Organizational Determinants of Workplace Violence Against Hospital Workers

Development and Psychometric Evaluation of the Thriving in Nursing Questionnaire (THINQ)

AIM

To develop and evaluate a questionnaire for measuring factors that contribute to thriving at work among nurses.

DESIGN

A cross-sectional study.

METHODS

An online questionnaire was administered in March 2024 to nurses in a community teaching hospital in Michigan, US. Questionnaire content was based on a literature search and was pilot tested among nursing professionals within the hospital system. Questionnaire factor structure was examined with exploratory and confirmatory factor analyses with split-half sample validation.

RESULTS

Based on exploratory and confirmatory factor analysis, a three-factor solution presented the best model, with factors comprised of 15 items measuring individual resources (3 items), work resources (6 items) and interpersonal aspects of the nursing work environment (6 items). Reliability estimates for all three factors exceeded 0.80, indicating good internal homogeneity. The questionnaire also demonstrated acceptable split-half validity and reliability.

CONCLUSION

The questionnaire presented here provides a potentially useful tool for measuring and evaluating thriving at work among nurses.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

A better understanding of factors that enhance nurse thriving would lay the foundation for targeted interventions aimed at improving the nursing work environment and nurse well-being. Enhancing nurse thriving could have a potentially positive impact on patient care.

IMPACT

This study addressed the need to understand factors that contribute to thriving in nursing work. The questionnaire that was developed revealed a three-factor solution measuring individual nurse resources, work environment resources and work interpersonal resources. By measuring thriving among nurses, hospitals and other healthcare organisations are taking an important first step in identifying interventions to enhance the nursing work environment, nurse well-being and potentially the quality of patient care.

REPORTING METHOD

We followed the STROBE checklist in reporting this study. No patient or public contribution.

Staff and Work Environment Factors Associated With Workplace Violence in Hospitals: Comparison of Units With High Versus Low Rates of Violence

OBJECTIVE

This study examined healthcare worker perceptions of physical environment and safety climate contributors to workplace violence.

METHODS

Inpatient hospital employee (2015) convenience sample survey ( n = 327) comparisons were via Mann-Whitney, Wilcoxon rank sum, or chi-squared to determine response differences by workplace violence experience (yes/no) and hospital units (higher/lower) violence rates.

RESULTS

Employees with workplace violence experience and units with higher violence rates identified a higher number of contributing physical environment factors. Safety climate ratings were higher among employees without workplace violence experience but did not differ between hospital units with higher and lower violence rates.

CONCLUSIONS

Prioritization of staff perceived climate safety and physical environment contributors can support organizational efforts to mitigate specific workplace violence hazards on hospital units.

Thematic Analysis of Mental Health Nurses' Views of Contributing Factors Fueling Workplace Violence in Psychiatric Hospitals: Insights From Unsung Soldiers

BACKGROUND

Workplace violence against mental health nurses is an international phenomenon that sparks concerns for nurses' safety and mental health. This phenomenon has recently arisen as a crucial concern in the Middle East as it has become pervasive and has negative implications, causing nurses to accumulate psychological and emotional distress. However, no research has yet investigated the contributing factors of this phenomenon in Jordanian psychiatric hospitals from the nurses' perspectives.

AIMS

This study aimed to explore the factors contributing to workplace violence in Jordanian psychiatric hospitals from the perspective of mental health nurses.

METHODS

An exploratory, qualitative design was utilized. Using audio-recorded, semi-structured, face-to-face interviews, a purposive sample of 24 mental health nurses were interviewed to collect data. Thematic analysis was used to analyze the data.

RESULTS

Four overarching themes were identified: Peak Time of Violence, Unavoidable Part of the Job, Poor Organization and Lack of Policy, and Bite the Bullet.

CONCLUSION

From nurses' perspectives, an in-depth understanding of factors contributing to workplace violence provides a foundation for developing preventive interventions, improving work environment safety, and promoting nurses' mental health. Prevention strategies and further studies are warranted to limit this phenomenon.

Workplace violence, work-related exhaustion, and workplace cognitive failure among nurses: A cross-sectional study

AIM

To examine the relationships between nurses' exposure to workplace violence and self-reports of workplace cognitive failure.

DESIGN

A cross-sectional study.

METHODS

An online questionnaire was administered in April 2023 to nurses in Michigan, US. Structural equation modelling was used to examine effects of physical and non-physical workplace violence (occupational stressors) and work efficiency and competence development (occupational protective factors) on workplace cognitive failure.

RESULTS

Physical violence was a significant predictor of the action subscale of cognitive failure. There were no direct effects of non-physical violence, workplace efficiency, or competence development on any of the workplace cognitive failure dimensions. Both types of violence and efficiency had significant indirect effects on workplace cognitive failure via work-related exhaustion. Work-related exhaustion predicted significantly higher scores for workplace cognitive failure.

CONCLUSION

Workplace violence and work efficiency exhibited primarily indirect effects on workplace cognitive failure among nurses via work-related exhaustion.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Nurses experiencing workplace violence may be at increased risk for workplace cognitive failure, especially if they are also experiencing work-related exhaustion. Workplaces that nurses perceive as more efficient can help to mitigate the effects of violence on nurses' cognitive failure.

IMPACT

This study addressed the possible effects of workplace violence as well as work efficiency and competence development on nurses' cognitive failure at work. Analyses revealed primarily indirect effects of workplace violence, and indirect protective effects of work efficiency, on nurses' cognitive failure via work-related exhaustion. This research has implications for healthcare organizations and suggests that efforts made by healthcare workplaces to prevent violence and work-related exhaustion, and to enhance work efficiency, may help to mitigate workplace cognitive failure among nurses.

REPORTING METHOD

We have followed the STROBE checklist in reporting this study.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or public contribution.

Haddon matrix model: Application to workplace violence in a hospital setting

The aim of this study was to identify hospital-based workplace violence (WPV) risk factors with the Haddon Matrix Model (HMM) to determine its potential utility to conceptualize multiple risks for WPV events. This descriptive study utilized two independent convenience samples Data from behavioral emergencies (2014-2015) for patient violence (N = 192) and from health care staff (N = 380) 12-month violence survey responses (2015) in a Midwestern academic hospital were analyzed. Logistic regression examined patient features associated with physical violence. Survey questions pertained to employee, environment, and cultural factors associated with WPV; responses were examined with Chi-square and two-sample t-tests. Violence risk factors populated the 4 Haddon Matrix domains at pre-event time frames as Host (worker)-age/demographics, Agent (patient)-age/gender, Physical Environment-door/window structure, and Social Environment-worker safety. Risks at event time frames populated for Agent-behavior/delirium, and Physical Environment-event medication/patient identification. The Haddon Matrix identification of hospital violence risks indicates its utility as a comprehensive approach to workplace violence.

How Do Algorithmic Management Practices Affect Workforce Well-Being? A Parallel Moderated Mediation Model

Modern workplaces increasingly use algorithmic management practices (AMPs), which shape task assignment, monitoring, and evaluation. Despite the potential benefits these practices offer, like increased efficiency and objectivity, their impact on workforce well-being (WFW) has raised concerns. Drawing on self-determination theory (SDT) and conservation of resources theory (COR), this study examines the relationship between algorithmic management practices and workforce well-being, incorporating job burnout (JBO) and perceived threat (PT) as parallel mediators and person-job fit (PJF) as a moderator. The research employed a cross-sectional survey design targeting 2450 KOSGEB-registered manufacturing SMEs in Istanbul, Turkey. A sample of 666 respondents participated, and the data were analyzed using Smart PLS 4, employing structural equation modeling to test the proposed model. The results indicated that algorithmic management practices significantly increased job burnout and perceived threat, both of which negatively impacted workforce well-being. However, the direct effect of algorithmic management practices on workforce well-being was non-significant. Person-job fit moderated the relationships between algorithmic management practices and both job burnout and perceived threat, further influencing workforce well-being. The findings underscore the critical need for organizations to balance algorithmic efficiency with human-centric practices. Prioritizing person-job fit and fostering transparency in algorithmic processes can mitigate negative impacts, enhance employee well-being, and drive sustainable organizational success in the digital age.

Insider versus outsider workplace mistreatment and their impact on affective ill-being in healthcare professionals: Can personal resources act as buffers?

AIMS

Workplace stress can negatively impact healthcare providers' professionalism and quality of care. One source of workplace stress is the experience of workplace mistreatment. Drawing on the Job Demands-Resources theory, this study aimed to (a) investigate the impact of mistreatment frequency experienced by healthcare workers from insider sources (i.e. co-workers, supervisors) and outsider sources (i.e. patients, visitors) on affective ill-being and (b) the potential moderating role of trait resilience and trait self-efficacy, as personal resources, in the mistreatment-ill-being relationship.

DESIGN

Lagged design.

METHODS

We collected data from 153 Irish healthcare workers between January 2018 and June 2019 via three surveys, separated by 1-week intervals. Personal resources were measured at Time 1, frequency of mistreatment from the two sources was assessed at Time 2 and affective ill-being was assessed at Time 3. We used moderated regression analyses to evaluate the association of mistreatment frequency from the two sources and affective ill-being and the moderating effect of personal resources.

RESULTS

Only insider mistreatment frequency was positively related to affective ill-being. Furthermore, the positive impact of insider mistreatment on affective ill-being was moderated by self-efficacy (but not by trait resilience). In contrast to our expectations, the relationship was stronger at high levels compared to low levels of self-efficacy.

CONCLUSION

Mistreatment from co-workers and supervisors is linked to higher levels of affective ill-being. Additionally, healthcare workers with high self-efficacy were more vulnerable to the negative consequences of co-worker and supervisor mistreatment as it impacted their affective ill-being.

IMPACT

These findings extend the literature on workplace mistreatment by integrating insider and outsider perpetrators of mistreatment and examining their differential impact on the employees' affective ill-being. It also highlights mistreatment from organizational insiders as a significant factor in the relationship between mistreatment and affective ill-being.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL COMMUNITY?: The findings underscore the detrimental impact of workplace mistreatment on the well-being of healthcare professionals. The study findings of higher frequency of insider mistreatment being associated with increased affective ill-being call for action, with line managers and supervisors being critical to achieving respective changes in healthcare workers' environment. The findings have implications for policymakers interested in developing a framework to support healthcare professionals in addressing workplace mistreatment, enabling them to effectively fulfil their role as care providers.

Violence in the healthcare workplace

PURPOSE OF REVIEW

Healthcare workers experience a disproportionate frequency of workplace violence. Identifying commonalities among incidents of workplace violence provides an opportunity for change to prevent and mitigate future violence.

RECENT FINDINGS

Despite a continued decline in overall workplace violence, the rate of violence in the healthcare sector is steadily rising. While healthcare workers make up 13% of the workforce, they experience 60% of all workplace assaults. Environmental, structural, and staffing issues may all contribute to the increased rates of workplace violence affecting healthcare workers.

SUMMARY

Comprehensive proactive workplace violence prevention programs can significantly reduce the frequency of violence and the negative impact on employees and institutions. Analyzing the factors that contribute to violence in the healthcare workplace provides the potential to mitigate these risks and reduce episodes of violence.

Association of school neighbourhood socioeconomic disadvantage and teaching staff's risk of violence at work

AIM

The aim of this study was to determine the association between neighbourhood socioeconomic disadvantage and teaching staff's risk of workplace violence and whether workplace psychosocial resources can act as effect modifiers.

METHODS

Primary school teaching staff in the six largest cities in Finland responded to a survey in 2018 and were linked to information on school neighbourhood disadvantage obtained from the national grid database (n = 3984).

RESULTS

After adjustment for confounders, staff working in schools located in the most disadvantaged neighbourhoods had a 1.2-fold (95% confidence interval 1.07-1.35) risk of encountering violence or threat of violence compared with staff working in the most advantaged neighbourhoods. The association was less marked in schools with strong support from colleagues (risk ratio 1.14, 95% confidence interval (95% CI) 0.98-1.32 for high support versus 1.23, 95% CI 1.07-1.43 for low/intermediate support), a strong culture of collaboration (1.08, 95% CI 0.93-1.26 versus 1.31, 95% CI 1.12-1.53), high leadership quality (1.12, 95% CI 0.96-1.31 versus 1.29, 95% CI 1.08-1.54), and high organizational justice (1.09, 95% CI 0.91-1.32 versus 1.29, 95% CI 1.09-1.52).

CONCLUSIONS

The association between school neighbourhood and teaching staff's risk of violence was weaker in schools with high workplace psychosocial resources, suggesting that targeting these factors might help in minimizing violence at schools, but future intervention studies are needed to confirm or refute this hypothesis.

Factors influencing the development of nursing professionalism: a descriptive qualitative study

BACKGROUND

The shortage of nurses threatens the entire healthcare system, and nursing professionalism can improve nurse retention and enhance the quality of care. However, nursing professionalism is dynamic, and the factors influencing its development are not fully understood.

METHODS

A qualitative descriptive study was conducted. Using maximum variation and purposive sampling, 14 southern and northern China participants were recruited. Semi-structured interviews were conducted from May 2022 to August 2023 in face-to-face conversations in offices in the workplace or via voice calls. The interviews were transcribed verbatim and analyzed via thematic analysis.

RESULTS

Three main themes emerged: (1) nourishment factors: promoting early sprouting; (2) growth factors: the power of self-activation and overcoming challenges; and (3) rootedness factors: stability and upward momentum. Participants described the early acquisition of nursing professionalism as derived from personality traits, family upbringing, and school professional education, promoting the growth of nursing professionalism through self-activation and overcoming challenges, and maintaining the stable and upward development of nursing professionalism through an upward atmosphere and external motivation.

CONCLUSION

We revealed the dynamic factors that influence the development of nursing professionalism, including "nourishment factors", "growth factors", and "rootedness factors". Our findings provide a foundation for future development of nursing professionalism cultivation strategies. Nursing administrators can guide the development of nurses' professionalism from many angles according to the stage they are in, and the development of professionalism deserves more attention. In the future, we can no longer consider the development of nursing professionalism solely as the responsibility of individual nurses; the power of families, organizations, and society is indispensable to jointly promoting nursing professionalism among nurses.

Association of quality of nursing care with violence load, burnout, and listening climate

BACKGROUND

Violence against nurses is common. Previous research has recommended further development of the measurement of violence against nurses and integration of the individual and ward-related factors that contribute to violence against hospital nurses. This study was designed to address these issues by investigating the associations between violence, the listening climate of hospital wards, professional burnout, and perceived quality of care. For this purpose, we used a new operationalization of the violence concept.

METHODS

We sought nurses to participate in the study through social media which yielded 765 nurses working in various healthcare systems across Israel who volunteered to complete a self-administered online questionnaire. 80% of the sample were hospital nurses, and 84.7% were female. The questionnaire included validated measures of burnout, listening climate, and quality of care. Instead of using the traditional binary measure of exposure to violence to capture the occurrence and comprehensive impact of violence, this study measured the incremental load of violence to which nurses are subjected.

RESULTS

There were significant correlations between violence load and perceived quality of care and between constructive and destructive listening climates and quality of care. Violence load contributed 14% to the variance of burnout and 13% to the variance of perceived quality of care. The ward listening climate moderated the relationship between burnout and quality of care.

CONCLUSIONS

The results of this study highlight the impact of violence load among nurses and the ward listening climate on the development of burnout and on providing quality care. The findings call upon policymakers to monitor violence load and allocate resources to foster supportive work environments to enhance nurse well-being and improve patient care outcomes.

Effects of Workplace Violence on Emotional Distress

The current study assessed the effects of workplace violence (WPV) and fear related to WPV on community mental health (CMH) workers' emotional distress. This cross-sectional study used structural equation modeling (SEM) and comprised participants who were CMH workers in Korea. We used WPV questionnaires and the Korean version of the Patient-Reported Outcomes Measurement Information System® item bank to evaluate emotional distress. SEM data from 763 workers revealed significant positive effects of WPV on anxiety (β = 0.23, p = 0.009) and anger (β = 0.26, p = 0.007), and significant positive effects of fear related to WPV on anxiety (β = 0.21, p = 0.004) and anger (β = 0.19, p = 0.002). Preventive measures significantly mediated the relationship between WPV and emotional distress and between fear related to WPV and emotional distress. Findings verified the relationship between WPV and workers' emotional distress and the mediating role of preventive measures. [Journal of Psychosocial Nursing and Mental Health Services, 62(4), 24-32.].

The Aggressive Incidents in Medical Settings (AIMS) Study: Advancing Measurement to Promote Prevention of Workplace Violence

BACKGROUND

Rates of aggressive events and workplace violence (WPV) exposure are often represented by proxy measures (restraint, incident, injury reports) in health care settings. Precise measurement of nurse and patient care assistant exposure rates to patient aggression on inpatient medical units in acute care hospitals advances knowledge, promoting WPV prevention and intervention.

METHODS

This prospective, multisite cohort study examined the incidence of patient and visitor aggressive events toward patient care staff on five inpatient medical units in a community hospital and an academic hospital setting in the northeastern United States. Data were collected with event counters, Aggressive Incident and Management Logs (AIM-Logs), and demographic forms over a 14-day period in early 2017.

RESULTS

Participants recorded a total of 179 aggressive events using event counters, resulting in a rate of 2.54 aggressive events per 20 patient-days. Patient verbal aggression rates (2.00 events per 20 patient-days) were higher compared to physical aggression rates (0.85 events per 20 patient-days). The staff aggression exposure rate was 1.17 events per 40 hours worked (verbal aggression exposure rate: 0.92 events per 40 hours; physical aggression exposure rate: 0.39 events per 40 hours). The most common precipitants included medication administration (18.6%), waiting for care (17.2%), and delivering food/drinks (15.9%). Most events were managed with verbal de-escalation (75.2%). The number of patients assigned to patient care staff was significantly greater during a shift when an aggressive event occurred compared to when no event occurred (6.3 vs. 5.7, t = -2.12, df = 201.6, p = 0.0348).

CONCLUSION

Event counters and AIM-Logs offer greater information about patterns of aggression and preventive interventions used and provide information on the need for debriefing and worker support after aggressive events. Additional studies of this methodology in other settings are needed to evaluate the value of this technology for improving worker and patient safety.

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.

A Qualitative Systematic Review of Healthcare Practitioners' Experience of Workplace Violence

Healthcare practitioners face significant risks of workplace violence due to various reasons such as hospital congestion, miscommunication, and aggressive behaviours of patients and relatives. Exposure to workplace violence may disrupt the workflow process and compromise patient care in healthcare facilities, ultimately affecting job performance, reducing job satisfaction, and negatively affecting the physical and mental health of healthcare practitioners. This study aimed to review all the published studies conducted on the experiences of workplace violence among healthcare practitioners. This study is a systematic review of qualitative studies. Data were collected through online databases including ScienceDirect, PubMed, MEDLINE and JSTOR were searched from the year 2015-2021. The inclusion criteria were: qualitative methods and mixed methods of data collection and analysis; studies that were carried out among healthcare practitioners who have been experience on workplace violence; scope of the primary studies included experience of workplace violence; and published in English/Malay in academic journal between 2015 and 2021. A total of 15 papers were included in the final analysis. The overall quality of the included papers was high. Of the 15 papers, 12 studies fully met the CASP criteria. The results of the 15 included studies were organised into the thematic groups of: i) verbal violence as the common workplace violence; ii) perceived causes of workplace violence and iii) seeking help. Across different countries, verbal violence was the most common type of workplace violence reported by healthcare practitioners. This review also identified that a lack of information, failure to meet patient expectations, and delayed treatment were the main contributing factors to workplace violence.

Consensus on relevant psychosocial interventions applied in health institutions to prevent psychological violence at work: Delphi method

OBJECTIVE

Studies on psychological violence in the workplace (PVW) in Latin America have focused on incidence values. In contrast, studies on preventive interventions (PIs) in the health sector are very limited. Our objective was to determine to what extent there is consensus on the most relevant characteristics of the psychosocial interventions applied in the prevention of PVW in health institutions in Peru. To that end, health professionals with knowledge and experience in PVW at the national level were recruited, and the Delphi consensus technique was applied.

RESULTS

The consensus study was developed in four stages that included three phases of Delphi consultation. In the third consultation phase, 428 experts participated in 25 analysis groups from 66 health institutions in the country. A total of 70.3% of the participants were women, and 27.6% of the participants worked in nursing and emergency services. After the Delphi consensus analysis, we obtained a list of 10 hierarchical psychosocial interventions to prevent PVW in the country. Most notable were interventions based on the prior resolution of interprofessional conflicts, on the visibility of incidents to generate an inverse effect and on experiential training to improve assertive and empathic communication skills.

Ethics of identity concordance requests in patient-clinician encounters

Systemic injustice has resulted in significant baseline inequality amongst populations according to gradients of privilege. What is the ethical approach to situations wherein equity may require differential treatment to correct for baseline disadvantages as a necessary means to its attainment? We explore this concept through the issue of patient requests for clinician identity concordance, when patients request a clinician who matches their race, ethnicity, or gender. Firstly, we discuss ethical grounds for refusing requests by exploring the balance between patient autonomy, a physician's obligation to not abandon one's patients, and the right of a clinician to be free from violence of any form. Next, we explore the ethics surrounding conditional acceptance through the frames of intent and clinical outcomes. We note the legacy of trauma experienced by marginalized patients at the hands of medicine and the abundance of data suggesting that identity concordance can mitigate disparities.

Workplace Violence Against Nurses: Challenges and Solutions for Europe

We report the results of a mapping exercise by the European Federation of Nurses (EFN) on challenges and solutions related to violence against nurses. This is an issue of growing international concern, with the problem accentuated during and following the COVID-19 pandemic. Following a cross-sectional observational design, an online questionnaire was distributed among 35 national nurses' associations across Europe in March 2021. Face validity was achieved through an expert panel. Descriptive statistics were used for data analysis, including counts, percentages, and tabulation. Qualitative data analysis followed thematic synthesis techniques. Three main findings are noted. First, violent incidents against nurses are under-reported due to fear of victimization, employer discouragement, and the perception that reporting will not make any difference. Second, perpetrators of violent acts extend beyond patients and families to include health professionals of different ranks. Third, violent incidences have a significant adverse effect on nurses' health and retention, leading to nurses reducing their working hours or opting for part-time work. Violence against nurses is an expression of a broader problem that is rooted in the failure to recognize and manage violence at the level of the healthcare organization, and the absence of appropriate legislation to maintain minimum standards of safe working environments. This is partly the result of inadequate European Union-wide legislation targeting workplace violence in the health professions. Nurses need more institutional support through dedicated funding aimed at targeted interventions, more legislative commitment to ratify policies against discrimination, and an opportunity to voice the needs to the appropriate policymakers with the ability to bring significant change to existing conditions. Given the severity of the situation, inaction could lead to irreplaceable damage to the nursing workforce, compounding pressures resulting from the COVID-19 pandemic. Ultimately, this situation can further drive existing nurses out of the profession, weakening health systems worldwide.

ViSHWaS: Violence Study of Healthcare Workers and Systems-a global survey

OBJECTIVE

To provide insights into the nature, risk factors, impact and existing measures for reporting and preventing violence in the healthcare system. The under-reporting of violence against healthcare workers (HCWs) globally highlights the need for increased public awareness and education.

METHODS

The Violence Study of Healthcare Workers and Systems study used a survey questionnaire created using Research Electronic Data Capture (REDCap) forms and distributed from 6 June to 9 August 2022. Logistic regression analysis evaluated violence predictors, including gender, age, years of experience, institution type, respondent profession and night shift frequency. A χ2 test was performed to determine the association between gender and different violence forms.

RESULTS

A total of 5405 responses from 79 countries were analysed. India, the USA and Venezuela were the top three contributors. Female respondents comprised 53%. The majority (45%) fell within the 26-35 age group. Medical students (21%), consultants (20%), residents/fellows (15%) and nurses (10%) constituted highest responders. Nearly 55% HCWs reported firsthand violence experience, and 16% reported violence against their colleagues. Perpetrators were identified as patients or family members in over 50% of cases, while supervisor-incited violence accounted for 16%. Around 80% stated that violence incidence either remained constant or increased during the COVID-19 pandemic. Among HCWs who experienced violence, 55% felt less motivated or more dissatisfied with their jobs afterward, and 25% expressed willingness to quit. Univariate analysis revealed that HCWs aged 26-65 years, nurses, physicians, ancillary staff, those working in public settings, with >1 year of experience, and frequent night shift workers were at significantly higher risk of experiencing violence. These results remained significant in multivariate analysis, except for the 55-65 age group, which lost statistical significance.

CONCLUSION

This global cross-sectional study highlights that a majority of HCWs have experienced violence, and the incidence either increased or remained the same during the COVID-19 pandemic. This has resulted in decreased job satisfaction.

Development and Validation of Questionnaires to Assess Workplace Violence Risk Factors (QAWRF): A Tripartite Perspective of Worksite-Specific Determinants in Healthcare Settings

Introduction

Workplace violence (WPV) incidences are prevalent in healthcare, and existing WPV interventions have only moderate evidence for effectiveness. This study aimed to develop and validate an instrument to assess worksite-specific WPV risk factors in healthcare settings based on a tripartite perspective of key stakeholders to facilitate improved interventions.

Methods

Three questionnaires were developed to get the responses from healthcare administrators, workers, and clients, representing the three components of Questionnaires to Assess Workplace Violence Risk Factors (QAWRF). The domains of the questionnaires were developed based on The Chappell and Di Martino's Interactive Model of Workplace Violence, and the items were generated from 28 studies identified from a systematic review of the literature. Six experts, 36 raters, and 90 respondents were recruited to assess the content validity, face validity, and usability and reliability of the QAWRF respectively. Item and Scale Level Content Validity Index, Item and Scale Level Face Validity Index, and Cronbach's alpha values were determined for QAWRF-administrator, QAWRF-worker, and QAWRF-client.

Results

The psychometric indices for QAWRF are satisfactory.

Conclusion

QAWRF holds good content validity, face validity, and reliability, and findings from QAWRF can contribute towards worksite-specific interventions that are expected to be resource efficient and more effective than general WPV interventions.

Understanding workplace violence against medical staff in China: a retrospective review of publicly available reports

BACKGROUND

Workplace violence against medical staff in China is a widespread problem that has negative impacts on medical service delivery. The study aimed to contribute to the prevention of workplace violence against medical staff in China by identifying patterns of workplace violence, key risk factors, and the interplay of risk factors that result in workplace violence.

METHODS

Ninety-seven publicly reported Chinese healthcare violent incidents from late 2013 to 2017 were retrospectively collected from the internet and analysed using content analysis. A modified socio-ecological model guided analysis of the violent incidents focusing on risk.

RESULTS

Physical violence, yinao, or a combination of physical and verbal violence were the typical forms of violence reported. The findings identified risk at all levels. Individual level risk factors included service users' unreasonable expectations, limited health literacy, mistrust towards medical staff, and inadequacy of medical staff's communication during the medical encounter. Organisational level risk factors under the purview of hospital management included problems with job design and service provision system, inadequacies with environmental design, security measures, and violence response mechanisms within hospitals. Societal level risk factors included lack of established medical dispute-handling mechanisms, problems in legislation, lack of trust and basic health literacy among service users. Situational level risks were contingent on risk factors on the other levels: individual, organisational, and societal.

CONCLUSIONS

Interventions at individual, situational, organisational, and societal levels are needed to systematically address workplace violence against medical staff in China. Specifically, improving health literacy can empower patients, increase trust in medical staff and lead to more positive user experiences. Organizational-level interventions include improving human resource management and service delivery systems, as well as providing training on de-escalation and violence response for medical staff. Addressing risks at the societal level through legislative changes and health reforms is also necessary to ensure medical staff safety and improve medical care in China.

Workplace Bullying among Healthcare Professionals: A Quanti-Qualitative Survey in a Sample of Women Working in an Italian Healthcare Setting

The main objective of this study was to analyze, in a sample of female healthcare workers in Italy, the training needs to improve positive relationships in the healthcare organization. To better understand these needs, perceived workplace bullying and its consequences in terms of professional commitment and well-being were analyzed from a descriptive and quantitative perspective (or mixed-methods analysis). A questionnaire was completed online in a healthcare facility in northwestern Italy. The participants were 231 female employees. The quantitative data showed that, on average, the sampled population perceived a low burden of WPB. The majority of the sample expressed moderate engagement at work and moderate perception of psychological well-being. It is interesting to note that one element seemed to be overarching in the responses to the open-ended questions: communication, which emerged as a problematic element that affects the entire organization. The research data provide useful evidence for intervention in favor of an environment that helps to recognize the phenomenon and intervene in time, offering the possibility of accepting the discomfort and fatigue of healthcare workers and offering useful interventions to the individual and the team.

Threats to professional dignity of Iranian clinical nurses: A qualitative study

AIM

Identifying threats to the nurses' professional dignity has an important role in maintaining and promoting their dignity. This study aimed to evaluate the perception of Iranian nurses' experiences of threats to their professional dignity in clinical settings.

DESIGN

A qualitative directed content analysis approach was used.

METHODS

The present qualitative study was conducted in Iran.Clinical nurses were selected using the purposive sampling method. Data were collected through in-depth semi-structured interviews with 15 clinical nurses from October 2020 to March 2021. The qualitative content analysis method was used to analyze the data.

RESULTS

Two main categories and 16 subcategories were extracted as follows: (1) professional factors (containing seven subcategories) and (2) organizational factors (containing nine subcategories).

CONCLUSIONS

To promote the professional dignity of nurses, it is recommended to identify the factors threatening their professional dignity and create healthy work environments for them.

Negative Acts as Risk Factor for Work-Related Violence and Threats from Clients towards Employees: A Follow-Up Study

BACKGROUND

Work-related violence and threats are major problems in many occupations, especially within the human service sector, with consequences at multiple levels, including reduced physical and mental health, increased absenteeism, and reduced organizational commitment. It is, therefore, crucial to identify risk factors for work-related violence and threats. However, only a few studies have examined whether negative acts at work increase the risk of work-related violence and threats from clients toward employees.

OBJECTIVE

To examine the associations between exposure to negative acts towards employees from colleagues, clients, or a combination of both, and the risk of work-related violence and threats perpetrated by clients towards employees in a longitudinal study.

METHODS

Questionnaire data were collected in 2010, 2011, and 2015. In total, 5333 employees from special schools, psychiatric wards, eldercare, and the Prison and Probation Services participated in the first round of data collection in 2010. Negative acts were measured in 2010 using the Short Negative Acts Questionnaire, while work-related threats and violence were measured at all three-time points. The analyses were performed using multilevel logistic regression.

RESULTS

Negative acts from clients and the combination of negative acts from both clients and colleagues were associated with later exposure to work-related violence and threats. The associations were observed after one year, and work-related threats were still present after four years.

CONCLUSION AND IMPLICATIONS

Negative acts are associated with an increased risk of work-related violence and threats perpetrated by clients toward employees. Organizations may reduce the risk of work-related violence and threats by preventing negative acts.

Professional Preparedness Implications of Workplace Violence against Medical Students in Hospitals: A Cross-Sectional Study

Workplace violence is an increasing public health concern around the world. In Vietnam, attacks on healthcare workers have become a huge issue in recent years. Our study aims to shed more light on the issue and look at what variables affect acts of violence toward healthcare workers. We conducted this cross-sectional study by surveying 550 medical students from 3 universities in Vietnam. Following this survey on SurveyMonkey's platform (surveymonkey.com), the participants were suggested to invite their associates who met the selection criteria to join in this online survey. The structured questionnaire included demographics and details on the violence. There were 90.5% of respondents were medical students, the mean age was 23.3, and verbal abuse had a prevalence rate of 29.3%. Women respondents are less likely to suffer from violent experiences than men (OR = 0.48, 95% CI = 0.28-0.84), and those specializing in nurse and technician also faced a lower rate of acts of aggression (physical violence: OR = 0.35; 95% CI = 0.19-0.63, sexual harassment: OR = 0.36; 95% CI = 0.15-0.87, and any type of violence: OR = 0.55, 95% CI = 0.37-0.82). Medical students working in Ho Chi Minh City (OR = 0.55; 95% CI = 0.34-0.89), and other regions (OR = 0.40; 95% CI = 0.19-0.85) were significantly less likely to face verbal abuse than those working in Hanoi. The workplace culture needs to be changed to make sure that people feel comfortable reporting, especially those who are younger. Protecting medical students also ensures patient safety since victims of assault in the workplace can have severe aftereffects affecting their ability to provide good patient care. Hence, policies need to be implemented at both the government and hospital administration levels to keep health workers safe.

Evaluation of general health, exposure to workplace violence, and predicting its consequences in health care employees in Iran

BACKGROUND

Workplace violence is an important event that affects the safety of healthcare employees, and diagnosing it in hospitals is an immediate occupational concern.

OBJECTIVE

The present study was conducted to investigate general health and the prevalence of occupational violence and to predict its consequences among nurses and paramedics as the main body in medical settings.

METHODS

This cross-sectional study was performed in 2020 in a selected hospital in Tehran, Iran. A total of 208 healthcare workers participated in the study. To study general health, exposure to workplace violence, job burnout, and productivity, the general health questionnaire (GHQ), the workplace violence questionnaire, the Maslach burnout questionnaire, and the workforce productivity questionnaire were provided to healthcare workers, respectively. Then, a multiple linear regression model was used to predict violence and its consequences.

RESULTS

The results revealed that 34.1% of the participants have psychological disorders, and 74.5% have experienced one type of violence in their workplace at least once during the past year. The multiple linear regression model results indicated that workplace violence prevalence proved the ability to predict the increase in burnout and decrease in job productivity.

CONCLUSION

Exposure to violence in the workplace significantly increases the risk of mental disorders associated with the risk of mental illness. Therefore, managing exposure to violence in the workplace is a practical step in improving general and mental health and ultimately increasing job productivity in medical settings.

Are Health Caregivers safe from workplace violence? A cross sectional study on workplace safety from Tertiary Care Hospital of Uttarakhand

Background: The prevalence of workplace violence in the healthcare sector is a problem that is frequently ignored and underreported. The performance of healthcare workers who have been the target of violence may suffer, which may have a negative effect on patient satisfaction and health. Aims & Objectives: The purpose of the current study was to determine the prevalence of workplace violence (WPV), risk factors for violence against healthcare workers, and their experiences regarding the same. Methodology: It was a cross-sectional study conducted on 157 hospital staff at Tertiary Care Medical College of Uttarakhand. Data was gathered using a semi-structured, self-administered questionnaire that was modified from the ILO, ICN, WHO, and PSI. Data were analyzed using SPSS software (version 20). Results: Factors like age, gender, job profile, lesser work experience, night shifts, and fewer staff on duty were found to have a positive association with workplace violence. It was observed that the majority of incidents took place in the ward, and the patient’s relatives were the attacker in most of the cases. It was also seen that the majority of Hospital staff did not get bothered by the incident except by staying super alert while dealing with other patients or their relatives. Conclusion: The study concludes that while caring for patients, Hospital staff are at risk of being victims of aggressive and violent situations. To reduce this problem, strategies like training staff in order to handle such incidents in the future should be brought into practice. Laws should be made stricter & assaulting staff on duty should be made a cognizable offense with serious consequences & heavy penalties. Also, the young budding MBBS students should be trained by incorporating these strategies, laws & policies in the CBME curriculum

Nonfatal Violence Involving Days Away From Work Following California's 2017 Workplace Violence Prevention in Health Care Safety Standard

Objectives. To examine the impact of the California Occupational Safety and Health Administration's (Cal/OSHA's) 2017 workplace violence (WPV) prevention in health care safety standard on nonfatal violent injuries among health care workers (HCWs). Methods. We accessed estimated counts of WPV from the survey of occupational injuries and illness from 2011 to 2019 specific to HCWs. We used the Current Population Survey estimates of HCWs to create rates per 10 000. We conducted a longitudinal panel analysis and a comparative interrupted time-series analysis to examine the change in incidence and in rates associated with California's new standard. Results. Adoption of the 2017 safety standard led to an additional 3.48 reported WPV injuries per 10 000 HCWs in California, or an additional 473 injuries. Sensitivity analyses suggest other injuries did not change in the same period. Conclusions. It appears that the Cal/OSHA standard increased reporting of WPV injuries among HCWs in the first year of its adoption compared with the United States. Mandating reporting of all WPV incidents in the health care setting may be a means to ensure a more complete understanding of this public health problem. (Am J Public Health. 2022;112(11):1668-1675. https://doi.org/10.2105/AJPH.2022.307029).

Factors associated with workplace violence among healthcare workers in an academic medical center

PURPOSE

We examined demographic, work-related, and behavioral factors associated with witnessing and/or experiencing workplace violence among healthcare workers.

DESIGN AND METHODS

Utilizing a correlational design, we analyzed the data to determine the associative factors related to workplace violence among the participants.

FINDINGS

More than half of the participants (54.5%) reported witnessing (23.8%) or experiencing (30.7%) workplace violence. There were significant differences between health provider groups in witnessing or experiencing workplace violence (Χ²  = 41.9[df12], p < 0.0001). Moreover, the experience of workplace violence differed by practice setting (Χ²  = 65.9[df14], p < 0.0001), with highest rates occurring in psychiatric (45.1%) and emergency (44.1%) services.

PRACTICE IMPLICATIONS

Findings may inform research, policies, and practice interventions to assess risks for workplace violence and implement preventative policies within high-risk professional groups and settings.

Identifying Predictors of Workplace Violence Against Healthcare Professionals: A Systematic Review

Understanding the predictors of workplace violence amongst healthcare professionals is important to develop and implement prevention and mitigation strategies. We conducted a systematic review to synthesize the recent evidence on predictors of workplace violence across healthcare settings. The review has been done as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two electronic databases (PubMed and Google Scholar) were used to search peer-reviewed studies published for the year 2009-2020 to identify studies reporting predictors of workplace violence. The significant predictors were analyzed using descriptive statistics such as proportions in most of the studies and some studies used inferential statistics such as logistic regression analysis, Chi-square test, ANOVA and Student's t-test. A total of 46 studies were identified and overall evidence was graded using an adapted GRADE approach. Some of the moderate quality predictors associated with workplace violence were the patient with a history of mental health disease, psychiatric setting, professional's gender and work experience and evening shift workers. Being a nurse was the only high-quality predictor. Healthcare professionals and administration can identify the predictors relevant to their setting to mitigate episodes of violence against healthcare personnel.

Prevalence of workplace violence against health care workers in hospital and pre-hospital settings: An umbrella review of meta-analyses

Introduction

Workplace violence (WPV) is associated with adverse consequences for patients and health care workers (HCWs). The aim of this study was to assess the prevalence of WPV against HCWs in the hospital and pre-hospital settings.

Methods

Using PRISMA guidelines, data resources including Scopus, PubMed, Web of Science, and Google Scholar were used for the search. The searches were conducted without any time limit until the end of December 2021. The random-effects model was used for this meta-analysis. I2 index was used to examine heterogeneity and the Egger test was used to examine publication bias.

Results

Of the 255 studies identified, 14 studies entered the umbrella review. The overall prevalence was as follows: WPV (58.7%); physical violence (20.8%); verbal violence (66.8%); and sexual harassment (10.5%).

Conclusion

The prevalence of WPV and its types against HCWs is relatively high. WPV is associated with physical, psychological, and occupational consequences. Measures should be taken to reduce the consequences of WPV.

Workplace violence in healthcare settings: The risk factors, implications and collaborative preventive measures

Violence at work refers to acts or threats of violence directed against employees, either inside or outside the workplace, from verbal abuse, bullying, harassment, and physical assaults to homicide. Even though workplace violence has become a worrying trend worldwide, the true magnitude of the problem is uncertain, owing to limited surveillance and lack of awareness of the issue. As a result, if workplace violence, particularly in healthcare settings, is not adequately addressed, it will become a global phenomenon, undermining the peace and stability among the active communities while also posing a risk to the population's health and well-being. Hence, this review intends to identify the risk factors and the implications of workplace violence in healthcare settings and highlight the collaborative efforts needed in sustaining control and prevention measures against workplace violence.

•

Workplace violence needs to be addressed more comprehensively, involving shared responsibilities from all levels.

•

Emphasis on healthcare management's commitment, assurance, and clearly defined policy, reporting procedures, and training.

•

The healthcare workers' commitment to update their awareness and knowledge regarding workplace violence.

•

The provision of technical support and assistance from professional organizations, NGOs, and the community.

Dimensions of hospital workplace violence: Patient violence towards the healthcare team

AIMS AND OBJECTIVES

To investigate the cognitive dimensions nurses use when perceiving patient-to-healthcare provider workplace violence.

BACKGROUND

The concept of workplace violence, especially with respect to healthcare settings, has been well documented. Healthcare workers are at particular risk for experiencing violence from their patients, though these incidents often go unreported. Experiencing violence in the workplace has been associated with numerous negative outcomes, including absenteeism, burnout and diminished quality of care. However, little emphasis has been placed on understanding the concept of violence itself, or why one type of violence might go unreported whilst another is readily communicated to officials.

DESIGN

A card-sorting, multidimensional scaling design.

METHODS

Thirty two nurses completed the card-sorting task. Using multidimensional scaling (MDS), 75 reported incidents of violence were considered. SPIRIT research reporting checklist followed.

RESULTS

Nurses categorise patient violence in three dimensions: physical versus verbal, active versus threatening and more versus less severe. Implications for further research and intervention are discussed.

CONCLUSIONS

Violence in the hospital workplace is a complex perception by the healthcare worker that cannot be captured by a single dimension.

RELEVANCE TO CLINICAL PRACTICE

This study provides a theoretical framework for understanding the complexity of patient-to-provider violence in a hospital setting. It sheds light on why only a minority of such events are reported. This model can serve as a foundation for future research exploring interventions for hospital violence.

Personal and Bystander Harassment Experiences and Outcomes for Hospital Nurses

OBJECTIVES

To examine experiences, context, and outcomes of personal and bystander harassment among hospital nurses.

BACKGROUND

Harassment of nurses is common, affecting victims and bystanders. Yet, little is known about the nature and context of these experiences.

METHOD

A cross-sectional study of hospital nurses was completed via an anonymous online survey.

RESULTS

A majority of nurses experienced personal or bystander harassment. Nearly half experienced both of these forms of harassment. Personal harassment victims frequently told their managers and coworkers, but actions to prevent further harassment or mitigate harm were rare. Bystanders frequently intervened to help victims of personal harassment but rarely reported it. These experiences negatively impacted work relationships and performance.

CONCLUSION

Personal and bystander harassment may co-occur in cultures that tolerate harassment. The lack of response to personal harassment and lack of reporting of bystander harassment may perpetuate it.

Dilemmas and Repercussions of Workplace Violence against Emergency Nurses: A Qualitative Study

Nurses received the highest rate of workplace violence due to their close interaction with clients and the nature of their work. There have been relatively few qualitative studies focus on nurses' perceptions of and experiences with the antecedents, dilemma and repercussions of the patient and visitor violence (PVV), leaving a considerable evidence gap. The aim of this study was to explore nurses' experience of PVV in emergency department, the impact of PVV on quality of care, and supports needed after exposure to such incidents. We conducted semi-structured interviews with a purposive and snowball sample of nurses, and analyzed the content of the interview transcripts. A total of 10 nurses were approached and agreed to participate. Those participants ranged in age from 24 to 41 years old, eight female and two male nurses, and the majority of them (80%) held a university Bachelor degree in nursing. The average time in nursing practice was 7.2 years. We conceptualized five analytical themes, which comprised: (1) multifaceted triggers and causes of PVV; (2) experiences following PVV; (3) tangled up in thoughts and struggle with the professional role; (4) self-reflexivity and adjustment; and, (5) needs of organizational efforts and support following PVV. This paper provides compelling reasons to look beyond solely evaluating the existence of workplace, and considering the perceived professional inefficacy, impacts of being threatened or assaulted in nurses. There are also urgent needs in provision of prevention and management of workplace training programs to ensure the high-quality nursing care.

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

IMPORTANCE

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

OBJECTIVE

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

DESIGN, SETTING, AND PARTICIPANTS

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

EXPOSURES

Medical career during 20 years in Norway.

MAIN OUTCOMES AND MEASURES

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

RESULTS

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

CONCLUSIONS AND RELEVANCE

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

Examining the utility of the Violence Prevention Climate scale: In a metropolitan Australian general hospital

AIM AND OBJECTIVES

To evaluate and examine the utility of the Violence Prevention Climate scale by generalist healthcare professionals.

BACKGROUND

Workplace violence in general hospital settings remains a challenge for healthcare organisations. High rates of violence are still being reported towards healthcare workers, despite organisational violence prevention strategies being implemented. There is a major challenge to healthcare organisation in the measurement of the effectiveness of these interventions, traditionally completed via the reporting and monitoring of workplace violent incidents. A novel approach to measuring workplace violence is by studying hospital atmosphere or climate.

DESIGN

A cross-sectional survey using the STARD guidelines was used.

METHODS

The Violence Prevention Climate scale was completed by 194 healthcare staff working in the emergency department, medical/surgical wards, respiratory/infectious disease, spinal care, renal unit, corrections health, and rehabilitation and community services of a major Australian tertiary referral hospital. The Violence Prevention Climate scale has previously been validated and used in mental health settings, but not general hospital settings. A content analysis of an open-ended question on violence prevention management strategies was also conducted.

RESULTS

Comprising of 14 items with two factors (patients and staff), the study revealed a 9-item staff factor scale that can be used in the general hospital setting, the patient factor did not show adequate reliability. The content analysis revealed seven categories of staff identified violence prevention and management strategies.

CONCLUSIONS

The use of the 9-item scale across an organisation annually, or added to existing organisational workforce surveys, could prove to be practical way of measuring the social climate of violence in a general hospital setting.

RELEVANCE TO CLINICAL PRACTICE

The results of which could guide clinical practice, workplace safety, policy and educational initiatives for the prevention and management of workplace violence.

How Toxic Workplace Environment Effects the Employee Engagement: The Mediating Role of Organizational Support and Employee Wellbeing

This study explores the effects of a toxic workplace environment (TWE) on employee engagement (EE). Building on conservation of resources (COR) theory and organizational support theory (OST), this study proposed a research model. In this research model, a toxic workplace environment negatively affected employee engagement, directly and indirectly, through organizational support (OS) and employee well-being (EW). In this study, we used a quantitative research approach, and data were collected from 301 workers employed in the small and medium-size enterprises of China. To estimate the proposed relationships of the research model, we used partial least squares structural equation modeling (PLS-SEM 3.2.2). The results of this study confirmed that a toxic workplace environment has a negative impact on employee engagement. Moreover, the findings of this research confirm that organizational support and employee well-being significantly mediate a toxic workplace environment and employee engagement. The conclusions of this study are as follows: First, the direct relationship between a toxic workplace environment and employee engagement confirms that if employees are working in a toxic environment, they will spread negative feelings among other co-workers. The feelings that come with a toxic workplace environment, i.e., harassment, bullying, and ostracism, can be detrimental and lead to unnecessary stress, burnout, depression, and anxiety among the workers. Second, employee well-being will affect employee behaviors that enhance employee engagement with the work as well as with the organization. Third, organizational support also increases employee engagement with the work as well as with the organization. So, it is also confirmed that when workers perceive the support from the organization, their sense of belonging to the organization is strengthened.

The effect of workplace violence on depression among medical staff in China: the mediating role of interpersonal distrust

OBJECTIVE

Workplace violence has been recognized globally as a serious occupational hazard in health service occupations, and existing studies have identified that workplace violence can significantly lead to depression. Interpersonal distrust, an important topic, has also been proved associated with workplace violence and depression. However, the mediating effect of interpersonal distrust has not been tested before. Results of such testing can help us to understand further the effect mechanism of workplace violence on depression.

METHODS

In the current study, we collected 3426 valid questionnaires based on a cross-sectional design distributed among medical staff in Chinese hospitals. Depression, workplace violence, interpersonal distrust, social support, physical diseases, and some other social-demographic variables were evaluated. SPSS macros program (PROCESS v3.3) was used to test the mediating effect of interpersonal distrust on the association between workplace violence and depression.

RESULTS

The data analyzed in the current study demonstrated that 52.2% of medical staff had experienced workplace violence before. Experiencing verbal violence (β = 2.99, p < 0.001), experiencing physical violence (β = 3.70, p < 0.01), experiencing both kinds of violence (β = 4.84, p < 0.001), high levels of interpersonal distrust (β = 0.22, p < 0.001), working as a nurse (β = 1.10, p < 0.05), working as a manager (β =  - 1.72, p < 0.001), suffering physical disease (β = 3.35, p < 0.001), and receiving social support (β =  - 0.23, p < 0.001) were significantly associated with depression. Workplace violence had not only positive direct effects on depression, but also an indirect effect on depression through interpersonal distrust as a mediator.

CONCLUSION

Interpersonal distrust can mediate the association between workplace violence and depression. Increasing interpersonal trust or reducing workplace violence would be beneficial to promoting mental health status among medical staff.

Effects of a Workplace Violence Intervention on Hospital Employee Perceptions of Organizational Safety

OBJECTIVE

To examine hospital employee perceptions of organizational safety one-year following a workplace violence intervention and to evaluate perceptions based on violence exposure status.

METHODS

In 2014, 343 employees across 41 hospital units (N = 21 control units, N = 20 intervention units) completed a questionnaire capturing organizational safety perceptions and violence exposure.

RESULTS

Intervention unit employees reported more positive perceptions of organizational safety compared to control unit employees. However, intervention group employees who experienced patient-to-worker violence (Type II) had significantly more positive perceptions than those who experienced worker-to-worker violence (Type III).

CONCLUSIONS

Organizational safety perceptions improved following a violence-prevention intervention, especially among employees who reported Type II violence. Certain employees report worsened safety perceptions. Hospitals and units that implement violence prevention interventions should strive to address all types of violent behavior.

Pattern of workplace violence against doctors practising modern medicine and the subsequent impact on patient care, in India

Introduction

The incidents of violence against doctors, leading to grievous injury and even death, seem to be on an increasing trend in recent years. There is a paucity of studies on workplace violence against doctors and its effect, in India. The present study was conducted to assess workplace violence faced by doctors, its effect on the psycho-social wellbeing of the treating doctor and, subsequently, on patient management.

Methods

The present nationwide cross-sectional study was conducted from November 2019 –April 2020. The sample size was calculated assuming the prevalence of workplace violence as 50%, with 20% non-response. Doctors, working in private and/or public set-up, with ≥1 year clinical experience, were included. A pre-tested study tool- Google form—was sent to study participants via social media platforms. The Microsoft Excel spreadsheet was downloaded from google drive and data was analysed using STATA-12 statistical software.

Results

A total of 617 responses were received from doctors all over India; out of which 477 (77.3%) doctors had ever faced workplace violence. “Actual or perceived non-improvement or deterioration of patient’s condition" (40.0%), followed by “perception of wrong treatment given” (37.3%) were the main causes of workplace violence; and the family members/relatives were the major perpetrators (82.2%). More than half of the participants reported “loss of self-esteem”, “feeling of shame” and “stress/depression/anxiety/ideas of persecution” after the incident. Management by surgical interventions (p-value<0.001) and handling of emergency/complicated cases (p-value<0.001) decreased significantly with an increase in severity of workplace violence; while the suggestion of investigations and referrals increased (p-value<0.001).

Conclusions

Workplace violence has a significant effect on the psycho-social well-being of doctors, as well as on patient management; which may escalate discontent and distrust among the general public, thereby increasing incidents of workplace violence—in a self-propagating vicious cycle.

How do aggression source, employee characteristics and organisational response impact the relationship between workplace aggression and work and health outcomes in healthcare employees? A cross-sectional analysis of the National Health Service staff survey in England

OBJECTIVES

To examine the prevalence of aggression in healthcare and its association with employees' turnover intentions, health and engagement, as well as how these effects differ based on aggression source (patients vs colleagues), employee characteristics (race, gender and occupation) and organisational response to the aggression.

DESIGN

Multilevel moderated regression analysis of 2010 National Health Service (NHS) survey.

SETTING

147 acute NHS trusts in England.

PARTICIPANTS

36 850 participants across three occupational groups (14% medical/dental, 61% nursing/midwifery, 25% allied health professionals or scientific and technical staff).

MAIN OUTCOME MEASURES

Employee turnover intentions, health and work engagement.

RESULTS

Both forms of aggression (from patients and colleagues) have significant and substantial effects on turnover intentions, health and work engagement; however, for all three outcome variables, the effect of aggression from colleagues is more than twice the size of the effect of aggression from patients. Organisational response was found to buffer the negative effects of aggression from patients for turnover intentions and the negative effects of aggression from patients and colleagues for employee health. The results also demonstrated that nurses/midwives, women and Black employees are more likely to experience aggression; however, no clear patterns emerged on how aggression differentially impacts employees of different races, genders and occupations with respect to the outcome variables.

CONCLUSIONS

Although aggression from patients and colleagues both have negative effects on healthcare employees' turnover intentions, health and work engagement, these negative effects are worse when it is aggression from colleagues. Having an effective organisational response can help ameliorate the negative effects of aggression on employees' health; however, it may not always buffer negative effects on turnover intentions and work engagement. Future research should examine other approaches, as well as how organisational responses and resources may need to differ based on aggression source.

A cross-sectional examination of factors associated with compassion satisfaction and compassion fatigue across healthcare workers in an academic medical centre

Compassion satisfaction (CS) among healthcare professionals is a sense of gratification derived from caring for their suffering patients. In contrast, compassion fatigue, often a consequence of burnout (BO) and secondary traumatic stress (STS), is detrimental to healthcare professionals' productivity and patient care. While several studies have examined CS, BO, and STS among healthcare professionals, the majority have assessed samples in specific disciplines. However, the comparative differences in these factors by discipline or work setting are not well known. The aims of this study were to examine the differences in CS, BO, and STS by discipline and work setting, and to assess demographic, work-related, and behavioural factors associated with these outcomes. An electronic survey was administered (N = 764) at a large academic medical centre in the southeast United States. Questions elicited demographic variables, work-related factors, behavioural/lifestyle factors, experience with workplace violence, and the Professional Quality of Life Scale. Findings of the study determined that the rates of CS, BO, and STS vary across healthcare disciplines and work settings. Demographic, work-related, behavioural, and work setting (i.e., experience of workplace violence) factors were differentially associated with experiences of CS, BO, and STS. The results of the study suggest two potential areas for research, specifically workplace violence and sleep quality as a means of further understanding reduced CS and increased BO and STS among healthcare workers. These findings have important implications for future research and policy interventions to enhance healthcare workers' health and safety.

Workplace violence against security personnel at a university hospital in Egypt: a cross-sectional study

Background: Violence is common among security personnel. To the best of the authors' knowledge no recent studies have investigated this problem. This study aimed to estimate the prevalence and associated factors of violence against hospital security personnel and describe circumstances of violence, type of perpetrators, and victims' response. Methods: In total, 170 security personnel from a university hospital in Egypt were recruited in this cross-sectional study. Data were collected using the Arabic version of a questionnaire developed by the International Labour Office. Results: The majority (87.3%) of security personnel reported violence exposure in the past year. Being a woman and working more than 5 years were independent predictors of violence exposure. The commonest forms of physical violence were pushing and beating. Verbal abuse and threats were the commonest emotional violence. Patients and their relatives/friends were the commonest perpetrators of violence. Conclusions: Violence is common among hospital security personnel in this setting. Adequate training and recruitment of more security personnel may contribute to decreasing violence.

Workplace Violence in the Setting of Pain Management

In the context of the opioid crisis, increased attention has been placed on the risk of violence in outpatient pain medicine clinics. The primary objective of this study was to determine the prevalence and characteristics of workplace violence in a mixed group of clinicians (ie, practicing physicians, resident and fellow physicians in training, nurse practitioners, physician assistants, psychologists) participating in a workplace violence education session at a national pain conference held March 6 through March 10, 2019. A published survey instrument developed to assess workplace violence among pain management clinicians was offered to all 70 attendees, and 58 (82.9%) completed the survey. The mean age of respondents was 47.5 years, and 23 of 56 (41.1%) were female. Of the 58 respondents, 48 (82.8%) reported calling security at least once in the past year, and 39 of 57 (68.4%) reported being threatened with bodily harm. Among those threatened (multiple responses possible per respondent), 41 of 78 responses (52.6%) reported verbal threats, 11 of 78 (14.1%) reported being threatened with an object, and 11 of 78 (14.1%) reported threats of physical violence. Of 59 reponses, 15 (25.6%) endorsed carrying a weapon or using protective equipment. When asked about the clinical context of threats, 37 of 77 responses (48.1%) cited opioid management, 9 (11.7%) cited Workers’ Compensation, 6 (7.8%) cited disability request, and 4 (5.2%) cited litigation related to an automobile accident. The observations from this survey suggest that clinicians practicing pain medicine experience workplace violence and threats of violence on a frequent basis. It is imperative for clinicians to acknowledge the risk of workplace violence and to recognize high-risk clinical scenarios. Future research should be directed toward developing and implementing data-driven risk mitigation strategies aimed at reducing the rate of workplace violence in outpatient pain clinics.

Effect of Workplace Violence and Psychological Stress Responses on Medical-Surgical Nurses' Medication Intake

BACKGROUND

Workplace violence is a prevalent phenomenon in the health-care sector globally, but few studies have examined its impact on nurses' use of prescribed and/or over-the-counter medications to manage signs and symptoms.

PURPOSE

The purpose of this study was to examine the direct and indirect effect of workplace violence, through the pathway of psychological stress responses, on nurses' frequencies of medication intake. An occupational stress and health outcomes model was tested in this study.

METHODS

A secondary analysis of cross-sectional survey data from 551 medical-surgical nurses in British Columbia was conducted. Both emotional and physical workplace violence were examined. Emotional exhaustion and posttraumatic stress disorder were psychological stress responses to workplace violence.

RESULTS

Emotional and physical violence from patients and/or families were the most prevalent sources of workplace violence. Physical violence and psychological stress responses increased the frequency of medication intake after controlling for nurse characteristics. Emotional violence was not related to medication intake over and above the effect of psychological stress responses. Physical and emotional violence elicited psychological stress responses resulting in increased medication use.

CONCLUSION

Workplace violence triggers psychological stress responses with adverse outcomes on nurses' health and well-being.

Violence against health care workers in China, 2013-2016: evidence from the national judgment documents

BACKGROUND

Incidents of patient-initiated workplace violence against health care workers have been a subject of substantial public attention in China. Patient-initiated violence not only represents a risk of harm to health care providers but is also indicative of general tensions between doctors and patients which pose a challenge to improving health system access and quality. This study aims to provide a systematic, national-level characterization of serious workplace violence against health care workers in China.

METHODS

This study extracted data from the China Judgment Online System, a comprehensive database of judgment documents. Three key phrases, "criminal case," "health care institution," and "health care worker" were used to search the China Judgment Online System for relevant cases between January 1, 2013, and December 31, 2016. Data extracted from identified cases was used to document the occurrence, the degree of risk, and the factors associated with serious workplace violence.

RESULTS

In total, 459 criminal cases involving patient-initiated workplace violence against health care workers in China were reported and processed. The analysis revealed geographic heterogeneity in the occurrence of serious workplace violence, with lower incidence in western provinces compared to central and eastern provinces. Primary hospitals experienced the highest rates of serious workplace violence and emergency departments and doctors were at higher risk compared with other departments and health workers. Perpetrators were primarily male farmers aged 18 to 44 with low levels of education. The most frequently reported reasons of serious patient-initiated workplace violence included perceived medical malpractice by the perpetrator after the death of a patient, death of a patient with no other reason given, failures of the compensation negotiations after the death of a patient, and dissatisfaction with the treatment outcomes.

CONCLUSIONS

Serious workplace violence against providers varies across regions and types of health care institutions in China. Perception of low-quality care is the most reported reason for violence. Efforts should be made to improve quality of care in the low-level health institutions and strengthen the doctor-patient communication during the whole course of service.