Workplace violence in the emergency department: a systematic review and meta-analysis

Influence of sleep quality on aggressive behaviours: Predictive validity of the Brøset Violence Checklist-revised

INTRODUCTION

Violent behaviours in acute psychiatric settings represent a critical issue within health systems. Prompt identification of patients at risk is a priority for nurses. The Brøset Violence Checklist (BVC), created to support nursing assessment, showed good psychometric skills; a new version of the instrument (BVCrev), including sleep alterations, seems to improve the predictivity of sleep compared to the original scale but is not available in Italian.

AIMS

To evaluate the psychometric properties of the Italian version of the Brøset Violence Checklist revised (BVCita-rev).

MATERIALS AND METHODS

This was a prospective, observational study. After back-translation and content validity assessment, the BVCita and BVCita-rev were used simultaneously for risk assessment on a sample of patients admitted to the psychiatric inpatient wards of two Italian hospitals. Sensitivity, specificity, positive predictive value, negative predictive value, and ROC curve were calculated for both BVCita and BVCita-rev.

RESULTS

137 patients were enrolled, and 1117 evaluations were performed. Thirty-four subjects (24.82 %) engaged in aggressive actions during hospitalization, 24 of whom more than once. The predictivity of BVCita-rev was higher than that of BVCita (ROC = 0.9528 vs 0.8811). The S-CVI of the new version of the instrument was = 0.92.

CONCLUSIONS

Including an item addressing sleep disturbances enhances the predictive capabilities of the BVCita-rev. This modified version of the BVC proves to be an effective tool for supporting nurses in the short-term assessment of violence risk within acute psychiatric inpatient settings.

Traumatic incident among nurses in the emergency department: A concept analysis

BACKGROUND

The term "traumatic incidents" (TI) has been utilized in the healthcare setting; however, the definition and dimensions among emergency department (ED) nurses remain unclear. This concept analysis was to clarify the concept of TI among nurses in the ED by defining its attributes, antecedents, consequences, and empirical references specifically tailored to nurses in the ED.

METHODS

A concept analysis using the Walker and Avant approach was conducted to investigate TI among nurses in the ED.

RESULTS

TI among nurses in the ED encompasses physically and emotionally distressing events encountered during their duties. The two defining attributes include nurses in the ED frequently exposed to sudden and unexpected events involving patients' suffering or life-threatening conditions and subjective reactions and the experiences of ED nurses.

CONCLUSION

A clarified understanding of antecedents, attributes, consequences, and the definition of TI among nurses in the ED can pave the way for a robust and reliable measurement tool, facilitating the assessment of such incidents within this specific nursing context. This contribution holds significant promise for advancing nursing and research.

Exploring the impact of workplace violence on defensive medicine and patient outcomes: an empirical analysis using regression discontinuity

Objective

This study aims to thoroughly examine the impact of workplace violence incidents in healthcare settings on the structure of medical expenses, with a particular focus on specific changes in defensive medical, and to further investigate the resulting patient outcomes.

Method

This study examines a high-profile workplace violence incident in W City, H Province, China, which had widespread societal impact, treating it as an exogenous shock. Utilizing inpatient medical record data from W City, the study constructs a regression discontinuity model to systematically analyze shifts in medical behaviors related to costs and decision-making following the incident, as well as the implications of these changes on patient burden and health outcomes.

Results

The findings indicate that workplace violence incidents lead to significant changes in the structure of medical costs, with a notable increase in comprehensive medical service fees and a significant decrease in invasive treatment fees. Further analysis reveals that such incidents trigger pronounced defensive medicine, including extended hospital stays, increased probabilities of departmental transfers, reduced surgical levels, and higher costs and a greater proportion of traditional Chinese medicine in total expenditures. Additionally, in terms of patient outcomes, workplace violence incidents slightly alleviate patients’ out-of-pocket expenses and payment ratios. However, these incidents significantly worsen patients’ primary health indicators and overall health status at discharge.

Conclusion

Workplace violence against healthcare professionals significantly impact the structure of medical costs and trigger defensive medicine, characterized by a tendency toward conservative treatment approaches and reduced treatment intensity. While such incidents may partially alleviate patients’ financial burdens, they have detrimental effects on patients’ health outcomes. Therefore, to enhance healthcare quality and safeguard patient well-being, it is imperative to implement measures to mitigate workplace violence in healthcare and encourage medical institutions to prioritize scientific and rational decision-making in treatment practices.

"Divergent Needs and the Empathy Gap": Exploring the Experience of Workplace Violence Against Nurses Employed in the Emergency Department

BACKGROUND/OBJECTIVES

Violence in healthcare settings, especially in emergency departments (ED), remains an important public health issue worldwide. Thus, additional insight into the effect of these incidents into nurses' professional attitudes, their work life and related implications to patient safety issues may be valuable. We investigated ED nurses' living experience of exposure to workplace violence by healthcare service users, with focus on the impact on them.

METHODS

Following a qualitative study design, data were collected (January-June 2024) through semi-structured interviews with open-ended questions and were analyzed according to an inductive, content analysis approach. Participants provided informed consent, and data collection continued until theoretical saturation was reached.

RESULTS

The sample included six nurses. Various forms of workplace violence and its psychological, social, and professional consequences were identified. Violence was more frequently perpetrated by patients' relatives, with verbal aggression being the most common form. A fundamental divergence in needs and expectation between patients and their family members/caregivers, on one side, and participants, on the other, revealed a pronounced empathy gap. Each group remained focused on its own priorities while struggling to recognize or accommodate others' perspectives. This lack of mutual understanding contributed to tension that, in some cases, escalated even into physically violent incidents against the participants. A similar gap was identified between the participants' needs and administrators' attitudes and related policies. The failure of administrative measures to bridge this gap was described as a crucial factor in further escalating conflicts and tension in the ED.

CONCLUSIONS

Further research on quality improvement projects, including all stakeholders, aiming to enhance empathy in all parties involved is proposed.

Prevalence of violence against health care workers among agitated patients in an urban emergency department

OBJECTIVE

Violence is a common hazard for those working in emergency departments (EDs), yet it remains understudied. We describe a prospectively derived estimate of the prevalence of violence against health care workers among agitated patients in an ED.

METHODS

This was a secondary analysis of two prospective, observational studies of patients receiving care in a dedicated portion of the ED meant primarily to observe patients with intoxication. We collected detailed data for patients with agitation, defined as a score of +1 or higher using the altered mental status scale, an ordinal agitation scale from -4 (coma) to 0 (normal) to +4 (most agitated). Trained observers present in the ED 24/7 recorded whether each encounter involved verbal abuse, threat of violence, or a violent act against a health care worker. The primary outcome was the occurrence of assault as defined by state statute (threat of violence or violent act). We compare observed events to those formally reported to the hospital.

RESULTS

From 17,873 encounters screened there were 4609 (25.8%) in which the patient had agitation. Alcohol or drug intoxication was present in 4108 (89.1%) encounters. The number of encounters with assault was 937 (20.3%, 95% confidence interval [CI] 19.1%-21.5%), which included 802 encounters (17.4%, 95% CI 16.3%-18.5%) with a threat of violence and 362 encounters (7.9%, 95% CI 7.1%-8.7%) with a violent act. Verbal abuse occurred in 1786 encounters (38.8%, 95% CI 37.3%-40.2%). Events were formally reported to the hospital in 9/1786 (0.5%) instances of verbal abuse and in 224/362 (61.9%) instances of a violent act.

CONCLUSIONS

Verbal abuse, threats of assault, and violent acts occurred frequently in ED patients with agitation and were underreported.

Dimensions of violence against healthcare workers in emergency departments: a cross-sectional comparative study

BACKGROUND

Violence against health workers in hospital emergency departments is a global concern. The aim of this comparative study is to assess the differences in the patterns, magnitude, effects and underlying reasons for violence against health workers in the emergency departments of Palestine and Türkiye.

METHODS

A cross-sectional study was conducted in 14 emergency departments in the West Bank and 3 in Isparta Province in Türkiye. A convenience sample of 377 health workers (227 in Palestine and 150 in Türkiye), consisting of 97 physicians, 198 nurses, and 82 other workers, including administrative and support health personnel, participated in the study. A self-administered survey was used to collect data between June and November 2024. Data was analyzed using SPSS with a significance level set at < 0.05. Statistical methods included, frequencies and percentages of the study variables, as well as Chi-square tests (χ2) and Fisher's exact tests used to assess the differences between the two countries in relation to violence prevalence and related factors.

RESULTS

A total of 68.7% of the participants reported exposure to workplace violence during the past year, which was significantly greater among Palestinian participants (84.6%) than among Türkiye participants. The prevalence rates of physical violence were 28.1%, 35.7% and 16.7% in Palestine and Türkiye, respectively; the prevalence rates of nonphysical violence were 65.3%, 81.1% and 41.1%, respectively (p < 0.05). Among the participants, physicians were the most affected by violence. The perpetrators were mainly (79.0%) patient families/companions and the patients themselves. A long waiting time to receive services, unmet expectations of patients and families and a lack of violence prevention measures were the top reported reasons. Approximately 80.0% of the events were not reported (62.1% in Türkiye, 86.3% in Palestine, p < 0.05), mainly because of a lack of follow-up and actions taken against aggressors or because the events were considered trivial/part of the job or feared consequences of reporting. The impacts of violence include significant negative psychological effects, such as hopelessness, disappointment, fear, and anxiety, in addition to effects on the delivery of care, e.g., minimizing communication and time spent with patients and companions. Violence was also associated with the intention of health care workers to leave their job in emergency services (p < 0.05).

CONCLUSIONS

Contextual differences are evident in the patterns and levels of violence in the countries studied; however, concerns are clearly common regarding and underlying reasons and impacts. The findings show that both settings suffer from considerable levels of workplace violence and negative consequences for healthcare workers and health care services with insufficient measures to combat them, which would require immediate attention. A collaborative approach among key stakeholders for developing and implementing evidence-based policies and strategies to mitigate the risks of this arduous public health problem is crucial.

Barriers to reporting workplace violence: a qualitative study of nurses' perceptions in tertiary care settings

BACKGROUND

Workplace violence (WPV) remains a formidable concern among nurses worldwide, with up to 60% in Saudi Arabia reportedly experiencing some form of aggression. In tertiary care hospitals, robust hierarchies and cultural norms intensify underreporting, thwarting evidence-based prevention and obscuring vital data.

AIM

This qualitative study investigated the perceived barriers to WPV reporting among nurses in tertiary care settings in the Aljouf region of Saudi Arabia, specifically addressing how organizational and cultural factors converge to discourage formal incident reporting.

METHODS

A qualitative descriptive design was employed, guided by Ajzen's Theory of Planned Behavior and the Social Ecological Model. Thirty-six registered nurses, purposively sampled from three tertiary hospitals, participated in six semi-structured focus groups conducted in Arabic or English, depending on participant preference. Data were thematically analyzed in NVivo, with methodological rigor ensured through triangulation and inter-coder reliability.

RESULTS

Three principal themes emerged: (1) Emotional and Psychological Barriers (78%), encompassing distress, anxiety, and fears of professional blame; (2) Organizational Ineffectiveness (65%), marked by convoluted reporting processes and perceived managerial indifference; and (3) Cultural and Hierarchical Influences (57%), reflecting deference to authority and normalization of violence. These themes illustrate how attitudes, subjective norms, and perceived behavioral control shaped by socio-cultural dynamics collectively contribute to persistent underreporting.

CONCLUSIONS

Mitigating WPV underreporting in Saudi tertiary care hospitals requires streamlined, user-friendly reporting channels, leadership accountability, and holistic psychosocial support. Implementing interprofessional education aimed at dismantling hierarchical imbalances can foster a zero-tolerance ethos toward violence. Longitudinal and comparative research should further examine evolving reporting behaviors to refine context-specific, culturally attuned strategies for addressing WPV.

CLINICAL TRIAL NUMBER

Not applicable.

Workplace violence against emergency physicians: A cross-sectional study on the role of communication skills

OBJECTIVES

Workplace violence (WPV) is a critical issue affecting healthcare professionals, posing significant risks to their safety and well-being. This study investigates WPV among emergency physicians in Türkiye, examining the relationship between WPV and physicians' communication skills.

METHODS

A cross-sectional study was conducted from March to June 2023, involving 63 emergency physicians recruited through a convenience sampling method. Participants completed an online survey that included demographic questions, the Turkish version of the Health Professionals Communication Skills Scale (HP-CSS-TR), and self-evaluation items on communication skills.

RESULTS

The findings revealed high WPV prevalence, with 85.7% of participants reporting verbal aggression during their residency and 90.5% during their specialty period. Physical violence was reported by 31.7% of participants during residency and 27.0% during their specialty period. Participants' HP-CSS-TR scores averaged 86.08, indicating relatively high communication skills. No significant relationships were found between HP-CSS-TR scores and demographic characteristics such as gender, age, or years of experience. A moderate positive correlation was observed between participants' self-evaluations and their HP-CSS-TR scores in the dimensions of empathy and respect, suggesting alignment between perceived and actual communication skills in these areas. Weak correlations were found in informative communication and social skills, highlighting areas for improvement in communication training programs.

CONCLUSIONS

This study highlights the critical issue of WPV against emergency physicians and its association with communication skills, emphasizing the complexities of high-stress environments such as emergency departments. It underscores the need for continued research and systemic interventions to enhance workplace safety and the well-being of healthcare professionals.

Workplace Verbal Violence Toward Romanian Doctors and Nurses: Prevalence, Contributing Factors, and Psychological Correlates

Background/Objectives: Workplace violence is a critical issue in the healthcare sector, with verbal violence being the most common form. This study is the first of its kind in Romania aiming to analyze the prevalence, characteristics, contributing factors, and psychological correlates of verbal workplace violence on doctors and nurses. Methods: A cross-sectional study was conducted using a questionnaire distributed online between February and April 2022 to doctors and nurses across Romania. Data were analyzed using descriptive statistics, the chi-squared test, and multivariate logistic regression to evaluate contributing factors and response patterns. Results: Out of 7951 participants, 56% of doctors and 9.2% of nurses reported experiencing verbal violence in the past 12 months (p = 0.001). Shift work and night shifts significantly increased the risk of verbal violence for both groups. Women were more vulnerable, with higher exposure among nurses (OR = 1.687; p = 0.001) and doctors (OR = 1.940; p = 0.001). The main aggressors were patients and patients' relatives in both groups of participants, while vertical violence was more common among doctors. Formal reporting was low, although active reactions were more common. In terms of psychological correlates, doctors reported greater psychological strain than nurses (p = 0.001). Conclusions: This study highlights a critical need for system-wide interventions to address verbal violence in the Romanian healthcare system. Measures such as reporting protocols, staff training on conflict management, and organizational support systems are essential to prevent verbal violence and combat its contributing factors. Implementing these strategies could significantly improve the safety and well-being of healthcare professionals.

Workplace Violence and Health Status of Female Nurses: A Cross-Sectional Study

As a female-dominant profession, nurses are at risk of workplace violence. However, the health outcomes of workplace violence among female nurses have been mostly studied in isolation from their history of lifetime violence experiences. Although social and organizational factors shape workplace violence, our understanding of its effects on female nurses' health is limited in different cultural contexts. This study examined how workplace violence affects the physical and mental health and the frequency of medication intake and sick leave of nurses employed in the Saudi healthcare system while controlling for the effect of lifetime violence experiences. A cross-sectional study was conducted with 340 female nurses working in tertiary hospitals in Saudi Arabia. Among the female nurses, 67.6% had experienced at least one act of workplace violence during the last 12 months. The highest level of workplace violence was recorded in nurses employed in psychiatric units. After controlling for the effect of child abuse and partner violence, workplace violence is associated with female nurses' physical health (β  = 0.335, t(336) = 6.73, p < 0.001), mental health (β  = 0.224, t(336) = 4.09, p < 0.001), medication intake (β  = 0.240, t(336) = 4.45, p < 0.001), and frequency of sick leave days (β  = 0.206, t(336) = 3.82, p < 0.001). The results indicate a need for a zero-tolerance policy against workplace violence and multidimensional strategies to address the issue. Additionally, gender and multi-component health interventions for female nurses who are survivors of violence are needed.

The impact of an All-Hazard mass casualty event on emergency department operations: A retrospective study

BACKGROUND

Mass Casualty Events (MCI) which have a direct and persisting impact on the safety and well-being of an emergency department (ED) and its staff, secondary to specific targeting of the healthcare setting, represent a distinct and complex operational challenge. ED physicians may be faced with the prospect of providing ongoing patient care while simultaneously experiencing direct threats to their own health or physical safety. In our study we considered the unique operational challenges encountered, and management strategies adopted, by the ED staff and its leadership to an all-hazard MCI impacting an academic urban emergency department.

METHODS

We conducted a retrospective, observational study of data from a tertiary academic medical center of patients arriving to the ED during a protracted MCI lasting from May 11th to May 21st, 2021. No arriving patients were excluded from analysis. Patient demographics, ED resource utilization, throughput, disposition and other pertinent data were considered. Analysis was done of three distinct patient populations including the event-group (EG), a non-event-group (NEG) and a control group (CG). Descriptive statistics were used to evaluating observational findings.

RESULTS

We reviewed the records of 8527 total patients presenting to the Shamir Medical Center ED during the event and control periods. Of those, 283 patients were identified as an EG consisting of casualties from the MCI. 3563 patients were identified as the NEG presenting with complaints not related to the event. Our CG consisted of the 4681 patients who presented in the two weeks prior to the MCI. EG patients were noted to have important characteristics including higher relative numbers of men n = 173 (61.6 %), higher CTAS triage acuities [n = 10 (3.8 %), classified as CTAS 1], and an increase utilization of specialty consultation and admission consistent with observed injury patterns, most notably for the orthopedic services [orthopedic consultations: n = 126 (44.5 %) / orthopedic admissions: n = 13 (4.6 %)].

CONCLUSION

Findings from our observational study suggested that in the absence of larger public health interventions a manmade MCI, with direct threats to an ED and its staff, could force EDs to concurrently address the unique clinical needs of two distinct patient populations while simultaneously needing to take measures to protect hospital staff. Additionally, a higher burden of patient volumes and clinical acuity are likely to be encountered by select specialty consultation services. Further studies could focus on quantitative analysis to better understand the operational impact of these types of events on both patients and staff.

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

Background

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

Methods

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

Results

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

Conclusion

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

Strengthening essential emergency departments: Transforming the safety net

Safety-net emergency departments (EDs) are a critical component of the US health care system, delivering emergency care for patients in need, including vulnerable populations. EDs provide unscheduled acute care for patients 24 hours a day, 7 days a week, regardless of a person's ability to pay. In addition, EDs have transformed beyond their traditional roles of providing emergency services and being the centers for regionalized trauma, cardiac, and stroke care, to also becoming stewards of public health by leading screening and treatment efforts for nonemergent conditions, such as HIV, hepatitis C, mental health, and opioid use disorder. Many safety-net hospitals and their EDs serve essential roles in urban and rural communities, making the impact of recent closures particularly concerning. In response, we convened clinical, operational, and administrative leaders of key safety-net EDs across the United States in order to develop expert consensus related to critical issues facing safety-net EDs. The goals were to help inform policymakers about current challenges and to offer timely recommendations so that together we can mend the safety net as the country works toward the goal of health equity for all.

Prevalence and associated factor of verbal abuse against nurses: A systematic review

BACKGROUND

Nurses who experience verbal abuse often report negative emotions, which can affect their work status and nurse-patient relationship. However, to the best of our knowledge, no study has summarized the prevalence of verbal abuse among nurses by different perpetrators and related risk factors.

AIM

This review aimed to synthesize the prevalence of verbal abuse among nurses and identify the most common sources and related risk factors.

METHODS

PubMed, Web of Science, Embase, and the Cochrane Library electronic databases were searched from inception to 15 October 2024, and observational studies reporting the prevalence of verbal abuse among nurses were selected. In this systematic review, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Methodological quality was appraised using a revised version of the Newcastle-Ottawa Quality Assessment Scale, and the STATA software was used for meta-analysis; PROSPERO registration number: CRD42022385401.

RESULTS

The search identified 458 records, of which 45 met the inclusion criteria. The overall prevalence of verbal abuse was estimated at 67% (95% CI: 61-72). Verbally abused nurses reported patients' relatives, friends (48%, 95% CI: 42-55), and physicians (39%, 95% CI: 20-58) as the main perpetrators of verbal abuse. Personal factors, work area, and work characteristics were the main factors related to verbal abuse among nurses.

CONCLUSIONS

The overall prevalence of verbal abuse among nurses was more than 65%, especially in the emergency department, and South or Southeast Asian countries had a significantly lower prevalence of verbal abuse than other countries. Physicians and patients' relatives were the main sources of verbal abuse. Hospital administrators should prevent various effects of verbal abuse on nurses' physical and mental health.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Developing safe workplaces and effective interventions to protect nurses is essential. Supervisors and institutions should thoroughly monitor verbal abuse. Additionally, organizations need to focus on preventive measures and provide the necessary administrative, legal, and psychological support to nurses who are exposed to verbal abuse to ensure nursing care sustainability.

Implementation and Evaluation of a High-Fidelity, Interprofessional Simulation Project Using Standardized Patients to Address Aggression in a Psychiatric Emergency Department

IntroductionIncreased aggression in a regional Comprehensive Psychiatric Emergency Program (CPEP) led to a significant rise in physical assaults, restraints, and use of security personnel. Root cause analysis revealed a need for more extensive training on de-escalation, teamwork and communication.

AIMS

This quality improvement project evaluated the impact of an interprofessional, high-fidelity simulation project on interdisciplinary collaboration to manage de-escalation and aggression safely and effectively.

METHODS

Interdisciplinary team members (N = 171 nurses, psychiatrists, social workers, crisis specialists, and safety officers) participated in a 2.5-hr educational initiative that included Crisis Prevention Intervention (CPI) and Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) interventions, high-fidelity simulation using standardized patients, observation, and debriefing. Quantitative data collection and analysis included the use of the Confidence in Coping with Patient Aggression Instrument (CCPAI), TeamSTEPPS Perception Questionnaire (T-TPQ), pre-post data on restraints, injuries, and an educational survey. A qualitative analysis of debriefing themes was also performed.

RESULTS

Statistically significant improvement was noted in individuals' confidence to manage aggression. In addition, data collected over a 5-month period before and after simulation demonstrated a 35% reduction in restraints and a 52% reduction in injuries. Interestingly, quantitative evidence revealed no changes in perceptions of teamwork. Results from the educational survey highlighted the positive impact of standardized patients and debriefing, and gaining new insights into patient care. Qualitative analysis of debriefing themes revealed educational opportunities to improve communication, role clarity, de-escalation, and insights into patient impact.

CONCLUSION

The use of high-fidelity simulation with standardized patients has the potential to strengthen interdisciplinary collaboration to safely manage aggression in an acute psychiatric setting.

Psychometric properties and measurement invariance of the medical staff occupational stress scale among Chinese clinical nurses

BACKGROUND

The Medical Staff Occupational Stress Scale (MSOSS) is a timely tool for the measurement of occupational stress among medical staff. It included a childhood stress dimension and seven other work-related stress dimensions. This study aimed to evaluate the psychometric properties and measurement invariance of the MSOSS using a large cohort of clinical nurses from Southeast China.

METHOD

A province-level survey was conducted from January 1st 2022 to May 31st 2022. Full-time clinical nurses from multiple hospitals in Hainan province were recruited. A total of 2989 nurses (1639 from secondary hospitals and 1350 from tertiary hospitals) completed the survey. The reliability of the MSOSS was assessed by its internal consistency. The validity of the MSOSS was assessed by its structural validity, convergent validity and concurrent validity. A series of multi-group confirmatory factor analyses were conducted to test and establish measurement invariance across variables such as age, work duration, hospital level, and job title.

RESULTS

The MSOSS exhibited excellent internal consistency in the different cohorts (Cronbach's α = 0.954-0.965, omega coefficient = 0.956-0.967 and Spearman-Brown coefficient = 0.883-0.905). The MSOSS exhibited stable structural validity and the confirmative factor analysis showed that the comparative fit index (CFI), incremental fit index (IFI) and Tucker-Lewis Index (TLI) were all around 0.9 in the different cohorts, indicating a good model fit. The measurement invariance of the MSOSS across hospital level, age, work duration and job title was supported by its metric invariance, scalar invariance and residual invariance. Cut-offs for the MSOSS as a depression and anxiety screening tool were also calculated. Scores above 102 and 207 were found to be indicative of depression and anxiety, respectively.

CONCLUSIONS

The MSOSS proved to be a suitable tool for assessing occupational stress among clinical nurses.

'That's Enough' - Workplace Violence Against Physicians, Pharmacists, and Nurses in Saudi Arabia: A Systematic Review of Prevalence, Causes, and Consequences

Background

Workplace violence (WPV) threatens the safety and well-being of healthcare providers and leads to significant organizational consequences, including staff burnout, reduced productivity, and high turnover rates. At the societal level, it reduces the quality of care, increases medical errors, and imposes a substantial economic burden on healthcare systems and communities. Despite the global attention to WPV, systematic reviews specifically addressing WPV across all three professions-physicians, pharmacists, and nurses-and in various healthcare settings in Saudi Arabia are lacking. This review examines the prevalence, contributing factors, types, sources, potential causes, reactions, and impact of WPV against HCPs in Saudi Arabia.

Methods

We conducted a systematic search of electronic databases from January 2010 to November 2024 and reviewed reference lists of included studies focusing on WPV against physicians, pharmacists, and nurses in Saudi Arabia. Two researchers independently screened studies for inclusion, resolved discrepancies through discussion, and extracted data in duplicate. The quality of included studies was assessed using critical appraisal tools for cross-sectional studies.

Results

A total of 42 studies were reviewed using the AXIS tool for cross-sectional studies. The prevalence of WPV against HCPs ranged from 26% to 90.7%. This range reflects overall WPV prevalence across various studies, encompassing different healthcare settings and professional groups. Verbal violence was the most reported type (19.7-98.2%), followed by threats (12-74.4%), physical violence (3-79%), and sexual violence (1.9-76.5%). Perpetrators were predominantly male, with patients (7.1-99.3%) and their relatives or friends (6.6-91%) as the primary sources. Contributing factors of WPV included gender, age, profession, workload, shift patterns, nationality, experience, and inadequate training. Causes included staff shortages, overcrowding, long waiting times, miscommunication, unmet patient demands, insufficient penalties, and inadequate security measures. Responses to WPV varied, with some HCPs reporting incidents and others taking no action. The impact on HCPs included psychological distress, reduced work quality, and occasional job resignation.

Conclusion

The high prevalence of WPV against HCPs in Saudi Arabia highlights the urgent need for enhanced protective measures, increased awareness of WPV policies, and improved reporting systems. Understanding the factors contributing to WPV can inform targeted intervention programs to foster safer healthcare environments.

Reducing physical assaults on residents through implementation of project BETA: Best practices in the evaluation and treatment of agitation

Background and objectives

We created a multitude of initiatives that were in line with the principles of the BETA (Best Practices in the Evaluation and Treatment of Agitation) guidelines to determine if these initiatives would reduce the physical assault rate by patients on emergency medicine (EM) residents.

Methods

We conducted three cross-sectional surveys of our EM residents (PGY-1 to -3) to determine the incidence of physical assaults by agitated patients at a large county hospital emergency department. These were primarily anonymous REDCap surveys and were administered at the following intervals: (1) pre-BETA initiative implementation, (2) approximately 12 months after implementation, and (3) 5 years postimplementation. Unfortunately, the in-person deescalation, self-defense, and simulation training were canceled 2 years prior to the last survey due to COVID-19. The second survey only looked at the incidence of physical assaults during the prior 6 months whereas the other two surveys evaluated the incidence of physical assaults since starting residency.

Results

The survey response rates for the three REDCap surveys were 76% (50/66), 80% (53/66), and 71% (49/69), respectively. The percentage of EM residents who were physically assaulted per survey period were as follows: preimplementation cumulative assaults 28% (14/50), 12 months after implementation for 1 full academic year 11.3% (6/53), and postimplementation cumulative assaults during residency 5 years later 30.6% (15/49). The two independent-samples proportions tests comparing the number of physical assaults before and approximately 12 months after all of these initiatives were implemented was significant (p = 0.032).

Conclusions

An education and training curriculum designed to improve EM residents' ability to manage agitated patients may reduce the incidence of physical assaults on them by patients in their care. However, the decrease in physical assaults after these initiatives followed by the increase in physical assaults experienced after the COVID-19 pandemic are most likely multifactorial.

Emergency Department Crowding as Contributing Factor Related to Patient-Initiated Violence Against Nurses-A Literature Review

AIM

To synthesise how ED crowding contributes to patient-initiated violence against emergency nurses.

DESIGN

Framework synthesis.

DATA SOURCES

A systematic literature search was conducted in the PubMed, PsycINFO, CINAHL and Scopus databases, covering articles up to 21 March 2024.

REVIEW METHODS

A total of 25 articles were reviewed, evaluating study quality using the Crowe Critical Appraisal Tool and employing a framework synthesis approach to chart and synthesise data.

RESULTS

The review identifies key factors linking emergency department crowding to patient-initiated violence, focusing on crowding conditions, vulnerable populations and adverse outcomes. It emphasises the importance of multidimensional assessments, including input, throughput, output stages and staffing characteristics. Special attention is needed for patients with severe symptoms who are triaged into lower priority categories, as their perceptions of injustice and dissatisfaction may increase the risk of aggressive behaviour. However, limited information is available regarding the perspectives of patients' family members.

CONCLUSION

Accurate assessments of emergency department crowding and a thorough understanding of cognitive and emotional changes in high-risk patients are essential to develop strategies to manage patient-initiated violence effectively.

IMPACT

This review improves emergency nurses' understanding of the dynamics of patient-initiated violence in crowded emergency departments, equipping them with knowledge to better anticipate and respond to such incidents. It also offers insights that are crucial for enhancing nursing practices and ensuring workplace safety, thereby supporting the development of future emergency safety strategies.

NO PATIENT OR PUBLIC CONTRIBUTION

As this is a systematic review and framework synthesis, there was no direct patient or public involvement.

Psychosocial working conditions and violence prevention climate in German emergency departments - a cross-sectional study

BACKGROUND

Emergency departments (EDs) are high pressure work environments with several psychosocial job demands, e.g., violence, and job resources, e.g., colleague support. So far, the perceptions of working conditions have been compared between doctors and nurses, but there is limited knowledge regarding their respective supervisors. In addition, the violence prevention climate has not been assessed in German EDs before. Thus, the current study focuses on differences in the perceptions of working conditions and the violence prevention climate between the groups of doctor-supervisors, doctor-employees, nurse-supervisors, and nurse-employees within the ED. Further analyses regarding the association between social relations and pressure for unsafe practices are performed, including the moderating role of belonging to one of the aforementioned groups.

METHODS

A cross-sectional online survey was carried out among N = 370 participants, who were doctors or nurses from German EDs. The Questionnaire for Psychosocial Risk Assessment (QPRA) and the Violence Prevention Climate Scale (VPCS) were applied. Kruskal-Wallis tests were performed for group comparisons, followed by a hierarchical multiple linear regression model and moderation analyses.

RESULTS

Statistically significant differences between the groups were found for eight out of 13 variables. The highest number of significant pairwise comparisons was found between the groups of doctor-supervisors and nurse-employees. High job demands regarding work intensity and work interruptions became apparent across all groups. Nurse-employees reported the highest social and emotional demands as well as the highest pressure for unsafe practices regarding violence prevention, significantly differing from the other groups on these variables. The variables of supervisor support and social stressors were found to be significantly predictive of pressure for unsafe practices. Furthermore, there was no moderating effect of belonging to one of the above-mentioned groups in the relationships between variables of social relations and pressure for unsafe practices.

CONCLUSIONS

Differences found in the current study can help tailor preventive measures according to the needs of distinct professions and positions in order to improve working conditions and the violence prevention climate in EDs. Furthermore, supervisor support should be strengthened while social stressors should be resolved in order to decrease pressure for unsafe practices regarding violence prevention.

Prevalence, consequences, and contributing factors beyond verbal and physical workplace violence against nurses in peripheral hospitals

Background

Globally, nearly one-third of workplace violence (WPV) occurs in the health sector. Exposure to WPV among Jordanian nurses has been widely speculated to be underreported. Understanding of the factors contributing to WPV among nurses and their consequences is limited.

Objectives

This study aimed to examine the consequences and contributing factors of WPV and explore suggestions for reducing WPV among nurses working in peripheral hospitals.

Methods

This descriptive, cross-sectional study included 431 Jordanian nurses. Data were collected using a self-report instrument between December 2022 and June 2023. A modified version of the ILO/ICN/WHO/PSI Workplace Violence in the Health Sector Country Case Study Questionnaire developed and validated in 2003 was used.

Results

The ages of the participants ranged from 20 to 49 years. A total of 349 nurses (81%) had experienced verbal violence, while 110 (25.5%) had experienced physical violence. Of the 110 nurses who were physically attacked, 44 (40 %) reported that an investigation was conducted to determine the cause of the incident. Approximately 38.2% of incidents involving physical violence in the last 12 months involved the use of weapons. The current study revealed that 59.6% of the nurses reported that verbal incidents were common in their workplace. The highest level of agreement among all participants was leniency in applying penalties to perpetrators of violence inside hospitals. The majority of participants (95.8%) agreed that improving staff-patient communication skills would effectively reduce violence.

Conclusion

Creating awareness among healthcare professionals, patients, and the general public regarding the impact of WPV and the importance of respect and professionalism is crucial.

A silent pandemic of violence against providers in obstetrics and gynecology: A mixed-methods study based on a global survey

OBJECTIVES

To quantify and qualify the experience of workplace violence (WPV) in a global sample of providers in obstetrics and gynecology (OBGYN).

METHODS

We performed a mixed-methods analysis on data from a global survey. Survey content was designed around categorical and open-ended questions in relation to WPV; the occurrence and character, the physical and psychological consequences, training and support structures, and perceived triggers of the experience of WPV. Quantitative data were analyzed using descriptive statistics and text data using mixed deductive-inductive content analysis. These data were integrated using convergent joint display.

RESULTS

Between October 2023 and January 2024, survey responses were collected from 77 individual countries. Among the final sample, 764/1016 (75.2%) had experienced WPV, 699/1016 (68.8%) verbal, and 123/1016 (12.1%) physical violence. The violence affected physical health, psychological health, or job satisfaction for 106/764 (13.9%), 36/7642 (47.4%), and 222/764 (29.1%) of individuals respectively; 216/764 (28.3%) received support. Main WPV triggers were staff shortages, lack of security personnel, and long waiting times, identified by 38.8%, 37.5%, and 37.3% of respondents respectively. Qualitative data indicated that violence caused severe and long-lasting suffering. Catalysts for WPV were often reported as complex interplays between unmet or unrealistic expectations and insufficient resources. Lack of support for WPV was explained as violence being "part of the job" and a culture of assumed resilience among providers.

CONCLUSION

WPV against OBGYN providers seems to be ubiquitous, arises from a complex interplay of factors, and causes significant injury while receiving insufficient mitigation and support.

Measuring the Risk of Violence Through Health Surveillance

Workplace violence (WV) is a ubiquitous, yet under-reported and under-studied phenomenon. Prevention measures may be ineffective because risk assessment is often based on unvalidated algorithms. After monitoring the risk of WV in a healthcare company for over 20 years, this paper presents the results collected in 2023 and details of the methodology used. Monitoring WV in health surveillance can involve three actions: (1) asking all the workers who attend periodic medical examinations in the workplace whether they have suffered physical aggression, threats, or harassment in the previous year; (2) investigating WV at the end of workplace inspections by setting up participatory ergonomics groups (PEGs) to suggest solutions; (3) investigating the characteristics and consequences of WV through anonymous online questionnaires. In 2023, 6.9% of the healthcare workers (HCWs) reported having experienced one or more physical attacks during the previous year; 12.7% reported having been threatened, and 12.9% reported other types of violent, harassing behavior. The HCWs observed an increase in violence after the pandemic years and, in the PEGs, suggested using different preventive measures in different health departments. The online survey provided further information on the characteristics of WV and its consequences. The risk of WV can be effectively characterized and measured through health surveillance.

Work Reward Moderates the Association Between Work Effect and Workplace Violence Among Medical Staff in China

Purpose

Workplace violence (WPV) against healthcare workers is a significant public health issue in China and globally. Although the effort-reward imbalance theory claimed that work rewards may moderate the relationship between work effort and WPV, the quantitative evidence is limited. This study aimed to examine if work reward could moderate the associations between work effort and WPV against medical staff based on the effort-reward imbalance theory.

Methods

This is a cross-sectional study, which was conducted in 12 hospitals in Shandong, China. Data collected from 3426 medical staff were analyzed in this study. Work effort was evaluated by working hours and night shift work times per month (NSWM), and work reward was evaluated by monthly income and perceived social status. WPV, occupational characteristics, physical disease, and social-demographic variables were also evaluated in this study.

Results

There were 1788 (52.2%) medical staff, who reported the experience of workplace violence. Working hours, NSWM, and perceived social status were associated with WPV (all p<0.001). Monthly income could moderate the associations between monthly income and WPV or verbal violence (p<0.05), and perceived social status could moderate the associations between NSWM and WPV (p<0.001).

Conclusion

Monthly income could moderate the associations between monthly income and WPV (verbal violence), and perceived social status could moderate the associations between NSWM and WPV, which could be explained by the effort-reward imbalance model. These findings also can be translated into practices to control WPV against medical staff.

Factors associated with occurrence of workplace violence against healthcare workers during the COVID-19 pandemic: a meta-analysis

Objectives. Healthcare systems all over the world are increasingly alarmed by the prevalence of workplace violence (WPV) directed at healthcare workers (HCWs) during the COVID-19 pandemic. Therefore, the aim of the current review was to investigate the factors associated with WPV against HCWs during the COVID-19 pandemic. Methods. This study was conducted in December 2021. Four international databases along with two Iranian databases were searched. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement served as the foundation for the reporting procedure. Results. A total of 13 articles were included in the analysis. Results showed that females are less at risk of WPV (odds ratio [OR] 0.76, 95% confidence interval [CI] [0.67, 0.84], p = 0.000 based on a fixed-effects model). Moreover, significant association was found between education level (OR 1.09, 95% CI [1.05, 1.14]), age (correlation = 0.025, 95% CI [0.014, 0.036]) and work experience (correlation = 0.028, 95% CI [0.016, 0.016]) and WPV. Conclusion. The primary factors linked to WPV exposure were found to be gender, education level, age and work experience. Additional research is necessary to provide more accurate and detailed data.

Nurses' perceived health and occupational burnout: A focus on sleep quality, workplace violence, and organizational culture

AIM

This study investigates the mediation of sleep quality between perceived health and occupational burnout in hospital nurses, considering the moderation of workplace violence and organizational culture.

BACKGROUND

Occupational factors lead to physical and mental distress, burnout, and sleep issues in nurses. Approximately two-thirds of nurses experience burnout, impacting patient care quality and safety. Cultivating a positive organizational culture is essential for nursing workforce stability.

METHODS

This cross-sectional study employed convenience sampling to recruit 346 nurses from a teaching hospital in southern Taiwan in July-August 2020 (response rate: 87.3%). Self-administered questionnaires containing validated instruments were employed, including an adapted occupational burnout scale, the Chinese version of an organizational culture scale, a Perceived Health Questionnaire, a Workplace Violence Experience Scale, and the CPSQI; all instruments were reliable and valid. The analysis involved descriptive statistics, linear regression, and the Johnson-Neyman technique.

RESULTS

Nurses with better perceived health exhibited significantly lower occupational burnout (p < 0.001). Perceived health indirectly impacted burnout through sleep quality (p < 0.01) with organizational culture as a partial moderator. Bureaucratic organizational culture exacerbated this relationship. Additionally, decreased workplace violence moderated the connections among perceived health, sleep quality, and occupational burnout among nurses.

CONCLUSIONS

Given the inverse correlation between nurses' perceived health and occupational burnout and considering factors such as workplace violence, organizational culture, and sleep quality, healthcare institutions can proactively take steps to enhance nurses' overall well-being and mitigate burnout.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

By implementing wellness programs, mental health support, security training, robust reporting, and a zero-tolerance approach to violence, healthcare stakeholders can foster a safe and supportive work environment for nurses, thus improving well-being, patient outcomes, and healthcare quality.

Understanding the Experience of Workplace Violence in Hospitals as Documented by Nursing Staff: Using the READ Approach

Background: Workplace violence has a significant impact on patients, families, and staff safety. Workplace violence can produce traumatic results for those involved; the importance of preventive measures needs to be paramount in health service policy and process. Health care staff are required to document their experiences of violent incidents after every occasion, usually via an incident reporting system, which allows for a free text description of the event. There is a lack of understanding of how health care staff document reports of violence and how they explain the events. Methods: This study aims to determine the circumstances surrounding workplace violent events as documented by health care staff. The four-step Review, Extract, Analyze, and Document (READ) approach to document analysis was used to examine workplace violence incident reports over 12 months (September 2021-September 2022) in a tertiary referral hospital. Findings: Six categories of workplace violence were found: (a) "Escalation Dynamics"-patterns and progression of how violence incidents intensify; (b) "Warning Behaviors"-verbal or non-verbal signals that may foreshadow physical violence if not addressed; (c) "Authoritative Institutional Interventions"-how aggression correlates to protocols involving security personnel or law enforcement; (d) "Care Delivery Methods"-how certain treatment procedures and approaches might inadvertently elicit violence; (e) "Situational Stressors"-external circumstances or changes that act as triggers for violence; and (f) "Unprovoked triggers"-sudden and seemingly unprovoked violent outbursts. Conclusions and application to practice: Workplace violence in health care is a multifaceted interplay of events with the nurse involved in all aspects of the process. These findings can be used by occupational health nurses in education and policy development. The findings can be used to focus education on how violent incidents may escalate and provide more opportunities for de-escalation by health care staff.

Workplace Violence in a Large Urban Emergency Department

Importance

Workplace violence (WPV) against health care workers (HCWs) is common and likely underreported. Reliable data on the incidence of WPV and its impact on victims are lacking.

Objective

To prospectively define the frequency of WPV against HCWs in the emergency department (ED), examine whether HCW demographics are associated with increased risk, and explore the impact of these events on HCWs.

Design, Setting, and Participants

This cross-sectional study was conducted over 2 months in 2023 (August 28 to October 22, 2023) in the ED of a large, urban, academic safety net hospital in the US. Participants included ED physicians, nurses, and other HCWs, who were asked to complete a brief so-called shift sheet for every ED shift worked during the study period.

Exposure

WPV as recorded on shift sheets.

Main Outcomes and Measures

The primary outcome was the number of events per shift. Events were coded for severity (types 1-5) and gender- or race and ethnicity-related bias. Shift sheets asked for the participant's demographics and whether they experienced verbal or physical abuse during the shift. If so, they were asked to provide a description; rate the impact the event had on them; and indicate whether they felt the event was sexist, racist, or otherwise biased. Perceived impact was recorded, and demographic characteristics associated with the likelihood of experiencing WPV were explored using multivariable logistic regression analysis.

Results

Among 72 HCWs who participated in the study, 52 were female (72%). A total of 575 shift sheets were returned of an estimated 1250 possible (46%), with 155 events, including 77 type 1 events (50%; shouting, yelling, or insults), 29 type 2 events (19%; threats of physical or sexual violence, death threats, or use of slurs), and 39 type 3 events (25%; physical violence); there was a mean (SD) of 3.7 (1.9) shifts per 1 event. No type 4 or 5 events, which involve physical violence causing grievous injuries requiring medical attention and, in the case of type 5 events, permanent disability or death, were recorded. Ten events could not be coded. Sexist or racist bias occurred in 38 events (25%) and 11 events (7%), respectively. Participants reported how the event impacted them in 133 events. Of those, moderate or severe impact was reported in 32 (24%) and mild to no effect in 101 (76%). There was no association between self-reported impact and coded severity of events. In a multivariable logistic regression analysis, a higher likelihood of experiencing WPV on any given shift was independently associated with being in the nursing role (odds ratio, 3.1; 95% CI, 1.9-5.0) and being age 40 years or younger (odds ratio, 2.0; 95% CI, 1.2-3.5).

Conclusions and Relevance

In this cross-sectional study of HCWs in the ED, participants experienced WPV once every 3.7 shifts. The nursing role and younger age were associated with increased risk. These results highlight an urgent need to identify interventions to support and protect HCWs.

The rate and predictors of violence against EMS personnel

BACKGROUND

Violence against Emergency Medical Services (EMS) personnel vary between studies. Current studies are mainly based on self-reporting, thus other designs are needed to provide more perspective. The purpose of this study was to explore the rate and predictors of violent behavior targeted at EMS personnel by exploring the Electronic patient care records (ePCR) documentation by EMS personnel.

METHODS

This was a retrospective cohort study of EMS patients in Finland. The data were collected from three regions between 1st June and 30th November 2018. Text mining and manual evaluation were used to identify and explore predictors of violence targeted at EMS personnel from the ePCR narratives. Multivariable logistic regressions were used to determine factors that were independently associated with violent behavior. The results are presented with odds ratios (ORs) with 95% confidence intervals (CIs).

RESULTS

The EMS personnel reported experiences of violence in a total of 297 identified missions (0.7%) of all EMS missions (n = 40,263). The violence was mostly verbal (62.3%) and the most common violence perpetrator was the patient (98.0%). The police were alarmed to many missions where violence was reported (40.7%). Sometimes violence occurred suddenly although the police were present. The multivariable logistic regression model indicates that violence occurred typically in urban areas (OR 1.699; 95% CI 1.283 to 2.248), at weekend nights (OR 1.357; 95% CI 1.043 to 1.765), by male (OR 1.501; 95% CI 1.160 to 1.942), and patients influenced by alcohol (OR 3.464; 95% CI 2.644 to 4.538). A NEWS2 score of 3 in any parameter (vs. score 0-4, OR 2.386; 95% CI: 1.788 to 3.185) and ALS unit type (vs. BLS, OR 1.373; 95% CI: 1.009 to 1.866) increased the likelihood as well.

CONCLUSIONS

The documentation in ePCRs show low rates of violence targeted at EMS personnel. However, violence is a multidimensional phenomenon connected to unfamiliar patients, rushed situations, and an uncontrolled environment. This means that the EMS personnels' safety cannot be ensured in all situations. Therefore, a balance between safety margins and treating patients needs to be considered.

Simulation-based education for teaching aggression management skills to healthcare providers in acute healthcare settings: A systematic review

BACKGROUND

Behavioural emergencies involving aggression in acute care hospitals are increasing globally. Acute care staff are often not trained or confident in their prevention or management. Of available training options simulation-based education is superior for clinical medical education and is gaining acceptance for teaching clinical aggression management skills.

OBJECTIVE

The aim of this study was to conduct a systematic review of the effectiveness of simulation-based education for teaching aggression management skills for health professionals working in acute healthcare settings.

METHODS

The study protocol was prepared in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) statement, registered (27/02/2020) and published. We included randomised controlled trials, non-randomised controlled trials, quasi-experimental studies, and observational studies involving healthcare professionals in acute hospital settings or trainee health professionals who received simulation-based training on managing patient aggression. Comprehensive searches were conducted in PubMed, Ovid MEDLINE, PsycINFO, CINAHL and The Cochrane Library. Two reviewers independently screened all records, extracted data and assessed risk of bias. The primary outcomes included patient outcomes, quality of care, and adverse effects. Secondary outcomes included workplace resource use, healthcare provider related outcomes, knowledge (de-escalation techniques), performance, attitudes, and satisfaction. A narrative synthesis of included studies was performed because substantial variation of interventions and outcome measures precluded meta-analyses.

RESULTS

Twenty-five studies were included with 2790 participants, 2585 (93 %) acute care hospital staff and 205 (7 %) undergraduate university students. Twenty-two studies combined simulation-based education with at least one other training modality. Three studies were randomised controlled trials, one was a pilot and feasibility cluster randomised controlled trial, one was a three-group post-test design and twenty were pre-/post-test design. Twenty-four studies were deemed to be high/critical or serious risk of bias. Four studies collected primary outcome data, all using different methods and with inconsistent findings. Twenty-one studies assessed performance in the test situation, seven studies provided objective ratings of performance and eighteen provided self-report data. Twenty-three studies reported objective or subjective improvements in secondary outcomes.

CONCLUSIONS

Acute healthcare staff who completed simulation-based education on managing clinical aggression showed statistically significant improvements in knowledge and self-reported confidence. However, there is a lack of evidence about the magnitude of these improvements and impact on patient outcomes.

REGISTRATION

PROSPERO Registration Number CRD42020151002.

TWEETABLE ABSTRACT

Simulation-based education improved acute healthcare clinician knowledge and confidence in managing aggression.

Beyond the Basics: Partnerships and Innovations for Empowerment to Address Workplace Violence, a Call to Action

Workplace violence (WPV) has become a crisis for health care workers, with a significant increase in violent events taking place in health care settings across the nation. Health care organizations should develop a comprehensive WPV program that includes recognition, management, and reporting of all types of WPV. A large health care system developed strategies and a program to address WPV. The health care system believes that a safe and respectful work environment is foundational to the goal of zero preventable harm. The "Safety in the Workplace" initiative was designed to raise awareness of concerning behaviors and to offer tools and resources for identifying, responding to, and reporting incidents of violence, aggression, or disruptive behaviors of WPV. During a 6-month pilot of a WPV bundle, there was a 44% reduction in physical violence reports and a 44% reduction in reported incidents of WPV. From June 2020 to June 2021, there was a 10% decrease in WPV overall.

Violent encounters on the front line: Sequential explanatory mixed-methods investigation of physical violence factors in the prehospital setting

OBJECTIVE

Workplace violence (WPV) is an important issue in prehospital care, especially for emergency medical technicians ( EMTs) who are at increased risk of physical violence due to the nature of their work. This study aimed to shed light on the specific factors that contribute to the underlying causes of physical WPV in the prehospital context through direct experience and insight into the work of EMTs.

METHODS

Sequential explanatory mixed methods were applied in five western provinces of Iran from 2022 to 2023. In total, 358 EMTs that met the criteria for the quantitative phase were selected using a multi-stage clustering method. In the quantitative phase, the researchers used a questionnaire on workplace violence in the healthcare sector. Based on the results of the quantitative phase, 21 technicians who had experienced physical violence in the past 12 months were invited for in-depth interviews in the qualitative phase.

RESULTS

The average age of the EMTs was 33.96 ± 6.86 years, with an average work experience of 10.57 ± 6.80 years. More than half (53.6%) of the staff worked 24-hour shifts. In addition, most EMTs were located in urban bases (50.3%), and 78 (21.8%) reported having experienced physical violence. No significant correlations were found between the demographic characteristics of the technicians and the frequency of physical violence, except base location in the last 6 months. The qualitative study also created one theme (the complexity of WPV in the prehospital setting), four categories, and ten subcategories.

CONCLUSION

The study's results emphasize the need for comprehensive WPV factors in the prehospital setting. These factors can lead to identifying and improving strategies such as organizational support, improving communication and collaboration between responders, and training in de-escalation techniques. In addition, it is crucial to address the root causes of WPV such as poverty and lack of education in the community to create a safer and more supportive environment for patients and staff.

Exploring perceptions of reporting violence against healthcare workers in the emergency department: A qualitative study

BACKGROUND

Violence against healthcare workers is a pervasive, yet in many cases, under-reported problem. This is due to various factors, including lack of time, support and a universal understanding of what constitutes a reportable event. This study explored facilitators and barriers to reporting workplace violence among emergency department nurses.

METHODS

In this descriptive, qualitative study, researchers conducted open-ended interviews with emergency nurses considered to be "high-" and "non-reporters" of violent events and analyzed for themes.

RESULTS

Participants cited consistent factors associated with less reporting, factors associated with more reporting and effectiveness of existing safety measures.

CONCLUSIONS

To encourage the reporting of violent events, frequently cited barriers and facilitators should be addressed. Strategies such as integrating reporting mechanisms into the health record, creating nuanced definitions of reportable events, and consistent education with positive feedback can promote reporting by staff. These efforts should be combined with prevention strategies to ensure we are collecting correct data about the success or failure of these programs.

"We just ignored them." Adaptation strategies used by emergency department personnel in the face of workplace violence: A qualitative study

BACKGROUND

Workplace violence (WPV) can have adverse psychological, physical, and emotional effects on emergency department (ED) personnel. Adaptive strategies can help them better adapt to WPV. The study aimed to explore ED personnel's experiences with adaptive strategies used in the face of WPV.

METHODS

In this qualitative study, 22 ED personnel (nurses, doctors, services patient care assistants, and security guards) were selected using purposive sampling from Urmia city hospitals. Deep semi-structured individual face-to-face interviews were used to collect data. After recording and implementing interviews, conventional content analysis was used to extract concepts.

RESULTS

Data analysis led to extracting an overarching theme of "mastering the situation and avoiding harm." Two categories that supported the main theme were: "effort to avoid violence" and "effort to escape suffering." The seven subcategories supported main categories included "managing patients and companions, "self-control," "seeking support, "emotional discharge," "thought diversion, "tendency to spirituality," and "seeking medical assistance."

CONCLUSION

Given the experiences of ED personnel regarding strategies used, health managers and policymakers are recommended to develop and implement comprehensive programs to reduce violence and empower nurses before and after dealing with violence. The following programs will help: developing and implementing guidelines such as zero-tolerance WPV policy, criminalizing violence against personnel and punishing perpetrators; holding classes related to communication skills, self-control skills, and deviant thinking skills for ED personnel; raising public awareness of the prevailing conditions in the emergency through mass media, and counseling and treating violent ED personnel.

Poor Work Ability Is Associated with Workplace Violence in Nurses: A Two-Wave Panel Data Analysis

Healthcare personnel must deal with two problems of growing importance: violence in the workplace and the loss of work ability due to the aging of the workforce. Our objective was to evaluate, with a two-wave perspective design, the relationships of work ability, social support, and occupational stress with workplace violence in nurses. In an Italian public health company, we asked nurses to self-assess their work ability using the Work Ability Index (WAI) and we analyzed the relationship between this indicator and the violence experienced in the previous and following years. A total of 321 out of 344 nurses (99.3%) participated. In a logistic regression model, the WAI score was a significant protective factor for violence experienced in the previous year (OR = 0.94 CI95% = 0.90; 0.98 p < 0.01) and in the following year (OR = 0.88 CI95% = 0.84; 0.92 p < 0.01). In a hierarchical logistic regression model, social support acted as a protective factor (OR = 0.87 CI95% = 0.79; 0.95 for violence experienced in the previous year), while occupational stress was a significant determinant of the risk of aggression (OR = 3.65 CI95% = 1.90; 7.03 in the previous year, OR = 3.54 CI95% = 1.801; 6.947 in the following year). The difficulties that nurses encounter in carrying out their growing work demands in an environment that is not promptly adapted to their changing physical and mental states can lead to an increased risk of violence. Prevention of workplace violence should include organizational and ergonomic measures that reduce stress and increase staff support and work ability.

Surveillance of Health Care-Associated Violence Using Natural Language Processing

BACKGROUND AND OBJECTIVES

Patient and family violent outbursts toward staff, caregivers, or through self-harm, have increased during the ongoing behavioral health crisis. These health care-associated violence (HAV) episodes are likely under-reported. We sought to assess the feasibility of using nursing notes to identify under-reported HAV episodes.

METHODS

We extracted nursing notes across inpatient units at 2 hospitals for 2019: a pediatric tertiary care center and a community-based hospital. We used a workflow for narrative data processing using a natural language processing (NLP) assisted manual review process performed by domain experts (a nurse and a physician). We trained the NLP models on the tertiary care center data and validated it on the community hospital data. Finally, we applied these surveillance methods to real-time data for 2022 to assess reporting completeness of new cases.

RESULTS

We used 70 981 notes from the tertiary care center for model building and internal validation and 19 332 notes from the community hospital for external validation. The final community hospital model sensitivity was 96.8% (95% CI 90.6% to 100%) and a specificity of 47.1% (39.6% to 54.6%) compared with manual review. We identified 31 HAV episodes in July to December 2022, of which 26 were reportable in accordance with the hospital internal criteria. Only 7 of 26 cases were reported by employees using the self-reporting system, all of which were identified by our surveillance process.

CONCLUSIONS

NLP-assisted review is a feasible method for surveillance of under-reported HAV episodes, with implementation and usability that can be achieved even at a low information technology-resourced hospital setting.

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

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

ABSTRACT

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

AIM

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

METHOD

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

FINDINGS

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

CONCLUSION

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

IMPLICATIONS FOR PRACTICE

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

Ensuring effectiveness and safety in emergency department triage

Triage is the first stage of a patient's journey through the emergency department and is used to determine patient acuity. There is no single quantifiable metric for determining acuity, which amalgamates different factors that are more or less relevant depending on the patient's presentation. This article explains the aim and process of triage and how nurses can ensure the process is effective and safe. The author discusses strategies nurses can use to mitigate uncertainty and to make their acuity assessments rapid, targeted and comprehensive. The author also highlights triage safety considerations, including infection prevention and control and the physical and emotional safety of patients and staff.

Implementing the Brøset Violence Checklist in the ED

ABSTRACT

The emerging field of implementation science (IS) facilitates the sustainment of evidence-based practice in clinical care. This article, the second in a series on applying IS, describes how a nurse-led IS team at a multisite health system implemented the Brøset Violence Checklist-a validated, evidence-based tool to predict a patient's potential to become violent-in the system's adult EDs, with the aim of decreasing the rate of violence against staff. The authors discuss how they leveraged IS concepts, methods, and tools to achieve this goal.

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

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

Support mechanisms that enable emergency nurses to cope with aggression and violence: Perspectives from New Zealand nurses

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.

Impact of the presence of a mediator on patient violent or uncivil behaviours in emergency departments: a cluster randomised crossover trial

BACKGROUND AND IMPORTANCE

Several studies reported that violent behaviours were committed by patients against healthcare professionals in emergency departments (EDs). The presence of mediators could prevent or resolve situations of tension.

OBJECTIVE

To evaluate whether the presence of mediators in EDs would have an impact on violent behaviours committed by patients or their relatives against healthcare professionals. Design, settings and participants A 6-period cluster randomised crossover trial was performed in 4 EDs during 12 months. Patients aged ≥18 and their relatives were included.

INTERVENTION

In order to prevent or resolve situations of tension and conflict, four mediators were recruited.Outcome measure and analysis Using a logistic regression mixed model, the rate of ED visits in which at least one act of violence was committed by a patient or their relatives, reported by healthcare professionals, was compared between the intervention group and the control group.

RESULTS

A total of 50 429 ED visits were performed in the mediator intervention group and 50 851 in the control group. The mediators reported 1365 interventions; >50% of the interventions were to answer questions about clinical management or waiting time. In the intervention group, 173 acts of violence were committed during 129 ED visits, and there were 145 acts of violence committed during 106 ED visits in the control group. The rate of ED visits in which at least one act of violence was committed, was 0.26% in the intervention group and 0.21% in the control group (OR = 1.23; 95% CI [0.73-2.09]); on a 4-level seriousness scale, 41.6% of the acts of violence were rated level-1 (acts of incivility or rudeness) in the intervention group and 40.0% in the control group.

CONCLUSION

The presence of mediators in the ED was not associated with a reduction in violent or uncivil behaviours committed by patients or their relatives. However, the study highlighted that patients had a major need for information regarding their care; improving communication between patients and healthcare professionals might reduce the violence in EDs.

TRIAL REGISTRATION

Clinicaltrials.gov (NCT03139110).

Perceived organizational support, self-efficacy and cognitive reappraisal on resilience in emergency nurses who sustained workplace violence: A mediation analysis

AIMS

The aims of this study were as follows: (a) to examine the relationship between perceived organizational support and resilience; (b) to investigate the potential mediating role of general self-efficacy and cognitive reappraisal among emergency nurses who have experienced workplace violence; and (c) to explore the application of Kumpfer's resilience framework to emergency department nurses.

DESIGN

A cross-sectional study.

METHODS

From February 17, 2021, to March 8, 2021, 825 emergency nurses working in the emergency departments of tertiary hospitals in Shanghai, China, completed an online survey. Data on resilience, organizational support, cognitive reappraisal and general self-efficacy were collected through questionnaires. The Spearman analysis was employed to investigate the relationship between variables, while the mediation analysis was conducted using AMOS 23.0 statistical software.

RESULTS

The findings of a study involving 825 emergency nurses who reported experiencing workplace violence reveal a positive correlation between perceived organizational support and resilience. Additionally, it has been observed that the relationship between these two factors is mediated by both cognitive reappraisal and general self-efficacy. Furthermore, the mediating effect of cognitive reappraisal is more significant in this relationship.

CONCLUSION

Kumpfer's resilience framework is found to apply to emergency nurses. Perceived organizational support, an environmental factor, affects resilience directly and positively. In addition, cognitive reappraisal and general self-efficacy, which are individual factors, mediate this influence path. These findings suggest an interaction between environmental and individual factors in determining the resilience of emergency nurses.

IMPACT

These findings have implications for developing resilience intervention strategies for emergency nurses exposed to occupational violence. Enhancing personal attributes such as general self-efficacy and cognitive reappraisal is as significant as strengthening external organizational support environments for enhancing nurses' resilience.

PATIENT OR PUBLIC CONTRIBUTION

Emergency nurses participated in the pilot test of our questionnaire survey and gave their opinions on the questionnaire design.

SUMMARY STATEMENT

What is already known about the topic? In emergency rooms, workplace violence is prevalent, and it seriously endangers nurses' physical and mental health. Enhancing resilience can improve nurses' ability to self-regulate after experiencing violence. However, the drivers and mechanisms of resilience among emergency nurses who have experienced workplace violence remain unidentified. What this paper adds? This study confirms the applicability of Kumpfer's resilience framework to emergency nurses who have experienced workplace violence. Nurses' self-efficacy and cognitive reappraisal mediate the relationship between perceived organizational support and resilience after exposure to workplace violence. The resilience process for emergency nurses involves the interaction of individual and environmental factors. Implications for practice/policy. Managers and researchers should consider the interaction between individual and environmental factors when developing resilience intervention strategies for emergency nurses who have suffered workplace violence. It is essential to support emergency nurses from the dyadic dimensions of the environment and the individual. A supportive organizational environment and individual positive adjustment strategies are equally important in promoting resilience among nurses.

The mediation role of work-family conflict in the effect of workplace violence on job satisfaction and intention to leave: a study on health care workers in Turkey

Background

This study aims to determine how workplace violence experienced by healthcare workers in Turkey affects their job satisfaction and intention to leave. It also examines the mediating role of employees' work-family conflict between these effects.

Methods

The PROCESS method was used in the study. The research was conducted on 595 health workers in three public hospital affiliated with the Istanbul Provincial Health Directorate. The convenience sampling method was used in the selection of the participants.

Results

As a result of the analysis, it was determined that there is a positive, significant, moderate (R = 0.35, p < 0.01) relationship between workplace violence and work-family conflict, and a negative, significant and weak relationship between workplace violence and job satisfaction (R = -0.27, p < 0.01), there is a positive, significant, and weak (R = 0.26, p < 0.01) relationship between workplace violence and intention to leave. In addition, there is a negative, significant, and weak (R = -0.27, p < 0.01) relationship between work-family conflict and job satisfaction, and a positive, significant, and weak (R = 0.28, p < 0.01) relationship between work-family conflict and intention to leave. Workplace violence had significant and negative effects on the employees' job satisfaction and significant and positive effects on the intention to leave and work-family conflicts.

Discussion

As a result of the mediating variable analysis, it was determined that work-family conflict has a partial mediator role in the relationship between workplace violence, job satisfaction, and intention to leave. The results are very important, especially for managers working in the healthcare sector. Reducing workplace violence against healthcare personnel will contribute to increasing productivity in the sector and providing better quality service to the healthcare sector.

Educational programs and interventions for health care staff to prevent and manage aggressive behaviors in acute hospitals: a systematic review

OBJECTIVE

The objective of this review was to determine the effect of educational programs that have been implemented in acute health care settings to manage or prevent aggressive behaviors toward staff perpetrated by patients, families, or visitors.

INTRODUCTION

Health care staff working within acute-level and tertiary-level hospitals are at high risk of exposure to aggressive behaviors by patients, their family, or visitors. Negative staff and organizational impacts reported in the literature include individual psychological or emotional distress and severe harm, increased absenteeism, high staff turnover, and awarded compensation. Reports of this kind of occupational violence are increasing globally; therefore, strategies to address prevention and management are needed to mitigate the risk of harm to staff and the wider hospital service. Various educational activities have been implemented to address the issue, but the overall effect of these is unclear.

INCLUSION CRITERIA

Experimental and quasi-experimental studies were considered for inclusion if they reported on an educational program or intervention for staff working within an acute hospital setting and aimed at managing or preventing occupational violence perpetrated by patients, family, or visitors. Reports of programs implemented to address occupational violence, whether verbal or physical, were included. Studies were excluded if they reported on upward violence or bullying, patients in psychiatric or dementia facilities, or pediatric patients, due to the specific care needs of these cohorts.

METHODS

The following databases were searched: PubMed (PubMed Central), CINAHL (EBSCOhost), PsycINFO (EBSCOhost), Embase, ERIC (ProQuest), Cochrane Central Register of Controlled Trials (Cochrane Library), and Scopus. ProQuest Dissertations and Theses was searched for unpublished studies. To obtain a wider perspective of the issue, studies published in Chinese were also searched in WanFang Database, China National Knowledge Infrastructure, and Chongqing VIP. A date filter of 2008-2023 was applied in a deliberate effort to expand from previous work. No language filters were applied. The review was conducted in accordance with JBI methodology for systematic reviews of effectiveness, and reported as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

RESULTS

The search process retrieved 4681 citations. A total of 32 studies representing 3246 health staff were included in the review. The studies were either before-and-after or pre-test/post-test study designs. Methodological quality of studies varied, with the main issues being absence of CIs within statistical analysis, limited detail on participant selection or attrition/non-response, and underreporting of confounding factors. Educational programs varied in content and duration. Content delivery across the studies also varied, with several didactic, role-play, debriefing, group work, and simulation exercises reported. While studies reported some improvement in self-reported confidence levels, results were mixed for other outcomes. Determining overall effect of included studies was challenging due to heterogeneity within and across studies with regard to intervention types, populations, measurement tools, and outcomes.

CONCLUSIONS

This review is unable to determine which workplace educational programs had an effect on staff outcomes or on the number of occupational violence incidents. In the future, educators and researchers could use the findings of this review to guide the design of educational programs and employ measures that are comparable to their settings.

REVIEW REGISTRATION

PROSPERO CRD42020190538.

SUPPLEMENTAL DIGITAL CONTENT

A Chinese-language version of the abstract of this review is available [ http://links.lww.com/SRX/A33 ].

"Cold feet": A qualitative study of medical students who seriously considered emergency medicine but chose another specialty

Introduction

Emergency medicine (EM) has historically been among the most competitive specialties in the United States. However, in 2022 and 2023, 219 of 2921 and 554 of 3010 respective National Resident Matching Program positions were initially unfilled. Medical students' selection of a medical specialty is a complex process. To better understand recent trends in the EM residency match, this qualitative study explored through one-on-one interviews the rationale of senior medical students who seriously considered EM but ultimately pursued another specialty.

Methods

A convenience sample of senior medical students from across the United States was recruited via multiple mechanisms after the 2023 match. Participant characteristics were collected via an online survey. Qualitative data were generated through a series of one-on-one semistructured interviews and thematic analysis of the data was performed using a constant comparative approach.

Results

Sixteen senior medical students from 12 different institutions participated in the study. Thematic saturation was reached after 12 interviews but data from all 16 interviews were included for qualitative analyses. Five major themes emerged as important in students' consideration but ultimate rejection of EM as a career: (1) innate features of EM attracted or dissuaded students, (2) widespread awareness of a recent workforce report, (3) burnout in EM, (4) their perception of EM's standing in the health care landscape, and (5) early EM experience and exposure.

Conclusions

This qualitative study identified five major themes in the career decisions of senior medical students who seriously considered EM but chose another specialty. These findings may help inform the perceptions of students and guide future EM recruitment efforts.

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

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

Meeting the Needs of Family Members of Trauma Patients in the Emergency Department

BACKGROUND

While the needs of family members have previously been studied, the needs of families of trauma patients have received less attention.

OBJECTIVE

This study aims to assess the needs of family members of trauma patients in the emergency department.

METHODS

This cross-sectional survey study was conducted over 4 months (February-May 2022) with family members of trauma patients admitted to the emergency department of a state hospital in Istanbul, Turkey. The validated Critical Care Family Needs Inventory - Emergency Department survey was administered face-to-face to a convenience sample of consenting family members.

RESULTS

A total of 248 family members participated, representing 84 patients. The mean age of the participants was 33 (8.18) years, with a gender distribution of 50% women. On average, 76.5% of the family members' needs were met. The most important needs reported as mean (SD) were as follows: communication, 3.52 (0.68); participation in care, 3.52 (0.68); comfort, 3.36 (0.65); and support needs, 3.21 (0.72). These needs were met to varying degrees: communication 85%, participation in care 81.2%, comfort 75.4%, and support needs 65.2%.

CONCLUSION

The study findings indicate that the needs of family members of emergency department trauma patients are not fully met. Families report needing communication the most and comfort the least.