health. The impact PHEICs are intricate and complex. The review revealed the consequences for health and care service delivery, with increased unplanned absenteeism, service disruption and occupation turnover that subvert the capacity to answer to the PHEICs, specifically challenging the resilience of health systems.

Workplace violence inflicted by patients or their family members/visitors and its relationship with suicidal ideation among undergraduate medical students during clinical training in China

BACKGROUND

Workplace violence in healthcare settings is a significant public concern that profoundly impacts healthcare workers. However, there is a dearth of knowledge regarding the prevalence of workplace violence and its correlation with suicidal ideation among undergraduate medical students in China during their clinical training. The objective of this study was to evaluate the prevalence of workplace violence inflicted by patients or their family members/visitors and to assess its association with suicidal ideation among undergraduate medical students.

METHOD

The snowballing sampling technique was used to recruit Chinese medical students. A question designed by the research team was used to ask medical students about their encounters with workplace violence. Students' basic demographic information and mental distresses (learning burnout, depression symptoms, anxiety symptoms, alcohol abuse/dependence, excessive daytime sleepiness and history of mental disorders) were also assessed. As appropriate, the data were analysed using descriptive statistics, chi-square tests, independent-sample t-tests and multiple logistic regression.

RESULTS

Out of the 1402 undergraduate medical students who participated, 493 (35.2%) reported having experienced workplace violence inflicted by patients or their family members/visitors, of which 394 (28.1%) were verbal abuse, 14 (1.0%) were physical aggression, and 85 (6.1%) were suffered from both verbal abuse and physical aggression. Furthermore, students exposed to workplace violence were more likely to report suicidal ideation and had a higher prevalence of learning burnout, depression symptoms, anxiety symptoms, alcohol abuse/dependence and excessive daytime sleepiness. Depression symptoms, history of mental disorders, learning burnout and having a partner were significantly associated with suicidal ideation in this population.

CONCLUSION

The prevalence of workplace violence inflicted by patients or their family members/visitors was high among undergraduate medical students in China. This may be associated with their mental distress and suicidal ideation. Consequently, it is crucial to strengthen workplace safety measures and promptly implement interventions to mitigate the potentially serious consequences.

The effectiveness of a workplace violence prevention strategy based on situational prevention theory for nurses in managing violent situations: a quasi-experimental study

BACKGROUND

Workplace violence (WPV) poses a significant occupational hazard for nurses. The efficacy of current education and training programs in mitigating WPV incidence among nurses remains uncertain, possibly due to insufficient consideration of clinical contexts and nurses' specific needs. Therefore, this study developed a WPV prevention strategy based on the actual requirements of clinical nurses and situational prevention theory and aimed to explore its application effects.

METHODS

Under the guidance of situational prevention theory, a WPV prevention strategy for nurses was constructed through literature review, semi-structured interviews and focus group discussion. This study adopted a self-controlled research design, and trained 130 nurses selected from a comprehensive tertiary grade A hospital in Suzhou in this WPV prevention strategy. Data were collected through structured questionnaires, including the revised WPV questionnaire, WPV severity grading scale, and hospital WPV coping resources scale. The WPV incidence, severity, and WPV coping resource scores of nurses were collected before the intervention, as well as at 3 months, 6 months, and 9 months after training.

RESULTS

The WPV prevention strategy comprised 11 prevention plans based on 11 high-risk situational elements of WPV. Each prevention plan included the WPV prevention flowchart, treatment principle, and communication strategy. The strategy demonstrated excellent feasibility and practicality. Following the intervention, the overall incidence of WPV among nurses significantly decreased from 63.85% (baseline) to 46.15% (9 months after training) (P < 0.05). After the training, the severity of psychological violence (Wald χ² = 20.066, P < 0.001) and physical violence (Wald χ² = 9.100, P = 0.028) reported by nurses decreased compared to the baseline (P < 0.05). Moreover, the overall WPV coping resource score significantly increased from [66.50 (57.00, 77.25) points] (baseline) to [80.00 (68.00, 97.25) points] (9 months after training) (P < 0.05).

CONCLUSIONS

The described WPV prevention strategy, grounded in situational prevention theory and tailored to the needs of clinical nurses, effectively reduced WPV incidence, mitigated its severity, and enhanced nurses' WPV coping resources. This approach offered new avenues for nurses in the prevention of WPV.

Implementation of an Assault Prevention Quality Improvement Initiative in an Urban Emergency Department

BACKGROUND

Emergency department (ED) health care workers experience high rates of workplace violence (WPV).

LOCAL PROBLEM

Patient-to-staff physical assaults at an urban, academic adult ED ranged between 1 and 5 per month, with a rate of 0.265 per 1000 patient visits.

METHODS

A quality improvement initiative, guided by the Social Ecological Model framework that contextualized WPV in the ED setting, informed the development of a Risk for Violence Screening Tool (RVST) to screen adult patients presenting to the ED.

INTERVENTIONS

Plan-Do-Study-Act cycles were utilized to implement a violence prevention bundle that incorporated the RVST, an alert system, and focused assault reduction strategies.

RESULTS

Patient-to-staff physical assaults decreased to a rate of 0.146 per 1000 patient visits.

CONCLUSIONS

Risk for violence screening, an alert system, and assault prevention strategies provide opportunities for nurse leaders to promote ED workplace safety.

Family resilience processes among guardians caring for children and youths with leukemia

Based on Walsh's concept of family resilience, this study aims to explain the processes and factors related to family resilience of guardians caring for children and youths with leukemia (GCYL) at a university-affiliated hospital in central Thailand. An explanatory case study is conducted. Semi-structured in-depth interviews were conducted with 21 guardians from 15 families caring for children and youths with leukemia (CYL). The interviews were recorded and transcribed for content analysis. The researcher categorized and coded the data to summarize, interpret, and validate the key study results of family resilience. This study found that families undergo three phases when facing the situation: pre-family resilience, family resilience, and post-family resilience. In each phase, these families face changes in emotions, perspectives, and behaviors related to the factors promoting family resilience. The results of this study will benefit multidisciplinary teams providing care for families with CYL by applying the information about family resilience processes to provide services that cultivate behavioral, physical, psychological, and social growth for the families and enable them to maintain peace in family life.

Negative association between workplace violence and patient safety behaviour in male, but not female, nursing interns: A cross-section study

AIM

The aim of the study was to compare the associations between workplace violence and patient safety behaviour between male and female nursing interns.

DESIGN

A cross-sectional survey.

METHODS

A cross-sectional survey was carried out at three general hospitals in Shandong Province in China to collect data from 466 nursing interns. We evaluated the associations between workplace violence and patient safety behaviours in men and women using multiple linear regressions.

RESULTS

Sex moderated the association between workplace violence and patient safety behaviour (B = 1.046, [SE = 0.477]; p = 0.029). Among male nursing interns, there was a significant association between workplace violence and patient safety (B = -1.353, 95% CI [-2.556, -0.151]; p = 0.028). In male nursing interns, verbal violence and sexual violence were significantly negatively associated with patient safety (B = -1.569, SE = 0.492, p = 0.002; B = -45.663, SE = 5.554, p < 0.001). No significant association was found in female nursing interns.

PATIENT OR PUBLIC CONTRIBUTION

This study did not have a patient or public contribution.

Evidence-Based Approaches to Mitigate Workplace Violence From Patients and Visitors in Emergency Departments: A Rapid Review

INTRODUCTION

This is a rapid review of the published evidence on the effectiveness of interventions for mitigating workplace violence against staff in hospital emergency departments. Focused on the specific needs of an urban emergency department in Canada, this project sought to address the question, "What interventions have evidence regarding effectiveness for addressing workplace patient/visitor violence toward staff in the emergency department?"

METHODS

Following Cochrane Rapid Review methods, 5 electronic databases (MEDLINE via PubMed, Cochrane CENTRAL, Embase, PsycINFO, CINAHL) and Google Scholar were searched in April 2022 for intervention studies to reduce or mitigate workplace violence against staff in hospital emergency departments. Critical appraisal was conducted using Joanna Briggs Institute tools. Key study findings were synthesized narratively.

RESULTS

Twenty-four studies (21 individual studies, 3 reviews) were included in this rapid review. A variety of strategies for reducing and mitigating workplace violence were identified and categorized as single or multicomponent interventions. Although most studies reported positive outcomes on workplace violence, the articles offered limited descriptions of the interventions and/or lacked robust data to demonstrate effectiveness. Insights from across the studies offer knowledge users information to support the development of comprehensive strategies to reduce workplace violence.

DISCUSSION

Despite a large body of literature on workplace violence, there is little guidance on effective strategies to mitigate workplace violence in emergency departments. Evidence suggests that multicomponent approaches targeting staff, patients/visitors, and the emergency department environment are essential to addressing and mitigating workplace violence. More research is needed that provides robust evidence on effective violence prevention interventions.