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Ustuner Top F, Kulakaç N, Cam HH. Prevalence and Determinants of Workplace Violence Against Pediatric Emergency Healthcare Workers and Its Effect on Their Psychological Resilience. Clin Pediatr (Phila) 2024; 63:942-952. [PMID: 37698082 DOI: 10.1177/00099228231199831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
The study aimed to determine the prevalence and risk factors of workplace violence (WPV) against pediatric emergency healthcare workers and evaluate the relationship between WPV and psychological resilience. This study is cross-sectional and correlational. According to the results, the prevalence of WPV was 69.8%, and its distribution was as follows: verbal abuse (56.9%), bullying/mobbing (37.6%), physical abuse (12.8%), and sexual abuse (2.2%). Being single/separated/divorced/widowed (odds ratio [OR]: 1.85, 95% confidence interval [CI]: 1.03-3.30), being a physician (OR: 4.74, 95% CI: 1.73-12.96), being a staff member (OR: 2.57, 95% CI: 1.10-5.99), routine direct physical contact with patients/clients (OR: 2.77, 95% CI: 1.40-5.48), and lack of encouragement to report WPV (OR: 3.76, 95% CI: 2.01-7.01) were independent predictors of WPV (P < .05), and WPV was found to be associated with low psychological resilience. Arrangements related to violence prevention, preparation, and intervention should be made and maintained in all pediatric emergency departments.
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Affiliation(s)
| | - Nurşen Kulakaç
- Faculty of Health Sciences, Gümüşhane University, Gümüşhane, Turkey
| | - Hasan Hüseyin Cam
- Yusuf Şerefoğlu Faculty of Health Sciences, Kilis 7 Aralık University, Kilis, Turkey
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Martins Irvine A, Moloney W, Jacobs S, Anderson NE. Support mechanisms that enable emergency nurses to cope with aggression and violence: Perspectives from New Zealand nurses. Australas Emerg Care 2024; 27:97-101. [PMID: 37743125 DOI: 10.1016/j.auec.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 09/17/2023] [Accepted: 09/18/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Although efforts to reduce aggression and violence in emergency departments are important, it is also critical to minimise harm and support staff where this occurs. This research describes support mechanisms emergency nurses value when they experience occupational aggression and violence. METHODS A mixed-methods design including thematic analysis of six interviews and descriptive analysis of fifty-one surveys, with experienced emergency nurse participants and respondents from a single large urban emergency department. RESULTS Four key themes summarised coping with aggression and violence: Minimising exacerbating factors (mental health, lack of understanding of zero tolerance in practice, and wait times); Support before violence (use of huddles and having experienced nurses on each shift); Support during violence (education including restraint, self-defence, de-escalation and legalities); and Support after violence (debriefing, incident reporting and a sense of 'toughness') CONCLUSION: Emergency nurses need preparation and support to competently manage complex mental health presentations, understand legal rights, communicate effectively with patients, families and colleagues and access event debriefing. Security staff are valued team members but also need adequate resourcing and preparation.
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Affiliation(s)
- Alice Martins Irvine
- School of Nursing, University of Auckland, Auckland, New Zealand; Waikato Emergency Department, Te Whatu Ora Waikato, Hamilton, New Zealand
| | | | - Stephen Jacobs
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Natalie Elizabeth Anderson
- School of Nursing, University of Auckland, Auckland, New Zealand; Auckland Emergency Department, Te Whatu Ora Te Toka Tumai, Auckland, New Zealand.
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Sammut D, Lees-Deutsch L, Ali L, Imasogie J, Nkundo L, Hallett N. Exploring staff experiences and perceptions of patient-perpetrated violence in hospital settings: A qualitative study. J Clin Nurs 2024. [PMID: 38764225 DOI: 10.1111/jocn.17218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 04/12/2024] [Accepted: 04/29/2024] [Indexed: 05/21/2024]
Abstract
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.
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Affiliation(s)
- Dana Sammut
- Centre for Healthcare and Communities, Coventry University, Coventry, UK
- School of Nursing and Midwifery, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Liz Lees-Deutsch
- Centre for Healthcare and Communities, Coventry University, Coventry, UK
- Centre for Care Excellence, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Luul Ali
- School of Nursing and Midwifery, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Jennifer Imasogie
- School of Nursing and Midwifery, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Lavinia Nkundo
- School of Nursing and Midwifery, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Nutmeg Hallett
- School of Nursing and Midwifery, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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Pointon L, Hinsby K, Keyworth C, Wainwright N, Bates J, Moores L, Johnson J. Exploring the experiences and perceptions of trainees undertaking a critical incident debrief training programme: A qualitative study. Int J Health Plann Manage 2024. [PMID: 38393977 DOI: 10.1002/hpm.3795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/21/2023] [Accepted: 02/15/2024] [Indexed: 02/25/2024] Open
Abstract
RATIONALE, AIMS AND OBJECTIVES Critical incident debriefing is an occupational health tool for supporting healthcare workers following critical incidents. Demand for debriefing has increased following the Covid-19 pandemic. There is now a need for more trained debrief facilitators to meet demand, but there is a dearth of literature regarding how best to train facilitators. This study addressed this by exploring participant experiences of an online critical incident debrief training programme. METHODS We conducted semi-structured interviews with 14 individuals who received a 5-day training programme based on the Critical Incident Stress Management model. Participants were recruited from a range of professional disciplines including psychology, nursing and human resources within one British healthcare system. Data were analysed using thematic analysis. RESULTS The analysis produced three themes. Managing trainee experiences and expectations suggested that disciplinary heterogeneity in training groups supported inter-participant knowledge exchange. However, this variation also meant that training materials did not meet the learning needs of all participants. Modality of training suggested that while online learning was acceptable for some, others experienced screen fatigue and found it hard to build rapport with other participants. Systematic and organisational obstacles to training access and delivery suggested that lack of managerial support and organisational mental health stigma may be barriers to accessing training. CONCLUSION A 5-day online CISM-based training programme was acceptable to participants. Organisations implementing critical incident debrief training may benefit from (1) offering both in-person and online training options, and (2) tailoring course materials according to the disciplinary make-up of groups.
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Affiliation(s)
- Lucy Pointon
- School of Psychology, University of Leeds, Leeds, UK
- School of Justice, Security and Sustainability, Staffordshire University, Stoke-on-Trent, UK
| | - Kerry Hinsby
- Leeds and York Partnership Foundation Trust, Leeds, UK
| | | | | | - Jenny Bates
- Mid-Yorkshire Hospitals NHS Trust, Wakefield, UK
| | - Lucie Moores
- Mid-Yorkshire Hospitals NHS Trust, Wakefield, UK
| | - Judith Johnson
- School of Psychology, University of Leeds, Leeds, UK
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
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Van de Glind G, Crilly J, Galenkamp N, Schut B, Werner L, Chan E, Hilton E, Schoonhoven L, Scheepers FE, Muir R, Baden D, van Veen M, Ham WHW. Defining the concept of mental dysregulation in patients requiring ambulance and/or emergency department care: protocol for a Delphi consensus study. BMJ Open 2024; 14:e077666. [PMID: 38262647 PMCID: PMC10824022 DOI: 10.1136/bmjopen-2023-077666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 12/20/2023] [Indexed: 01/25/2024] Open
Abstract
INTRODUCTION From the patient and staff perspective, care delivery for patients experiencing a mental health problem in ambulance and emergency department (ED) settings is challenging. There is no uniform and internationally accepted concept to reflect people with a mental health problem who require emergency care, be it for, or as a result of, a mental health or physical health problem. On initial presentation to the emergency service provider (ambulance or ED), the cause of their healthcare condition/s (mental health and/or physical health) is often initially unknown. Due to this (1) the prevalence and range of underlying causes (mental and/or physical) of the patients presenting condition is unknown; (2) misattribution of physical symptoms to a mental health problem can occur and (3) diagnosis and treatment of the initial somatic complaint and cause(s) of the mental/physical health problem may be hindered.This study will name and define a new concept: 'mental dysregulation' in the context of ambulance and ED settings. METHODS AND ANALYSIS A Delphi study, informed by a rapid literature review, will be undertaken. For the literature review, a steering group (ie, persons with lived experience, ED and mental health clinicians, academics) will systematically search the literature to provide a working definition of the concept: mental dysregulation. Based on this review, statements will be generated regarding (1) the definition of the concept; (2) possible causes of mental dysregulation and (3) observable behaviours associated with mental dysregulation. These statements will be rated in three Delphi rounds to achieve consensus by an international expert panel (comprising persons with lived experience, clinicians and academics). ETHICS AND DISSEMINATION This study has been approved by the Medical Ethical Committee of the University of Applied Sciences Utrecht (reference number: 258-000-2023_Geurt van der Glind). Results will be disseminated via peer-reviewed journal publication(s), scientific conference(s) and to key stakeholders.
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Affiliation(s)
| | - Julia Crilly
- Department of Emergency Medicine, Gold Coast Health, Gold Coast, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
| | - Niek Galenkamp
- University of Applied Sciences, Utrecht, The Netherlands
| | - Bart Schut
- Person With Lived Experience, Utrecht, The Netherlands
| | - Lente Werner
- Person With Lived Experience, Utrecht, The Netherlands
| | - Eric Chan
- Foothills Medical Centre, Calgary, Alberta, Canada
| | - Emily Hilton
- Person With Lived Experience, Calgary, Alberta, Canada
| | - Lisette Schoonhoven
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- UMC Utrecht, Utrecht, The Netherlands
| | | | - Rachel Muir
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - David Baden
- Emergency Department, Diakonessenhuis Utrecht Zeist Doorn Locatie Utrecht Spoedeisende hulp, Utrecht, The Netherlands
| | - Mark van Veen
- University of Applied Sciences, Utrecht, The Netherlands
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Bilgin A, Kovanci MS, Öcalan S. "Working in the emergency department is not a job; it's like a war" A narrative inquiry and interpretive phenomenology of the violence experienced by emergency nurses in Turkey. Int J Nurs Pract 2023:e13225. [PMID: 38112041 DOI: 10.1111/ijn.13225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 05/27/2023] [Accepted: 11/26/2023] [Indexed: 12/20/2023]
Abstract
AIMS This study aims to reveal the violent experiences of nurses working in the emergency department and the meanings they attribute to them. METHODS This research was conducted as narrative inquiry and interpretive phenomenology and recruited 15 nurses. Interviews with nurses actively working in the emergency department and who had been exposed to violence by patients or their relatives were conducted with a semi-structured interview form. The consolidated criteria for reporting qualitative research (COREQ) checklist was used. RESULTS In the study, three themes were determined (1) Unpredictable event, (2) Interminable effects of violence, and (3) Like a bottomless pit. With seven sub-themes. CONCLUSIONS This study underlined that violence applied to nurses by patients or relatives of patients in the emergency department is an unexpected situation that causes negative emotions. Violence affects all aspects of life and limits communication with the patient. Coping with a violent situation is challenging for nurses, and they demand support from the management.
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Affiliation(s)
- Aylin Bilgin
- Faculty of Health Sciences, Internal Medicine Nursing Department, Sakarya University of Applied Sciences, Sakarya, Turkey
| | - Mustafa Sabri Kovanci
- Faculty of Nursing, Psychiatric Nursing Department, Hacettepe University, Ankara, Turkey
| | - Sinem Öcalan
- Faculty of Nursing, Psychiatric Nursing Department, Hacettepe University, Ankara, Turkey
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Zhong XF, Shorey S. Experiences of workplace violence among healthcare workers in home care settings: A qualitative systematic review. Int Nurs Rev 2023; 70:596-605. [PMID: 36580395 DOI: 10.1111/inr.12822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 11/24/2022] [Indexed: 12/30/2022]
Abstract
AIMS The aims of this systematic review were to obtain a comprehensive understanding of healthcare workers' experiences who were subjected to workplace violence in the home care environment and identify their specific support needs. BACKGROUND Workplace violence toward healthcare workers has been a prevalent and ongoing issue. With the expansion of home care services, more emphasis should be placed on maintaining a safe in-home care environment for healthcare workers. Understanding healthcare workers' experience of workplace violence is crucial for developing effective interventions. METHODS A systematic search was conducted in 10 databases from their inception date until January 2022. Primary qualitative studies were included. Two reviewers performed screening of studies, methodological quality assessment, and data extraction and analysis independently. The two-step approach by Sandelowski and Barroso on meta-summary and meta-synthesis was used. This qualitative systematic review was reported according to the PRISMA guidelines. RESULTS Eight studies were included. Three themes were identified: (1) impact of workplace violence, (2) reasons behind tolerating violence, and (3) way forward to prevent violence. CONCLUSION Workplace violence is common among healthcare workers in home care settings, yet the support provided to healthcare workers is inadequate. The findings suggest the need for effective interventions and policies to address this grave issue in order to improve the well-being of healthcare workers as it may indirectly affect the care quality provided to patients. IMPLICATIONS FOR NURSING Due to the unique nature of home care services, interventions preventing workplace violence must be tailored to the specific home care settings and needs of healthcare workers. Future research should develop and evaluate different interventions to prevent workplace violence in home care settings.
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Affiliation(s)
- Xiao Fan Zhong
- Nursing Division, National University Hospital, Singapore, Singapore
| | - Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Singapore, Singapore
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Ernur D, Hanci V, Gökmen N. Workplace violence against physicians in intensive care units in Turkey: A cross-sectional study. THE NATIONAL MEDICAL JOURNAL OF INDIA 2023; 36:327-333. [PMID: 38759988 DOI: 10.25259/nmji_691_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2024]
Abstract
Background Although there are many studies on violence against physicians in the literature, there are few studies on violence against physicians working in intensive care units (ICUs). We aimed to investigate the frequency, type and underlying factors of violence against physicians working in ICUs in Turkey in the past 1 year. Methods We collected data by sending a questionnaire about violence against physicians working in ICUs via e-mail and WhatsApp between 1 and 15 May 2022. IBM SPSS Statistics V.24.0 was used for data analysis. The chi-square test and Fisher precision test were used to compare categorical data. Results Over one-third (38.6%) of the 354 physicians participating in our study reported that they had been exposed to violence in the past year, while 20.7% reported that they had been exposed to violence more than once in the past year. There was a significant relationship between the frequency of exposure to violence, female gender, age group, title, subspecialization status, working style and duration of working in the ICU (p<0.05). There was no relationship between the working area, type of hospital and ICU and exposure to violence (p>0.05). The presence of restriction and control points at the entrance to ICUs prevented violence (p<0.05). Conclusion Physicians working in ICUs encounter violence against them. The frequency of violence increased after the Covid-19 pandemic. A significant relationship was found between the frequency of violence and female gender, age group, title, subspecialization status, working style and duration of working in ICUs.
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Affiliation(s)
- Damla Ernur
- Department of Internal Diseases, Subdivision of Critical Care Medicine, Dokuz Eylul University Faculty of Medicine, Balçova, Ýzmir 35150, Turkey
| | - Volkan Hanci
- Department of Anesthesia and Reanimation, Subdivision of Critical Care Medicine, Dokuz Eylul University Faculty of Medicine, Balçova, Ýzmir 35150, Turkey
| | - Necatý Gökmen
- Department of Anesthesia and Reanimation, Subdivision of Critical Care Medicine, Dokuz Eylul University Faculty of Medicine, Balçova, Ýzmir 35150, Turkey
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Guliani M, Reißmann S, Westenhöfer J, Harth V, Mache S. Violence Prevention Climate and Health-Oriented Leadership in German Emergency Departments. Healthcare (Basel) 2023; 11:2234. [PMID: 37628432 PMCID: PMC10454408 DOI: 10.3390/healthcare11162234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/19/2023] [Accepted: 08/02/2023] [Indexed: 08/27/2023] Open
Abstract
Emergency departments (EDs) are high-risk environments for workplace violence. Research into techniques to prevent violence has less frequently explored the influence of leadership. This study aims to analyze the association of leadership with the prevention of violence using the concepts of health-oriented leadership (HoL) and the violence prevention climate (VPC). This quantitative cross-sectional study was conducted through online surveys between November 2021 and March 2022 across Germany. A sample of 370 doctors and nurses working in German EDs were recruited. Perceptions towards VPC and HoL were compared between groups divided according to profession and position using independent t-tests or Mann-Whitney U tests. Separate multiple linear regression models for supervisors and employees analyzed the association between different profiles of HoL with VPC. Supervisors and employees showed significant differences in supervisor staff-care and VPC. Regression analysis demonstrated that supervisors' self-care and employees' assessment of supervisor's staff-care positively predicted all dimensions of VPC. This empirical study provides insights into the variable perceptions of different groups and the association of leadership profiles with the perceptivity of VPC. The results of this study can be used to emphasize the importance of HoL training for both employees and supervisors to improve communication and health-promoting behavior.
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Affiliation(s)
- Mannat Guliani
- Department of Health Sciences, Hamburg University of Applied Sciences (HAW), Ulmenliet 20, 21033 Hamburg, Germany; (M.G.); (J.W.)
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), Seewartenstraße 10, Haus 1, 20459 Hamburg, Germany; (S.R.); (V.H.)
| | - Sonja Reißmann
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), Seewartenstraße 10, Haus 1, 20459 Hamburg, Germany; (S.R.); (V.H.)
| | - Joachim Westenhöfer
- Department of Health Sciences, Hamburg University of Applied Sciences (HAW), Ulmenliet 20, 21033 Hamburg, Germany; (M.G.); (J.W.)
| | - Volker Harth
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), Seewartenstraße 10, Haus 1, 20459 Hamburg, Germany; (S.R.); (V.H.)
| | - Stefanie Mache
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), Seewartenstraße 10, Haus 1, 20459 Hamburg, Germany; (S.R.); (V.H.)
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Jakobsson J, Örmon K, Axelsson M, Berthelsen H. Exploring workplace violence on surgical wards in Sweden: a cross-sectional study. BMC Nurs 2023; 22:106. [PMID: 37029387 PMCID: PMC10079490 DOI: 10.1186/s12912-023-01275-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/28/2023] [Indexed: 04/09/2023] Open
Abstract
BACKGROUND Workplace violence is a global threat to healthcare professionals' occupational health and safety and the situation has worsened during the COVID-19 pandemic. This study aimed to explore workplace violence directed against assistant and registered nurses working on surgical wards in Sweden. METHODS This cross-sectional study was conducted in April 2022. Using a convenience sampling procedure, 198 assistant and registered nurses responded to an online questionnaire developed for this specific study. The questionnaire comprised 52 items and included, among other items, subscales from validated and previously used instruments. Data analysis included descriptive statistics, the chi-square test, and independent-samples t-test. RESULTS The most frequently reported type of workplace violence was humiliation (28.8%), followed by physical violence (24.2%), threats (17.7%), and unwanted sexual attention (12.1%). Patients and patients' visitors were reported as the main perpetrators of all kinds of exposure. Additionally, one third of the respondents had experienced humiliation from colleagues. Both threats and humiliation showed negative associations with work motivation and health (p < 0.05). Respondents classified as working in a high- or moderate-risk environment were more frequently exposed to threats (p = 0.025) and humiliation (p = 0.003). Meanwhile, half of the respondents were unaware of any action plans or training regarding workplace violence. However, of those who indicated that they had been exposed to workplace violence, the majority had received quite a lot or a lot of support, mainly from colleagues (range 70.8-80.8%). CONCLUSION Despite a high prevalence of workplace violence, and especially of humiliating acts, there appeared to be low preparedness within the hospital organizations to prevent and/or handle such incidents. To improve these conditions, hospital organizations should place more emphasis on preventive measures as part of their systematic work environment management. To help inform such initiatives, it is suggested that future research should focus on the identification of suitable measures regarding different types of incidents, perpetrators, and settings.
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Affiliation(s)
- Jenny Jakobsson
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden.
- Centre for Work Life and Evaluation Studies (CTA), Malmö University, Malmö, Sweden.
| | - Karin Örmon
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
- The Västra Götaland Region Competence Center on Intimate Partner Violence, Gothenburg, Sweden
| | - Malin Axelsson
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Hanne Berthelsen
- Centre for Work Life and Evaluation Studies (CTA), Malmö University, Malmö, Sweden
- Faculty of Odontology, Malmö University, Malmö, Sweden
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Timmins F, Catania G, Zanini M, Ottonello G, Napolitano F, Musio ME, Aleo G, Sasso L, Bagnasco A. Nursing management of emergency department violence-Can we do more? J Clin Nurs 2023; 32:1487-1494. [PMID: 35102617 DOI: 10.1111/jocn.16211] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 01/04/2022] [Accepted: 01/07/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Emergency departments are the services with the highest risk of violence for nurses. Reports of violence in health care have increased exponentially in the last decade. Front line hospital services are more at risk, and worldwide there are attempts to quantify, manage and prevent episodes of violence, but no consistent solutions have yet been identified. AIMS To stimulate reflection on causal factors of violence against nurses in emergency departments and discuss potential solutions and strategies for aspects that largely remain unresolved. DESIGN A position paper underpinned by experiences and evidence reported in the literature. METHODS A search of Scopus and CINAHL using the term 'violence' provided information concerning the prevalence of the term 'violence' in contemporary literature and enabled to capture a general overview of contributing factors of violence and current approaches to its management and prevention. CONCLUSIONS However, while risk factors have been identified, there is a tendency to over accentuate the extent of their contribution. The main risk factors present conditions related to or accompanied by mental illness and the impact of overcrowding and long waiting times. RELEVANCE TO CLINICAL PRACTICE More is needed in terms of implementation of more far-reaching, holistic, practical and effective management solutions to promote nurses' safety and adequately support vulnerable patients.
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Affiliation(s)
- Fiona Timmins
- School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin 4, Ireland
| | - Gianluca Catania
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Milko Zanini
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Giulia Ottonello
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | | | - Maria Emma Musio
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Giuseppe Aleo
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Loredana Sasso
- Department of Health Sciences, University of Genoa, Genoa, Italy
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Johnson J, Pointon L, Keyworth C, Wainwright N, Moores L, Bates J, Hinsby K. Evaluation of a training programme for critical incident debrief facilitators. Occup Med (Lond) 2023; 73:103-108. [PMID: 36516291 PMCID: PMC10016050 DOI: 10.1093/occmed/kqac125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Critical incident debriefs are a commonly used occupational health tool for supporting staff after traumatic work incidents. However, there is a dearth of literature evaluating training programmes for debrief facilitators. AIMS To evaluate a 5-day training programme to equip healthcare, social care and voluntary, community and social enterprise sector staff to act as post-incident peer supporters and debrief facilitators. METHODS A mixed-methods, single-arm, before-and-after study. Data were collected at baseline and post-training. The quantitative outcome measure was 'Confidence'; the sum of two items measuring confidence in (i) supporting peers after critical incidents and (ii) facilitating post-incident structured team discussions. At post-training, quantitative and qualitative feedback regarding experiences and perceptions of the training was also gathered. RESULTS We recruited 45 participants between October 2021 and January 2022. Confidence in supporting peers following incidents and facilitating post-incident structured team discussions increased significantly following the training, t(35) = -6.77, P < 0.001. A majority of participants reported they would do things differently because of the training and that they found the training relevant, useful and engaging. Summative content analysis of qualitative feedback indicated that participants (i) believed the role plays were an important learning tool and (ii) thought it was important that the trainer was engaging. Some participants would have preferred in-person delivery. CONCLUSIONS Participants valued training in post-incident peer support and debriefing skills. Organizations implementing post-incident support pathways could usefully include this training and ensure optimal uptake and engagement by (i) providing in-person and online delivery options and (ii) including role play as a learning technique.
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Affiliation(s)
- J Johnson
- School of Psychology, Lifton Place, University of Leeds, Leeds LS29JT, UK
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford BD96RJ, UK
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW 2033, Australia
| | - L Pointon
- School of Psychology, Lifton Place, University of Leeds, Leeds LS29JT, UK
| | - C Keyworth
- School of Psychology, Lifton Place, University of Leeds, Leeds LS29JT, UK
| | - N Wainwright
- Mid-Yorkshire Hospitals NHS Trust, Wakefield WF1 4DG, UK
| | - L Moores
- Mid-Yorkshire Hospitals NHS Trust, Wakefield WF1 4DG, UK
| | - J Bates
- Mid-Yorkshire Hospitals NHS Trust, Wakefield WF1 4DG, UK
| | - K Hinsby
- Leeds and York Partnership NHS Foundation Trust, Leeds LS73JX, UK
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Lee H, Yun H, Choi M, Kim H. Predicting Workplace Violence in the Emergency Department Based on Electronic Health Record Data. J Emerg Nurs 2023; 49:415-424. [PMID: 36925384 DOI: 10.1016/j.jen.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/28/2023] [Accepted: 01/28/2023] [Indexed: 03/15/2023]
Abstract
INTRODUCTION Emergency departments are extremely vulnerable to workplace violence, and emergency nurses are frequently exposed to workplace violence. We developed workplace violence prediction models using machine learning methods based on data from electronic health records. METHODS This study was conducted using electronic health record data collected between January 1, 2016 and December 31, 2021. Workplace violence cases were identified based on violence-related mentions in nursing records. Workplace violence was predicted using various factors related to emergency department visit and stay. RESULTS The dataset included 1215 workplace violence cases and 6044 nonviolence cases. Random Forest showed the best performance among the algorithms adopted in this study. Workplace violence was predicted with higher accuracy when both ED visit and ED stay factors were used as predictors (0.90, 95% confidence interval 0.898-0.912) than when only ED visit factors were used. When both ED visit and ED stay factors were included for prediction, the strongest predictor of risk of WPV was patient dissatisfaction, followed by high average daily length of stay, high daily number of patients, and symptoms of psychiatric disorders. DISCUSSION This study showed that workplace violence could be predicted with previous data regarding ED visits and stays documented in electronic health records. Timely prediction and mitigation of workplace violence could improve the safety of emergency nurses and the quality of nursing care. To prevent workplace violence, emergency nurses must recognize and continuously observe the risk factors for workplace violence from admission to discharge.
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Yan S, Feng J, Gan Y, Wang R, Song X, Luo Z, Han X, Lv C. Prevalence and predictors of workplace violence against emergency physicians in China: a cross-sectional study. HUMAN RESOURCES FOR HEALTH 2023; 21:8. [PMID: 36755287 PMCID: PMC9907873 DOI: 10.1186/s12960-022-00784-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 11/27/2022] [Indexed: 06/18/2023]
Abstract
BACKGROUND Workplace violence (WPV) is considered a global problem, particularly in the health sector; however, no studies have assessed the national prevalence of WPV against emergency physicians and the associated factors in China. METHODS A national cross-sectional survey was conducted in 31 provinces/autonomous regions/municipalities across China between July 2019 and September 2019. A total of 15 455 emergency physicians were selected using a multistage stratified random sampling method. A structured self-administered questionnaire was used to collect information on WPV and potential associated factors among emergency physicians. Descriptive and multivariable logistic regression analyses were used to identify the predictors of WPV. RESULTS A total of 14 848 emergency physicians responded effectively (effective response rate: 96.07%). Of the respondents, 90.40%, 51.45%, and 90.00% reported exposure to any type of WPV, physical or nonphysical violence in the preceding year, respectively. Verbal aggression (87.25%) was the most common form of violence, followed by threat (71.09%), physical assault (48.24%), verbal sexual harassment (38.13%), and sexual assault (19.37%). Patients' families were the main perpetrators of these incidents. Unmet patient needs, taking drugs or drinking, and long waiting times were the main contributors to WPV. Physicians who were from low-developed regions, female, and without shift work were less likely to have experienced any type of WPV. Chinese emergency physicians who were from medium-developed regions, had a bachelor's degree, worked in a higher level hospital, had a higher professional title, with lower incomes, had a history of hypertension or coronary heart disease, were smokers or drinkers, and worked in hospitals without preventive measures or training for WPV and not encouraging to report WPV were more likely to have experienced any type of WPV. The predictors of WPV varied in different types of WPV. CONCLUSIONS This study shows that the prevalence of WPV against emergency physicians is high in China. Measures should be taken at the physicians, patients, hospital, and national levels to protect GPs from WPV; for example, improving physicians' level of service and hospital' reporting procedures. Creating a prevention strategy and providing a safer workplace environment for emergency physicians should be prioritized.
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Affiliation(s)
- Shijiao Yan
- Department of Emergency Medicine, Hunan Provincial People's Hospital/The First Affiliated Hospital, Hunan Normal University, Changsha, Hunan, China
- School of Public Health, Hainan Medical University, Haikou, Hainan, China
| | - Jing Feng
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yong Gan
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Rixing Wang
- Department of Emergency, Hainan Clinical Research Center for Acute and Critical Diseases, The Second Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Xingyue Song
- Department of Emergency, Hainan Clinical Research Center for Acute and Critical Diseases, The Second Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
- Research Unit of Island Emergency Medicine, Chinese Academy of Medical Sciences (No. 2019RU013), Hainan Medical University, Haikou, Hainan, China
| | - Zhiqian Luo
- Department of Emergency Medicine, Hunan Provincial People's Hospital/The First Affiliated Hospital, Hunan Normal University, Changsha, Hunan, China
- Research Unit of Island Emergency Medicine, Chinese Academy of Medical Sciences (No. 2019RU013), Hainan Medical University, Haikou, Hainan, China
- Emergency and Trauma College, Hainan Medical University, Haikou, Hainan, China
| | - Xiaotong Han
- Department of Emergency Medicine, Hunan Provincial People's Hospital/The First Affiliated Hospital, Hunan Normal University, Changsha, Hunan, China.
- Clinical Research Center for Emergency and Critical Care in Hunan Province, Changsha, Hunan, China.
| | - Chuanzhu Lv
- Research Unit of Island Emergency Medicine, Chinese Academy of Medical Sciences (No. 2019RU013), Hainan Medical University, Haikou, Hainan, China.
- Emergency Medicine Center, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No. 32 Yi Huan Lu Xi Er Duan, Chengdu, 610072, Sichuan, China.
- Key Laboratory of Emergency and Trauma of Ministry of Education, Hainan Medical University, Haikou, Hainan, China.
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15
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Violence in the emergency department. Is it a curse? CAN J EMERG MED 2023; 25:5-6. [PMID: 36617612 DOI: 10.1007/s43678-022-00439-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 12/09/2022] [Indexed: 01/10/2023]
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16
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Muacevic A, Adler JR, Daud A, Osman Y, Mustapa N, Abdul Hadi A. Development and Validation of a Questionnaire Assessing the Perception and Practice of Workplace Violence Prevention Among Employers at Healthcare Facilities in North-Eastern Malaysia. Cureus 2023; 15:e34046. [PMID: 36824545 PMCID: PMC9940995 DOI: 10.7759/cureus.34046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2023] [Indexed: 01/23/2023] Open
Abstract
Introduction Healthcare workers have been suffering from workplace violence in alarming numbers, showing the importance of its prevention initiative. This study aims to develop and validate a new questionnaire to assess the perception and practice scores of workplace violence prevention among employers at healthcare facilities. Methods Existing literature has been reviewed to establish the domains and refine the items. The first drafted domain was the perception constructed by six components and 59 items. The second drafted domain was practice, consisting of six components and 41 items. Content validation was measured by a panel of experts using the item-level content validity index (I-CVI). Then, face validation analysis was carried out among 10 healthcare employers and presented as the item-level face validity index (I-FVI). Lastly, 222 participants were recruited to determine the validity and reliability of the questionnaire by using an exploratory factor analysis (EFA) and internal consistency reliability. Results Following content validation, two items in the practice domain were removed because of the I-CVI below 0.78. The I-CVI values of the remaining items for both domains were above 0.78, indicating good relevancy of 59 items to assess the perception and 39 items to evaluate the practice domains. The I-FVI values for both domains were above 0.80, suggesting that the participants easily understood the questionnaire. Bartlett's test of sphericity was significant for both domains (p<0.001). The Kaiser-Meyer-Olkin measure was 0.879 for the perception domain and 0.941 for the practice domain. All items load above 0.6 in their respective factor. In addition, Cronbach's alpha coefficient of reliability test ranged from 0.71 to 0.92 and from 0.82 to 0.97 for the perception and practice domains, respectively. The final revised questionnaire consisted of nine components (35 items) for perception and four components (27 items) for practice. Conclusion The newly developed set of questionnaires is a valid and reliable tool to assess the perception and practice of workplace violence prevention among employers at healthcare facilities.
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Sammut D, Hallett N, Lees-Deutsch L, Dickens GL. A Systematic Review of Violence Risk Assessment Tools Currently Used in Emergency Care Settings. J Emerg Nurs 2022; 49:371-386.e5. [PMID: 36585335 DOI: 10.1016/j.jen.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 11/05/2022] [Accepted: 11/05/2022] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Violence risk assessment is commonplace in mental health settings and is gradually being used in emergency care. The aim of this review was to explore the efficacy of undertaking violence risk assessment in reducing patient violence and to identify which tool(s), if any, are best placed to do so. METHODS CINAHL, Embase, Medline, and Web of Science database searches were supplemented with a search of Google Scholar. Risk of bias assessments were made for intervention studies, and the quality of tool development/testing studies was assessed against scale development criteria. Narrative synthesis was undertaken. RESULTS Eight studies were included. Three existing violence risk assessment tools featured across the studies, all of which were developed for use with mental health patients. Three newly developed tools were developed for emergency care, and 1 additional tool was an adaptation of an extant tool. Where tested, the tools demonstrated that they were able to predict patient violence, but did not reduce restraint use. The quality issues of the studies are a significant limitation and highlight the need for additional research in this area. DISCUSSION There is a paucity of high-quality evidence evaluating the psychometric properties of violence risk assessment tools currently used along the emergency care pathway. Multiple tools exist, and they could have a role in reducing violence in emergency care. However, the limited testing of their psychometric properties, acceptability, feasibility, and usability in emergency care means that it is not possible to favor one tool over another until further research is conducted.
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18
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The Lived Experience of Workplace Violence Among Emergency Nurses. J Emerg Nurs 2022; 49:425-430. [PMID: 36517288 DOI: 10.1016/j.jen.2022.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 11/03/2022] [Accepted: 11/04/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Workplace violence remains a significant threat to the United States health care workforce. With increasingly aggressive patients, emergency nurses reported that the increased prevalence of workplace violence impacted their professional and personal lives. METHODS This study employed a qualitative, descriptive phenomenological approach with purposive sampling. Participants were asked to describe their lived experience with workplace violence while working as emergency nurses and how this affected them personally and professionally. RESULTS Eleven experienced emergency registered nurses from 3 mid-Atlantic hospitals participated in the study. After reviewing, clustering, and validating significant statements, 4 major themes were identified: walking wounded to wounded healer, unexpected shock, betrayal, and resilient but changed. DISCUSSION Our findings were consistent with other studies exploring the effects of workplace violence in emergency departments. We validated that trauma has long-lasting effects. Organizations should ensure that programs and processes are in place to support the nurse or health care worker when workplace violence events occur.
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19
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Grinberg K, Revach C, Lipsman G. Violence in hospitals and burnout among nursing staff. Int Emerg Nurs 2022; 65:101230. [DOI: 10.1016/j.ienj.2022.101230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 09/17/2022] [Accepted: 10/01/2022] [Indexed: 11/28/2022]
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20
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Stafford S, Avsar P, Nugent L, O'Connor T, Moore Z, Patton D, Watson C. What is the impact of patient violence in the emergency department on emergency nurses' intention to leave? J Nurs Manag 2022; 30:1852-1860. [PMID: 35767371 PMCID: PMC9796507 DOI: 10.1111/jonm.13728] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 06/24/2022] [Indexed: 01/01/2023]
Abstract
AIM To examine the impact that patient violence, experienced in the emergency department, has on emergency nurses' intention to leave their job. BACKGROUND Emergency departments have become known for their overcrowding, chaos, unpredictability and violence. Emergency nurses are at high risk of experiencing workplace violence, which is cited in the literature as having a direct effect on general nurses' intention to leave. A high rate of nursing turnover may lead to short staffing, jeopardize the quality of patient care and increase overcrowding and wait times. EVALUATION A systematic review was undertaken in CINAHL, Medline and Psych INFO databases using published data until November 2021. Six articles were included, and PRISMA guidelines were adhered it. KEY ISSUES Workplace violence in the emergency department had a direct impact on emergency nurses' intention to leave and decreased their job satisfaction. Verbal abuse is the most experienced form of workplace violence. CONCLUSIONS Workplace violence experienced by emergency nurses in the emergency department had a direct positive impact on their intention to leave and subsequently negative impact on their job satisfaction. IMPLICATIONS FOR NURSING MANAGEMENT This review may inform clinical decision-making and aid in the development of clinical practice guidelines for a workplace violence prevention programme, specific to the emergency department.
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Affiliation(s)
- Sarah Stafford
- School of Nursing and MidwiferyThe Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health SciencesDublinIreland
| | - Pinar Avsar
- School of Nursing and MidwiferyThe Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health SciencesDublinIreland
| | - Linda Nugent
- School of Nursing and MidwiferyThe Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health SciencesDublinIreland,Fakeeh College of Health SciencesJeddahSaudi Arabia
| | - Tom O'Connor
- Fakeeh College of Health SciencesJeddahSaudi Arabia,Skin Wounds and Trauma Research CentreRCSI University of Medicine and Health SciencesDublinIreland,School of Nursing and MidwiferyRCSI University of Medicine and Health SciencesDublinIreland,School of Nursing and MidwiferyGriffith UniversityGold CoastQueenslandAustralia,Lida InstituteShanghaiChina
| | - Zena Moore
- Fakeeh College of Health SciencesJeddahSaudi Arabia,Skin Wounds and Trauma Research CentreRCSI University of Medicine and Health SciencesDublinIreland,School of Nursing and MidwiferyRCSI University of Medicine and Health SciencesDublinIreland,School of Nursing and MidwiferyGriffith UniversityGold CoastQueenslandAustralia,Lida InstituteShanghaiChina,Faculty of Medicine, Nursing and Health SciencesMonash UniversityClaytonVictoriaAustralia,Department of Public Health, Faculty of Medicine and Health SciencesGhent UniversityGhentBelgium,University of WalesCardiffUK,National Health and Medical Research Council Centre of Research Excellence in Wiser Wound CareMenzies Health Institute QueenslandGold CoastQueenslandAustralia
| | - Declan Patton
- Fakeeh College of Health SciencesJeddahSaudi Arabia,Skin Wounds and Trauma Research CentreRCSI University of Medicine and Health SciencesDublinIreland,School of Nursing and MidwiferyRCSI University of Medicine and Health SciencesDublinIreland,School of Nursing and MidwiferyGriffith UniversityGold CoastQueenslandAustralia,Faculty of Science, Medicine and HealthUniversity of WollongongWollongongNew South WalesAustralia
| | - Chanel Watson
- School of Nursing and MidwiferyRCSI University of Medicine and Health SciencesDublinIreland
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21
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Hou Y, Corbally M, Timmins F. Violence against nurses by patients and visitors in the emergency department: A concept analysis. J Nurs Manag 2022; 30:1688-1699. [PMID: 35700325 PMCID: PMC9795924 DOI: 10.1111/jonm.13721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 06/10/2022] [Accepted: 06/13/2022] [Indexed: 12/30/2022]
Abstract
AIM This analysis investigates the concept of violence against nurses by patients and visitors in the emergency department. It aims to differentiate, clarify, and clearly identify this specific concept, which will facilitate more apt measurement and reporting, ultimately to contribute violence reduction measures. BACKGROUND Due to contextual factors, occupational risk and patient characteristics, violence against nurses by patients and visitors in the emergency department varies from other types of violence against other health care staff. METHODS This study employed Walker and Avant's concept analysis technique. RESULTS The analysis found that violence against nurses by patients and visitors in the emergency department is primarily an occurrence of interpersonal violence based on the working relationship, whereby the patient and/or visitor becomes an assailant, and a nurse becomes a target in the absence of capable guardianship. There is also an intentional use of physical force or power, which results in or has a high chance of causing harm. CONCLUSION A clearer understanding of the antecedents, attributes, and consequences of violence against nurses by patients and visitors arising from this concept analysis provides a framework that will assist in the understanding, measurement, reporting, and prevention of violence and inform future research. IMPLICATIONS FOR NURSING MANAGEMENT Nursing managers are encouraged to adopt strategies that act on the factors related to attributes and antecedents that will serve to reduce the occurrence of intentional violent acts.
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Affiliation(s)
- Yongchao Hou
- Emergency DepartmentShanXi Provincial People's HospitalTaiyuanShanXiChina
| | - Melissa Corbally
- School of Nursing and MidwiferyTrinity College DublinDublinIreland
| | - Fiona Timmins
- School of Nursing, Midwifery & Health SystemsUniversity College DublinDublinIreland
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22
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Lei Z, Yan S, Jiang H, Feng J, Han S, Herath C, Shen X, Min R, Lv C, Gan Y. Prevalence and Risk Factors of Workplace Violence Against Emergency Department Nurses in China. Int J Public Health 2022; 67:1604912. [PMID: 35990192 PMCID: PMC9385966 DOI: 10.3389/ijph.2022.1604912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 07/07/2022] [Indexed: 11/29/2022] Open
Abstract
Objectives: We aim to find out the prevalence, characteristics, and predictors of workplace violence (WPV) against current Chinese emergency department (ED) nurses. Methods: A cross-sectional survey of 20,136 ED nurses was conducted in 31 provinces in China between July and September 2019. Descriptive analyses were used to examine the prevalence and characteristics of WPV. Chi-square analysis and Binary logistic regression analysis were used to identify the predictors of WPV. Results: During the past 12 months, there are 79.39% of ED nurses exposed to any type of WPV, including 78.38% and 39.65% exposed to nonphysical and physical violence, respectively. Binary logistic regression analysis shows that ED nurses who were male, had bachelor’s degrees, had average monthly salary between 5,001 and 12,000, worked in central China, had higher professional titles, were more experienced, arranging shift work, and had higher work stress were more likely to experience WPV. Conclusion: A relatively high prevalence of WPV against Chinese ED nurses has been revealed in this study. The characteristics and predictors of WPV remind us to take positive measures to reduce WPV.
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Affiliation(s)
- Zihui Lei
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shijiao Yan
- Department of Emergency Medicine, Hunan Provincial People’s Hospital/The First Affiliated Hospital, Hunan Normal University, Changsha, China
- School of Public Health, Hainan Medical University, Haikou, China
| | - Heng Jiang
- Centre for Alcohol Policy Research, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Jing Feng
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shuyang Han
- The Fourth Clinical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Chulani Herath
- Department of Psychology and Counselling, Faculty of Health Sciences, The Open University of Sri Lanka, Colombo, Sri Lanka
| | - Xin Shen
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Rui Min
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Yong Gan, ; Chuanzhu Lv, ; Rui Min,
| | - Chuanzhu Lv
- Emergency Medicine Center, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Research Unit of Island Emergency Medicine, Chinese Academy of Medical Sciences, Hainan Medical University, Haikou, China
- *Correspondence: Yong Gan, ; Chuanzhu Lv, ; Rui Min,
| | - Yong Gan
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Yong Gan, ; Chuanzhu Lv, ; Rui Min,
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23
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Bitar E, Carron PN, Khoury A, Souaiby N. Crisis within the crisis: violence towards Lebanese emergency department workers. Eur J Emerg Med 2022; 29:93-94. [PMID: 35210374 DOI: 10.1097/mej.0000000000000907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Eugénie Bitar
- Department of Emergency Medicine, Hotel Dieu de France University Hospital, Beirut, Lebanon
- Department of Emergency Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Pierre Nicolas Carron
- Department of Emergency Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Abdo Khoury
- Department of Emergency Medicine and Critical Care, Besançon University Hospital
- INSERM CIC 1431, Besançon University Hospital, Besançon, France
| | - Nagi Souaiby
- Department of Emergency Medicine, ND Maritime Hospital, Byblos
- School of Medicine, St Joseph University, Beirut, Lebanon
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Violence against physicians and nurses: a systematic literature review. J Public Health (Oxf) 2022; 30:1837-1855. [PMID: 35096514 PMCID: PMC8783572 DOI: 10.1007/s10389-021-01689-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 12/13/2021] [Indexed: 12/15/2022] Open
Abstract
Background Violence against physicians and nurses is a global public health problem. This study explored violence against physicians and nurses using a systematic literature review. Methods Pubmed and Scopus were searched using search words 'violence' OR 'aggression' 'against' 'physicians' AND 'nurses'. Articles published between 2010 and 2020 in the English language, excluding review/systemic review articles, were included in the study. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for literature search and reporting and assessed the quality of the article based on the JBI checklist for analytical cross sectional studies. Results A total of 22 studies were included. The majority of the studies showed that there was a significant violent incident within every setting, often directly involving patients or their relatives. Workers of emergency departments were more likely to be exposed to violence. Verbal abuses were the highest among all settings. Physicians were more likely to face physical violence, while nurses were more prone to sexual harassment. Lack of communication plays a significant role. Fewer reports of violence were noted due to lack of action taken previously. Conclusion Adequate policy making and implementation and operational research are required to further mitigate the episodes of violence.
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Caruso R, Toffanin T, Folesani F, Biancosino B, Romagnolo F, Riba MB, McFarland D, Palagini L, Belvederi Murri M, Zerbinati L, Grassi L. Violence Against Physicians in the Workplace: Trends, Causes, Consequences, and Strategies for Intervention. Curr Psychiatry Rep 2022; 24:911-924. [PMID: 36445636 PMCID: PMC9707179 DOI: 10.1007/s11920-022-01398-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/07/2022] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Rosangela Caruso
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Via Fossato di Mortara 64a, 44121 Ferrara, Italy ,Integrated Department of Mental Health and Pathological Addictions, S. Anna University Hospital and Local Health Trust, Ferrara, Italy
| | - Tommaso Toffanin
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Via Fossato di Mortara 64a, 44121 Ferrara, Italy
| | - Federica Folesani
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Via Fossato di Mortara 64a, 44121, Ferrara, Italy.
| | - Bruno Biancosino
- Integrated Department of Mental Health and Pathological Addictions, S. Anna University Hospital and Local Health Trust, Ferrara, Italy
| | - Francesca Romagnolo
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Via Fossato di Mortara 64a, 44121 Ferrara, Italy
| | - Michelle B. Riba
- Department of Psychiatry, University of Michigan, Ann Arbor, MI USA
| | - Daniel McFarland
- Department of Medicine, Northwell Health Cancer Institute, Lenox Hill Hospital, New York, NY USA
| | - Laura Palagini
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Via Fossato di Mortara 64a, 44121 Ferrara, Italy ,Integrated Department of Mental Health and Pathological Addictions, S. Anna University Hospital and Local Health Trust, Ferrara, Italy
| | - Martino Belvederi Murri
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Via Fossato di Mortara 64a, 44121 Ferrara, Italy ,Integrated Department of Mental Health and Pathological Addictions, S. Anna University Hospital and Local Health Trust, Ferrara, Italy
| | - Luigi Zerbinati
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Via Fossato di Mortara 64a, 44121 Ferrara, Italy ,Integrated Department of Mental Health and Pathological Addictions, S. Anna University Hospital and Local Health Trust, Ferrara, Italy
| | - Luigi Grassi
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Via Fossato di Mortara 64a, 44121 Ferrara, Italy ,Integrated Department of Mental Health and Pathological Addictions, S. Anna University Hospital and Local Health Trust, Ferrara, Italy
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Evans JC, Evans MB, Slack M, Peddle M, Lingard L. Examining non-technical skills for ad hoc resuscitation teams: a scoping review and taxonomy of team-related concepts. Scand J Trauma Resusc Emerg Med 2021; 29:167. [PMID: 34863278 PMCID: PMC8642998 DOI: 10.1186/s13049-021-00980-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 11/15/2021] [Indexed: 12/02/2022] Open
Abstract
Background Non-technical skills (NTS) concepts from high-risk industries such as aviation have been enthusiastically applied to medical teams for decades. Yet it remains unclear whether—and how—these concepts impact resuscitation team performance. In the context of ad hoc teams in prehospital, emergency department, and trauma domains, even less is known about their relevance and impact. Methods This scoping review, guided by PRISMA-ScR and Arksey & O’Malley’s framework, included a systematic search across five databases, followed by article selection and extracting and synthesizing data. Articles were eligible for inclusion if they pertained to NTS for resuscitation teams performing in prehospital, emergency department, or trauma settings. Articles were subjected to descriptive analysis, coherence analysis, and citation network analysis. Results Sixty-one articles were included. Descriptive analysis identified fourteen unique non-technical skills. Coherence analysis revealed inconsistencies in both definition and measurement of various NTS constructs, while citation network analysis suggests parallel, disconnected scholarly conversations that foster discordance in their operationalization across domains. To reconcile these inconsistencies, we offer a taxonomy of non-technical skills for ad hoc resuscitation teams. Conclusion This scoping review presents a vigorous investigation into the literature pertaining to how NTS influence optimal resuscitation performance for ad hoc prehospital, emergency department, and trauma teams. Our proposed taxonomy offers a coherent foundation and shared vocabulary for future research and education efforts. Finally, we identify important limitations regarding the traditional measurement of NTS, which constrain our understanding of how and why these concepts support optimal performance in team resuscitation. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s13049-021-00980-5.
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Affiliation(s)
- J Colin Evans
- Division of Emergency Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
| | - M Blair Evans
- Department of Psychology, Western University, London, ON, Canada
| | - Meagan Slack
- Middlesex-London Paramedic Service, London, ON, Canada
| | - Michael Peddle
- Division of Emergency Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Lorelei Lingard
- Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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Ielapi N, Andreucci M, Bracale UM, Costa D, Bevacqua E, Giannotta N, Mellace S, Buffone G, Cerabona V, Arturi F, Provenzano M, Serra R. Workplace Violence towards Healthcare Workers: An Italian Cross-Sectional Survey. NURSING REPORTS 2021; 11:758-764. [PMID: 34968266 PMCID: PMC8715454 DOI: 10.3390/nursrep11040072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/15/2021] [Accepted: 09/28/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Workplace violence (WPV) is a major healthcare problem with important consequences in healthcare areas and may impact negatively not only healthcare workers but also the quality and safety of patient care. OBJECTIVES This an observational online web-based survey using Google® Modules, specifically aiming to investigate the phenomenon of WPV in Italian healthcare services. METHODS Data collection for this study lasted one month, with the questionnaire available from 1 May 2021 to 31 May 2021. Continuous variables were considered as either mean ± standard deviation (SD) or median and interquartile range (IQR) based on their distribution. Comparison between groups was assessed by unpaired t-test or Mann-Whitney U test according to variable distribution. Categorical variables were analyzed using the chi-squared test. RESULTS The study population consisted of 203 healthcare workers, represented by nurses (61.6%), medical doctors (16.8%), patient care assistants (4.9%), and others (16.7%). Female gender was associated with a 2.6 times higher risk for the presence of aggression (p = 0.034), and nurse as a job with about 4 times increased risk for the presence of aggression (p = 0.006). The risk for aggression increased by 5% for each year of work experience. CONCLUSIONS WPV is still matter of concern in Italian healthcare services. A strong organizational effort is demanded from healthcare institutions in order prevent internal and external violence in healthcare settings.
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Affiliation(s)
- Nicola Ielapi
- Department of Public Health and Infectious Disease, “Sapienza” University of Rome, 00185 Rome, Italy;
- Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, University Magna Graecia of Catanzaro, Viale Europa, 88100 Catanzaro, Italy; (D.C.); (E.B.)
| | - Michele Andreucci
- Department of Health Sciences, University of Catanzaro, 88100 Catanzaro, Italy;
| | | | - Davide Costa
- Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, University Magna Graecia of Catanzaro, Viale Europa, 88100 Catanzaro, Italy; (D.C.); (E.B.)
- Department of Law, Economics and Sociology, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy
| | - Egidio Bevacqua
- Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, University Magna Graecia of Catanzaro, Viale Europa, 88100 Catanzaro, Italy; (D.C.); (E.B.)
- Department of Medical and Surgical Sciences, University of Catanzaro, 88100 Catanzaro, Italy; (N.G.); (F.A.); (M.P.)
| | - Nicola Giannotta
- Department of Medical and Surgical Sciences, University of Catanzaro, 88100 Catanzaro, Italy; (N.G.); (F.A.); (M.P.)
| | - Sabrina Mellace
- Department of Surgery, Health Agency of Trento, 38100 Trento, Italy;
| | - Gianluca Buffone
- Department of Vascular Surgery, Health Agency of Trento, 38100 Trento, Italy;
| | - Vito Cerabona
- Department of Public Health and Infectious Disease, “Sapienza” University of Rome, 00185 Rome, Italy;
| | - Franco Arturi
- Department of Medical and Surgical Sciences, University of Catanzaro, 88100 Catanzaro, Italy; (N.G.); (F.A.); (M.P.)
| | - Michele Provenzano
- Department of Medical and Surgical Sciences, University of Catanzaro, 88100 Catanzaro, Italy; (N.G.); (F.A.); (M.P.)
| | - Raffaele Serra
- Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, University Magna Graecia of Catanzaro, Viale Europa, 88100 Catanzaro, Italy; (D.C.); (E.B.)
- Department of Medical and Surgical Sciences, University of Catanzaro, 88100 Catanzaro, Italy; (N.G.); (F.A.); (M.P.)
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Mouliou DS, Pantazopoulos I, Gourgoulianis KI. Societal Criticism towards COVID-19: Assessing the Theory of Self-Diagnosis Contrasted to Medical Diagnosis. Diagnostics (Basel) 2021; 11:diagnostics11101777. [PMID: 34679475 PMCID: PMC8534791 DOI: 10.3390/diagnostics11101777] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Coronavirus disease 2019 (COVID-19) has emerged as a pandemic introducing the mass autodiagnosis via rapid antigen testing methods, and self-tests were important for several populaces, yet with several neglected issues. In addition, hospital diagnosis was a target of many people or media, as the various COVID-19 clinical phenotypes trammel the precise emergency physicians’ response. Methods: A web-based questionnaire was disseminated through social media in the first half of August 2021 in the Greek populace, assessing the societal criticism for autodiagnosis and medical diagnosis and their issues, just before the occurrence of the fourth pandemic wave in the country. Results: Two thirds of the responders characterized self-tests as unreliable and two fifths reported them dangerous. Reliability (OR 1.335; CI 0.060–0.300; p = 0.000) and danger (OR 5.068; CI 3139–8184; p = 0.000) were significant predictors for the population-based sample’s volition for a self-test. Reversely, regarding medical diagnosis, half of the responders reported the lack of reliability and effectiveness in the emergency departments, which had a significant impact on willingness to visit a hospital if needed (OR 3.207; CI 1987–5182; p = 0.000 and OR 3.506; CI 2167–5670; p = 0.000). Conclusions: The importance of community-based questionnaires is highlighted for assessing people’s criticism and improving the highlighted points in several topics.
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Affiliation(s)
- Dimitra S. Mouliou
- Department of Emergency Medicine, Faculty of Medicine, University of Thessaly, BIOPOLIS, 41110 Larissa, Greece;
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, BIOPOLIS, 41110 Larissa, Greece;
- Correspondence:
| | - Ioannis Pantazopoulos
- Department of Emergency Medicine, Faculty of Medicine, University of Thessaly, BIOPOLIS, 41110 Larissa, Greece;
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, BIOPOLIS, 41110 Larissa, Greece;
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Dunsford J. Nursing violent patients: Vulnerability and the limits of the duty to provide care. Nurs Inq 2021; 29:e12453. [PMID: 34398479 PMCID: PMC9286030 DOI: 10.1111/nin.12453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/25/2021] [Accepted: 08/01/2021] [Indexed: 11/30/2022]
Abstract
The duty to provide care is foundational to the nursing profession and the work of nurses. Unfortunately, violence against nurses at the hands of recipients of care is increasingly common. While employers, labor unions, and professional associations decry the phenomenon, the decision to withdraw care, even from someone who is violent or abusive, is never easy. The scant guidance that exists suggests that the duty to care continues until the risk of harm to the nurse is unreasonable, however, “reasonableness” remains undefined in the literature. In this paper, I suggest that reasonable risk, and the resulting strength of the duty to provide care in situations where violence is present, hinge on the vulnerability of both nurse and recipient of care. For the recipient, vulnerability increases with the level of dependency and incapacity. For the nurse, vulnerability is related to the risk and implications of injury. The complex interplay of contextual vulnerabilities determines whether the risk a nurse faces at the hands of a violent patient is reasonable or unreasonable. This examination will enhance our understanding of professional responsibilities and can help to clarify the strengths and limitations of the nurse's duty to care.
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Affiliation(s)
- Jennifer Dunsford
- Rady Faculty of Health Sciences, College of Nursing, University of Manitoba, Winnipeg, Manitoba, Canada
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Jakobsson J, Örmon K, Berthelsen H, Axelsson M. Workplace violence from the perspective of hospital ward managers in Sweden: A qualitative study. J Nurs Manag 2021; 30:1523-1529. [PMID: 34273122 DOI: 10.1111/jonm.13423] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/16/2021] [Accepted: 07/15/2021] [Indexed: 02/03/2023]
Abstract
AIM The aims of the study are to explore workplace violence perpetrated by patients or visitors from the perspective of hospital ward managers and to describe how ward managers perceive their leadership role and manage related incidents. BACKGROUND Few studies focus on workplace violence from the perspective of ward managers even though they are the closest managers to the operational staff. METHOD Fifteen semistructured interviews were analysed using qualitative content analysis. RESULTS Four categories emerged: the face of workplace violence, a two-fold assignment, strive towards readiness to act, and managing incidents. CONCLUSION While the most common acts of workplace violence are considered less serious and related to patients' medical conditions or dissatisfied visitors, hospital organizations focus on serious but rarely occurring incidents. Consequently, ward managers have limited opportunities to ensure a safe work environment on an everyday basis. IMPLICATIONS FOR NURSING MANAGEMENT To support ward managers' occupational safety and health management, workplace violence prevention and management should be acknowledged as an important responsibility for senior management in hospitals. It is important to identify incidents that most likely will occur at the wards and to create strategies related to those incidents. Strategies could include risk assessments, prevention, evaluation, education and reflection combined with, for example, scenario training.
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Affiliation(s)
- Jenny Jakobsson
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden.,Centre for Work Life and Evaluation Studies (CTA), Malmö University, Malmö, Sweden
| | - Karin Örmon
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden.,The Västra Götaland Region Competence Center on Intimate Partner Violence, Gothenburg, Sweden
| | - Hanne Berthelsen
- Centre for Work Life and Evaluation Studies (CTA), Malmö University, Malmö, Sweden.,Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Malin Axelsson
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
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Anderson N, Pio F, Jones P, Selak V, Tan E, Beck S, Hamilton S, Rogan A, Yates K, Sagarin M, McLeay A, MacLean A, Fayerberg E, Hayward L, Chiang A, Cadzow A, Cadzow N, Moran S, Nicholls M. Facilitators, barriers and opportunities in workplace wellbeing: A national survey of emergency department staff. Int Emerg Nurs 2021; 57:101046. [PMID: 34243105 DOI: 10.1016/j.ienj.2021.101046] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/28/2021] [Accepted: 06/14/2021] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Emergency department (ED) staff face daily exposure to the illness, injury, intoxication, violence and distress of others. Rates of clinician burnout are high and associated with poor patient outcomes. This study sought to measure the prevalence of burnout in ED personnel as well as determine the important facilitators of and barriers to workplace wellbeing. METHOD An anonymous online survey including six open-ended questions on workplace wellbeing was completed by 1372 volunteer participants employed as nurses, doctors, allied health or nonclinical roles at 22 EDs in Aotearoa, New Zealand in 2020. Responses to the questions were analysed using a general inductive approach. RESULTS The three key themes that characterise what matters most to participants' workplace wellbeing are: (1) Supportive team culture (2) Delivering excellent patient-centred care and (3) Professional development opportunities. Opportunities to improve wellbeing also focused on enhancements in these three areas. CONCLUSION In order to optimise workplace wellbeing, emergency departments staff value adequate resourcing for high-quality patient care, supportive and cohesive teams and professional development opportunities. Initiatives in these areas may facilitate staff wellbeing as well as improving safety and quality of patient care.
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Affiliation(s)
- Natalie Anderson
- Faculty of Medical & Health Sciences, University of Auckland, New Zealand; Emergency Department, Auckland City Hospital, Auckland District Health Board, New Zealand.
| | - Fofoa Pio
- Malatest International, Auckland, New Zealand
| | - Peter Jones
- Faculty of Medical & Health Sciences, University of Auckland, New Zealand; Emergency Department, Auckland City Hospital, Auckland District Health Board, New Zealand
| | - Vanessa Selak
- Faculty of Medical & Health Sciences, University of Auckland, New Zealand
| | - Eunicia Tan
- Faculty of Medical & Health Sciences, University of Auckland, New Zealand; Emergency Department, Middlemore Hospital, Counties Manukau Health, New Zealand
| | - Sierra Beck
- Division of Health Sciences, University of Otago, New Zealand; Emergency Department, Dunedin Hospital, Southern District Health Board, New Zealand
| | - Suzanne Hamilton
- Emergency Department, Christchurch Hospital, Canterbury District Health Board, New Zealand; Emergency Department, Wellington Hospital, Capital & Coast District Health Board, New Zealand
| | - Alice Rogan
- Division of Health Sciences, University of Otago, New Zealand; Emergency Department, Christchurch Hospital, Canterbury District Health Board, New Zealand
| | - Kim Yates
- Faculty of Medical & Health Sciences, University of Auckland, New Zealand; Emergency Departments, North Shore & Waitakere Hospitals, Waitematā District Health Board, New Zealand
| | - Mark Sagarin
- Emergency Department, Taranaki Base Hospital, Taranaki District Health Board, New Zealand
| | - Adam McLeay
- Emergency Department, Southland Hospital, Southern District Health Board, New Zealand
| | - Alistair MacLean
- Emergency Department, Tauranga Hospital, Bay of Plenty District Health Board, New Zealand
| | - Eugene Fayerberg
- Emergency Department Whangarei Hospital, Northland District Health Board, New Zealand
| | - Luke Hayward
- Emergency Department, Hutt Hospital. Hutt Valley District Health Board, New Zealand
| | - Arthur Chiang
- Division of Health Sciences, University of Otago, New Zealand; Emergency Department, Timaru Hospital, South Canterbury District Health Board, New Zealand
| | - Alastair Cadzow
- Emergency Department, Timaru Hospital, South Canterbury District Health Board, New Zealand
| | - Natalie Cadzow
- Emergency Department, Timaru Hospital, South Canterbury District Health Board, New Zealand
| | - Suzanne Moran
- Emergency Department, Rotorua Hospital, Lakes District Health Board, New Zealand
| | - Mike Nicholls
- Faculty of Medical & Health Sciences, University of Auckland, New Zealand; Emergency Department, Auckland City Hospital, Auckland District Health Board, New Zealand
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Timmins F, Timmins B. An integrative review of waiting time, queuing, and design as contributory factors to emergency department violence. J Evid Based Med 2021; 14:139-151. [PMID: 34032010 DOI: 10.1111/jebm.12432] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Reports of violence in health care are continuously increasing. Globally there are attempts to manage this phenomenon. However, while risk factors have been identified, there is a tendency to over accentuate the extent of their contribution. Alcohol and drug misuse, for example, are frequently reported, with limited consideration of the ED environment. By far the biggest cause of violence appears to be the presentation of conditions related to or accompanied by mental illness and the impact of queuing and crowded departments on patients and their families. This study aims to examine the extent to which ED waiting times, design and queuing are linked to ED violence. METHODS An integrative literature review was performed using CINAHL Complete and MEDLINE databases. 110 papers were initially selected, and the final analysis included 25 papers. RESULTS The literature revealed three emerging themes: the nature of emergency department violence, environmental contributory factors and its management and control. CONCLUSION The findings of this review reveal several causes of violence. Surprisingly most approaches take a victim blaming approach aimed at identifying potential perpetrators rather than taking a holistic approach to prevention that would also address environmental and societal issues. More is needed in terms of implementation of more far-reaching, practical, and effective management solutions to promote health care workers' safety and adequately support vulnerable patients.
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Affiliation(s)
- Fiona Timmins
- School of Nursing, Midwifery & Health Systems, University College Dublin, Belfied, Dublin, Ireland
| | - Bernard Timmins
- School of Engineering & Built Environment, Technological University of Dublin, Bolton Street, Dublin, Ireland
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Provost S, MacPhee M, Daniels MA, Naimi M, McLeod C. A Realist Review of Violence Prevention Education in Healthcare. Healthcare (Basel) 2021; 9:339. [PMID: 33802868 PMCID: PMC8002651 DOI: 10.3390/healthcare9030339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/07/2021] [Accepted: 03/10/2021] [Indexed: 12/02/2022] Open
Abstract
Violence from patients and visitors towards healthcare workers is an international concern affecting the safety and health of workers, quality of care, and healthcare system sustainability. Although the predominant intervention has been violence prevention (VP) education for healthcare workers, evaluating its effectiveness is challenging due to underreporting of violence and the inherent complexity of both violence and the health care environment. This review utilized a theory-driven, realist approach to synthesize and analyze a wide range of academic and grey literature to identify explanations of how and why VP education makes a difference in preventing violence and associated physical and psychological injury to workers. The review confirmed the importance of positioning VP education as part of a VP strategy, and consideration of the contexts that influence successful application of VP knowledge and skills. Synthesis and analysis of patterns of evidence across 64 documents resulted in 11 realist explanations of VP education effectiveness. Examples include education specific to clinical settings, unit-level modeling and mentoring support, and support of peers and supervisors during violent incidents. This review informs practical program and policy decisions to enhance VP education effectiveness in healthcare settings.
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Affiliation(s)
- Sharon Provost
- Interdisciplinary Studies, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Maura MacPhee
- School of Nursing, University of British Columbia, Vancouver, BC V6T 1Z3, Canada;
| | - Michael A. Daniels
- Sauder School of Business, University of British Columbia, Vancouver, BC V6T 1Z2, Canada;
| | - Michelle Naimi
- School of Population & Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada; (M.N.); (C.M.)
| | - Chris McLeod
- School of Population & Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada; (M.N.); (C.M.)
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Commentary on "Nurses' perspectives of violence in emergency departments: A metasynthesis. Int Emerg Nurs. 2020; 52:100905 by Al-Qadi MM". Int Emerg Nurs 2021; 56:100978. [PMID: 33647506 DOI: 10.1016/j.ienj.2021.100978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/17/2021] [Accepted: 02/08/2021] [Indexed: 11/23/2022]
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Charrier P, Occelli P, Buchet-Poyau K, Douplat M, Delaroche-Gaudin M, Fayard-Gonon F, Jacquin L, Potinet V, Sigal A, Tazarourte K, Touzet S. Strategies used by emergency care professionals to handle interpersonal difficulties with patients: a qualitative study. BMJ Open 2021; 11:e042362. [PMID: 33558353 PMCID: PMC7871700 DOI: 10.1136/bmjopen-2020-042362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Identify the strategies implemented by emergency care professionals when facing tension and interpersonal violence from patients and their friends and family. DESIGN Descriptive qualitative study based on 38 semidirective interviews. PARTICIPANTS Doctors, nurses, nursing assistants and administrative staff. SETTING Four emergency departments (EDs) from three French university hospitals. RESULTS According to the medical professionals interviewed, the difficulties that they encounter with patients or their accompanying family members can be explained by a lack of understanding of the functioning of EDs, by a general increase in individualistic behaviours leading to a lack of civility or by deviant behaviours (related to toxic substance abuse or mental illness). While managing deviant behaviours may sometimes require a collective intervention, ED staff also implement what are essentially individual communication strategies (with the use of rational explanation, seduction and empathy), confrontation or flight to deal with interpersonal difficulties. CONCLUSIONS Strategies used by staff members tend to be individualised for the most part, and some, such as confrontational or escape strategies, may not be adapted to all situations. In the face of difficulties between staff and patients, mediators, specialised in resolving conflict, could entrust some cases to professionals. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT03139110).
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Affiliation(s)
- Philippe Charrier
- Centre Max Weber (UMR 5283), University Lumière Lyon 2, F-69007 Lyon, France
- Public Health Department, Hospices Civils de Lyon, F-69003 Lyon, France
| | - Pauline Occelli
- Public Health Department, Hospices Civils de Lyon, F-69003 Lyon, France
- Health Services and Performance Research Lab (HESPER EA 7425), University Claude Bernard Lyon 1, F-69008 Lyon, France
| | | | - Marion Douplat
- Health Services and Performance Research Lab (HESPER EA 7425), University Claude Bernard Lyon 1, F-69008 Lyon, France
- Emergency Department, Centre Hospitalier Lyon Sud, F-69310 Pierre-Bénite, France
| | | | | | - Laurent Jacquin
- Emergency Department, Edouard Herriot Hospital, F-69008 Lyon, France
| | - Véronique Potinet
- Emergency Department, Centre Hospitalier Lyon Sud, F-69310 Pierre-Bénite, France
| | - Alain Sigal
- Emergency Departement, Croix-Rousse Hospital, F-69004 Lyon, France
| | - Karim Tazarourte
- Health Services and Performance Research Lab (HESPER EA 7425), University Claude Bernard Lyon 1, F-69008 Lyon, France
- Emergency Department, Edouard Herriot Hospital, F-69008 Lyon, France
| | - Sandrine Touzet
- Public Health Department, Hospices Civils de Lyon, F-69003 Lyon, France
- Health Services and Performance Research Lab (HESPER EA 7425), University Claude Bernard Lyon 1, F-69008 Lyon, France
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Ferri P, Stifani S, Accoto A, Bonetti L, Rubbi I, Di Lorenzo R. Violence Against Nurses in the Triage Area: A Mixed-Methods Study. J Emerg Nurs 2021; 46:384-397. [PMID: 32389213 DOI: 10.1016/j.jen.2020.02.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 02/13/2020] [Accepted: 02/14/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Workplace violence is a serious occupational problem among nurses in emergency departments. The aim of this study was to better understand workplace violence experienced by triage nurses. METHODS A mixed-methods study was carried out with 27 Italian nurses involved in the triage area of an emergency department. Quantitative data were collected using the Violent Incident Form and qualitative data were obtained from 3 focus groups. RESULTS Ninety-six percent of triage nurses had suffered an episode of violence during the previous year. Participants reported that perpetrators of violence were primarily patients' relatives or friends (62%), usually male and in a lucid state of consciousness. The aggressor was a male patient in 31% of violent episodes. Male nurses reported only verbal abuse, unlike female nurses who suffered both physical and verbal episodes. Females received assistance from other staff during the aggression event more frequently than males, and females more frequently suffered from physical injury. Only physical and verbal aggressions were associated with physical injury. Four main themes emerged from the focus groups. DISCUSSION Nurses reported that high exposure to workplace violence in triaging had significant consequences on their psychological well-being and on their behavior at work and at home. Violence, perceived as a personal and/or professional injury owing to insufficient organizational support, led professionals to experience feelings of resignation and to believe that abuse was an inevitable part of the job. Nevertheless, in our study, the precipitating factors were investigated, suggesting several possible solutions to limit this phenomenon.
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Caruso R, Antenora F, Riba M, Belvederi Murri M, Biancosino B, Zerbinati L, Grassi L. Aggressive Behavior and Psychiatric Inpatients: a Narrative Review of the Literature with a Focus on the European Experience. Curr Psychiatry Rep 2021; 23:29. [PMID: 33825996 PMCID: PMC8026454 DOI: 10.1007/s11920-021-01233-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/21/2021] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW We summarized peer-reviewed literature on aggressive episodes perpetrated by adult patients admitted to general hospital units, especially psychiatry or emergency services. We examined the main factors associated with aggressive behaviors in the hospital setting, with a special focus on the European experience. RECENT FINDINGS A number of variables, including individual, historical, and contextual variables, are significant risk factors for aggression among hospitalized people. Drug abuse can be considered a trans-dimensional variable which deserves particular attention. Although mental health disorders represent a significant component in the risk of aggression, there are many factors including drug abuse, past history of physically aggressive behavior, childhood abuse, social and cultural patterns, relational factors, and contextual variables that can increase the risk of overt aggressive behavior in the general hospital. This review highlights the need to undertake initiatives aimed to enhance understanding, prevention, and management of violence in general hospital settings across Europe.
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Affiliation(s)
- Rosangela Caruso
- Institute of Psychiatry, Department of Neurosciences and Rehabilitation, University of Ferrara, Ferrara, Italy. .,University Hospital Psychiatry Unit and Consultation-Liaison Psychiatry and Program on Psycho-Oncology and Psychiatry in Palliative Care, S. Anna University Hospital and Health Trust, Via Fossato di Mortara 64a, 44121, Ferrara, Italy.
| | - Fabio Antenora
- Institute of Psychiatry, Department of Neurosciences and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Michelle Riba
- Department of Psychiatry, University of Michigan, Ann Arbor, MI USA ,University of Michigan Comprehensive Depression Center, Ann Arbor, MI USA ,Psycho-oncology Program, University of Michigan Rogel Cancer Center, Ann Arbor, MI USA ,Department of Psycho-oncology, Cancer and Molecular Medicine, University of Leicester, Leicester, UK
| | - Martino Belvederi Murri
- Institute of Psychiatry, Department of Neurosciences and Rehabilitation, University of Ferrara, Ferrara, Italy ,University Hospital Psychiatry Unit and Consultation-Liaison Psychiatry and Program on Psycho-Oncology and Psychiatry in Palliative Care, S. Anna University Hospital and Health Trust, Via Fossato di Mortara 64a, 44121 Ferrara, Italy
| | | | - Luigi Zerbinati
- Institute of Psychiatry, Department of Neurosciences and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Luigi Grassi
- Institute of Psychiatry, Department of Neurosciences and Rehabilitation, University of Ferrara, Ferrara, Italy ,University Hospital Psychiatry Unit and Consultation-Liaison Psychiatry and Program on Psycho-Oncology and Psychiatry in Palliative Care, S. Anna University Hospital and Health Trust, Via Fossato di Mortara 64a, 44121 Ferrara, Italy
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Ceballos JB, Frota OP, Nunes HFSS, Ávalos PL, Krügel CDC, Ferreira Júnior MA, Teston EF. Physical violence and verbal abuse against nurses working with risk stratification: characteristics, related factors, and consequences. Rev Bras Enferm 2020; 73:e20190882. [PMID: 33338160 DOI: 10.1590/0034-7167-2019-0882] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 06/11/2020] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE to analyze the characteristics, related factors, and consequences of physical violence and verbal abuse against nurses working with risk stratification. METHODS a cross-sectional, descriptive and quantitative study carried out with 80 nurses who work with risk stratification in emergency services. Data were collected using an adapted instrument and analyzed using (uni)bivariate inferential statistics. RESULTS companions were the main perpetrators of verbal abuse (86.1%); and patients inflicted physical violence (100%). Professionals with up to five years of experience are 74% less likely to suffer physical violence (p=0.029). Women suffer 5.83 times more verbal abuse than men (p=0.026). Sadness (15.8%) and fear of the aggressor (15.3%) were the main consequences of verbal abuse; and fear of the aggressor (22.2%) and stress (22.2%) were results of physical violence. CONCLUSION violence is influenced by institutional, professional and client aspects. Therefore, coping with it requires multidimensional strategies.
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Affiliation(s)
- Joyce Borges Ceballos
- Universidade Federal de Mato Grosso do Sul. Campo Grande, Mato Grosso do Sul, Brazil
| | - Oleci Pereira Frota
- Universidade Federal de Mato Grosso do Sul. Campo Grande, Mato Grosso do Sul, Brazil
| | | | - Patricia Lima Ávalos
- Universidade Federal de Mato Grosso do Sul. Campo Grande, Mato Grosso do Sul, Brazil
| | | | | | - Elen Ferraz Teston
- Universidade Federal de Mato Grosso do Sul. Campo Grande, Mato Grosso do Sul, Brazil
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Case CA. STARS interventions for violence reduction: Safety, technology, activity, relief, and surroundings. Nurs Forum 2020; 56:453-459. [PMID: 33331015 DOI: 10.1111/nuf.12538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 12/04/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Caregivers without behavioral health expertise struggle to manage behaviorally challenging patients while providing continuous observation (CO) care. PROBLEM A gap in knowledge exists concerning effective CO interventions to reduce patient violence with limited psychiatric resources. The objectives of this project were to improve safety and engagement among staff providing in-person 1:1 CO for patients and optimize acute care CO utilization. METHODS OR INTERVENTIONS Nurse leaders rounded regularly on CO staff and patients requiring CO and provided the safety, technology, activity, relief, and surroundings interventions tool kit for CO staff, patients, and families. Patient readiness to trial remote video monitoring CO was assessed, and violence prevention and assault reporting education to CO staff was reinforced. RESULTS A survey of 46 CO staff demonstrated positive responses to perceptions of: (1) improved safety (p < .01); (2) violence reduction (p < .001); (3) increased awareness of the importance of the CO role (p < .001); and (4) improved CO care (p < .001). CONCLUSION Nurse leader rounding with an educational tool kit yielded CO staff-endorsed feelings of increased staff safety and engagement.
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Affiliation(s)
- Christina A Case
- Clinical Nurse Manager, Acute Medical Telemetry Unit and Surgical Acute Unit, Providence St. Peter Hospital, Olympia, Washington, USA
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Bingöl S, İnce S. Factors influencing violence at emergency departments: Patients' relatives' perspectives. Int Emerg Nurs 2020; 54:100942. [PMID: 33302240 DOI: 10.1016/j.ienj.2020.100942] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 09/28/2020] [Accepted: 10/21/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION In hospitals, the places where the highest rate of violence is perpetrated are emergency departments (EDs). Evaluating patient relatives' perceptions of violence and obtaining their views about how to prevent violence incidents are important in terms of uncovering the factors that increase violent behaviors. This study was aimed at determining the factors increasing violence in the emergency department (ED) from the perspectives of patient relatives. METHODS The sample of this study consisted of 520 individuals who brought a relative to the Adult ED of Akdeniz University Hospital in Turkey between April 2017 and June 2017. Data was collected using a two-part questionnaire prepared by the researcher. The first part consists of 15 items questioning the demographic characteristics of the participants. The second part consists of 20 statements asked the participants to rate the reasons urged patients or their relatives to perpetrate violence in the emergency department. Numbers and percentage calculations were used to evaluate the data. RESULTS Of the participants, 55.6% were men and 54.7% were married. According to the participants' statements, of the relatives of the 520 patients, 141 (27.1%) witnessed verbal violence against emergency department staff, 76 (14.6%) witnessed physical violence against emergency department staff, 9 (1.7%) witnessed verbal threat against emergency department staff, especially against nurses. According to the participants, the primary factor causing people to perpetrate violence at EDs was that patients or their relatives were not adequately informed about the patient's condition. More than 40% of patients' relatives said that anxiety and nervousness arising from being a patient's relative, and stress and sadness they suffered were among the leading factors causing people to perpetrate violent incidents. CONCLUSION In order to prevent and decrease incidents of violence in the emergency departments, healthcare systems should be reviewed and revised. Our study revealed that informing patients and their relatives about the patient's condition and empathic approaches displayed by healthcare employees towards patients reduced the number of incidents of violence. Unlike other studies, this study addresses the negative experiences of patients' relatives in the emergency department and the factors influencing these experiences. Obtaining the opinions of the patients' relatives about possible solutions to the violent events in the ED makes this study unique.
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Affiliation(s)
- Serap Bingöl
- Akdeniz University Hospital of Emergency Department, Campus/Antalya, Turkey
| | - Serpil İnce
- Fundamentals of Nursing Department, Akdeniz University Nursing Faculty Antalya, Turkey.
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Kumari A, Kaur T, Ranjan P, Chopra S, Sarkar S, Baitha U. Workplace violence against doctors: Characteristics, risk factors, and mitigation strategies. J Postgrad Med 2020; 66:149-154. [PMID: 32675451 PMCID: PMC7542052 DOI: 10.4103/jpgm.jpgm_96_20] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Workplace violence is a major occupational issue concerning doctors that has a significant impact on their physical and psychological well-being. This ultimately affects the health care services of the country. Patient-led episodes of verbal violence are more prevalent in Asian countries, especially in the emergency department, psychiatric wards, and intensive care units, mostly faced by junior doctors and residents. Some common precursors of violence against doctors are patients and their attendants' dissatisfaction and low impulse control, poor administration, miscommunication, infrastructural issues especially differences in services between private and public hospitals, and negative media portrayal of doctors. The assessment of risk factors, development and implementation of workplace violence programs, and addressing underreporting of violent episodes have been suggested as some successful organizational mitigation strategies. Recommendations on the management of workplace violence include the development of participative, gender-based, culture-based, nondiscriminatory, and systematic strategies to deal with issues related to violence. This article aims to present a comprehensive review of workplace violence against doctors, discussing the prevalence, degree of violence, predictors, impact on physical and psychological health and intervention strategies to devise practical actions against workplace violence.
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Affiliation(s)
- A Kumari
- Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
| | - T Kaur
- Department of Medicine, AIIMS, New Delhi, India
| | - P Ranjan
- Department of Medicine, AIIMS, New Delhi, India
| | - S Chopra
- Department of Home Science, AIIMS, New Delhi, India
| | - S Sarkar
- Department of Psychiatry and National Drug Dependence Treatment Centre, AIIMS, New Delhi, India
| | - U Baitha
- Department of Medicine, AIIMS, New Delhi, India
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Zhang J, Zheng J, Cai Y, Zheng K, Liu X. Nurses' experiences and support needs following workplace violence: A qualitative systematic review. J Clin Nurs 2020; 30:28-43. [PMID: 32936970 DOI: 10.1111/jocn.15492] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 08/23/2020] [Accepted: 08/28/2020] [Indexed: 02/03/2023]
Abstract
AIMS AND OBJECTIVES To systematically identify, appraise and synthesise existing qualitative studies exploring nurses' lived experiences of workplace violence by patients, families and hospital visitors, identifying their support needs following workplace violence. BACKGROUND Workplace violence against nurses is a significant concern globally, as it leads to serious negative consequences for nurses, patients and organisations as a whole. Having adequate support is considered significant. While numerous studies have been conducted on workplace violence, few qualitative reviews have focused on identifying nurses' support needs following episodes of workplace violence. METHODS Four databases (MEDLINE, CINAHL, PsychINFO and Scopus) were systematically searched. Additionally, hand searching of prominent journals, grey literature and reference lists of included studies was also performed to identify additional research. The Critical Appraisal Skills Programme checklist for qualitative studies was used to assess all included articles. Thomas and Harden's three-stage approach to thematic analysis was followed, using the ENTREQ statement for reporting. RESULTS Ten studies published in English, conducted across eight countries, met the inclusion criteria. Four analytical themes relating to nurses' experiences were identified: "inevitable and unpredictable trauma in the career" "higher tolerance and understanding of unintentional violence," "positive learning or passive adjustment" and "struggle with the role and behaviour conflict." In terms of nurses' support needs, the analysis yielded two themes: "informal support needs" and "formal support needs." CONCLUSION Nurses experience significant and lasting psychological trauma due to workplace violence; however, the support for nurses remains seriously inadequate. Establishing an effective and robust support system based on nurses' needs must be viewed as a priority for organisations, as well as researchers. RELEVANCE TO CLINICAL PRACTICE Institutions and managers have a duty to maintain an awareness of nurses' experiences and support needs regarding workplace violence. There is a need for further policymaking and research, based on clinical practice, in order to develop effective preventive and interventive strategies regarding workplace violence.
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Affiliation(s)
- Junfeng Zhang
- Department of Nursing, SSL Central Hospital of Dongguan City, Dongguan, China
| | - Jing Zheng
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou, China
| | - Yingying Cai
- Department of Chemotherapy, Jieyang People's Hospital, Jieyang, China
| | - Kexin Zheng
- Department of Psychiatry, Zhuhai Center for Chronic Disease Control, Zhuhai, China
| | - Xingling Liu
- Department of Nursing, SSL Central Hospital of Dongguan City, Dongguan, China
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Dafny HA, Beccaria G. I do not even tell my partner: Nurses’ perceptions of verbal and physical violence against nurses working in a regional hospital. J Clin Nurs 2020; 29:3336-3348. [DOI: 10.1111/jocn.15362] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 05/09/2020] [Accepted: 05/17/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Hila A. Dafny
- School of Nursing and Midwifery Faculty of Health Engineering and Sciences University of Southern Queensland Toowoomba Australia
| | - Gavin Beccaria
- School of Psychology and Counselling Faculty of Health Engineering and Sciences University of Southern Queensland Toowoomba Australia
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The Face of Workplace Violence: Experiences of Healthcare Professionals in Surgical Hospital Wards. Nurs Res Pract 2020; 2020:1854387. [PMID: 32550024 PMCID: PMC7275198 DOI: 10.1155/2020/1854387] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/07/2020] [Accepted: 05/13/2020] [Indexed: 02/07/2023] Open
Abstract
Background Though workplace violence (WPV) is a global problem for healthcare professionals, research within in-hospital care has mainly focused on WPV in emergency healthcare settings. Thus, the number of qualitative studies that explores experiences of WPV in general hospital wards with a longer length of stay is limited. Aim The aim of this study was to explore how healthcare professionals in surgical hospital wards experience and manage WPV perpetrated by patients or visitors. Method The study applied a qualitative, inductive approach using focus group interviews for data collection. A purposeful sample of 16 healthcare professionals working in surgical wards was included. Data were analysed using a thematic analysis. Findings. The analysis resulted in four main themes: workplace violence characteristics, partly predictable yet not prevented, approaching workplace violence, and consequences from workplace violence. During the focus group interviews, the healthcare professionals described various acts of physical violence, verbal abuse, and gender discrimination perpetrated by patients or their visitors. Despite the predictability of some of the incidents, preventive strategies were absent or inadequate, with the healthcare professionals not knowing how to react in these threatful or violent situations. They experienced that WPV could result in negative consequences for the care of both the threatful or violent person and the other patients in the ward. WPV caused the healthcare professionals to feel exposed, scared, and unprotected. Conclusion and clinical implications. Exposure to WPV is a problem for healthcare professionals in surgical wards and has consequences for the patients. Preventive strategies, guidelines, and action plans are urgently needed to minimise the risk of WPV and to ensure a safe work and care environment.
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Violence and Its Impact on the Emergency Nurse. J Emerg Nurs 2020; 46:354-358. [DOI: 10.1016/j.jen.2020.01.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 01/16/2020] [Indexed: 01/23/2023]
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Spelten E, Thomas B, O’Meara P, van Vuuren J, McGillion A. Violence against Emergency Department nurses; Can we identify the perpetrators? PLoS One 2020; 15:e0230793. [PMID: 32240231 PMCID: PMC7117706 DOI: 10.1371/journal.pone.0230793] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 03/08/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Violence against health care workers is a major issue in health care organisations and is estimated to affect 95% of workers, presenting an enormous risk for workers and employers. Current interventions generally aim at managing rather than preventing or minimising violent incidents. To create better-targeted interventions, it has been suggested to shift attention to the perpetrators of violence. The aim of this study was to identify and discuss the perceptions, held by Emergency Department nurses, about perpetrators of occupational violence and aggression. METHODS Two focus groups were conducted with Emergency Department nurses at a major metropolitan hospital in Australia. In the focus groups, the nurses' perceptions about perpetrators of violence against health care workers were identified and discussed. The results were analysed using descriptive analysis. RESULTS This study confirmed that violence is a major issue for Emergency Department nurses and has a considerable impact on them. Participants acknowledged that violence at work had become an intrinsic part of their job and they tend to focus on coping mechanisms. The nurses identified six overlapping groups of perpetrators and described their approach to dealing with these perpetrators. The results highlighted additional factors that impact on the occurrence and management of violence, such as the presence of security, wait times, and the triage system. CONCLUSIONS Based on the focus groups with Emergency Department nurses we conclude that violence at work is an everyday danger for Emergency Department nurses, who feel vulnerable and recognise that it is not within their power to solve this issue given the societal component. Our conclusion is that attention needs to shift from equipping workers with tools to manage violence to the perpetrator and the development of interventions to reduce violence from targeted perpetrator groups.
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Affiliation(s)
- Evelien Spelten
- Department of Psychology and Public Health, Rural Health School, La Trobe University, Melbourne, Australia
| | - Brodie Thomas
- La Trobe Rural Health School, La Trobe University, Mildura, Australia
| | - Peter O’Meara
- Department of Community Emergency Health and Paramedic Practice, Monash University, Melbourne, Australia
| | - Julia van Vuuren
- Department of Psychology and Public Health, Rural Health School, La Trobe University, Melbourne, Australia
| | - Anthony McGillion
- School of Nursing and Midwifery, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
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Pérez-Fuentes MDC, Molero Jurado MDM, Martos Martínez Á, Simón Márquez MDM, Oropesa Ruiz NF, Gázquez Linares JJ. Cross-sectional study of aggression against Spanish nursing personnel and effects on somatisation of physical symptoms. BMJ Open 2020; 10:e034143. [PMID: 32152167 PMCID: PMC7064063 DOI: 10.1136/bmjopen-2019-034143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Violence against nursing personnel in their place of work is a severe problem generating important consequences for these workers. Even though there is a large body of research on the subject, the emotional impact of aggression against healthcare workers continues to be debated. OBJECTIVES The objective of this quantitative, observational cross-sectional study was to analyse the effects of aggression against nursing personnel and the mediating role of anxiety in somaticising physical symptoms. METHOD The sample was made up of 1357 nursing professionals who answered questionnaires evaluating their sensitivity to anxiety and the presence of somatic symptoms. RESULTS Of the professionals who indicated that they had been the victims of aggression by family members or patients in the previous year, 52.8% said it had happened to them on one occasion, 25.2% had experienced two episodes, while 6.9% and 15.1% said they had undergone three or more aggressions, respectively. Although 89.3% of the professionals affected by acts of indicated that they had not undergone physical or psychological consequences, there was a higher prevalence of somatic alteration among workers who had been victims of violence in the workplace. Furthermore, aggression at work had a direct effect on physical somatisation, which in turn acted as a mediator in the level of anxiety of nursing professionals. Thus, aggression increased the level of anxiety of nurses through the appearance of somatic symptoms. CONCLUSIONS The results are discussed based on some of the consequences that appeared after episodes of aggression in the healthcare sector and their relationship.
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Affiliation(s)
- María Del Carmen Pérez-Fuentes
- Department of Psychology, University of Almeria, Almeria, Andalucía, Spain
- Universidad Politécnica y Artística del Paraguay, Asuncion, Gran Asunción, Paraguay
| | | | | | | | | | - José Jesús Gázquez Linares
- Department of Psychology, University of Almeria, Almeria, Andalucía, Spain
- Universidad Autónoma de Chile, Temuco, Chile
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Al-Maskari SA, Al-Busaidi IS, Al-Maskari MA. Workplace violence against emergency department nurses in Oman: a cross-sectional multi-institutional study. Int Nurs Rev 2020; 67:249-257. [PMID: 31984506 DOI: 10.1111/inr.12574] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 12/04/2019] [Accepted: 12/30/2019] [Indexed: 11/30/2022]
Abstract
AIM To examine the prevalence, characteristics and factors associated with workplace violence against emergency department nurses in Oman. BACKGROUND Violence against healthcare professionals, including nurses, is a global public health problem. Understanding the epidemiology of violence is crucial for the implementation of appropriate preventative and management policies. METHODS We conducted a multi-centre cross-sectional study in February 2019 utilizing a widely employed self-report questionnaire developed by the World Health Organization. We invited all emergency department nurses working in four governmental hospitals in Al-Sharqiyah and Al-Dakhiliyah Governorates of Oman to participate in the study. RESULTS Of the 103 respondents, most were Omani (57.3%), female (73.8%), and 30 years or older (65%). The majority (87.4%) were exposed to violence in the past 12 months, and non-physical violence (84.5%) was over fourfold greater than physical violence (18.4%). Most physical and non-physical incidents took place during weekends (68.4% and 82.8%, respectively) and in the afternoon or night shifts (78.9% and 93.1%, respectively), and family members and visitors were the most common perpetrators of violence (62.6% physical and 66.7% non-physical). Non-Omani nurses (P = 0.03) and those with education less than a bachelor's degree (P = 0.007) were less likely to experience physical violence. DISCUSSION/CONCLUSION Workplace violence is highly prevalent among emergency department nurses in Oman. Future studies should investigate violent incident reporting, and the causes and consequences of workplace violence on nurses' psychological and physical well-being, work functioning and the quality of care provided to patients. IMPLICATIONS FOR NURSING POLICY The high prevalence of workplace violence is alarming and demonstrates the need for additional interventions to reduce violence and limit its consequences on healthcare professionals and patients' quality of care. Findings from this study can be used to implement changes in existing anti-violence policies.
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Affiliation(s)
| | - I S Al-Busaidi
- Department of Medicine, Christchurch School of Medicine, University of Otago, Christchurch, New Zealand.,Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand
| | - M A Al-Maskari
- Ibra Hospital, Ibra, Oman.,Oman College of Health Sciences, North Al-Sharqiyah Branch, Ibra, Oman
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Yagil D, Dayan H. Justification of aggression against nurses: The effect of aggressor distress and nurse communication quality. J Adv Nurs 2019; 76:611-620. [DOI: 10.1111/jan.14269] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 10/27/2019] [Accepted: 11/07/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Dana Yagil
- University of Haifa Department of Human Services Mount Carmel Haifa Israel
| | - Hana Dayan
- University of Haifa Department of Human Services Mount Carmel Haifa Israel
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50
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Richardson SK, Ardagh MW, Morrison R, Grainger PC. Management of the aggressive emergency department patient: non-pharmacological perspectives and evidence base. Open Access Emerg Med 2019; 11:271-290. [PMID: 31814780 PMCID: PMC6861170 DOI: 10.2147/oaem.s192884] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 08/29/2019] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Aggression in the Emergency Department (ED) remains an ongoing issue, described as reaching epidemic proportions, with an impact on staff recruitment, retention, and ability to provide quality care. Most literature has focused on the definition (or lack of) core concepts, efforts to quantify the phenomenon or provide an epidemiological profile. Relatively little offers evidence-based interventions or evaluations of the same. AIM To identify the range of suggested practices and the evidence base for currently recommended actions relating to the management of the aggressive Emergency Department patient. METHODS A meta-synthesis of existing reviews of violence and aggression in the acute health-care setting, including management of the aggressive patient, was undertaken. This provided the context for critical consideration of the management of this patient group in the ED and implications for clinical practice. RESULTS An initial outline of issues was followed by a systematic search and 15 reviews were further assessed. Commonly identified interventions are grouped around educational, interpersonal, environmental, and physical responses. These actions can be focused in terms of overall responses to the wider issues of violence and aggression, targeted at the pre-event, event, or post-event phase in terms of strategies; however, there is a very limited evidence base to show the effectiveness of strategies suggested. CLINICAL IMPLICATIONS The lack of evidence-based intervention strategies leaves clinicians in a difficult situation, often enacting practices based on anecdote rather than evidence. Local solutions to local problems are occurring in a pragmatic manner, but there needs to be clarification and integration of workable processes for evaluating and disseminating best practice. CONCLUSION There is limited evidence reporting on interventional studies, in addition to identification of the need for high quality longitudinal and evaluation studies to determine the efficacy of those responses that have been identified.
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Affiliation(s)
- Sandra K Richardson
- Emergency Department, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand
- Centre for Postgraduate Nursing Studies, University of Canterbury, Christchurch, New Zealand
| | - Michael W Ardagh
- Emergency Department, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand
- Department of Surgery, University of Otago, Christchurch, New Zealand
| | - Russell Morrison
- Well-being Health and Safety Team, Canterbury District Health Board, Christchurch, New Zealand
| | - Paula C Grainger
- Emergency Department, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand
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