Workplace violence (WPV) in healthcare systems

Prevalence, pattern, and predictors of WPV against medical interns in Southwest Nigeria: a cross-sectional study

BACKGROUND

Workplace violence (WPV) is a significant occupational hazard threatening the safety and well-being of medical interns in Nigeria. Despite its critical impact, there is a notable research gap regarding the prevalence, patterns, and influencing factors of WPV among medical interns in Southwest Nigeria. This study aims to fill this gap by investigating these aspects.

METHODS

This cross-sectional study utilized online questionnaires to collect data from 379 medical interns at ten hospitals in Southwest Nigeria. The data were analyzed using descriptive statistics and logistic regression.

RESULTS

The study found that 62.5% of medical interns had experienced WPV. Verbal abuse was the most common type of violence (63.3%), followed by threats (50.4%), physical assault (24.3%), verbal sexual harassment (13.2%), and physical sexual abuse (2.6%). The primary perpetrators were patients' relatives (81.9%) and patients (61.2%). WPV predominantly occurred in the afternoon (68.8%) and in emergency rooms (70.5%). The primary triggers were long waiting times (64.6%) and unmet patient needs (54.9%). Female interns had higher odds of experiencing WPV, with an adjusted odds ratio of 3.01 (95% CI: 0.82-11.03, p = 0.01) than their male counterparts.

CONCLUSION

WPV is prevalent among medical interns in Southwest Nigeria, with patients as the main perpetrators. Healthcare organizations must implement measures such as promoting a culture of respect, establishing zero-tolerance policies, training interns to recognize and address WPV, and providing support for victims.

Prevalence, Patterns, and Determinants of Workplace Violence Among Healthcare Providers in Ethiopia: A Systematic Review and Meta-Analysis

Background

Workplace violence remains a persistent health and occupational issue, but stakeholders often lack sufficient evidence to guide effective mitigation strategies. This review aims to ascertain the prevalence and determinants of workplace violence among healthcare providers in Ethiopia, where the issue is under-researched.

Methods

The search included studies conducted in Ethiopia, regardless of publication year, that reported workplace violence among healthcare providers using PubMed, SCOPUS, Web of Sciences, EMBASE, CINHAL, Google Scholar, university repositories, and reference. After each author independently evaluated a study for inclusion, data was extracted, and disagreements were discussed and settled. A random-effects meta-analysis approach was used to evaluate the pooled prevalence, patterns, and determinants of workplace violence at 95% confidence intervals. Additionally, the I 2 and P-value were used to evaluate the heterogeneity. Meta-regression and subgroup analysis were used to assess the difference by study-level characteristics. Additionally, to evaluate the stability of pooled values to outliers and publication bias, sensitivity analysis and funnel plots were performed.

Results

A total of 6986 participants from 17 eligible studies were included in this study. Of the participants, 56% (95% CI: 48%-63%) reported having experienced any form of workplace violence. Verbal abuse accounted for 57% (95% CI: 49-65%), sexual harassment for 56% (95% CI: 48-65%), physical violence for 55% (95% CI: 46-63%), and bullying/mobbing for 51% (95% CI: 40-62%), according to the participants' reports of workplace violence. Working night hours (AOR: 1.57; 95% CI: 1.20-1.93), being female (AOR: 2.24; 95% CI: 1.07-3.41), being single (AOR: 4.58; 95% CI: 2.44-6.73), working in an emergency department (AOR: 3.87; 95% CI: 2.33-5.41), and consuming alcohol (AOR: 2.69; 95% CI: 1.10-4.28) were all associated with a higher risk of workplace violence. Egger's test and the funnel plot revealed no publication bias, and sensitivity analysis demonstrated that the pooled odds ratios were stable.

Conclusion

Given the comparatively high prevalence of workplace violence and its various types among healthcare providers, a multilevel intervention strategy was necessary to address and lessen its effects. In order to make the workplace safer and avoid negative consequences for health care providers as well as the larger healthcare system, this strategy should incorporate both individual-level strategies and targeted policies.

Occupational violence against nursing staff in the surgical wards of Murzuq locality hospitals, Libya (2024)

BACKGROUND

Occupational violence is a significant issue for nurses worldwide, impacting their well-being, job satisfaction, and patient care quality. This study investigated the prevalence, types, and effects of such violence on nursing staff in surgical wards in Murzuq locality hospitals, Libya, to inform effective prevention strategies.

METHODS

This cross-sectional study examined occupational violence against nursing staff in surgical wards across three hospitals in Murzuq, Libya. Using a convenience sampling approach, data were collected from 50 nurses in general surgical and emergency surgical wards over four weeks through a self-administered questionnaire. The variables included demographic data (gender, experience) and information on violence types, sources, impacts, and reduction strategies. The data were analysed via SPSS v27, with descriptive statistics applied. For inferential statistics, the chi-square test and Fisher's exact test were conducted at a significance level of 0.05. Ethical approval was obtained from the academic research committee of Fezzan University, and informed consent was secured from all participants.

RESULTS

Verbal insults (60%) and discrimination (64%) were the most reported types of violence. Patient companions (68%) were identified as the primary source, followed by patients (40%) and colleagues (28%). Occupational violence significantly impacted nurses' lives, with 62% reporting stress, 48% experiencing decreased job satisfaction, and 28% considering leaving their jobs. Additionally, 40% reported difficulty concentrating due to violence. Significant associations were found between gender and sources of violence (p ≤ 0.001) and between years of experience and types, sources, and impacts of violence (p ≤ 0.001).

CONCLUSION

These findings underscore the need for gender-sensitive interventions, comprehensive training, and support mechanisms to address workplace violence. Future research should explore the long-term effects of violence on nursing staff and the effectiveness of tailored interventions in different healthcare settings. The results highlight the critical role of improving work conditions and organizational policies to enhance workplace safety for nurses.

'I Feel Disempowered Because I Could Not Do Anything': Clinical Facilitators' Perception of Violence Towards Nursing Students During Clinical Placement

AIMS

To explore clinical facilitators' understanding, experiences and perceptions of their role in supporting registered nurse students (RNS) who experience workplace violence (WPV) during clinical placement.

DESIGN

An exploratory, qualitative design.

METHODS AND DATA SOURCE

Data were collected between September and November 2022 using semi-structured interviews of 1-h duration with 11 clinical facilitators working in South Australia. The interviews were transcribed verbatim and analysed using thematic analysis.

RESULTS

Participants reported that WPV is experienced in many forms, including verbal and physical violence towards RNS during clinical placements. Clinical facilitators are not always aware of this experience and have mixed abilities to resolve the damage. Most importantly, clinical facilitators saw themselves as disempowered to provide the support required by RNS after WPV incidents as they perceived themselves as visitors to the facilities.

CONCLUSION

Findings indicate that a clinical facilitator's scope and ability to support a RNS is often not at a level where real impact and safety can occur. Varying perceptions of what WPV is, what is acceptable, and the authority or influence of a clinical facilitator have all informed this issue and need to be considered in developing strategies to address WPV towards RNS.

IMPLICATIONS FOR THE NURSING PROFESSION

This study highlights that by understanding the causation of WPV and recognising the lack of influence and scope of clinical facilitators to act to support RNS during WPV events, positive industry changes can be instigated to promote student placement experiences and healthcare provision.

IMPACT

Clinical facilitators felt limited in their role to support RNS experiencing WPV. This research impacts future nursing students, education providers, clinical facilitators and clinical placement providers.

REPORTING METHOD

COREQ guidelines were utilised to report qualitative research.

NO PATIENT OR PUBLIC CONTRIBUTION

This paper explores specifically the clinical facilitators' perceptions of WPV.

Protective and risk factors of workplace violence against nurses: A cross-sectional study

AIMS

To describe how workplace violence (WPV) is experienced by nurses in hospitals and community services and identify protective and risk factors.

METHODS

An online cross-sectional national study was conducted from January to April 2021 in Italy. Hospitals and community services were involved in the study. The survey combined the adapted and validated Italian version of the Violence in Emergency Nursing and Triage (VENT) questionnaire, which explores the episodes of WPV experienced during the previous 12 months, the Practice Environment Scale of the Nursing Work Index (PES-NWI) and some additional questions about staffing levels extracted from a previous RN4CAST study. Nurses working in all clinical settings and community services were invited to participate in the survey. Descriptive and inferential statistics were used for data analysis. We adhered to the STROBE reporting guidelines.

RESULTS

A total of 6079 nurses completed the survey, 32.4% (n = 1969) had experienced WPV in the previous 12 months, and 46% (n = 920) reported WPV only in the previous week. The most significant protective factors were nurses' age, patients' use of illegal substances, attitude of individual nurses and considering effective the organization's procedures for preventing and managing episodes of violence. The most significant risk factors included workload, recognizing violence as an inevitable part of the job, patients' cultural aspects and patients' agitated behaviour. The frequency of WPV was significantly higher in certain areas, such as the emergency department and in mental health wards.

CONCLUSION

Workplace violence (WPV) against nurses is a very frequent and concerning issue, especially in hospitals and community services. Based on our findings, integrated and multimodal programmes for prevention and management of WPV are recommended. More attention and resources need to be allocated to reduce WPV by improving the quality of nurses' workplace environment and implementing violence-free policies for hospitals.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Impact Workplace verbal and physical violence is a widespread phenomenon, both in hospital and community settings, and even during COVID-19 pandemic. This problem is exacerbated by the lack of effective reporting systems, fear of retaliation and the tendency to consider violence as an inevitable part of the job. The characteristics of professionals, patients, work environment and organizational factors are involved in the spread of workplace violence, determining its multifactorial nature. Integrated and multimodal programmes to prevent and manage of workplace violence are probably the only way to effectively counteract workplace violence against nurses. Healthcare policymakers, managers of hospital and community services need to proactively prevent and effectively manage and monitor episodes of violence. Nurses need to feel protected and safeguarded against any form of verbal or physical violence, to provide high-quality care in a totally safe environment.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Magnitude of workplace violence and its associated factors against nurses working in public hospitals of Western Ethiopia: a cross-sectional study

BACKGROUND

Workplace violence (WPV) is a situation in which employees are harassed, intimidated, or assaulted at work or while commuting to and from work. Even though WPV can result in physical and psychological suffering, little evidence is available in Ethiopia. Hence, this study aimed to assess magnitude of workplace violence and its associated factors against nurses working in public hospitals of Western Ethiopia.

METHODS

An institution based cross-sectional study was carried out among nurses working in five public hospitals found in east Wollega from September 15 to October 1, 2022. A simple random sampling technique was used to select 396 study participants. Self-administered adapted questionnaire and semi structured questionnaires were used to collect data. Data was coded and entered Epi data 3.1 and exported to SPSS version 20 analysis. Bi-variable and multivariable logistic regressions were done. Level of association was determined using adjusted odds ratio at 95% confidence interval and p-values of < 0.05.

RESULTS

The prevalence of Workplace violence in the last 12 months was 42.8%. Age group 25-29 years [AOR:3.93, 95% CI = 1.2, 13.3) and 30-34 years [AOR:4.01, 95%CI = 1.4, 11.8], Married nurses [AOR:0.4, 95%CI = 0.2, 0.92], work experience = < 5 years [AOR:2.21, 95%CI = 1.27, 3.82] working between 6:30- 7:30 PM o'clock [AOR:3.49,95%CI = 1.4,8.62], availability of reporting system [AOR:2.58, 95%CI = 1.04, 6.4], Encouragement to report violence[AOR:3.98, 95%CI = 2.05, 7.72], substance use [AOR:3.56, 95%CI = 1.49, 8.46] and nurses ever stressed by job [AOR:3.66, 95%CI = 1.8, 7.34] were significantly associated with workplace violence. CONCLUSION AND RECOMMENDATION: In the current study Workplace violence among nurses was high. Therefore, an intervention like developing reporting system, encouragement to report the violence and training that focuses on prevention and controlling of violence is recommended.

Workplace violence against female healthcare workers: a systematic review and meta-analysis

BACKGROUND

Workplace violence (WPV) is highly prevalent in the health sector and remains a major occupational issue causing significant harm, ranging from bodily and psychological harm to death. Female healthcare workers (HCWs) are at high risk of WPV.

OBJECTIVES

Identify risk factors of WPV among different professional categories of female HCWs.

DATA SOURCES

PubMed, EMBASE and Web of Science, along with their references lists January 2010 and March 2022.

ELIGIBILITY CRITERIA

English language observational studies focusing on WPV among HCWs evaluating the risk factors, impacts and consequences of WPV in female HCWs.

METHOD

Risk of bias was assessed for all studies by Joanna Briggs Institute critical appraisal checklists. We estimated the pooled prevalence of WPV and the associated 95% CI using a random-effects meta-analysis model. We then described the associated factors and effects of WPV.

RESULTS

28 reviewed studies (24 quantitative, 4 qualitative and 1 mixed-method) from 20 countries were selected. From the available results of 16 studies, the pooled prevalence of WPV was estimated at 45.0% (95% CI 32% to 58%). Types of violence included verbal abuse, verbal threats, physical assaults, sexual harassment, mobbing, bullying and discrimination. Perpetrators were patients, patients' relatives, colleagues and supervisors. Nurses were the most studied HCWs category. WPV was found to affect both mental and physical health. Age, marital status, lower occupational position, substance abuse, shorter work experience and low support at work were the main socio-demographic and organisational factors associated with higher risk of WPV.

CONCLUSION

WPV prevalence is high among female HCWs, warranting a multilevel intervention approach to address and mitigate its impact. This approach should include targeted policies and individual-level strategies to create a safer work environment and prevent adverse effects on both HCWs and the broader healthcare system. Further research is needed to better document WPV in categories of HCWs other than nurses.

PROSPERO REGISTRATION NUMBER

CRD42022329574.

Healthcare Workers: Heroes or Victims? Context of the Western World and Proposals to Prevent Violence

Episodes of direct violence against healthcare workers and social workers represent a worrying and widespread phenomenon in Western countries. These violent attacks, whether verbal or physical, occur in various work environments, targeting professionals working in private facilities, medical practices, or those employed within the National Health System facilities. We conducted a search using a single search engine (PubMed) using the terms "violence against healthcare workers AND Western" for the period 2003-2023, identifying 45 results to which we added to the literature through hand searching. Our review thus analyzed the sector literature to highlight the phenomenon of violence against healthcare workers, particularly in Western countries. We began with an analysis of the problem and then focused on the true purpose of the study, which is to propose new solutions to protect healthcare workers in all work settings. Consequently, we aim to improve both the working environment for healthcare professionals and to enhance the overall healthcare and public health outcomes.

Factors associated with workplace violence against Chinese healthcare workers: an online cross-sectional survey

Objectives

Workplace violence (WPV) against healthcare workers (HCWs) has reached significant levels globally, impeding the quality and accessibility of healthcare systems. However, there is limited available knowledge regarding the determinants linked with WPV among HCWs and the discrepancies observed across various levels of hospitals in China. The objective of the present research was to investigate the factors linked to WPV and job satisfaction among HCWs in China.

Methods

A self-developed questionnaire based on WeChat was employed to collect data. The questionnaire consisted of demographic information as well as occupational factors. To measure WPV, the Chinese version of the Workplace Violence Scale was utilized. Career satisfaction was assessed through two questions regarding career choices. The collected data was analyzed using descriptive analyses, chi-square tests, and multivariate logistic regressions.

Results

A total of 3,781 valid questionnaires (1,029 doctors and 2,752 nurses) were collected. Among all participants, 2,201 (58.2%) reported experiencing at least one form of WPV in the past year, with emotional abuse being the most frequent occurrence (49.7%), followed by threats (27.9%). The multivariate logistic regression analysis revealed several risk factors associated with WPV, including male gender, shift work, senior professional title, bachelor's degree education, employment in secondary-level hospitals, and working over 50 h per week (p < 0.05). Career satisfaction among HCWs who experienced high levels of WPV was low, with only 11.2% remaining confident in their profession, and a mere 2.0% supporting their children pursuing careers in healthcare.

Conclusion

WPV poses a significant challenge within the Chinese healthcare system. Efforts should be made to address the identified risk factors and promote a safe and satisfying working environment for HCWs.

Interdisciplinary Simulation Training Reduces Restraint Use in the Emergency Department: A Pilot Study

Introduction Safe and effective management of agitated patients poses multiple challenges for healthcare professionals. Patients placed in restraints because of agitated behavior are at a higher risk of complications, including death. This intervention was designed to provide emergency department staff a framework for de-escalation, improve teamwork, and reduce the use of violent physical restraints. Methods Emergency medicine nurses, patient support associates, and protective services officers underwent a 90-minute educational intervention in 2017. A 30-minute lecture focusing on communication and early use of medication for agitation was followed by a simulation using standardized participants, then a structured debriefing. A standardized return-on-learning tool determined participants' reactions to and application of the educational intervention. Additionally, data was collected and reported as a ratio of number of restraints applied each month compared to total emergency department visits that month. Data were analyzed comparing the six months before the education and the subsequent six months after the education. Results A pilot group of 30 emergency department staff members completed the educational intervention. The intervention contributed to the overall decrease in restraint use in the department. Most participants (86%) felt more confident in their ability to manage agitated patients. Conclusion An interdisciplinary simulation-enhanced educational intervention successfully reduced use of restraints in the emergency department and improved staff attitudes toward de-escalation techniques for agitated patients.

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.

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

Patient and visitor violence (PVV), the most prevalent source of workplace violence, is largely ignored, underreported, and a persistent problem in emergency departments. It is associated with physical injuries, psychological distress, and occupational stress in nurses. A randomized controlled trial was conducted in Taiwan from January to December 2020. This study aimed to test the efficacy of an integrated Workplace Violence Prevention and Management Training Program on PVV in 75 emergency department (ED) nurses from a hospital. Cluster sampling was used because the policy of subdivision strategy was enforced during the COVID-19 pandemic. ED nurses received either the intervention or 1-hour in-service class. Data were collected from questionnaires. Data were analyzed mainly by the repeated measure analysis of variance and generalized estimating equations. The intervention had positive effects on developing stronger goal commitment, improving occupational coping self-efficacy, increasing confidence in ability to deal with violent situations, and modifying attitudes toward the causes and management of PVV in ED nurses (p < 0.05). The marginal R2 of the generalized estimating equation model for goal commitment, occupational coping self-efficacy, confidence, attitudes toward aggression in ED and aggressive behavior variables was high as 0.54 (p < 0.001), 0.45 (p < 0.001), 0.58 (p < 0.001), 0.29 (p < 0.05), and 0.72 (p < 0.001), respectively. These study models could effectively predict changes in the mean values. The benefit was driven by the effect of the intervention in ED nurses. Thus, the intervention, when applied in conjunction with routine in-service class, could exert synergistic improvements on outcomes measured in nurses.