A Systematic Review: Effectiveness of Interventions to De-escalate Workplace Violence against Nurses in Healthcare Settings

The Development of Violence Research in Psychiatric Nursing: A Bibliometric Perspective

BACKGROUND

There is a growing emphasis on violence-related research in psychiatric nursing, with an annual increase rate of 2.12% in publications and the highest number of publications occurring in 2024. This trend underscores the escalating importance of addressing violence in mental health settings.

AIM

This study aims to demonstrate the quantitative and qualitative features of violence publications in the field of psychiatric nursing from a bibliometric perspective. Web of Science was used during the research.

METHODS

This study employed bibliometric analysis, a methodological approach for delineating the scope of information and assessing productivity within a specific domain. The data were searched with the keyword combination 'violence and psychiatric nursing', including studies published until December 2024, the study date, without a time limit.

RESULTS

In this study, 464 violence research/reviews in the field of nursing were identified between 2001 and 2025, and the research was completed with 438 violence studies in line with the exclusion criteria. 1493 authors wrote 390 research and 48 review/systematic review articles, with an average of 22.14 citations for each publication. Most were published in 2024.

DISCUSSION

There is an apparent increase in the involvement of psychiatric nurses in studies pertaining to violence. It is proposed that nursing professionals should undertake further research to investigate violence processes and develop ethically sound approaches to patients and healthy individuals, taking into account biopsychosocial factors.

IMPLICATIONS FOR PRACTICE

These findings collectively suggest that while progress is being made in understanding and addressing violence in psychiatric nursing, there remains a critical need for ongoing research, policy development and practical interventions to ensure the safety and well-being of both nurses and patients in mental health settings.

Workplace Violence in the Emergency Department: A Bibliometric Analysis

INTRODUCTION

Workplace violence against health care workers is a widespread global issue, particularly in emergency departments. This study aimed to identify and visualize research on workplace violence in the emergency department and reveal global trends in this field.

METHODS

Publications related to workplace violence in the emergency department were retrieved from the Web of Science Core Collection database. VOSviewer, CiteSpace, and Scimago Graphica were used for bibliometric analysis and visualization.

RESULTS

A total of 348 articles were selected for this study. These articles were published across 50 countries from November 1, 1988 to December 31, 2024, with the United States, Australia, and China leading in publication output. These articles were featured in 142 journals, with the Journal of Emergency Nursing publishing the most (n = 33). Gillespie is both the most prolific author and among the most frequently cited in this field. Keyword clustering analysis identified 4 distinct research themes, including factors associated with the occurrence of violence, prevention strategies for workplace violence, its psychological and occupational impacts on emergency department staff, and different forms of violence. In addition, keyword burst analysis revealed emerging trend topics, notably "COVID-19," "experience," and "qualitative research."

DISCUSSION

Despite a growing body of research on workplace violence in the emergency department in recent years, incidents of violence continue to arise. This bibliometric study is the first to comprehensively summarize the research developments and trends in this field, identifying research frontiers and hotspots. The findings offer new perspectives on workplace violence in the emergency department and may inform future research on violence prevention strategies.

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.

A Qualitative Exploration of Why Novice Nurses Left Their Jobs

OBJECTIVE

This qualitative study sought to answer the question "Why are novice nurses leaving their jobs?"

BACKGROUND

Nearly one-third of all new RNs in the United States left their 1st jobs within a year in 2024. Research is needed to understand why nurses are leaving so interventions can be designed.

METHODS

Using qualitative descriptive methodology, 13 nurses from the United States who left their jobs within the 1st 2 years of practice were interviewed.

RESULTS

Two main themes emerged that were related to leaving: Starting out and hitting a wall and Trying to stick it out and couldn't. A 3rd theme, The aftereffects, described the nurses' reflection on their experience and how it impacted their current situation.

CONCLUSIONS

Nurse leaders must critically examine the work environment, preceptor training, and novice nurse transition programs to provide swift interventions to staunch the exodus of novice nurses leaving their 1st jobs.

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.

Exploring Registered Nurses' Experiences of Workplace Adversity: A Descriptive Qualitative Study

AIM

To explore registered nurses' firsthand experiences of workplace adversity.

DESIGN

A qualitative exploratory, descriptive study.

METHODS

Data were collected from July to September 2022 using semi-structured interviews. A purposive sample of seven registered nurses from New Zealand was used. Data were analysed using Braun and Clarke's six-step thematic analysis.

RESULTS

Four themes emerged: (1) manifestations of workplace adversity, (2) professional identity and resilience, (3) coping and resilience in workplace adversity and (4) nature and characteristics of support. This study highlights the multifaceted nature of workplace adversity for nurses, impacting their physical, psychological and emotional well-being and performance, and beyond the workplace, spilling over to their personal lives. However, nurses demonstrated resilience, drawing on past experiences and professional identity to cope. While professional development opportunities fostered growth, a supportive work environment emerged as crucial. This work environment should value diverse experiences, promote positive role models and prioritise ethical practices alongside career advancement.

CONCLUSION

Nurses are greatly affected by various aspects of workplace adversity. Cultivating professional identity and resilience may help counter the negative effects of workplace adversity. Further research is necessary to identify organisational-level strategies to decrease workplace adversity.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Healthcare organisations must prioritise safe and supportive work environments for nurses.

IMPACT

The purpose of this research was to explore the problem of workplace adversity nurses face. Despite valuing professional identity, psychological resilience and coping mechanisms, participating registered nurses find it difficult to overcome the adverse effects of workplace adversity due to mounting demands. The results of this study are relevant when formulating policies, strategies, and programmes that can benefit nurses, healthcare institutions and patients globally.

REPORTING METHOD

The Consolidated Criteria for Reporting Qualitative Research was used.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution. Participants were not involved in the design or conduct of the study.

Optimizing Workplace Violence Reporting in a Multisite Hospital Setting: A Quality Improvement Initiative

INTRODUCTION

Workplace violence (WPV) is a significant concern in healthcare settings and indicates the need for accurate reporting to plan and implement effective interventions. This article presents the results of a quality improvement (QI) initiative implemented at a large academic health sciences center to improve the reporting of WPV events.

METHODS

The Plan-Do-Study-Act (PDSA) model was adopted to optimize the electronic reporting process, reduce inaccuracies of WPV reporting, and ensure appropriate follow-up from leadership and the Workplace Health, Safety, and Wellness (WHSW) team. Over two PDSA cycles, modifications of an electronic incident reporting form were made.

RESULTS

The proportion of inaccurate reporting was significantly lower (χ 2 (1, N = 1,219) = 111.86, p = .001), after the QI initiative. In addition, the revisions increased staff follow-up and support from WHSW.

CONCLUSIONS

Our QI initiative demonstrated that simple adjustments to our WPV reporting, with the revision of an electronic reporting form, had a significant improvement on incident data accuracy and staff follow-up. These findings will contribute to our organization's staff and patient safety.

Validity and Reliability Study of the Workplace Violence Scale in Healthcare (TYPE 2 Violence) in Turkish

Background: Workplace violence refers to acts that occur inside or outside the workplace, ranging from verbal harassment, bullying, threats and physical assaults against workers to homicide. Workplace violence in health care settings is an incident involving verbal, physical or sexual assault against healthcare workers by patients, their relatives or others that poses a threat to healthcare workers. Violence in healthcare settings is a significant public health problem, not only for the victims of violence, but also for society because of its direct and indirect, short and long-term effects. Objectives: The aim of this study is to adapt the Workplace Violence Scale in Healthcare to Turkish, to conduct validity and reliability studies, and to determine its psychometric properties in order to overcome the problems faced by health policy makers in assessing workplace violence and to ensure that they implement appropriate interventions. Methods: In the research in which 191 healthcare workers were included in the pilot study and 627 healthcare workers in the main sample, data were collected using the Sociodemographic Data Form and the Workplace Violence Scale in Healthcare. SPSS 25.0 and AMOS 25.0 programs were used to analyse the data. In the scale validity and reliability study stage, Explanatory Factor Analysis and Confirmatory Factor Analysis methods were used after the language and content validity analyses. Results: The Cronbach alpha coefficient of the scale was found to be 0.946, and it was observed that the CR values of the scale consisting of five subdimensions and 37 items were over 0.70 and the AVE values were over 0.50. At the same time, in order to reveal the stability of the scale over time, the test-retest method was applied, and it was seen that the correlation coefficients obtained were 0.97 for the whole scale and between 0.80 and 0.94 for its subdimensions, indicating an excellent level of reliability. Conclusions: As a result of this study, it was accepted that the Workplace Violence Scale in Healthcare, developed with five subdimensions (frequency of workplace violence, impact of workplace violence on the individual, reasons for not reporting workplace violence legally, risk factors increasing workplace violence and workplace violence prevention strategies) and 37 items, can be used as a comprehensive and standard measurement tool that evaluates to measure workplace violence in healthcare settings. With this scale, future studies will be able to determine the type of violence (physical/verbal) that patients and their relatives use against healthcare professionals, how often healthcare professionals are exposed to violence, and how they, their families and social circles are affected physically and psychologically by the violence they experience (psychologically and socially). In addition, the results from the sections of the scale that ask about the risk factors for violence, the reasons why violence is not legally reported, and the practices used to prevent violence can guide health and legal policy makers.

Workplace Bullying and Coping Strategies Among Portuguese Healthcare Professionals

Workplace bullying is a violent, devastating social phenomenon that affects professionals from various fields. The present study aimed to map the bullying behaviors suffered by Portuguese healthcare professionals in the workplace and the coping strategies they used. In this quantitative, cross-sectional, and correlational study, 208 Portuguese healthcare professionals participated by completing an online survey consisting of a sociodemographic questionnaire and two instruments, the Negative Acts Questionnaire-Revised and the Brief COPE. The association between sociodemographic characteristics and victimization, patterns of coping strategy frequency, and the relationship between negative work experiences and coping strategies were analyzed. It was found that only 35 participants self-identified as victims of bullying, and there was no association between victimization and any sociodemographic characteristics. However, it was observed that nurses are more frequently victims of bullying than doctors. Regarding coping strategies, participants on average used more planning and active coping. Moreover, women more frequently used social and emotional support as a coping strategy. Additionally, an association was observed between negative work experiences and coping strategies, with a higher frequency of coping strategies among those who reported more negative experiences. Finally, victims of workplace bullying reported higher use of coping strategies such as venting, distraction, and behavioral disengagement. The results are discussed based on the empirical literature on the topic, and they support reflection on the practical and scientific implications of research on workplace violence, emphasize the potential benefits of our research beyond the individual level, highlight how it could inform policies, improve institutional practices, and foster a healthier work environment for healthcare professionals.

Exploring the Impact of Workplace Violence in Urban Emergency Departments: A Qualitative Study

Background: Workplace violence (WPV) in healthcare, particularly in emergency departments (EDs), is a growing and complex issue that significantly impacts healthcare providers (HCPs). Following the COVID-19 pandemic, the rates of WPV have increased globally, contributing to increased burnout, reduced morale, and heightened challenges in staff retention within EDs. Objective: This study aimed to explore HCPs' perspectives on WPV in EDs. The insights gathered were intended to inform targeted interventions in a quality improvement initiative focused on addressing WPV in our healthcare institutions. Methods: A qualitative study involving semi-structured interviews was conducted with 52 HCPs across two urban EDs at a multi-site academic health center. Participants from various roles and shifts shared experiences related to safety, leadership, training, and security. Interviews were recorded, transcribed, anonymized, and thematically analyzed to identify key themes surrounding WPV in EDs. Results: The thematic analysis identified four main themes, including (1) Violence is Part of the Job, (2) Leadership Dynamics regarding WPV, (3) Disconnect Among ED Staff During WPV Response, and (4) Enhancing Systems and Culture for Effective WPV Management. These themes provide a comprehensive view of HCPs' experiences and offer actionable recommendations for healthcare organizations seeking to address WPV. Conclusions: The study provides valuable qualitative insights into WPV in EDs, emphasizing the importance of addressing cultural, structural, and procedural gaps. These findings can guide the development of more supportive and effective strategies to create a safer environment for ED staff. Further rounds of interviews are planned post-intervention to assess changes in HCPs' perceptions and experiences.

Workplace violence experiences of intensive care unit healthcare providers: a qualitative systematic review and meta--synthesis

OBJECTIVE

Workplace violence (WPV) in intensive care units (ICUs) is a prevalent issue that affects staff well-being and patient care. Although individual studies have explored various facets of WPV, there is a need for a comprehensive synthesis to provide a cohesive understanding of the phenomenon and inform effective interventions. This study aimed to understand its impact on the mental health and work status of ICU staff, identify the coping strategies used by ICU staff to manage WPV and explore the support required by healthcare professionals when facing WPV.

METHODS

A systematic literature search was conducted in PubMed, Scopus, Medline, PsycINFO, and Web of Science from the date of inception until June 5, 2024. Only qualitative studies or the qualitative part of mixed methods studies were included in the analysis, with no restrictions on the type of ICU or type or source of violence. This study assessed the risk of bias in the included studies and synthesized the results according to the guidelines of the Joanna Briggs Institute (2024).

RESULTS

Six studies were included. These studies, which were published between 2018 and 2023, were conducted in four countries and involved 91 participants. Six analytical themes and 17 subthemes emerged from the qualitative data. The themes were as follows: Prevalence of ICUs Violence, ICU healthcare perceptions of WPV, The Ripple Effect of WPV in ICU, Practical Strategies for ICU Staff Dealing with WPV, What they need when facing WPV, and Reasons for Not Reporting WPV.

CONCLUSIONS

The synthesized findings highlight the pervasive nature of WPV in ICUs and its profound impact on staff members. This review underscores the need for systematic interventions, including comprehensive training, accessible psychological support, and robust reporting mechanisms, to mitigate the effects of WPV.

OTHER

This study was funded by the Wu Jieping Medical Foundation(320.6750.18526),China. The review protocol was prospectively registered in the Prospective Register of PROSPERO (CRD42024559076).

RELEVANCE TO CLINICAL PRACTICE

The research findings can provide important evidence for hospital managers and policymakers, helping them develop more effective workplace management policies to enhance the safety and well-being of ICU staff.

Pupils' aggressive behaviour towards teachers: identifying protective factors at organizational level examined in a follow-up study

BACKGROUND

Teacher's exposure to pupils' aggressive behaviour is an international phenomenon that requires more attention. This study examined if organizational prevention measures are associated with decreased risk of pupils' aggressive behaviour.

METHOD

94 public schools in Denmark participated. Questionnaire data about preventive measures at school level were collected in 2018 and outcome data about pupils' aggressive behaviour in form of harassment, threats and violence towards teachers were collected in 2019. In total, 1198 teachers participated in both rounds. The analyses were performed using multivariate logistic regressions with cluster adjusted standard errors to account for cluster effects.

RESULTS

The results were mixed. Violence prevention climate perceptions at the management level decreased the risk of pupils' aggressive behaviour, however when adjusting for baseline harassment, threats, and violence the associations became statistically insignificant. Violence prevention climate perceptions at co-worker level statistically significant decreased the risk of pupils' aggressive behaviour in form of violence even when adjusted for baseline violence. Practice and procedures statistically significantly decreased the risk of harassment. The results for conflict management training were mixed, while supervision in case of challenging pupils decreased the risk of harassment, threats, and violence, but none of the associations were statistically significant. Finally, the registration of threats and violence statistically significantly increased the risk of threats and violence at follow-up.

CONCLUSION

This study shows that implementing organizational prevention measures in public schools may reduce the risk of pupils' aggressive behaviour towards teachers. It is, therefore, recommended to implement organizational prevention measures in public schools to reduce the risk of pupils' aggressive behaviour towards teachers.

Creation of a Novel Virtual Reality Simulation to Increase Nursing Skills in Management of Workplace Violence

OBJECTIVE

This article presents the design, development, and implementation of a novel and innovative virtual reality (VR) simulation aimed at increasing nursing skills in identifying, managing, and deescalating workplace violence (WPV) incidents and mitigating the effects after critical incidents.

BACKGROUND

The ANA reports that 1 in 4 nurses in the United States experience workplace assault annually, highlighting the novel role of VR simulations in educating and preparing nurses to recognize, address, and minimize the impact of WPV.

METHODS

A multidisciplinary team designed and implemented a VR simulation based on real WPV incidents reported by nurses in an urban health system, enlisting a film and video company's expertise to bring scenarios to life, addressing a critical gap.

CONCLUSIONS

This article discusses the collaborative creation of simulations using VR as a novel strategy for educating nurses on identification, management, and deescalation of incidents of WPV and mitigating the effects of WPV after critical incidents.

Why are Turkish nurses migrating? A mixed-methods study

AIM

This study aimed to identify the factors influencing nurses' migration patterns in Turkey.

BACKGROUND

The flow of nurse migration from developing countries to developed countries is steadily increasing. As a result, countries that are sources of migration tend to develop domestic inequities with respect to the population's ability to access health services. In particular, fragile economic conditions and the pandemic triggered the migration of nurses from Turkey, a developing country.

METHODS

This study employed a mixed-method explanatory sequential design and was conducted in Turkey between April and November 2022. The decision to migrate was the focus of both the quantitative aspect, involving 237 participants, and the qualitative aspect, with 20 participants. Quantitative data were gathered through a questionnaire, and qualitative data were obtained using open-ended questions during in-depth individual interviews. We followed the Strengthening the Reporting of Observational Studies in Epidemiology checklist in the quantitative phase and the Consolidated Criteria for Reporting Qualitative Research checklist in the qualitative phase. Descriptive statistics and thematic analyses were used to analyze the data.

RESULTS

In the quantitative stage of the study, nurses' reasons for deciding to migrate were identified as economic conditions, working conditions, society's outlook on the profession, political factors, and professional growth opportunities. In the qualitative stage, four major themes influencing nurse migration patterns emerged: devaluation and poor collegiality in nursing; inadequate management support; negative work environment; and health, social, and economic policies.

CONCLUSION

The results of the study showed that the three factors most influential in the decision to migrate were economic issues, a negative work environment, and political climate.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

In developing countries, there is an urgent need for nurse administrators and health workforce decision-makers to create healthy working conditions and manage resources efficiently, focusing on improving nurses' economic situations while developing appropriate nationwide and international strategies.

Finding the paths between job demand-resources and turnover intention of community mental health nurses in Korea

AIM

This study aimed to investigate the pathways between client violence, supervision, workplace spirituality, burnout, work engagement, and turnover intention in community mental health nurses using the job demand-resources model with the goal of reducing turnover and improving workforce retention.

BACKGROUND

High turnover of nurses has a negative impact on the rehabilitation and recovery of people with mental illness. While individual factors influencing turnover intention are well studied, there is a lack of research on the dynamics between variables and what should be focused on.

METHODS

Participants were 243 mental health nurses working in the community health organizations. Data were collected through online questionnaires in April 2022 and analyzed using path analysis.

RESULTS

Client violence against nurses as a job demand directly and indirectly negatively affected turnover intention through burnout. Supervision as a job resource only directly decreased turnover intention without mediating factors. Workplace spirituality as a personal resource indirectly lowered turnover intention through work engagement.

CONCLUSION

We need to focus more on organizational issues first, such as workplace safety (client violence) and administrative support (supervision) related to the nurses' turnover intention, and then on individual issues (workplace spirituality).

IMPLICATIONS FOR NURSING PRACTICE

The worst path (client violence to burnout) to accelerate turnover intention of the nurses must be managed and disconnected, while the best path (from workplace spirituality to work engagement) to lower turnover intention should be maintained.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Policymakers should extend Workplace Safety Legislation to community organizations less well-served by the laws and incorporate supervision into organizational evaluation items and curricula. Collaboration between community organizations and law enforcement is essential to enhance safety and support for the nurses.

Understanding and measuring workplace violence in healthcare: a Canadian systematic framework to address a global healthcare phenomenon

BACKGROUND

Globally, healthcare institutions have seen a marked rise in workplace violence (WPV), especially since the Covid-19 pandemic began, affecting primarily acute care and emergency departments (EDs). At the University Health Network (UHN) in Toronto, Canada, WPV incidents in EDs jumped 169% from 0.43 to 1.15 events per 1000 visits (p < 0.0001). In response, UHN launched a comprehensive, systems-based quality improvement (QI) project to ameliorate WPV. This study details the development of the project's design and key takeaways, with a focus on presenting trauma-informed strategies for addressing WPV in healthcare through the lens of health systems innovation.

METHODS

Our multi-intervention QI initiative was guided by the Systems Engineering Initiative for Patient Safety (SEIPS) 3.0 framework. We utilized the SEIPS 101 tools to aid in crafting each QI intervention.

RESULTS

Using the SEIPS 3.0 framework and SEIPS 101 tools, we gained a comprehensive understanding of organizational processes, patient experiences, and the needs of HCPs and patient-facing staff at UHN. This information allowed us to identify areas for improvement and develop a large-scale QI initiative comprising 12 distinct subprojects to address WPV at UHN.

CONCLUSIONS

Our QI team successfully developed a comprehensive QI project tailored to our organization's needs. To support healthcare institutions in addressing WPV, we created a 12-step framework designed to assist in developing a systemic QI approach tailored to their unique requirements. This framework offers actionable strategies for addressing WPV in healthcare settings, derived from the successes and challenges encountered during our QI project. By applying a systems-based approach that incorporates trauma-informed strategies and fosters a culture of mutual respect, institutions can develop strategies to minimize WPV and promote a safer work environment for patients, families, staff, and HCPs.

Workplace Violence Against Primary Care Physicians in Chengdu, China: A Cross-sectional Survey

BACKGROUND

The purpose of this study is to examine workplace violence (WPV) toward primary care physicians (PCPs), including prevalence, associated factors, impacts, and response to WPV in Chengdu, China.

METHODS

We used an online cross-sectional design to collect data from October to November 2022 with a structured self-administered questionnaire from a purposive sample of 568 PCPs in Chengdu city.

RESULTS

Among the 490 valid questionnaires, 44.3% of respondents reported at least encountered 1 type of WPV in the preceding year, with 38.0% experiencing emotional abuse, 24.5% threats, 9.8% experiencing physical assault, 5.5% verbal sexual harassment, and 1.6% sexual abuse. The common perpetrators of WPV were patients (81.6%) and their relatives (44.2%). A multilevel analysis showed that PCPs without night shift had lower odds of experiencing WPV (odds ratios [OR] = 0.461, 95% confidence interval [CI] = 0.299-0.700, P = .0004), while higher education levels were associated with increased odds (OR = 1.835, 95% CI = 1.126-3.005, P = .015). The common reasons of causing WPV perceived by PCPs were "rejected unreasonable demands" (81.6%), "unmet the expectations" (51.2%), and "waiting too long" (47.9%). In response to WPV, 80.6% of PCPs had communicated positively with patients, 61.8% informed superiors, and 23.5% called security guards/police officers, but still 10.6% took no action. Most respondents (82.9%) did not receive training on how to deal with WPV. After experiencing WPV, PCPs reported low work efficiency (56.2%), decreased patient trust (32.7%), and anxious feelings (32.7%).

CONCLUSIONS

This study revealed a moderate prevalence of violence against PCPs in primary care settings. Most PCPs lack coping strategies to handle WPV and suffer many negative effects. It is imperative that PCPs receive formal training in WPV management, and our study provides evidence to support such training programs.

Effectiveness of an e-book in enhancing knowledge, coping behaviors and preventive strategies for sexual harassment prevention among new nurses: A randomized controlled study

AIM

To evaluate the effectiveness of an interactive e-book in improving new nurses' knowledge, coping behaviors and preventive strategies for sexual harassment prevention, while also assessing its impact on learning motivation.

BACKGROUND

Sexual harassment has a detrimental effect on nurses' physical and mental well-being, as well as on patient safety, with new nurses being particularly vulnerable.

DESIGN

A single centre, randomized controlled study.

METHODS

The study included 102 new nurses with less than 6 months of experience, recruited from a medical center in Taiwan. Participants were randomly assigned to the intervention group (e-book, n = 51) or the control group (video and manual, n = 51). Scales assessing sexual harassment prevention knowledge, coping behaviors, prevention strategies and learning motivation were used at baseline (T1), post-course (T2) and 2 weeks after the course (T3).

RESULTS

Baseline measurements were similar between groups. The intervention group had significantly higher scores in prevention knowledge, strategies and learning motivation (p = 0.001; p = 0.05; p < 0.001) compared with the control group, though coping behavior scores were not statistically different (p = 0.228). Group and time effects were significant at T3 for prevention knowledge (p = 0.039), strategies (p = 0.042) and learning motivation (p < 0.001).

CONCLUSIONS

The e-book may enhance new nurses' knowledge and learning motivation for sexual harassment prevention, offering potential advantages over video/manual-based methods. Incorporating interactive e-books into nurse training programs could improve the effectiveness of sexual harassment prevention education.

TRIAL REGISTRATION

This study was registered at the Clinical Research Information Service (NCT04139720.) on 30 January 2020 and the participant recruitment was initiated in 11 April 2020.

A longitudinal study of healthcare workers' mental health during Western Australia's unique policy response to COVID-19

BACKGROUND

Western Australia's response to the COVID-19 pandemic was swift and effective in implementing public health protections and preventing the spread of the virus for the first 2 years. However, healthcare staff continued to be at increased risk of mental health concerns.

AIMS

To investigate the longitudinal patterns of post-traumatic stress symptoms (PTSS), depression and anxiety among healthcare workers in Western Australia, and the risk and protective factors associated with changes in status during the first wave.

METHOD

Participants comprised 183 healthcare staff working at tertiary hospitals and major clinics across Perth, for whom longitudinal data were available. Questionnaire data were collected before Western Australia's first major COVID-19 community wave in early 2022 and following the first wave in late 2022. Online surveys comprised validated measures assessing psychological symptoms, risk and protective factors, and original measures of workplace factors.

RESULTS

Overall rates of PTSS, depression and anxiety remained stable across the two assessment points. However, latent growth models revealed that those with lower PTSS, depression or anxiety symptoms at baseline reported a larger increase in symptoms over time, and those with higher symptoms at baseline had a smaller decline over time, indicating a 'catch-up' effect. Workplace stressors, sleep difficulties and trauma exposure were key risk factors for changes in psychological symptoms from baseline, and workplace and social supports played protective roles.

CONCLUSIONS

Improvements in systemic workplace factors are needed to support healthcare workers' mental health during periods of acute stress, even in settings with high levels of emergency preparedness.

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

AIMS

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

METHODS

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

RESULTS

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

CONCLUSION

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

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

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

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Medical and surgical nurses' experiences of modifying and implementing contextually suitable Safewards interventions into medical and surgical hospital wards

AIM

To explore general nurses' experiences of modifying and implementing contextually suitable Safewards interventions into medical and surgical hospital wards.

DESIGN

Qualitative action research was used working with nurses as co-researchers.

METHODS

Pre-implementation focus groups were conducted in April 2022 to understand and explore the current strategies nurses utilized to avert, respond to or decrease violence. Following this, two Safewards interventions were modified by the nurses on the wards. Post-implementation focus groups were conducted in October 2022, to explore the nurses' experience of implementing Safewards interventions and the effect on their nursing practice. Data were analysed using Braun and Clarke's framework for thematic analysis.

RESULTS

Three themes emerged from the analysis of the pre-implementation focus groups that reflected the type of violence experienced by these nurses and the context within which they occurred: 'the space is hectic'; 'it can feel like a battlefield'; and 'the aftermath'. These themes encompass the nurses' experience of violence from patients and their visitors. Following the implementation of two modified Safewards interventions, the analysis of the focus groups reflected a change in nursing skills to avert or respond to violence: 'Safewards in action'; 'empathy and self-reflection'; and 'moving forward'.

CONCLUSION

Safewards interventions can be successfully modified and used in general hospital wards and influence nursing practice to manage patient and visitor violence.

IMPLICATIONS FOR THE PROFESSION

In the interests of safety, successful interventions to reduce violence towards general hospital nurses should be a priority for managers and healthcare organizations. Averting, mitigating and managing violence can decrease the negative professional and personal effect on nurses and ultimately improve well-being, job satisfaction and retention rates. Furthermore, decreasing violence or aggressive incidents leads to a safer patient experience and decreased number of nursing errors ultimately improving patient experiences and outcomes. Understanding nurses' experiences of violence and working with them to explore and develop contextually relevant solutions increases their capacity to respond to and avert violent incidents. Contextually modified Safewards interventions offer one such solution and potentially has wider implications for healthcare settings beyond the specific wards studied.

IMPACT

This study addressed the implementation of modified Safewards strategies in medical and surgical wards to prevent violence. Three themes emerged from the analysis of the pre-implementation focus groups that reflected the type of violence experienced by these nurses and the context within which they occurred. Following the implementation of two modified Safewards interventions, the post-implementation focus groups reported positive changes to their practices using the modified resources to prevent violence from patients and their visitors. Mental health interventions, such as those used in the Safewards model can be modified and provide a tool kit of interventions that can be used by medical and surgical nurses.

REPORTING METHOD

This paper has adhered to the COREQ guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: This paper outlines and discusses the action research approach undertaken to work with general hospital nurses to modify mental health nurses' Safewards interventions into their clinical practice. This paper provides evidence of the 'real world' application of Safewards interventions by medical and surgical nurses in general hospital wards. This paper presents qualitative findings based on focus group methods to highlight the narratives of general nurses and their experiences of violence.

Workplace Violence and Worker Well-Being: A Preliminary Cross-Sectional Study

PURPOSE

To investigate the prevalence of workplace violence (WPV) in home health care and long-term care facilities (LTCFs) and explore the relationship between WPV and worker well-being.

METHOD

A cross-sectional survey was conducted with health care workers in an agency that provided care in homes or LTCFs. Six measures of worker well-being were collected: satisfaction with work and life, work-related rumination, work/family conflict, burnout, and turnover intention. Surveys also assessed type and frequency of WPV.

RESULTS

Seventeen participants completed surveys. Verbal abuse by patients was the most often experienced type of WPV. Employees who reported experiencing WPV had higher burnout and lower satisfaction with work and life.

CONCLUSION

WPV routinely occurs in home health care and LTCFs and appears to be related to worker well-being. Facility managers who can control WPV will likely impact the well-being of employees. [Journal of Gerontological Nursing, 50(11), 44-52.].

Workplace Violence Pervasiveness in the Perioperative Environment: A Multiprofessional Survey

BACKGROUND

Workplace violence in health care has gained attention with its rising incidence and its impact on patient safety and clinician well-being. Legal and regulatory organizational requirements related to workplace violence are broadening, including updated Joint Commission standards. Although workplace violence surveys have been administered across health care settings, the few that have focused on the perioperative environment have predominantly been single-profession surveys.

METHODS

This cross-sectional, prospective survey focused on perioperative care was conducted by the Anesthesia Patient Safety Foundation using simultaneous convenience sampling across professional societies representing anesthesiologist assistants, certified registered nurse anesthetists, physicians, and registered nurses. Descriptive statistics were used to summarize responses, and multivariable regression was used to model the odds of experiencing or witnessing physical or nonphysical workplace violence. Open-text entries were analyzed using thematic analysis.

RESULTS

Of 4,662 survey respondents, 3,645 (78.2%) reported some form of workplace violence: 1,446 (31.0%) experienced physical workplace violence, 1,718 (36.9%) witnessed physical workplace violence, and 3,226 (69.2%) experienced nonphysical workplace violence. Fewer than half (49.8%) of the respondents experiencing physical workplace violence and fewer than one third (31.4%) of the respondents experiencing nonphysical workplace violence felt that the "situation was addressed and resolved to their satisfaction."

CONCLUSION

Workplace violence is commonplace and reported by all perioperative professionals. There is a pressing need for actions at multiple levels to respond to and eventually eliminate perioperative workplace violence, preventing harm to both patients and staff.

Realist synthesis of a rapid response system in managing mental state deterioration in acute hospital settings

Mental state deterioration in patients poses significant challenges in healthcare, potentially resulting in adverse outcomes for patients and continued reliance on restrictive interventions. Implementing evidence-based approaches such as a rapid response system that prioritises early identification and intervention can effectively manage adverse outcomes. However, little is known regarding the effectiveness of these interventions. The objective of this synthesis was to test and refine initial programme theories by synthesising evidence to understand what works, for whom and under what circumstances. Based on the realist synthesis methodology, we searched EMBASE, CINAHL, MEDLINE, the Cochrane Library and grey literature for evidence to inform contexts, mechanisms and outcomes on the functioning of a rapid response model. We identified 28 relevant sources encompassing peer-reviewed journal articles and grey literature. This synthesis identified three important elements that contribute to the effectiveness of a rapid response system for managing mental state deterioration: care processes, therapeutic practices and organisational support. Essential elements include improving confidence and clinical skills through training, timely assessment and intervention, teamwork, communication and the creation of governance structures for monitoring and evaluation. To ensure the effectiveness, an organisation must adopt a comprehensive approach that incorporates organisational support, resource allocation, training, clear communication channels and commitment to continuous quality improvement. However, implementing interventions within a complex healthcare system requires thoughtful consideration of the organisational culture and governance structures. By taking a comprehensive and holistic approach to improvement initiatives, organisations can strive to achieve optimal outcomes in managing mental state deterioration and improving patient care.

Training Nurses in Trauma-Informed Care to Address Workplace Violence in Inpatient Settings

BACKGROUND

Frontline workers in psychiatric facilities are exposed to considerable risks of verbal and physical assaults, with 40% to 65% of mental health nurses experiencing violence in the workplace. The goal of this pilot study was to assess the readiness and motivation for adopting trauma-informed care (TIC) to address workplace violence in an acute care psychiatric hospital.

METHOD

A pre-post quality improvement study was conducted in two pilot units of a 274-bed acute care psychiatric hospital, involving a discussion-based seminar and a practical exercise. Surveys assessed participants' readiness and motivation posttraining.

RESULTS

Sixty-eight staff members completed part 1 training, with 63 (92.6%) reporting being prepared to use TIC principles afterward. All 14 staff members (100%) who completed part 1 and part 2 training reported being motivated to apply the TIC model after the intervention.

CONCLUSION

The results show that TIC training may impact self-reported strategies for reducing workplace violence. Education in trauma-informed care may prove to be beneficial in providing nurses with the necessary skills to effectively implement TIC principles in their daily practices. [J Contin Educ Nurs. 2024;55(10):472-478.].

The Role of Virtual Simulation in De-Escalating a Patient Demonstrating Escalating Behavior

BACKGROUND

Undergraduate nursing students are unprepared to manage patients demonstrating escalating aggressive behavior encountered during their clinical placements. Confidence and competence surrounding de-escalation skills can be achieved through virtual simulated learning opportunities. This study evaluated undergraduate nursing students' perceptions of confidence and success in their de-escalation skills following a virtual simulation intervention.

METHOD

A quantitative, one-group pretestposttest design was used to complete this study. Students (n = 33) completed a 10-question demographic questionnaire with four additional questions on participants' psychosocial well-being considering the pandemic, and a nine-question pre- and postvirtual simulation de-escalation confidence and knowledge survey.

RESULTS

Virtual simulation had positive effects on participants' feelings of confidence and success. Male students and students who reported Caucasian as their ethnicity were the most comfortable with de-escalating behaviors.

CONCLUSION

These findings emphasize the effectiveness of de-escalation education. [J Nurs Educ. 2024;63(10):698-702.].

Critical soft skill competencies that clinical nurse educators consider important to evaluate in nurses

AIM

Guided by Benner's framework, From Novice to Expert, this study aimed to identify (1) critical soft skills to be evaluated in nurses and (2) levels of nursing behaviour indicating achievement of soft skills to provide a framework for developing a soft skills rubric.

BACKGROUND/INTRODUCTION

Nurse shortages are often attributable to high turnover rates among nurses. To improve this situation, healthcare facilities implement transition programmes and continuing education with a primary focus on developing and maintaining nurses' knowledge and performance (hard skills). However, balancing hard and soft skills (beliefs, values and attitudes) is key to nurses' quality of care and ultimately to their retention. Despite the importance of soft skills, their intangible nature creates problems in evaluating nurses' attainment of these skills and in providing constructive feedback to help them set concrete goals for improving their practice.

METHODS

This qualitative descriptive study described critical soft skills in the nursing context. A purposeful sampling strategy was used to enrol 13 clinical nurse educators from multiple hospital units; each had more than 2 years of clinical nurse educator experience and had completed preceptor training. One-to-one interviews with these individuals were audio recorded, transcribed and subjected to direct content analysis using NVivo 12. The study follows the Consolidated criteria for reporting qualitative research (COREQ) guidelines for qualitative studies.

FINDINGS

Five main competencies, comprising 20 subcompetencies, were identified: personal growth, effective interactions, professionalism, teamwork and the caring role. For each subcompetency, four skill levels were delineated using clinical indicators.

CONCLUSION

This study's findings can enhance understanding of clinical nurse educators' perceptions regarding soft skills required of nurses.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

The soft skills identified can be incorporated into a rubric to be used by clinical nurse educators to evaluate and guide nurses' professional development and contribute to improving quality of care. No patient or public contribution is required for this study.

Exploring client violence during home visits: a qualitative study of perceptions and experiences of Israeli nurses

BACKGROUND

Home care provides an excellent opportunity for personalizing treatment as nurses see patients in their natural environment. Along with its many advantages, the home care environment carries unique risks, as nurses are usually alone, without the protection and security provided by primary care clinics. There are no accurate data in Israel on the scope and characteristics of client violence against nurses during home visits. We conducted a qualitative study to investigate the nature of client violence faced by Israeli nurses during home visits, to gain insights into their perceptions and experiences, and to contribute to the development of effective policies and strategies to combat client violence in the healthcare sector.

METHODS

Twenty-seven female nurses from primary care clinics, who were exposed to client violence during a home visit, were interviewed using a semi-structured interview guide. The interviews were transcribed and analyzed, and categories and themes were extracted.

RESULTS

Most nurses interviewed experienced at least three incidents of client violence, the most common of which was verbal abuse. The nurses perceived that the location of the encounter between the nurse and the patient in the patient's natural surroundings, rather than within the controlled boundaries of a clinic, contributes to the risk of violence. Violence affected the nurses' professional decisions. The nurses reported that their organization had no established guidelines or instructions for safely conducting home visits, they were not provided with protective or security measures for emergencies, nor did they perceive that they had sufficient training to deal with client violence in clients' homes.

CONCLUSIONS

Nurses encounter a range of challenges that make it difficult for them to deal with client violence during home visits, affecting their personal safety and professional decisions. Their ability to manage such situations is shaped by a complex interplay of personal and organizational factors and requires a range of strategies and resources to effectively address them.

Italian Version of the Hospital Aggressive Behaviour Scale-Users: Initial Psychometric Evaluation among Hospital Healthcare Professionals

BACKGROUND

Healthcare professionals frequently encounter various forms of aggression, ranging from verbal abuse to physical assaults, which can compromise both their occupational well-being and patient-care quality. Despite its prevalence and serious consequences, workplace aggression is often underreported due to a lack of standardized assessment tools. This study aims to develop a valid Italian version of the Hospital Aggressive Behaviour Scale-Users.

METHODS

The scale's structure was evaluated using exploratory (EFA) and confirmatory (CFA) factor analyses on two samples of healthcare professionals during and after the pandemic. Reliability, measurement invariance, and nomological validity were examined.

RESULTS

EFA revealed a two-factor structure comprising eight items (χ2 = 59.651, df = 13, p = 0.00; CFI = 0.98; TLI = 0.95; RMSEA = 0.07; SRMR = 0.02), distinguishing non-physical and physical aggression, and meeting all recommended criteria. CFA confirmed this structure, demonstrating good reliability and outperforming alternative models. The same factor structure was confirmed in standard (χ2 = 35.01, df = 19, p = 0.00; CFI = 0.99; TLI = 0.99; RMSEA = 0.03; SRMR = 0.02) and emergency (χ2 = 30.65, df = 19, p = 0.04; CFI = 0.98; TLI = 0.97; RMSEA = 0.06; SRMR = 0.04) contexts. Full residual invariance was found across job tenure groups. Aggression was positively associated with emotional exhaustion, psychological distance, psychosomatic symptoms, post-traumatic stress symptoms, and turnover intentions while negatively related to job satisfaction. Nurses and healthcare assistants reported higher levels of aggression than doctors.

CONCLUSIONS

This study provides a reliable, context-specific instrument for documenting and analysing outsider aggression. The insights can inform targeted interventions, contributing to a healthier hospital environment.

Modifiable work stress factors and psychological health risk among nurses working within 13 countries

INTRODUCTION

Nurses are identified as having higher work stress and poor mental health risk among health care workforce globally. It remains unclear which modifiable stress factors pose the greatest risk for poor psychological health among nursing workforce and needed to inform targeted practice and policy change. To determine which occupation-related or personal stress factors precipitate higher risk for burnout, depression, anxiety, job satisfaction or intention to leave one's position among nurses globally.

DESIGN

A cross-sectional anonymous survey was administered via email using a snowball recruitment strategy.

METHODS

Academic researchers and clinical industry leaders across 3 global regions collaborated to generate an email listserv of professional nursing contacts for survey distribution. The survey included valid and reliable measures to scale stress factors (Work Stress Questionnaire), and screen for burnout (single item), depression (Patient Health Questionnaire-2), anxiety (Generalized Anxiety Disorder-2), resilience (Brief Resilience Scale) and intention to leave one's job (single item). We used logistic regression, first unadjusted and then adjusted for personal and professional characteristics, to determine associations between stress factors and psychological health risk.

RESULTS

The final sample consisted of responses from 2864 nurses working across 13 countries. Most respondents reported working as a clinical nurse in the Philippines (n = 2275), United States (n = 424) and Saudi Arabia (n = 104). One third of nursing respondents endorsed high burnout and intention to leave their job. Those reporting work conflict had significantly higher odds of burnout (odds ratio 3.18; 95% CI 2.22-4.54) and three times more likely to screen positive for depression (odds ratio 3.02; 95% CI 1.36-6.72) and anxiety (odds ratio 2.92; 95% CI 1.57-5.43). Those endorsing difficulty sleeping were 15 times more likely to screen positive for depression (odds ratio 15.63; 95% CI 2.09-117.06). Lack of social support was significantly associated to higher risk for burnout, job dissatisfaction, depression, anxiety, and intention to leave one's position.

CONCLUSIONS

Nurses remain at risk for burnout and poor psychological health stemming from work stress. Factors such as clear workplace goals and assignments, increased engagement, good sleep health and social support may serve as protective factors against suboptimal psychological health, and in-turn poor workforce retention.

CLINICAL RELEVANCE

Nurses reporting conflict in the workplace are three times more likely to screen positive for burnout, depression, and anxiety. Nurses reporting difficulty sleeping are 15 times more likely to screen positive for depression. Several modifiable factors can be targeted to reduce poor psychological health and high workforce turnover among nurses across countries.

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

BACKGROUND

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

OBJECTIVES

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

DATA SOURCES

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

ELIGIBILITY CRITERIA

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

METHOD

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

RESULTS

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

CONCLUSION

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

PROSPERO REGISTRATION NUMBER

CRD42022329574.

Developing a customised set of evidence-based quality indicators for measuring workplace violence towards healthcare workers: a modified Delphi method

BACKGROUND

Workplace violence (WPV) is a complex global challenge in healthcare that can only be addressed through a quality improvement initiative composed of a complex intervention. However, multiple WPV-specific quality indicators are required to effectively monitor WPV and demonstrate an intervention's impact. This study aims to determine a set of quality indicators capable of effectively monitoring WPV in healthcare.

METHODS

This study used a modified Delphi process to systematically arrive at an expert consensus on relevant WPV quality indicators at a large, multisite academic health science centre in Toronto, Canada. The expert panel consisted of 30 stakeholders from the University Health Network (UHN) and its affiliates. Relevant literature-based quality indicators which had been identified through a rapid review were categorised according to the Donabedian model and presented to experts for two consecutive Delphi rounds.

RESULTS

87 distinct quality indicators identified through the rapid review process were assessed by our expert panel. The surveys received an average response rate of 83.1% in the first round and 96.7% in the second round. From the initial set of 87 quality indicators, our expert panel arrived at a consensus on 17 indicators including 7 structure, 6 process and 4 outcome indicators. A WPV dashboard was created to provide real-time data on each of these indicators.

CONCLUSIONS

Using a modified Delphi methodology, a set of quality indicators validated by expert opinion was identified measuring WPV specific to UHN. The indicators identified in this study were found to be operationalisable at UHN and will provide longitudinal quality monitoring. They will inform data visualisation and dissemination tools which will impact organisational decision-making in real time.

In-Hospital Violence and Its Impact on Critical Care Practitioners

OBJECTIVES

To provide a narrative review of hospital violence (HV) and its impact on critical care clinicians.

DATA SOURCES

Detailed search strategy using PubMed and OVID Medline for English language articles describing HV, risk factors, precipitating events, consequences, and mitigation strategies.

STUDY SELECTION

Studies that specifically addressed HV involving critical care medicine clinicians or their practice settings were selected. The time frame was limited to the last 15 years to enhance relevance to current practice.

DATA EXTRACTION

Relevant descriptions or studies were reviewed, and abstracted data were parsed by setting, clinician type, location, social media events, impact, outcomes, and responses (agency, facility, health system, individual).

DATA SYNTHESIS

HV is globally prevalent, especially in complex care environments, and correlates with a variety of factors including ICU stay duration, conflict, and has recently expanded to out-of-hospital occurrences; online violence as well as stalking is increasingly prevalent. An overlap with violent extremism and terrorism that impacts healthcare facilities and clinicians is similarly relevant. A number of approaches can reduce HV occurrence including, most notably, conflict management training, communication initiatives, and visitor flow and access management practices. Rescue training for HV occurrences seems prudent.

CONCLUSIONS

HV is a global problem that impacts clinicians and imperils patient care. Specific initiatives to reduce HV drivers include individual training and system-wide adaptations. Future methods to identify potential perpetrators may leverage machine learning/augmented intelligence approaches.

Relational skill training for patient engagement and the creation of a trauma-informed critical care

Patients and families in critical care have a high likelihood of previous and re-experienced trauma. Unaddressed, physical, and psychological impacts of these traumas can worsen outcomes for patients and families. A trauma-informed care approach has been proposed for critical care; however, training programs do not include relational competencies or de-escalation techniques, risking the re-traumatization of patients and families in critical care and negatively impacting clinicians. This article describes a strategy that can be adopted by critical care teams towards the creation of a trauma-informed critical care unit including the use of a framework for relational training. Principles of relationship management and de-escalation are discussed with the use of a fictional exemplar scenario. Key messages include a call to action for relational training for care teams to enhance skilled relational engagement of patients and families. This article also highlights the foundational importance of policies supporting a trauma-informed approach in critical care.

Nursing faculty members' response to bullying in the eyes of their students: A pilot study in Pangasinan

BACKGROUND

Bullying is a pervasive issue that can occur in any setting, including among nursing students and within the nursing profession. Faculty members have a vital role in resolving bullying.

OBJECTIVES

To examine the nursing faculty members' responses to incidents of bullying within two nursing institutions in Pangasinan.

DESIGN

Descriptive- comparative design.

SETTINGS

Two Colleges of Nursing in a city in Pangasinan, Philippines.

PARTICIPANTS

Nursing students from first to fourth year BS Nursing students.

METHODS

An online survey was the main tool in this study, Lynch formula was utilized to calculate the sample size. There are 458 nursing students who participated in this study. Frequency, percentage, mean, standard deviation, one-way ANOVA, and t-test were used to analyze the data.

RESULTS

It was revealed that faculty members sometimes address bullying by group discussion (M = 3.26, SD = 1.27), and they almost never utilized non-intervention in bullying (M = 2.33, SD = 0.85). There is a variation in terms of group discussion with a one-way ANOVA score of F (2, 455) = 3.22, p = 0.04, when faculty members are grouped according to their degrees. Regarding the difference between the faculty members' responses to bullying when grouped according to gender, there is a significant difference between male and female for mediation (t(457) = 2.10, p = 0.04), group discussion (t(457) = 2.79, p = 0.01), victim support (t(457) = 2.54, p = 0.01), and disciplinary methods (t(457) = 2.66, p = 0.01).

CONCLUSION

The study emphasizes the complex nature of tackling bullying among nursing students. It highlights the efficacy of several solutions used by faculty members, such as group discussions, mediation, victim assistance, and disciplinary measures. The findings indicate that a comprehensive understanding of the dynamics involved in addressing bullying is necessary. This understanding highlights the significance of a cooperative and compassionate strategy that includes all individuals involved in the educational setting. It is clear that a standardized approach may not be enough, and customized techniques that take into account the particular circumstances and requirements of the persons involved are essential.

Impact of Workplace Bullying on Nursing Care Quality: A Comprehensive Review

Workplace bullying, commonly known as mobbing, persists as a significant problem across various industries, including the healthcare sector. To establish effective interventions and protocols for enhancing the well-being of healthcare workers and patients, it is vital to fully grasp the link between workplace bullying and the quality of nursing care. The analysis highlights the complex link between workplace bullying and nursing care quality, stressing the urgency of addressing this issue due to its wide-reaching impact on individuals and healthcare organizations, ultimately affecting patient safety. Emphasizing the significance of addressing workplace bullying across different professional settings is crucial for protecting the mental health and well-being of employees. The research identifies various forms of aggression and emphasizes the need to understand how these behaviors affect patient outcomes. Further investigation is needed to clarify nurses' responses to workplace violence, particularly in specialized settings like mental health facilities. The studies underscore the numerous challenges nurses encounter when trying to report incidents of workplace bullying. This insight is vital for developing effective reporting mechanisms and targeted interventions to combat bullying behaviors in medical environments. Ultimately, establishing a safer working environment for nurses is paramount. This article aims to review the associations between workplace bullying and the quality of nursing care.

Exposure of Pharmacists and Pharmacy Technicians to Violence in Community Pharmacies in Southeast Europe: Frequency and Ethical Considerations

Pharmacists and pharmacy technicians working in community pharmacies are exposed to the risk of violence in their workplaces. Studies have shown that workplace violence is affecting their job satisfaction, productivity, and mental health. This study aims to identify the frequency of different types of violence, as well as the common perpetrators that community pharmacy staff in SEE (Southeast Europe) are dealing with. A cross-sectional study was conducted using an online questionnaire created for this purpose. Selected community pharmacies in Croatia, Serbia, Bosnia and Herzegovina, and Montenegro participated in this study. In total, 732 responses were collected from 24 pharmacy chains or independent pharmacies including all community pharmacy staff. More than 80% of pharmacists and pharmacy technicians reported having been exposed to verbal violence at the workplace, while more than 20% of them reported physical and sexual violence in the preceding 12 months. There were no statistically significant differences between pharmacists and pharmacy technicians, gender, age groups, or countries in relation to exposure to physical, verbal, and sexual violence. The most common perpetrators were identified as patients/clients. More than 90% of pharmacy staff reported they did not receive any kind of support from their employer nor any other help after experiencing a robbery. There is a need for a structured approach to addressing violence in pharmacies including organized support for pharmacy staff. Achieving quality patient care, despite dealing with violent individuals or situations daily, is one of the greatest ethical challenges for healthcare providers in community pharmacies to be empowered.

Experiences of healthcare workers who faced physical workplace violence from patients or their relatives in Nepal: a qualitative study

Abstract

Introduction

Workplace violence (WPV) against healthcare workers (HCWs) has become a global concern. Our aim was to investigate the firsthand experience of HCWs who faced physical WPV from patients or their relatives in Nepal and to identify the factors that contribute to WPV, its consequences, as well as recommendations from HCWs on preventing and managing WPV in healthcare settings.

Methods

We conducted semistructured in-depth interviews of 12 HCWs who faced physical WPV from patients or their relatives in the last 2 years in Nepal. We recruited participants by announcing volunteer participation on social media and reaching out to HCWs who had experienced WPV through a review of national news archives. All interviews were conducted between September and November 2022. We analysed the data using a hybrid thematic analysis.

Results

Most participants were male (9/12). The average age of participants was 31.6 years with an average experience of 8.3 years. We generated three domains: (1) factors contributing to WPV, (2) response to WPV and (3) recommendations. Within these three domains, we identified a total of nine themes: two themes (proximal and distal factors) under domain 1, four themes (personal response, hospital administration response, police response and other responses) under domain 2 and three themes (recommendations at personal, organisational and policy level) under domain 3. We found that physical WPV against HCWs is multifactorial. Most HCWs did not receive expected support from hospital and police administration. They had a wide range of recommendations at personal, organisational and policy level. The most important recommendation was to ensure safety and security of HCWs.

Conclusions

This qualitative study showed that experiences of HCWs who faced physical WPV in Nepal were traumatic. The concerned stakeholders should carefully consider the recommendations from HCWs to establish a safe, secure and supportive working environment.

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

AIMS

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

DESIGN

Descriptive qualitative study.

METHODS

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

RESULTS

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

CONCLUSIONS

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

IMPLICATIONS FOR THE PROFESSION

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

REPORTING METHOD

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

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Behavioral skills training for teaching safety skills to mental health service providers compared to training-as-usual: a pragmatic randomized control trial

BACKGROUND

Violence in the healthcare workplace has been a global concern for over two decades, with a high prevalence of violence towards healthcare workers reported. Workplace violence has become a healthcare quality indicator and embedded in quality improvement initiatives of many healthcare organizations. The Centre for Addiction and Mental Health (CAMH), Canada's largest mental health hospital, provides all clinical staff with mandated staff safety training for self-protection and team-control skills. These skills are to be used as a last resort when a patient is at imminent risk of harm to self or others. The purpose of this study is to compare the effectiveness of two training methods of this mandated staff safety training for workplace violence in a large psychiatric hospital setting.

METHODS

Using a pragmatic randomized control trial design, this study compares two approaches to teaching safety skills CAMH's training-as-usual (TAU) using the 3D approach (description, demonstration and doing) and behavioural skills training (BST), from the field of applied behaviour analysis, using instruction, modeling, practice and feedback loop. Staff were assessed on three outcome measures (competency, mastery and confidence), across three time points: before training (baseline), immediately after training (post-training) and one month later (follow-up). This study was registered with the ISRCTN registry on 06/09/2023 (ISRCTN18133140).

RESULTS

With a sample size of 99 new staff, results indicate that BST was significantly better than TAU in improving observed performance of self-protection and team-control skills. Both methods were associated with improved skills and confidence. However, there was a decrease in skill performance levels at the one-month follow-up for both methods, with BST remaining higher than TAU scores across all three time points. The impact of training improved staff confidence in both training methods and remained high across all three time points.

CONCLUSIONS

The study findings suggest that BST is more effective than TAU in improving safety skills among healthcare workers. However, the retention of skills over time remains a concern, and therefore a single training session without on-the-job-feedback or booster sessions based on objective assessments of skill may not be sufficient. Further research is needed to confirm and expand upon these findings in different settings.

A participatory and comprehensive intervention to improve violence prevention in two high-risk occupations: effect and process evaluation of a stepped wedge cluster randomised trial

BACKGROUND

Work-related violence committed by clients, patients, and customers represents a major occupational health risk for employees that needs to be reduced.

METHODS

We tested a comprehensive violence prevention intervention involving active participation of both employees and managers in the Prison and Probation Service (PPS) and on psychiatric wards in Denmark. We used a stepped wedge cluster randomised controlled trial design. We measured the degree of implementation of the intervention by registration of fidelity, reach, and dose and used a mixed-effects regression analysis to estimate the effects of the intervention.

RESULTS

We recruited 16 work units for the intervention, but three work units dropped out. The average implementation rate was 73%. In the psychiatric wards, the intervention led to statistically significant improvements in the primary outcome (an increase in the degree to which managers and employees continuously work on violence prevention practices based on their registration and experiences), but none statistically significant improvements in any of the secondary outcomes. In the PPS units, the intervention did not lead to a statistically significant improvement in the primary outcome, but to statistically significant improvements in three secondary outcomes.

CONCLUSION

Most work units were able to carry out the intervention as planned. The intervention showed mixed results regarding the primary outcome. Nevertheless, the results indicate improvements also in the sector where a change in the primary outcome was not achieved. The results point at that a participatory and comprehensive approach could be a viable way of working with violence prevention in high-risk workplaces.

TRIAL REGISTRATION

ISRCTN86993466: 20/12/2017.

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.

The Neuman Systems Model: A Framework for Aggression and Violence Prevention

Aggression and violence influence nurse-client relationships and the quality of care provided, and just as important, they also influence the nurses' physical and emotional well-being. The Neuman systems model is utilized to define and understand factors that contribute to aggressive and violent behavior and for the purposes of providing a systematic approach to the prevention and management of stressors leading to aggression and violence.

Exposure to patient aggression and health outcomes for forensic mental health nurses: A cross-sectional survey

AIMS

The aims of the study were to determine the types and prevalence of forensic mental health nurse exposure to patient aggression and explore the impact of these exposures on their physical and mental health and work absences.

DESIGN

Cross-sectional survey conducted January to April 2020.

METHODS

All 205 nurses working in an Australian high-security inpatient forensic mental health hospital were invited to participate. An online survey included the Perception of Prevalence of Aggression Scale to measure respondent exposure to types of patient aggression, and the SF-36v2 to measure mental and physical health. Absence from work and other work and individual characteristics were also explored.

RESULTS

Sixty-eight respondents completed the survey. Verbal abuse was the most experienced aggression type, followed by physical violence and observing violence, patient self-harming behaviours and sexual violence. Nurses who worked in acute units experienced significantly more exposure to overall aggression than nurses in non-acute units. Higher level of aggression was associated with number of days sick leave taken and days off due to aggression or violence. Higher level of aggression was associated with poorer mental health, and patient self-harming behaviour was associated with poorer physical health.

CONCLUSIONS

Nurses in acute units experience higher levels of inpatient aggression and are therefore at increased risk of being impacted by the exposure. Findings indicate a psychological impact of exposure to frequent aggression and potential for an accumulative effect of exposure to traumatic events on nurse well-being. Nurses who are victim of, or witness, physical violence are most likely to take time off work.

IMPACT

This study provides further evidence that forensic mental health nurses are frequently exposed to various forms of patient aggression. For some nurses, this exposure to patient aggression negatively impacted their mental and physical health. Employing organizations should therefore prioritize provision of formal support for nurses. No patient or public contribution.

The Prevalence of Type II Workplace Violence in US Nurses 2000 to 2022: A Meta-Analysis

BACKGROUND

Physical violence against nurses is a concern in the United States; however, its prevalence is not well quantified.

OBJECTIVE

We sought to describe the prevalence of workplace violence against nurses in the United States over a 22-year period.

METHODS

A meta-analysis was performed following a literature search of English texts through Scopus, CINAHL Plus, and Ovid MEDLINE. Inclusion criteria included the following: (1) primary reports of workplace violence incidents in the United States against nurses, (2) perpetrator was a patient, family member, or visitor, and (3) publications between January 1, 2000, and June 21, 2022. Reports where prevalence rates for nurses could not be calculated were excluded. Study quality was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology checklist.

RESULTS

Thirty-seven studies met the inclusion criteria; 27 030 nurses were included. The pooled prevalence of workplace violence was 0.35 (95% confidence interval [CI]: 0.29-0.42; Q = 3189.40; I2 = 98.87). Pooled rates of workplace violence increased from 30% in 2000 to 2004 to 43% in 2020 to 2022; however, the overlapping CIs indicate that the increase may not be statistically significant. The mean prevalence of reported workplace violence among nurses who work in the emergency department, in corrections, and psychiatric mental health settings (pooled prevalence = 0.59, 95% CI: 0.46-0.71) was higher than that of nurses who worked in all other settings (pooled prevalence = 0.24, 95% CI: 0.18-0.30).

CONCLUSIONS

Workplace violence is a significant and potentially increasing problem for nurses in the United States. This critical problem requires an effective response from nurse policymakers.

Violence against nurses by patients and visitors in the emergency department: An integrative review

AIM

This integrative review explored violence against emergency nurses by patients/visitors, examining its nature, contributing factors and consequences.

DESIGN

Integrative review.

DATA SOURCES

Articles were obtained from PubMed, CINAHL, EMBASE, Web of Science and PsycInfo databases, up until December 2021.

REVIEW METHODS

26 articles were reviewed, evaluating study quality with the Crowe Critical Appraisal Tool and synthesizing conclusions through theme development and coding.

RESULTS

This review delves into the issue of violence perpetrated against emergency nurses by patients and visitors. It elucidates three overarching themes: the nature of violence, the contributing factors and the consequences of such acts.

CONCLUSION

The findings inform healthcare policy for the development of prevention approaches while identifying research gaps and emphasizing the need for alternative study designs and methodologies.

IMPACT

This review has implications for nursing practice, policymaking and research, emphasizing the need for stakeholder engagement and tailored interventions for at-risk emergency nurses.

NO PATIENT OR PUBLIC CONTRIBUTION

This project was an integrative review of the literature therefore no patient or public contribution was necessary.

WHAT ALREADY IS KNOWN

Violence by patients and visitors in healthcare settings, especially in emergency departments, has garnered considerable attention.

WHAT THIS PAPER ADDS

This review specifically examines violence-targeting emergency department nurses from patients and visitors, assessing its characteristics, contributing factors and consequences.

IMPLICATIONS FOR PRACTICE/POLICY

The findings will guide stakeholder engagement in developing interventions to support vulnerable emergency nurses.

Realist synthesis protocol on the effectiveness of a rapid response system in managing mental state deterioration in acute hospital settings

INTRODUCTION

Patient mental state deterioration impacts patient outcomes, staff and increases costs for healthcare organisations. Mental state is broadly defined to include not only mental health but a broad range of cognitive, emotional and psychological well-being factors. Mental state deterioration is inconsistently identified and managed within acute and tertiary medical settings. This protocol aims to synthesise the evidence to test and refine initial programme theories that outline the functioning of a rapid response system.

METHODS AND ANALYSIS

This synthesis will be guided by Pawson's key steps in realist reviews. We will clarify the scope of synthesis through an initial literature search, focusing on understanding the functioning of rapid response system in managing patients presenting with mental state deterioration in acute hospital settings. Initial programme theories will be refined by developing a search strategy to comprehensively search electronic databases for relevant English language peer-reviewed studies. Additionally, we will search the grey literature for sources to supplement theory testing. An abstraction form will be developed to record the characteristics of literature sources. We will use spreadsheets to code and report contextual factors, underlying mechanisms, and outcome configurations.

ETHICS AND DISSEMINATION

As this study is a realist synthesis protocol, ethics approval is not required. Synthesis findings will be published in a peer-reviewed journal and presented at scientific conferences.