Frequency and risk factors of workplace violence on psychiatric nurses and its impact on their quality of life in China

Rationale for Nurse Underreporting of Workplace Violence: A Qualitative Systematic Review

Workplace violence is a major global societal issue that demands attention. Nurses commonly underreport workplace violence (WPV) perpetrated by patients and visitors, which not only poses risks to their physical and emotional health but also disrupts the regular operation of health care services. We used a qualitative thematic synthesis to evaluate the rationale behind the underreporting of WPV systematically. We identified 4 thematic analysis results. We found that to reduce underreporting of WPV, health care organizations should improve their policies and training, and management should prioritize nursing safety, increase awareness of regulations, and work together to maintain safe environments.

Psychiatric nurses' preferences for job: a discrete choice experiment

BACKGROUND

Psychiatric nurses are instrumental in enhancing accessibility to care and addressing the mental health care needs of individuals. However, the field faces a significant shortage of nurses coupled with a high turnover rate. Developing policies to attract or retain psychiatric nurses is imperative, but little is known about the preferences of psychiatric nurses regarding the economic and non-economic attributes of work. Here, a discrete choice experiment (DCE) was used to explore psychiatric nurses' job preferences.

METHODS

A survey instrument was developed adhering to the design-principles of DCE. Psychiatric nurses were surveyed nationwide based on convenience sampling. A mixed logit model was used to estimate the psychiatric nurses' preferences. Willingness to pay was calculated and the change in the probability of psychiatric nurses accepting a job when attribute levels changed was simulated.

RESULTS

The attribute level most valued by respondents was 'violent coping strategies-impeccable' (coefficient = 1.002, p < 0.01) and willingness to pay for it is 4476.5323 CNY. The most important attribute level for psychiatric nurses living in cities was 'respect-high' (coefficient = 0.505, p < 0.01), and for psychiatric nurses living in town is 'study assistance for children-thorough' (coefficient = 0.620, p < 0.01). Notably, psychiatric nurses with less than ten years of work experience exhibited significant preferences for 'opportunity to upgrade-sufficient' (coefficient = 0.417, p < 0.01), whereas this preference was insignificant among those with ten years or more of experience (p > 0.05). Changing 'violence coping strategies' from 'without' to 'impeccable' increased the probability of psychiatric nurses accepting the job by 37.04%. The optimal job increased the probability of psychiatric nurses accepting the job by 86.06%.

CONCLUSION

Psychiatric nurses would prefer jobs with higher income, more respect, better coping strategies with violence, better opportunities for promotion, and a good working atmosphere. Psychiatric nurses with different seniority and residence had different preferences.

Association between workplace violence from patients and the mental health status of healthcare workers in Zhuhai China: a cross-sectional study

Objective

Workplace violence (WPV) poses a serious occupational risk. This study aims to explore the association between WPV from patients and the occurrence of insomnia, depression, and anxiety among healthcare workers.

Methods

Information about the WPV from patients was collected by a self-designed questionnaire. Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), and Insomnia Severity Index (ISI) were used for the assessment of mental health. Logistic regression was used to explore the association between WPV from patients and insomnia, depression, and anxiety. Mediation analysis was used to evaluate the mediation effect of depression and anxiety on the relationships between WPV from patients and insomnia.

Results

Of 10,413 included healthcare workers, 40.05% experienced verbal violence, 6.44% experienced physical violence from patients in the past year. There is a significant association between verbal violence and insomnia (OR = 1.780, 95% CI: 1.591-1.990), depression (OR = 1.823, 95% CI: 1.640-2.026), and anxiety (OR = 1.831, 95% CI: 1.606-2.087), as well as physical violence (insomnia: OR = 1.220, 95% CI: 1.002-1.481; depression: OR = 1.274, 95% CI: 1.052-1.540; anxiety: OR = 1.316, 95% CI: 1.058-1.630). Moreover, depression and anxiety mediated the relationship between WPV and insomnia, the mediated proportion was 62.21% in the association between verbal violence and insomnia, and 60.22% in the association between physical violence and insomnia.

Conclusions

The association between WPV from patients and heightened risks of mental health issues emphasizes the necessity of supportive work environments. Recognizing the mediating role of depression and anxiety stresses the significance of tailored mental health training for healthcare staff.

The association between the adverse event reporting system and burnout and job satisfaction of nurses: Workplace violence as a mediator

AIMS

This study aims to explore the association between the implementation of the adverse event reporting system (AERS), burnout, and job satisfaction among psychiatric nurses, with a focus on examining the mediating effect of workplace violence from patients.

BACKGROUND

Many organizational and personal factors contribute to burnout and job satisfaction experienced by nurses. AERS, serving as a key component of organizational-level quality improvement system, impacts the overall workplace wellness of nurses.

METHODS

A national sample of 9,744 psychiatric nurses from 41 psychiatric hospitals across 29 provinces in China participated. Burnout was measured by the Maslach Burnout Inventory. Job satisfaction was measured using the Minnesota Satisfaction Questionnaire. Workplace violence was assessed by nurses' experience of verbal and physical violence. Multilevel linear regression analyses were carried out to examine if AERS impacts burnout and job satisfaction and to identify the mediating role of workplace violence.

RESULTS

AERS was positively associated with job satisfaction, but negatively with burnout and workplace violence. Workplace violence exhibited a positive association with burnout and a negative association with job satisfaction. Mediation analyses indicated that the associations between AERS, burnout, and job satisfaction were mediated by workplace violence.

CONCLUSIONS

The application of AERS is associated with a reduction in workplace violence in hospitals, which contributes to the diminished burnout and heightened job satisfaction among psychiatric nurses.

IMPLICATIONS FOR NURSING PRACTICE AND HEALTH POLICY

The study highlights the importance of organizational efforts and mechanisms in promoting nurses' well-being. It is necessary for hospital management to create a safe workplace through the implementation of AERS.

A gender-based review of workplace violence amongst the global health workforce-A scoping review of the literature

Workplace violence (WPV) impacts all levels of the health workforce, including the individual provider, organization, and society. While there is a substantial body of literature on various aspects of WPV against the health workforce, gender-based WPV (GB-WPV) has received less attention. Violence in both the workplace and broader society is rooted in gendered socio-economic, cultural, and institutional factors. Developing a robust understanding of GB-WPV is crucial to explore the differing experiences, responses, and outcomes of GB-WPV with respect to gender. We conducted a scoping review and report on the prevalence and risk factors of GB-WPV in healthcare settings globally. The review followed the Preferred Reporting Items for Systematic and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). We registered the scoping review protocol on the Open Science Framework on January 14, 2022, at https://osf.io/t4pfb/. A systematic search was conducted of empirical literature in five health and social science databases. Of 13667, 226 studies were included in the analysis. Across the studies, more women than men experienced non-physical violence, including verbal abuse, sexual harassment, and bullying. Men experienced more physical violence compared to women. Younger age, less experience, shifting duties, specific clinical settings, lower professional status, organizational hierarchy, and minority status were found to be sensitive to gender, reflecting women's structural disadvantages in the workplace. Given the high prevalence and impact of GB-WPV on women, we provided recommendations to address systemic issues in clinical practice, academia, policy, and research.

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

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

Workplace violence and depressive symptoms: the mediating role of fear of future workplace violence and burnout among Chinese nurses

BACKGROUND

The mechanisms underlying the relationship between workplace violence (WPV) and depressive symptoms in nurses have been less studied. This study aims to examine the mediating role of fear of future workplace violence (FFWV) and burnout in the association between WPV and depressive symptoms.

METHODS

We conducted a cross-sectional web survey at 12 tertiary hospitals in Shandong province, China, in 2020. The Center for Epidemiologic Studies Depression Scale (CESD-10), the Chinese version of the Maslach Burnout Inventory-General Survey and the Fear of Future Violence at Work Scale were used to collect data. Descriptive statistics, independent sample t-test, one-way analysis of variance, Pearson's correlation coefficient, and ordinary least squares regression with bootstrap resampling were used to analyze the data.

RESULTS

The prevalence of depressive symptoms was 45.9% among nurses. The regression model showed that FFWV and burnout mediated the relationship between WPV and depressive symptoms. The total effects of WPV on depressive symptoms (3.109, 95% bootstrap CI:2.324 - 3.713) could be decomposed into direct (2.250, 95% bootstrap CI:1.583 - 2.917) and indirect effects (0.769, 95% bootstrap CI:0.543 - 1.012). Indirect effects mediated by FFWV and burnout were 0.203 (95% bootstrap CI:0.090 - 0.348) and 0.443 (95% bootstrap CI:0.262 - 0.642), respectively. Furthermore, serial multiple mediation analyses indicated that the indirect effect mediated by FFWV and burnout in a sequential manner was 0.123 (95% bootstrap CI:0.070 - 0.189).

CONCLUSION

The prevalence of depressive symptoms among Chinese nurses was high. The WPV was an important risk factor for depressive symptoms and its negative effect was mediated by FFWV and burnout. The importance of decreasing WPV exposure and level of FFWV and burnout was emphasized to prevent depressive symptoms among nurses. The findings implied that hospital managers and health policy makers should not only develop targeted interventions to reduce exposure to WPV in daily work among all nurses, but also provide psychological support to nurses with WPV experience to reduce FFWV and burnout.

Workplace Violence Against Nurses in Psychiatric Hospitals in Oman: A cross-sectional multi-centre study

Objectives

This study aimed to assess the prevalence of workplace violence (WPV) against nurses in Oman's psychiatric hospitals and explore associated factors.

Methods

This cross-sectional study was conducted between October and December 2021 and included all tertiary mental healthcare hospitals in Oman (Al Masarra Hospital and Sultan Qaboos University Hospital, Muscat, Oman). The participants completed a sociodemographic survey and a questionnaire on WPV in the health sector.

Results

A total of 106 participants (response rate = 80.3%) were included in this study. Most were female (52.8%) and Omani (72.6%) and aged 30-39 years. WPV prevalence was high (90.6%), with verbal (86.8%) and physical violence (57.5%) being the most common types. WPV incidents were more frequent on weekdays (26.4%) and during morning shifts (34%), while 81.1% of the nurses worked in shifts and had direct physical contact with patients (83.0%). The majority (92.5%) were aware of standardised WPV reporting procedures and 89.7% confirmed the presence of such procedures in hospitals. WPV was more prevalent among nurses in inpatient wards (P = 0.047).

Conclusion

WPV against nurses in Omani psychiatric hospitals is alarmingly high. Future studies should investigate contributing factors among healthcare providers and emphasise violence prevention by providing staff nurses with effective training to handle violent incidents involving psychiatric patients.

Paediatric nurses' burnout, quality of life and perceived patient adverse events during the COVID-19 pandemic: Testing an integrated model using structural equation modelling

PURPOSE

A model was hypothesised by integrating two theoretical models: the compassion satisfaction-compassion fatigue and empowerment models. This study aimed to assess the extent to which this integrated model can explain the relationships between paediatric nurses' burnout quality of life, perceived patient safety and work-related variables during the COVID-19 pandemic.

BACKGROUND

Nurses' burnout is negatively associated with quality of life (QOL) and positively with patient safety. Several theoretical models were introduced to explain burnout determinants and outcomes such as Golembiewski, Munzenrider and Stevenson model, Leiter and Maslach's process model, and Lee and Ashforth's model. However, few models described burnout in relation to QOL or patient safety.

METHODS

A sample of 225 paediatric nurses responded to questionnaires about burnout, QOL, adverse events and work-related variables. Compassion satisfaction - compassion fatigue and empowerment models were integrated into a single model and tested using structural equation modelling analysis. This study was prepared and is reported according to the STROBE checklist.

RESULTS

The final model explained 65% of the variance of burnout and 37% of the variance of QOL. The work-related variables (co-workers' support, job satisfaction, satisfaction with the monthly salary, participation in continuous education and exposure to violence) are predicting paediatric nurses' burnout and quality of life.

CONCLUSION

The Compassion satisfaction - compassion fatigue -Empowerment integrated model allows for assessing the different paths in the relationship between work-related variables and burnout.

RELEVANCE TO CLINICAL PRACTICE

These results might be essential for nursing managers to develop strategies that improve nurses' work environment and minimise their burnout during COVID-19 pandemic. These strategies should focus on enhancing co-workers' support, job satisfaction and participation in continuous education. Furthermore, paediatric nurses should be protected from any violence.

Utilization and effects of security technologies in mental health: A scoping review

Violence in healthcare is an urgent and increasing issue. Mental health settings are particularly affected, with severe negative impacts on staff, patients, and organizations. Security technologies could help maintain and improve safety in this field. However, knowledge of their utilization and effectiveness in mental health is lacking. A scoping review was conducted using the methodology recommended by the Joanna Briggs Institute to map research on the utilization and effects of security technologies in mental health, identify how research is currently performed, and highlight gaps in the existing knowledge. Literature search for peer-reviewed publications was performed on PubMed, CINAHL, PsycInfo, Embase, and Scopus. Following the screening process and the eligibility criteria, 22 articles were included in this review. The publication range was 2002-2020, many studies were surveys, and European countries were the most investigated, especially the United Kingdom. Overall, the use of 10 different technologies was reported 46 times. The most represented category was alarms, followed by video cameras, other technologies (such as wearable sensors), and metal detectors. More than half of the included papers reported positive effects of these measures on safety. This review indicates that several security technologies are available in mental health settings, with encouraging positive safety outcomes for both patients and healthcare professionals, especially nurses. However, research on the topic is still emerging, with a limited number of sources and a few high-quality designed studies. Therefore, future research should focus on producing evidence on the availability and effectiveness of these measures in mental health settings across countries.

Psychological resilience and work engagement of Chinese nurses: a chain mediating model of career identity and quality of work life

Aim

To investigate how nurses' psychological resilience affects their work engagement and the resulting pathways, namely, the intermediary effect of career identity and quality of work life.

Background

Psychological resilience is the ability to adapt to new circumstances and overcome difficulties. Work engagement is a positive, perfect emotional and cognitive state in the work process, which has a positive effect on nurses' physical and mental health and career development. The importance of psychological resilience in nursing is growing in popularity. However, few studies have explored the relationship between psychological resilience and nurses' work engagement.

Design

This is a cross-sectional study.

Methods

From March to April 2023, 356 nurses in the First Affiliated Hospital of Jinzhou Medical University in China received valid questionnaires. The study was surveyed using the Connor-Davidson, Resilience Scale, the Nursing Career Identity Scale, the Work-Related Quality of Life Scale, and the 15-item Utrecht Work Engagement Scale. Process version 3.5 plug-in SPSS 25 was used to test the mediating effect.

Results

(1) Psychological resilience was significantly and positively correlated with career identity, quality of work life, and work engagement (r = 0.702-0.803, p < 0.001). (2) Career identity and quality of work life partially mediated the relationship between psychological resilience and work engagement, with effect sizes of 0.2382 and 0.0958, respectively. (3) There was a chain mediation model between psychological resilience and work engagement that had a value of 0.1219.

Conclusion

Career identity and quality of work life played a chain-mediating role between psychological resilience and work engagement. Thus, in order to enhance the work engagement of clinical nurses, it is necessary for nursing managers to take measures to enhance not only psychological resilience but also their career identity and the quality of work life.

Compassion fatigue prevalence and risk factors among Saudi psychiatric nurses: A cross-sectional study

In recent times, compassion fatigue is increasingly being recognized as a damaging outcome associated with the stress experienced by psychiatric nurses. In addition to affecting their job performance work-related stress undermines nurses' physical and emotional well-being. However, there is a lack of research on compassion fatigue that specifically focuses on psychiatric nurses working in Saudi Arabia. This cross-sectional study investigated the prevalence and factors associated with compassion fatigue among Saudi psychiatric nurses. The study participants were asked to complete a demographic questionnaire and the Arabic form of the Professional Quality of Life Scale. Statistical analyses, including one-way ANOVA, t-tests, the Levene test, and multiple linear regression, were employed to assess variables related to compassion fatigue. The survey spanned 158 psychiatric nurses from the Mental Health Complex located in Riyadh City. The mean scores for compassion satisfaction, burnout, and secondary traumatic stress were 39.72 ± 6.881, 24.29 ± 5.386, and 26.94 ± 6.973, respectively. The analysis revealed that variables such as age range (36-55 years) and an associated degree or lower explained 5.2% of the variance in compassion satisfaction. Age range (18-25 years), exercise frequency, and years of nursing experience collectively accounted for 8.4% of the variables contributing to burnout. The age range (25 to 35 years) and working night shifts also explained 5% of the variance in secondary traumatic stress. The findings indicated that compassion satisfaction, burnout, and secondary traumatic stress among the population of psychiatric nurses working in Saudi Arabia were at a moderate level. A higher frequency of healthy lifestyle practices, such as regular exercise, and being in an older age range, were positively associated with compassion satisfaction and negatively associated with burnout and secondary traumatic stress.

Experience of verbal violence among Chinese nursing students in clinical practice: a qualitative study

BACKGROUND

Workplace violence is prevalent in the nursing profession, and as a relatively junior link of the professional hierarchy, nursing students are not immune to it. Among these, verbal violence may have more serious consequences for the victims than physical violence, but the literature on verbal violence among nursing students in Chinese clinical settings is limited.

AIMS

To explore the verbal violence experience among Chinese nursing students in clinical practice, and the strategies used by nursing students to cope with violence.

DESIGN

A descriptive qualitative study.

METHODS

From January 2022 to June 2022, semi-structured interviews were conducted with 21 nursing students in clinical practice by purposive snowball sampling. Nvivo12 software and inductive content analysis were used for data analysis. This paper followed the COREQ (Consolidated criteria for Reporting Qualitative Research) guidance.

RESULTS

Through data analysis, three themes were defined:(1) Multiform verbal violence; (2) Hurting and impacting and (3) Struggling or Coping. The findings indicated that nursing students were subjected to multiple forms of verbal violence in clinical practice, not only from patients and caregivers, but also from peers such as clinical tutors and doctors, which not only harmed students' personal health and well-being, but may also contribute to the nursing industry's future loss of human resources. Seeking emotional support from others and forcing themselves to grow up were the most commonly used coping strategies.

CONCLUSION

Nursing educators and nursing managers need to pay attention to verbal violence in the clinical environment, and actively develop the ability of nursing students to deal with uncivilized behavior. Establishing relevant courses and training such as communication, resilience, and violence prevention, establishing a stricter clinical mentor appointment system, and teaching assessment system may be strategies to help nursing students better perform clinical practice.

Systemic relations among the variables involved in occupational accidents of the nursing team in a psychiatric hospital

BACKGROUND

The occupational activities carried out in hospital environments pose occupational risks to professionals. In psychiatric hospitals, due to the characteristics of the patients treated, professionals are also subjected to other risks, such as physical aggression.

OBJECTIVE

This research aimed to identify the systemic context, highlighting the cause-and-effect relationships that culminate in occupational accidents that occurred with the nursing staff in a psychiatric hospital in Brazil.

METHODS

The current study is an applied research and was divided into three stages. First, the collection of data related to the case study was made and accidents were analyzed and occupational hazards were identified. In the second stage, from the collected information, occupational safety indicators were defined. Lastly, in the third stage, the qualitative aspect of System Dynamics was applied to perform the systemic analysis and to identify how the different variables were related.

RESULTS

The results showed that physical aggression was the main cause of accidents. Regarding safety indicators, while both the level of use of Personal Protective Equipment (PPE) by professionals and the high level of PPE protection were positive aspects, the level of training of professionals to use PPE was a negative aspect. The Causal Link Diagram (CLD) showed that the perception of risk influenced the level of use of PPE and those organizational measures influenced the accident rate.

CONCLUSION

In conclusion, the systemic analysis of the system dynamics can optimize the diagnostic process of occupational accidents in psychiatric hospitals, and especially help to identify the cause and effect among the variables involved.

Experiences of Sexual Harassment by Patients among Nurses at the Mental Hospital of West Java Province: A Qualitative Study

Sexual harassment is behavior related to forced sex without the consent of the victim. Incidents of sexual harassment on nurses can be in the form of physical behavior and verbal behavior. The factor of power relations between men and women and the patriarchal culture in Indonesia are the causes of the sexual harassment of mental health nurses, so many incidents of the sexual harassment of women occur. The forms of sexual harassment that occur include kissing, hugging from behind, and verbal abuse related to sex. The purpose of this study was to explore the experience of sexual harassment of psychiatric nurses at the Mental Hospital of West Java Province. This study implemented a qualitative descriptive approach using the NVIVO 12 software application. The sample in this study was 40 psychiatric nurses at the Mental Hospital of West Java Province. The sampling technique in this study was focus group discussions with semi-structured and in-depth interviews. The data analysis in this study used a thematic analysis. This study shows that sexual harassment behavior is carried out by patients in physical and verbal forms. Sexual harassment is mostly carried out by male patients towards female nurses. Meanwhile, sexual harassment took the form of hugging from behind, kissing, naked patients in front of nurses, and disturbing nurses with verbal abuse related to sex. Nurses feel disturbed, afraid, anxious, and shocked by the incidents of sexual harassment committed by patients. Sexual harassment by patients towards nurses causes psychological problems for nurses and causes nurses to want to leave their jobs. Gender adjustment between nurses and patients is a preventive effort to prevent the sexual harassment of nurses. Sexual harassment by patients causes a decrease in the quality of work of nurses in providing nursing care, creating a work environment that is less safe and comfortable.

The factors that affect violence against nurses in emergency departments

Background

Violence against nurses within healthcare setting is a serious issue of concern within the global healthcare sector. A considerably large percentage of nurses, 30%, in particular, have experienced or witnessed cases of violence in the workplace.

Objective

To conduct a scoping review on the factors influencing violence against nurses in emergency departments.

Design

Literature review.

Settings

The SLR was performed in various academic databases namely SpringerLink, Google Scholar, Science Direct, ERIC, and Academic Search Elite.

Participants

A total of N = 10 articles were included in the study.

Methods

A scoping/mapping review (SR) was performed in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis recommendations.

Results

The literature review consisted of 10 articles published in the English language within the last 10 yrs (between 2013 and 2022). The studies reviewed utilized various designs. Cross-sectional were 7, Case study was 1, while Qualitative retrospective descriptive studies were 2. The total sample size of all the studies recruited was N = 38, 031 participants. The reviewed literature revealed various factors that contribute to violence against nurses namely the level of a nurse's experience, low quality of service, unmet expectations, patient or colleague disruptive behaviors, delay in care or waiting time, mistakes in care/errors, degree of pain of the patient, death of a patient, class in roles among colleagues, and high workload and overcrowding.

Conclusions

Violence against nurses is a major problem in the healthcare sector due to its adverse consequences; however, it remains persistent. This study reveals that the main factors of violence against nurses are fewer years of experience as a nurse, level of pain of patients, quality of healthcare service, waiting time, unmet patient expectation, and disagreements among nurses in the workplace.

Criminal Litigation of Workplace Violence in Chinese Hospitals and Legal Effort to Deescalate Crimes

Workplace violence in Chinese hospitals has increasingly attracted world attention. This study aimed to describe the characteristics of criminal litigation cases on workplace violence in Chinese hospitals at a national level and explore the influencing factors associated with the severity of workplace violence. A retrospective study was designed to analyse 507 criminal litigation cases on workplace violence in Chinese hospitals, with data extracted from the Chinese court website. The multiple ordered logistic regression model was used to analyse the impact of the potential influencing factors on the severity of workplace violence. The crimes as workplace violence in the hospitals were concentrated in East and Central China (53.9%). The most common clinical specialty involved in workplace violence was Gynecology and Obstetrics (27.8%). The first 4 types of crimes as workplace violence in the hospitals were the crime as picking quarrels and provoking trouble (26.0%), the crime as disrupting public service (20.7%), the crime as intentional injury (19.1%), and the crime as gathering people to disturb public order (15.2%). The severity of crimes as workplace violence in the hospitals was significantly associated with location (OR = 2.569, P = .013), victim type (policemen or security guards) (OR = 0.495, P = .005), more than 3 victims (OR = 2.252, P = .035), perpetrators (patients' family member) (OR = 0.491, P = .045), previous arrest (OR = 2.113, P = .024), premeditation (OR = 2.234, P = .004), and psychiatric disorders (OR = 1.911, P = .019). The number of the crimes as workplace violence in Chinese hospitals was slightly declining from 2014 to 2020. The severity of crimes as workplace violence in the hospitals was significantly associated with secondary hospitals, more than 3 victims, victim type (policemen or security guards), perpetrators (patients' family member), previous arrest, premeditation, and psychiatric disorders.

Incidents related to safety in mental health facilities in Kenya

BACKGROUND

Both patients and health care providers working in mental health facilities witness high rates of incidents that have the potential to jeopardize their safety. Despite this, there are few studies that have documented the kind of incidents that are experienced, or explored the potential contributors to these incidents, and solutions that would result in better safety. This study explored various types of safety related incidents occurring in mental facilities in Kenya, perceived contributing factors, and recommendations for improve.

METHODS

This qualitative descriptive study was carried out between December 2019 - February 2020. It included 28 mental health staff across 14 mental health unit spread across the country.

RESULTS

All the participants reported having personally experienced an incident that threatened their safety or that of the patients. Most of the respondents (24/26. 91.67%) admitted to have experienced verbal aggression while 54.17%, (n = 24) had experienced physical assault. Participating health care workers attributed the safety incidents to poor infrastructure, limited human resources, and inadequate medication to calm down agitated patients. Suggested solutions to improve patient safety included; improving surveillance systems, hiring more specialized healthcare workers, and provision of adequate supplies such as short-acting injectable psychotropic.

CONCLUSION

Incidents that threaten patient and staff safety are common in mental health facilities in Kenya. There is need to strengthen staff capacity and reporting mechanisms, as well as invest in infrastructural improvements, to safeguard patient and staff safety in mental health facilities in Kenya.

Gender differences in the experience of burnout and its correlates among Chinese psychiatric nurses during the COVID-19 pandemic: A large-sample nationwide survey

Psychiatric nurses often experience burnout and other mental health symptoms. However, few studies have examined these phenomena and gender-specific associated factors during the COVID-19 pandemic. We surveyed a national sample of psychiatric nurses (N = 8971) from 41 tertiary psychiatric hospitals in China as part of a large national survey conducted during the pandemic. The Maslach Burnout Inventory-Human Service Survey was used to assess burnout and the Depression, Anxiety, and Stress Scale-21 was used to assess mental health symptoms. Binary logistic regression analyses were used to explore factors associated with burnout in the entire sample and separately by gender. The overall prevalence of burnout was 27.27%, with the rate in male psychiatric nurses (32.24%) being significantly higher than that in female psychiatric nurses (25.97%). Many key demographic factors (such as the male gender and marital status), work-related variables (such as a mid-level professional title, having an administrative position, longer working hours, more monthly night shifts, and the perceived negative impact of the COVID-19 pandemic on medical work) were significantly associated with burnout in the whole sample. Moreover, burnout was associated with depression, anxiety, and stress symptoms in the whole sample. Gender-specific factors associated with burnout were also identified: burnout was associated with night shifts in male psychiatric nurses, whereas it was associated with single or married marital status, a mid-level professional title, and having an administrative position among female psychiatric nurses. The high rates of burnout and mental health symptoms in psychiatric nurses need attention from hospital administrators. While mental health symptoms, longer working hours, and the perceived impact of COVID-19 are associated with burnout in both genders, gender-specific factors also warrant special attention when developing gender-specific interventions.

(Un)Broken: Lateral violence among hospital nurses, user violence, burnout, and general health: A structural equation modeling analysis

Introduction

Workplace violence is a social problem yet to be solved. Although it is present in virtually all work environments, its prevalence in healthcare settings stands out, being perceived as something inherent to the job. Most studies in this context have focused on user violence against professionals. However, it has been observed that violence among colleagues in these types of jobs is a risk factor for the health of workers and has rarely been studied as a whole. Among the main consequences of exposure to violence reported in the literature, burnout syndrome, depression, anxiety, or somatic problems have been among the most studied. On the one hand, some authors claim that being exposed to workplace violence can increase the associated physical and psychological pathology and lead to a picture congruent with burnout. On the other hand, it has been hypothesized that violence is associated with burnout, which can trigger physical and psychological symptoms. Taking into account this background, the aim of this study is to explore workplace violence in health personnel, symptomatology, and burnout syndrome through mediation models that allow us to know the interrelationships between the variables.

Methods

A cross-sectional design with a double descriptive-associative strategy was used. The sample was composed of 950 nursing professionals from public hospitals. The scales of physical and non-physical violence from users to professionals HABS-U, personal, social, and occupational violence among co-workers using the Health Aggressive Behavior Scale - Co-workers and Superiors (HABS-CS) scale, the burnout scale Maslach Burnout Inventory - General Survey (MBI-GS) which evaluates professional exhaustion, efficacy and cynicism, and the factors referring to depression, anxiety, somatization, and dysfunction of the GHQ-28 scale were applied. In order to calculate the models, workplace violence was used as a predictor of symptomatology, using the burnout variables as mediators. Regression coefficients with and without mediation model, direct and standardized estimates were obtained. For statistical power, Bootstrap analysis was used to calculate direct mediation effects.

Results

After controlling the mediation effects of burnout and cynicism, physical and non-physical user violence toward healthcare personnel were significant predictors of the GHQ-28 scores. These same results were obtained when assessing the relationship between social, occupational, and personal violence among co-workers and GHQ-28 scores.

Conclusion

Our results contribute to increase the evidence about the effects of violence on the health of professionals and to advance in the characterization of the possible consequent psychological damage. Regardless of the type of violence experienced, exposure to violence can lead to anxious, depressive or somatization symptoms, among others. Violence is also a predictor of burnout syndrome, which in turn accentuates the rest of the consequences studied. Despite the limitations of the proposed model, these results serve to highlight the complexity of the situation experienced by healthcare professionals. Moreover, it serves as a basis for proposing intervention/prevention programs to raise awareness and protect professionals from these risks. To this end, self-care tools should be proposed with which professionals take care of their own health through the management of violent situations and/or the improvement of occupational health.

Dental Students' Experience, Impact, and Response to Patient Aggression in Saudi Arabia: A Nationwide Study

Patient aggression and violence comprise a wide range of behaviors and actions that may include verbal aggression and physical aggression. The aim of this study is to report dental students' experience with, impact from, and response to patient aggression in Saudi Arabia. A cross-sectional analytical study was conducted among dental students from various health universities representing each region of Saudi Arabia. Data were collected using a self-administered, structured and validated questionnaire. A total of 375 participants responded to the questionnaire and 121 (32.3%) study participants reported experiencing patient aggression. Out of those, 91 (75.21%) experienced patients displaying anger or raising their voice toward them, 37 (30.58%) reported being insulted by a patient, 22 (18.18%) reported being threatened, 12 (6.2%) had experienced sexual harassment, and 65 (50.41%) had experienced verbal harassment. Furthermore, 91 (75.21%) participants reported being abandoned by patients because they were students. A total of 55 (45.45%) participants stated that aggressive patient behavior had an impact on their clinical performance, and 44 (36.36%) considered themselves stressed out. A total of 24 (19.83%) participants took time off due to incidents and 22 (18.18%) thought about quitting dentistry. Prevalence of patient aggression was significant among dental students in Saudi Arabia. These episodes of patient aggression negatively impacted students' academic performance and wellbeing, necessitating urgent attention. Educational institutions should conduct periodic workshops for students in order to address these issues. Policymakers should develop better policies in order to reduce violence and aggression against health care providers.

Predictors of events of violence or aggression against nurses in the workplace: A scoping review

AIM

To identify predictors and consequences of violence or aggression events against nurses and nursing students in different work contexts.

BACKGROUND

Workplace violence against nurses and nursing students is a very common and widespread phenomenon. Actions to manage or prevent violent events could be implemented knowing the risk factors and consequences. However, there is a lack of systematic reviews that summarize knowledge on the predictors and consequences of workplace violence.

EVALUATION

A scoping review was conducted using electronic databases including APA PsycInfo, CINAHL, Cochrane, Ovid Medline, PubMed and Scopus.

KEY ISSUES

After full text analysis, 87 papers were included in the current scoping review. Risk factors of horizontal violence were grouped into 'personal' and 'Environmental and organizational', and for violence perpetrated by patients into 'personal', 'Environmental and organizational' and 'Characteristics of the perpetrators'.

CONCLUSIONS

The results of this scoping review uncover problems that often remain unaddressed, especially where these episodes are very frequent. Workplace violence prevention and management programmes are essential to counter it.

IMPLICATIONS FOR NURSING MANAGEMENT

The predictors and the consequents identified constitute the body of knowledge necessary for nurse managers to develop and implement policy and system actions to effectively manage or prevent violent events.

Prevalence and Risk Factors of Workplace Violence Against Emergency Department Nurses in China

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.

The impact of the COVID-19 pandemic on the prevalence and risk factors of workplace violence among healthcare workers in China

Background

The pandemic of COVID-19 has significantly increased the burden on healthcare workers and potentially affect their risk of workplace violence (WPV). This study aimed to explore the prevalence and risk factors of WPV among healthcare workers during the peaking and the remission of the COVID-19 pandemic in China.

Methods

Using the snowball method, a repeated online questionnaire survey was conducted among Chinese healthcare workers from March 27th to April 26th in 2020 and 2021, respectively. Data included healthcare workers' socio-demographic and occupational characteristics, psychological status, and workplace violence.

Results

A total of 3006 samples in 2020 and 3465 samples in 2021 were analyzed. In 2020, the prevalence of WPV and witnessing colleagues suffering from WPV among healthcare workers were 64.2% and 79.7% respectively. Compared with 2020, the prevalence decreased by 11.0% and 14.4% in 2021, respectively. Logistic regression showed that WPV in 2020 was influenced by males, long working experience, working in the psychiatric department, direct contact with COVID-19 patients, self-discovery of medical errors, moral injury, depression, and anxiety (minimum OR = 1.22, maximum OR = 2.82). While risk factors of WPV in 2021 included males, working in psychiatric departments, self-discovery of medical errors, moral injury, depression, and anxiety (minimum OR = 1.33, maximum OR = 3.32); and protective factors were holding a master's degree (OR = 0.78) and working in other departments (OR = 0.54).

Conclusion

This study retains the common effects of WPV among healthcare workers, though after the baptism of the COVID-19 pandemic, the prevalence of WPV among healthcare workers decreased; however, part of the influencing factors changed. In addition, COVID-19 has seriously affected the mental health of healthcare workers, and the effect of mental health problems on WPV should also attract more attention.

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

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

Workplace Violence, Workforce Stability, and Well-being in China's Psychiatric Hospitals

INTRODUCTION

Workplace violence against psychiatric professionals is a growing problem, yet nationally representative data in China are lacking. This study examines workplace violence against psychiatrists and psychiatric nurses in China as well as its association with workforce stability and well-being .

METHODS

Data came from a 2019 national survey of 14,264 participants (including 4,520 psychiatrists and 9,744 nurses) from 41 psychiatric hospitals across China. The occurrence of physical and verbal assaults among psychiatrists and psychiatric nurses was reported. Logistic regression models were constructed to examine the participants' characteristics associated with encountering workplace violence and the association of encountering violence with self-reported quality of life, health status, turnover intention, and career satisfaction. Analyses were performed during 2020.

RESULTS

In 2019, among 14,264 psychiatrists and psychiatric nurses in China, 81% reported encountering workplace violence during the past year. Psychiatrists were 0.68 (95% CI=0.55, 0.83) times less likely to report an encounter of violence than nurses. Male and younger nurses were 2.20 (95% CI=1.72, 2.81) and 1.21 (95% CI=1.01, 1.45) times more likely to report violence. Psychiatrists who had a higher educational degree or a higher professional rank were more vulnerable to violence. Encountering violence was significantly associated with poor quality of life, less satisfaction with health status, greater intention to leave the current job, and career dissatisfaction.

CONCLUSIONS

Workplace violence against psychiatrists and psychiatric nurses are common in China, indicating that China's psychiatric professionals are facing a significant threat to occupational safety. To maintain psychiatric workforce stability, actions are needed to reduce the prevalence of workplace violence at the system, institutional, and individual levels.

Grit and Meaning in Life of Chinese Nurses: The Chain Mediating Effect of Social Support and Hope

Grit is defined as perseverance and passion for long-term goals, and it may affect the stability of the nursing workforce and the physical and mental health of nurses continuously. Meaning in life has received considerable attention from scholars, which is an important component in positive psychology. This study aimed to delve into the relationship between grit and the meaning in life of Chinese nurses. Additionally, we also sought to prove the chain mediating effect of social support and hope on this relationship. An online questionnaire survey was used to collect data from 704 Chinese nurses using the self-made demographic questionnaire with Short Grit Scale (Grit-S), the Perceived Social Support Scale (PSSS), Adult Dispositional Hope Scale (ADHS), and Meaning in Life Questionnaire (MLQ). Moreover, Process version 3.3 plug-in SPSS 25 was used to test the mediation effect between variables. The results showed a strong positive relationship between grit and meaning in life and verified the mediating effect of social support and hope on grit and meaning in life. The results also confirmed the chain mediating model between grit, social support, hope, and meaning in life.

Mediating Effect of Work Stress on the Associations Between Psychological Job Demands, Social Approval, and Workplace Violence Among Health Care Workers in Sichuan Province of China

Objective: The aim of this study was to investigate the prevalence of workplace violence against health care workers, to explore the combined association of work stress, psychological job demands, and social approval with workplace violence and their respective mechanisms among health care workers. Methods: Using data from the Chinese Sixth National Health Service Survey (NHSS) in 2018 conducted among 1,371 health care workers in Sichuan province of China. A self-administered structured questionnaire was used to collect data on health care workers' socio-demographic and work-related characteristics, work stress, psychological job demands, social approval, and workplace violence. We used structural equation modeling (SEM) to test the hypothesized relationship among the variables. Results: The results showed that a total of 77.0% health care workers were exposed to workplace violence. Work stress was directly related to workplace violence (β = 2.167, 95%CI: 1.707, 2.627), while psychological job demands and social approval had indirect associations with workplace violence via work stress [β = 0.427, 95%CI: 0.297, 0.557; β = -0.787, 95%CI: (-0.941)-(-0.633)]. Both psychological job demands (β = 0.197, 95%CI: 0.139, 0.255) and social approval [β = -0.346, 95%CI: (-0.399)-(-0.294)] had direct associations with work stress, while social approval had direct association with psychological job demands [β = -0.085, 95%CI: (-0.136)-(-0.034)]. Psychological job demands mediated the relationship between social approval and work stress. Conclusion: Overall, decreasing workplace violence among health care workers requires to promote interventions to reduce work stress and psychological job demands by improving social approval.

Aggression on the psychiatric ward: Prevalence and risk factors. A systematic review of the literature

INTRODUCTION

On psychiatric wards, aggressive behaviour displayed by patients is common and problematic. Understanding factors associated with the development of aggression offers possibilities for prevention and targeted interventions. This review discusses factors that contribute to the development of aggression on psychiatric wards.

METHOD

In Pubmed and Embase, a search was performed aimed at: prevalence data, ward characteristics, patient and staff factors that are associated with aggressive behaviour and from this search 146 studies were included.

RESULTS

The prevalence of aggressive behaviour on psychiatric wards varied (8-76%). Explanatory factors of aggressive behaviour were subdivided into patient, staff and ward factors. Patient risk factors were diagnosis of psychotic disorder or bipolar disorder, substance abuse, a history of aggression, younger age. Staff risk factors included male gender, unqualified or temporary staff, job strain, dissatisfaction with the job or management, burn-out and quality of the interaction between patients and staff. Staff protective factors were a good functioning team, good leadership and being involved in treatment decisions. Significant ward risk factors were a higher bed occupancy, busy places on the ward, walking rounds, an unsafe environment, a restrictive environment, lack of structure in the day, smoking and lack of privacy.

CONCLUSION

Despite a lack of prospective quantitative data, results did show that aggression arises from a combination of patient factors, staff factors and ward factors. Patient factors were studied most often, however, besides treatment, offering the least possibilities in prevention of aggression development. Future studies should focus more on the earlier stages of aggression such as agitation and on factors that are better suited for preventing aggression such as ward and staff factors. Management and clinicians could adapt staffing and ward in line with these results.

Prevalence and determinants of workplace violence among nurses in the South-East Asian and Western Pacific Regions: a systematic review and meta-analysis

BACKGROUND

Workplace violence (WPV) includes verbal abuse, physical violence, bullying or mobbing, assault and sexual harassment. The area has been well researched in the developed and high-income countries among nurses and healthcare professionals, but in the case of the low and upper-middle-income countries, there remains a paucity of comprehensive data on the prevalence of WPV and its contributing factors.

AIMS

To estimate the prevalence and determinants of WPV among nurses working in the South-East Asian Region and Western Pacific Regions.

DESIGN

Systematic review and Meta-analysis.

METHOD

A comprehensive search was done to retrieve articles based on a PRISMA compliant protocol registered in PROSPERO: CRD 42020223605. Study selection, quality assessment and data abstraction were independently done by the team members and discrepancies addressed through mutual consensus. Random-effect meta-analysis, I2 statistics and subgroup analysis were done.

RESULTS

The review included 41 studies conducted among 42,222 nurses from 13 countries. The pooled prevalence of WPV, verbal abuse, physical violence, threatening behaviour, physical assault, sexual harassment and bullying/mobbing were 58% (CI 51%-64%), 64% (CI 59%-70%), 23% (CI 14%-34%), 30(CI-11%-52%), 21% (CI 8%-38%), 12% (CI 7%-17%) and 25% (17%-33%), respectively. The various determinants of WPV included attributes related to the patient, nurses and organisation. Moreover, the impact of WPV included physical, psychological repercussions on nurses and the various measures used to manage it.

CONCLUSION

Nurses encounter a high level of WPV especially verbal abuse in their workplace settings. Nursing councils and professional nursing organisations should put in their effort towards the formulation and implementation of occupational safety legislation in their respective countries through appropriate political lobbying.

RELEVANCE TO CLINICAL PRACTICE

Our review highlights the emerging need to focus on the prevention of WPV among nurses working in lower, middle and upper-middle-income countries. Legislation changes and organisational commitment are vital for ensuring effective policies to combat WPV.

It Takes Two to Tango: Public Attitudes Toward Prevention of Workplace Violence Against Health Care Staff: A Mixed-Methods Study

Workplace violence (WPV) directed toward health care staff by patients and their relatives has become one of the major problems faced by health care systems around the world. Incidences of WPV have increased over the past decade, crossing borders and cultures and creating a worrisome global phenomenon. To date, most of the research has examined health care workers' perceptions of strategies that might prevent violence. Although the public, as prospective patients, has a central role in this state of affairs, little is known about public attitudes to prevention of violence in health care settings. In light of this, the current mixed-methods study aimed to explore public attitudes toward appropriate preventive and punitive measures that should be employed to diminish the occurrence of WPV incidents in health care settings. Five hundred sixty Jewish Israeli individuals participated in the study. Quantitative findings indicate the public's overall agreement and positive attitudes toward preventive and punitive measures aimed at reducing WPV against health care staff. Qualitative findings revealed two main themes: "focusing on the staff" by improving their work conditions, training them to deal with violence, and providing a sense of security, as well as "focusing on the public" by teaching tolerance, raising awareness of zero tolerance to violence, and punitive measures. The Israeli public believes that to deal with the problem of violence in the health care system, it is necessary to act simultaneously on two levels: health staff and the health care system, and the general public. In view of these findings, we recommend that policy makers address this issue by adopting preventive measures, such as increasing the number of health care personnel, workshops for the staff on dealing with violence, campaigns against violence in health care settings, and enforcing appropriate punitive measures against attackers.

The Prevalence of Burnout and its Associations with Demographic Correlates and Quality of Life among Psychiatric Nurses in China

This study examined the prevalence of burnout and its association with quality of life (QOL) among psychiatric nurses in China.Ten psychiatric hospitals were included. Burnout and QOL were measured using standardized instruments. Altogether, 1449 nurses completed the assessment. The mean scores of emotional exhaustion (EE), depersonalization (DP) and personal accomplishment (PA) were 11.87 (SD = 6.72), 6.98 (SD = 5.71) and 22.06 (SD = 8.67), respectively. Of the participants, 59.8% (95% CI: 57-62%) experienced burnout; with 23.3% (95% CI: 21-25%) in EE, 14.6% (95% CI: 13-16%) in DP and 45.1% (95% CI: 43-48%) in PA. Psychiatric nurses who reported burnout had lower QOL in social (F _{(1, 1448)} = 86.20, P < 0.001), physical (F _{(1, 1448)} = 170.46, P < 0.001), psychological (F _{(1, 1448)} = 205.63, P < 0.001), and environmental (F _{(1, 1448)} = 120.24, P < 0.001) domains. Multiple logistic regression analysis revealed that alcohol users (P = 0.04; OR = 1.29, 95%CI: 1.01-1.64 in model 1 and P = 0.03; OR = 1.32, 95%CI: 1.04-1.69 in model 2) were significantly more susceptible to burnout, while senior nurses (P = 0.007; OR = 0.70, 95%CI: 0.53-0.91) and nurses with longer work experience (P = 0.02; OR = 0.70, 95%CI: 0.53-0.91) were less likely to develop burnout. Burnout is common in psychiatric nurses in China. In light of its negative impact on health and QOL, there is an urgent need for regular screening as well as effective preventive measures and interventions to reduce burnout within this at-risk occupational group.

Analysis of Career Stage, Gender, and Personality and Workplace Violence in a 20-Year Nationwide Cohort of Physicians in Norway

IMPORTANCE

Workplace violence (WPV) is a worldwide problem in health services. Several studies have pointed to organizational factors, such as working in psychiatry and work stress. However, there is a lack of long-term longitudinal cohort studies with respect to trends during the career and individual factors among physicians.

OBJECTIVE

To investigate WPV trends during Norwegian physicians' careers and assess individual and work-related factors associated with WPV in a long-term longitudinal study.

DESIGN, SETTING, AND PARTICIPANTS

This cohort study involved 2 nationwide medical student cohorts who graduated 6 years apart and were surveyed at graduation (T1: 1993-1994 and 1999) and 4 years later (T2), 10 years later (T3), 15 years later (T4), and 20 years after graduation (T5). Generalized estimated equations were used. Statistical analysis was performed from January to September 2020.

EXPOSURES

Medical career during 20 years in Norway.

MAIN OUTCOMES AND MEASURES

WPV was measured as threats or acts of violence from a patient or visitor experienced at least twice, at each of the stages after leaving medical school. Individual factors were obtained at T1 and work-related factors at T2 through T5. We analyzed WPV by repeated measures.

RESULTS

At T1, a total of 893 participants (with a mean [SD] age of 28 (2.83) years; 499 [56%] women) responded to the questionnaire. The prevalence of multiple threats of violence was 20.3% (156 of 769) at T2, 17.1% (118 of 691) at T3, 11.2% (66 of 588) at T4, and 8.6% (46 of 536) at T5; and the prevalence of multiple acts of violence was 4.3% (33 of 763) at T2, 5.2% (36 of 687) at T3, 3.1% (18 of 584) at T4, and 2.2% (12 of 532) at T5. There was a decline from T2 to T5 of both multiple threats (β = -1.06; 95% CI, -1.31 to -0.09; P < .001) and acts of violence (β = -1.13; 95% CI, -1.73 to -0.53; P < .001). In adjusted analysis, factors associated with multiple threats of violence were male gender (odds ratio [OR], 2.76; 95% CI, 1.73 to 4.40; P < .001), vulnerability trait (neuroticism) (OR, 0.90; 95% CI, 0.82 to 0.99; P = .03), young physician cohort (OR, 1.63; 95% CI, 1.04 to 2.58; P = .04), and working in psychiatry (OR, 7.50; 95% CI, 4.42 to 12.71; P < .001). Factors associated with multiple acts of violence in adjusted analysis were male gender (OR, 3.37; 95% CI, 1.45 to 7.84; P = .005), young physician cohort (OR, 6.08; 95% CI, 1.68 to 21.97; P = .006), and working in psychiatry (OR, 12.34; 95% CI, 5.40 to 28.23; P < .001). There were no interactions with gender or cohort in the significant associated factors.

CONCLUSIONS AND RELEVANCE

Higher rates of multiple threats and acts of violence were observed during early medical careers, among male physicians, and in psychiatry. Low levels of the vulnerability trait (neuroticism) were associated with the experience of multiple threats. There was an association between the young physician cohort and WPV. Preventive efforts should include early-career and male physicians, with additional emphasis on personality.

Violence in Psychiatric Settings: Demographic and Clinical Characteristics of Patients Who Were Targets of Aggression

ABSTRACT

Violence is a serious concern in the psychiatric inpatient and emergency setting. Much of the research on victims of inpatient violence has focused on identifying and supporting staff who are at risk of being victimized when working in psychiatric settings. This article presents an analysis of 72 patients who were targeted during incidents of patient-on-patient physical aggression in hospital-based psychiatric settings (both inpatient and emergency) from 2014 to 2018. Results suggest that patients who are at risk of being targeted by another patient while in the hospital tend to be younger, are more likely to be male, and present with manic symptoms and recent cannabis use. These variables have all been identified as risk factors for perpetration of violence by patients with mental illness. This study adds to a literature demonstrating a consistent overlap between individuals with mental illness who are victimized and those who initiate violence.

Does workplace violence, empathy, and communication influence occupational stress among mental health nurses?

Workplace violence is a major cause of occupational stress among mental health nurses, particularly those working in acute care. This study investigated the occurrence of occupational stress among mental health nurses in psychiatric hospitals and explored whether workplace violence, empathy, and communication skills influenced occupational stress levels in this population. A socio-demographic questionnaire and the Chinese Nursing Work Stress Scale, Workplace Violence Scale, Jefferson Scale of Empathy - Health Professions version, and Nurses' Clinic Communication Competence Scale were administered to 539 mental health nurses from three top-grade tertiary research hospitals in the Beijing-Tianjin-Hebei region. The analysis revealed a high level of job stress (3.06 ± 0.69) and a moderate prevalence of workplace violence (6.21 ± 2.94) existed among participants when compared with among other nurses. Meanwhile, participants' empathy (114.78 ± 15.99) and communication (4.31 ± 0.60) abilities were similar to or higher than those of other nursing populations. Mental health nurses with varying years of practice experience distinct levels of job stress. A linear regression analysis revealed that, while practice years (β = 0.104; P < 0.05) and workplace violence (β = 0.264; P < 0.01) aggravated occupational stress levels, empathy (β = -0.147; P < 0.01) facilitated reductions in stress. Results suggest that reducing workplace violence and improving empathy in therapeutic relationships can limit the pervasiveness of occupational stress among mental health nurses. Having both psychological support and organizational support after a violent incident is essential, and the importance of professional education should be stressed.

Depression and its relationship with quality of life in frontline psychiatric clinicians during the COVID-19 pandemic in China: a national survey

This was a national survey that determined the prevalence of depressive symptoms (depression thereafter) and its relationship with quality of life (QOL) in frontline clinicians working in psychiatric hospitals in China during the COVID-19 pandemic. Depression and QOL were assessed using the Patient Health Questionnaire nine items (PHQ-9) and the World Health Organization Quality of Life Questionnaire-brief version (WHOQOL-BREF), respectively. Multivariable logistic regression analyses and analysis of covariance were used. A total of 10,516 frontline clinicians participated in this study, of which, 28.52% (n=2,999) met screening criteria for depression. Compared to those without depression, clinicians with depression had a lower quality of life (F _{(1, 10515)} =2874.66, P<0.001). Higher educational level (OR=1.225, P=0.014), if the number of COVID-19 patients in the hospital catchment area surpassed 500 (OR=1.146, P=0.032), having family/friends/colleagues who were infected (OR=1.695, P<0.001), being a current smoker (OR=1.533, P<0.001), and longer working hours (OR=1.020, P=0.022) were independently associated with higher risk of depression. Living with family members (OR=0.786, P<0.001), and being junior clinicians (OR=0.851, P=0.011) were independently associated with lower odds of depression. The results showed that depression was common in frontline psychiatric clinicians during the COVID-19 pandemic. Timely assessment and effective interventions of depression for frontline clinicians in psychiatric hospitals were warranted.

Workplace Violence Against Chinese Frontline Clinicians During the COVID-19 Pandemic and Its Associations With Demographic and Clinical Characteristics and Quality of Life: A Structural Equation Modeling Investigation

Background: Workplace violence is a major concern for clinicians worldwide. There has been little data on the epidemiology of workplace violence against frontline clinicians during the COVID-19 pandemic. This study examined the pattern of workplace violence and its association with quality of life (QOL) against frontline clinicians during the outbreak of COVID-19 pandemic in China. Methods: A cross-sectional online study was conducted in China between March 15 and March 20, 2020. Frontline clinicians' experience with workplace violence was measured with six standardized questions derived from the Workplace Violence Scale, while anxiety, depressive, and insomnia symptoms, and QOL were measured using the General Anxiety Disorder Questionnaire, the Patient Health Questionnaire, the Insomnia Severity Index, and the World Health Organization Quality of Life Questionnaire, respectively. Univariate analyses, multivariable logistic regression analyses, and structural equation modeling (SEM) were conducted. Results: A total of 15,531 clinicians completed the assessment; 2,878 (18.5, 95% CI = 17.92-19.14%) reported workplace violence during the outbreak of the COVID-19 pandemic (verbal violence: 16.1%; physical violence: 6.9%). According to multivariable models, key correlates of workplace violence were male gender, longer work experience, higher education level, smoking, working in the psychiatry or emergency department, working in tertiary hospitals, being involved in direct care of infected patients, having infected family/ friends/ colleagues, and frequently using social communication programs. Clinicians working in inpatient departments were less likely to report workplace violence compared to those working in outpatient departments. SEM analysis revealed that both violence and emotional disturbances (anxiety, depression, and insomnia) directly affected QOL (standardized direct effect = -0.031, and -0.566, respectively, P < 0.05), while emotional disturbances partly mediated the association between work violence and QOL (standardized indirect effect = -0.184, P < 0.05). Conclusion: Frontline clinicians were vulnerable to workplace violence during the COVID-19 pandemic. Due to the negative impact of workplace violence on quality of care and clinicians' QOL, health authorities and policymakers should take effective measures to reduce workplace violence against clinicians.

Determination of the Society's Perceptions, Experiences, and Intentions to Use Violence Against Health Professionals

Background

Violence against health professionals is an increasing problem in Turkey. This study aims to determine the societal perception of violence, experience of violence, and the intentions to use violence against health professionals.

Methods

This descriptive study sample comprised 484 individuals. Data were collected by using the “Descriptive Information Form” and “Intentions to Use Violence against Health Professionals Scale.”

Results

Of the participants, 8.3% used violence against health professionals. Most of the participants (81.2%) stated that violence was not a solution, and 65.9% believed that health professionals did not deserve violence. Past behavior of the participants was the most influential factor on the intention to use violence (β = .473, p = 0.000).

Conclusions

More than half of the participants believed that health professionals did not deserve violence and violence was not a solution. We found that intention to use violence was affected by past experiences.

Mental Health Problems in Chinese Healthcare Workers Exposed to Workplace Violence During the COVID-19 Outbreak: A Cross-Sectional Study Using Propensity Score Matching Analysis

OBJECTIVE

This study aimed at examining the effect of medical workplace violence (MWV) on the mental health of Chinese healthcare workers during the outbreak of coronavirus disease 2019 (COVID-19).

METHODS

An anonymous online survey was issued to Chinese healthcare workers (N=1063) from 31 provinces and autonomous regions between February 13th and February 20th. Mental health was measured by the Chinese Depression Anxiety Stress Scales-21 (DASS-21). Medical workplace violence was measured using a single item, whether any type of workplace violence was experienced during the COVID-19 outbreak. Propensity score matching was used to assess the impact of MWV on mental health.

RESULTS

Out of 1063, 217 (20.4%) reported experiencing MWV during the COVID-19 outbreak. Before matching, MWV was correlated with elevated mental health problems (b=8.248, p<0.001), after adjusting for other variables. After matching, Chinese healthcare workers who experienced MWV were more likely to suffer from mental health problems than those who did not.

CONCLUSION

MWV exerts a detrimental effect on mental health among Chinese healthcare workers during the COVID-19 outbreak. It is necessary to create a more supportive and safer work environment for healthcare workers at this special context of the COVID-19 outbreak.

Opinions of staff working in workplace-violence-related units on violence against nurses: A qualitative study

The aim of this study was to assess the opinions of staff working in workplace-violence related units on violence against nurses. A qualitative and descriptive design was used. The participants were seven nurses, one biologist, and one social worker who agreed to attend an interview and worked in employee rights unit or occupational health and safety unit. Data were collected from June to December 2017. The interviews were analyzed with content analysis. Four main themes were identified, and the themes were the following: (1) risk factors; (2) reporting of violence; (3) consequences of violence; and (4) prevention and control. In summary, factors related to the patient, the nurse, and the physical structure of the hospital were determined.

Prevalence of sexual harassment toward psychiatric nurses and its association with quality of life in China

OBJECTIVE

This study aimed to examine the prevalence of sexual harassment (SH) toward Chinese psychiatric nurses and its association with quality of life (QOL).

METHODS

A total of 2124 psychiatric nurses were consecutively recruited from 10 psychiatric hospitals distributed across 10 provinces of China; of them, 1,449 were included for analyses. Participants' socio-demographic characteristics, experiences of workplace SH in the past year, and QOL were recorded.

RESULTS

Overall, 21.5% (n = 311) of participants reported SH, with 8.4% (n = 121) reporting once, 7.1% (n = 103) reporting twice and 6.0% (n = 87) reporting three times or more. Psychiatric nurses who experienced SH had lower QOL in physical, psychological, social, and environmental domains. Multiple logistic regression analysis found that nurses with shorter clinical experience were more likely to experience SH.

CONCLUSIONS

Workplace SH toward psychiatric nurses is common in mental health treatment settings in China. Considering its deleterious impact on nurses' well-being and care quality, effective staff training on the management of SH and a zero tolerance policy against SH should be developed for this population.

The Relationship between Workplace Violence and Innovative Work Behavior: The Mediating Roles of Employee Wellbeing

It has been contended that violence is prevalent in the workplace, and there has been increasing research interest into its potential effects. Human interactions at workplaces are apparent. However, the interactions among humans may have positive or negative dimensions. Usually, the positive or negative interactions between workers lead to different outcomes. Sometimes, they lead to a productive working environment; however, in some cases, they lead to toxicity among workers. In this study, we investigate the impact of workplace violence (WV) on innovative work behavior (IWB). Specifically, it examines the impact of the three dimensions of WV, namely, harassment, mobbing, and sabotage. Moreover, employees’ wellbeing mediates the relationship between WV (harassment, mobbing, and sabotage) and IWB. A questionnaire survey approach was used in this study. The target population were the workers of SMEs entrepreneurs located in Guangdong Province (China). The results confirm that, in the direct relationship, WV (harassment, mobbing, and sabotage) has a negative relationship with innovative IWB. Moreover, results also confirm that employee wellbeing is mediated between WV (harassment, mobbing, and sabotage) and IWB. Therefore, the empirical results of this paper identify that workplace violence reduces employees’ innovative work behavior by reducing their subjective and eudemonic wellbeing, which further broadens the perspective of IWB’s motivation analysis. Practical implications for small and medium enterprise organizations have also been discussed in this paper.

Prevalence and factors of compassion fatigue among Chinese psychiatric nurses: A cross-sectional study

Compassion fatigue has emerged as a detrimental consequence of experiencing work-related stress among psychiatric nurses, and affected the job performance, emotional and physical health of psychiatric nurses. However, researches on Chinese psychiatric nurses' compassion fatigue are dearth. This cross-sectional study aimed to investigate the prevalence and factors of compassion fatigue among Chinese psychiatric nurses.All participants completed the demographic questionnaire and the Chinese version of Professional Quality of Life Scale (ProQOL-CN). One-way ANOVA, t-tests, Levene test and multiple linear regression analysis were conducted to evaluate factors associated with compassion fatigue.A total of 352 psychiatric nurses in 9 psychiatric hospitals from the Chengdu, Wuhan, and Hefei were surveyed. The mean scores of compassion satisfaction, burnout and secondary traumatic stress were 32.59 ± 7.124, 26.92 ± 6.003 and 25.97 ± 5.365, respectively. Four variables of job satisfaction, exercise, had children, and age range from 36 to 50 years explained 30.7% of the variance in compassion satisfaction. Job satisfaction, sleeping quality, and marital status accounted for 40.4% variables in burnout. Furthermore, job satisfaction, average sleeping quality, and years of nursing experience remained significantly associated with secondary trauma stress, explaining 10.9% of the variance.Compassion satisfaction, burnout and secondary traumatic stress among Chinese psychiatric nurses were at the level of moderate. The higher job satisfaction, healthy lifestyle (high sleep quality and regular exercise), and family support (children, stable and harmonious marital status) positively influenced compassion satisfaction and negatively associated with burnout or secondary traumatic stress.

Evaluating the effectiveness of a CRSCE-based de-escalation training program among psychiatric nurses: a study protocol for a cluster randomized controlled trial

BACKGROUND

The high incidence of workplace violence (WPV) in clinical mental health settings has caused a series of negative impacts on nurses, which has subsequently increased public concern. De-escalation (DE) is recommended as a training program which aims at providing nurses with skills and strategies to more effectively respond and manage WPV. Very few studies have examined the effectiveness of DE training, with current studies possessing various limitations due to their design and small sample sizes. By using a cluster randomized controlled design, the proposed study aims to evaluate the effectiveness of a CRCSE-based DE training programs among psychiatric nurses.

METHOD

A cluster randomized controlled trial, with a 6-month follow-up period after the end of the intervention, will be conducted among psychiatric hospitals in Guangdong, China. The randomization unit is each involved psychiatric hospital. Participants in the control group will be assigned to routine WPV management training, participants of the intervention group will undergo the same training while additionally receiving DE training. The DE training will include the following five modules: communication, response, solution, care, and environment (CRSCE). Primary outcomes are objective clinical indicators, which will be extracted from the information systems of the enrolled hospitals. These include the incidence of WPV, injuries caused by WPV, and the use of coercion (physical restraint and seclusion) by nurses. Secondary outcomes, aims at evaluating the effects of DE training on nurses, include the capacity of DE, DE confidence, level of job burnout, and professional quality of life. Data will be collected at baseline (T0), at 3 months (T1, intervention completed), and at 6 months after intervention (T2, follow-up).

DISCUSSION

This study will offer trial-based evidence of the efficacy of a DE training program targeted at WPV among psychiatric nurses. DE training is expected to reduce both the total incidence and negative impacts of WPV, with additional improvements in psychiatric nurses' coping skills.

TRIAL REGISTRATION

Chinese Clinical Trial Registry, ChiCTR1900022211 . Prospectively registered on 30 March 2019.

Frequency and correlates of violence against patients with schizophrenia living in rural China

BACKGROUND

Violence against patients with schizophrenia is very common, however it is rarely studied in China, especially in primary health care institutions of rural areas. Therefore, we investigated the frequency of violence against patients with community-living schizophrenia in rural China and examined its associated factors and impact on quality of life (QoL) and social function.

METHOD

A survey was conducted among 487 patients with schizophrenia living in rural communities. Data about violent victimization experiences in the past 6 months, demographic information, and clinical characteristics were collected by questionnaires.

RESULTS

We found that 92 (18.9%) of 487 subjects experienced at least one type of violent event in the past 6 months. Logistic regression analysis suggested that a history of conducting dangerous behaviors(OR = 1.702, P = 0.02, 95%CI: 1.05-2.73), higher Brief Psychiatric Rating Scale (anxiety domain) score (OR = 1.15, P = 0.02, 95%CI: 1.01-1.304) and lower hospitalization rates (OR = 0.89, P = 0.04, 95%CI: 0.81-0.99) were significantly associated with violent victimization in patients with schizophrenia. Analysis of covariance showed the victims of violence tended to have worse social function in patients with schizophrenia living in rural communities of China (P = 0.04).

CONCLUSIONS

Individuals with schizophrenia living in rural China had a high risk of being exposed to violence and violent victimization of patients with schizophrenia had adverse consequences for social function. More attention is needed for those patients experiencing violent events, because they are simultaneously possible to conduct dangerous behaviors.

Aggression and Violence Toward Healthcare Workers in a Psychiatric Service in Italy: A Retrospective Questionnaire-Based Survey

Workplace violence and aggression are receiving increasing attention, especially when perpetrated in at-risk services such as psychiatric and emergency departments. Many healthcare providers have been victims of verbal aggressions (VAs) and physical aggressions (PAs), as well as injuries (INs), at the hands of patients. We conducted a 1-year retrospective questionnaire-based survey to assess workplace violence and aggression experienced by staff working at the Psychiatric Service of the Health District of Bolzano-Bozen (Italy). We performed parametric statistics. Logistic regression estimated the size of the association between PA occurrence and staff characteristics. Our psychiatric service's employees were frequent victims (91.5%) of 1 or more aggression/injury in the previous year. VAs and INs showed comparable frequencies among the three sites of our service, that is, the inpatient (INP), the outpatient (OUTP), and the rehabilitation (REHAB) units, differently from PAs, which were more common at INP (p < 0.001). The logistic regression model showed that female sex, working at INP, and a shorter psychiatry work experience predicted PAs occurrence. Most of the staff felt they could benefit from aggression management. Findings show that VAs, PAs, and INs are common among our psychiatric service's employees and point to the need to provide staff training on de-escalation.

Relationships Between Positive and Negative Attributes of Self-Compassion and Perceived Caring Efficacy Among Psychiatric-Mental Health Nurses

The purpose of this correlational quantitative study was to examine the relationships between work-related demographic variables, self-compassion, and perceived caring efficacy among psychiatric-mental health nurses (PMHNs), as measured using the Self-Compassion Scale and Caring Efficacy Scale. Participants were RNs actively working in psychiatric-mental health settings in the United States who are currently members of the American Psychiatric Nurses Association. Results suggest PMHNs with high levels of positive attributes of self-compassion had higher perceived levels of caring efficacy and those with high levels of negative attributes of self-compassion had lower perceived levels of caring efficacy. No statistically significant relationships were found between demographic variables, such as years of work experience, nurse:patient ratio, and perceived level of caring efficacy. The knowledge of the association between attributes of self-compassion and perceived caring efficacy can provide nurses with improved awareness of the need to be compassionate to the self and its relationship to effectiveness of care provided, potentially leading to positive health outcomes in clients. [Journal of Psychosocial Nursing and Mental Health Services, 58(2), 32-40.].

Analysis and strategy research on quality of nursing work life

Quality of Working Life (QWL) was developed in 1970s as a new theory on a basis of social-technical system theory. In 2004, Brooks considered that quality of nursing work life is a degree to which the registered nurses are able to satisfy important personal needs through their experiences in their work organization's goal. Quality of Nursing Work Life plays an important role in nursing management.The purpose of the project was to identify factors associated with nursing work life quality.A convenience sample of 3498 nurses from five tertiary general hospitals in Shanxi, Shandong, and Liaoning provinces in China was surveyed regarding quality of work life, working conditions, stress at work, general being, and job and career satisfaction (JCS).The mean overall quality of work life score was found to be 3.40 ± 0.61 (on a scale of 1-5, with 5 being the highest), while the working conditions and stress at work received lower scores. The general well-being of females (3.49 ± 0.74) was higher than that of males (3.35 ± 0.87). We also found a statistically significant difference of JCS of different department groups (P = .004).The quality of working life of nurses was found to be in the middle range, with room for improvement. Nurse managers have an opportunity to implement measures to improve the quality of working life for nurses in China.