Violence against nurses working in the health sector in five European countries-pilot study

Violence Against Nurses During Care: A Systematic Review

AIMS

To analyse and synthesise knowledge on workplace violence perpetrated by patients and caregivers against nurses, its consequences and strategies to prevent this phenomenon.

DESIGN

A systematic review of the literature was conducted following the method of the Center for Reviews and Determination and reported in accordance with the PRISMA checklist. A pre-defined protocol was designed (PROSPERO ID: CRD42023432271).

METHODS

Three researchers screened eligible studies independently. The Joanna Briggs Institute Critical Appraisal for Analytical Cross-Sectional Studies was used to assess the risk of bias within the studies included.

DATA SOURCES

Quantitative primary studies published between January 2012 and June 2023 were included through specific research strings used in the CINHAL, Scopus, PubMed and PsychInfo databases.

RESULTS

A total of 15 studies were selected, the majority of which were cross-sectional and observational. The consequences related to events of verbal and physical violence were highlighted, ranging from the psychological to the physical effects on nurses' mental health, for example, gastrointestinal symptoms, headache and sleep problems. Four studies analysed the strategies used to cope with such violence.

CONCLUSION

The results showed that aggression on the part of patients affects nurses' health adversely on both a personal and a work level, and makes it necessary to pay more attention to the phenomenon and to find strategies to reduce the incidents, such as developing policies to safeguard the professionals' physical and mental health.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Nurses and nursing managers should be aware of violence and its consequences on the victims' health. Therefore, it is essential for nursing managers to develop effective policies to reduce violence and its consequences.

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

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

The Relationship Between Individual Social Responsibility and the Public's Intention to Act Violently Toward Nurses-A Cross-Sectional Study

AIMS

To explore (a) the associations between individual social responsibility and the public intention to use violence against nurses; and (b) the relationship between individual social responsibility, personal variables and the public's intention to employ violence against nurses.

BACKGROUND

Workplace violence against nurses is a significant widespread occupational health issue. To date, no reference has been found to the association between personality traits such as individual social responsibility and the public's intention to use violence against nurses.

DESIGN AND METHODS

A cross-sectional survey design with a convenience sample of 667 Israeli participants from among the public. A structured self-report questionnaire was distributed, including socioeconomic variables, individual social responsibility and responses to four vignettes describing incidents of violence directed at nurses. Multiple linear regressions were calculated for intention to employ violence, with demographic variables and individual social responsibility as independent variables. The STROBE checklist for cross-sectional studies was used for reporting.

RESULTS

Negative correlations were found between individual social responsibility and the intention to employ violence against nurses. Gender, having witnessed physical violence and individual social responsibility explained 19% of the variance in the intention to employ violence against nurses. Demographic variables and having witnessed verbal or physical violence were found to moderate the association between individual social responsibility and the intention to employ violence against nurses.

CONCLUSIONS

Witnessing a violent incident in a healthcare setting is a risk factor for the intention to employ violence against nurses. Our findings point to the role of individual social responsibility as one of the strategies to help reduce violent events.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Educating and promoting values of social responsibility among the public can reduce incidents of violence in healthcare settings, thus contributing to the safety and quality of care provided.

PATIENT OR PUBLIC CONTRIBUTION

The public contributed via study participation.

Why Violence Cannot be Prevented in Healthcare Settings in Türkiye?: A Retrospective Policy Analysis

Preventive policies have been devised with the aim of curbing health-related violence, and their efficacy is believed to furnish evidence for their continued implementation, thereby enhancing their effectiveness. This study undertakes a retrospective analysis of these policies in the context of Türkiye. A comprehensive examination involved the review of 26 documents, employing a progressive scanning approach for data collection. This methodology encompassed the utilization of gray literature databases (OECD iLibrary and WHO Iris), extensive Google searches, thorough website scans, and consultations with subject-matter experts. Data analysis was meticulously conducted within the framework of the Health Policy Triangle. The findings reveal active participation from diverse stakeholders, including governmental bodies, political entities, professional organizations, and trade unions, in various preventive initiatives aimed at mitigating health-related violence. Notably, the adoption of legislation for health violence prevention, perceived as a paramount achievement, can be attributed to persistent efforts by both the media and other influential actors and stakeholders. These endeavors have sustained the topic's prominence on the policy agenda, positioning it as a promising source for the development of novel violence prevention and management strategies. This study underscores the necessity for a comprehensive investigation into the working conditions, personal rights, and wage policies of healthcare workers, in light of documented factors that frequently precipitate violence. Concomitantly, it advocates for the development of effective mechanisms to address these issues.

Violence against physicians working in public tertiary care hospital of Bangladesh: a facility-based cross-sectional study

BACKGROUND

Violence against physicians in the workplace is a prevalent global issue, and Bangladesh is no exception. Such violence significantly disrupts healthcare delivery and the attainment of universal health coverage. This study aimed to comprehensively evaluate the prevalence, nature and associated risk factors of workplace violence (WPV) against physicians in Bangladesh.

METHODS

This descriptive cross-sectional study was conducted at a public tertiary care hospital involving 441 physicians with a minimum tenure of 6 months. Data were gathered through a structured self-reported questionnaire, and statistical analyses were performed by using SPSS V.25.

RESULTS

Out of the surveyed physicians, 67.3% (n=297) reported experiencing violence, categorised as 84.5% psychological, 13.5% physical and 2% sexual in nature. Predominant forms of psychological violence included bullying (48.8%) and threats (40.1%). The mean age of exposed physicians was 32.5±4.3 (SD) years. Those working in the emergency unit (45.8%), surgery and allied departments (54.2%), engaging in rotating shift work (70%), morning shifts (59.6%) and postgraduate trainees (68%) were frequently subjected to violence. Factors significantly associated with WPV included placement in surgery and allied departments (p<0.001), working rotating shifts (p<0.001), marital status (p=0.011) and being a male physician (p=0.010). Perpetrators were primarily identified as relatives of patients (66%). Working in rotating shifts (adjusted OR(AOR):2.6, 95% CI:1.2 to 5.4) and surgery and allied departments (AOR:5.7, 95% CI:3.4 to 9.8) emerged as significant risk factors of violence against physicians.

CONCLUSION

A higher proportion of physicians at the early to mid-level stages of their careers, especially those in rotating shifts and surgery-related departments, reported incidence of WPV. Urgent intervention from policy-makers and healthcare entities is imperative to implement preventive measures. Strengthening security measures, establishing antiviolence policies and providing comprehensive training programmes are crucial steps towards ensuring a safer work environment for healthcare professionals.

Verbal violence and missed nursing care: A phenomenological study

AIM

To define the missed care experiences of nurses exposed to verbal violence from patients.

BACKGROUND

Verbal violence takes the first place among the types of violence that nurses face in healthcare settings. This can cause negative emotional and physical responses in nurses and issues in patient and nurse interaction. As a result, it may lead to missed nursing care, defined as skipped, postponed or incomplete care during the patient's care.

METHODS

This is a phenomenological study. The study sample included 16 nurses working in inpatient clinics who reported experiencing verbal violence at least once in Turkey. The study was conducted between January and February 2022 with institutional permission and ethics committee approval (09/12/2021-2021/357). A semi-structured interview method was used to collect data. The information gathered from the interviews underwent thematic analysis using an inductive approach. The 'Consolidated Criteria for Reporting Qualitative Research (COREQ)' was used to report this qualitative study based on a comprehensive protocol.

RESULTS

The types of verbal violence most frequently faced by nurses were determined as swearing, insulting, shouting and threats. Study findings were classified into three main themes: (i) response to verbal violence, (ii) missed nursing care experiences and (iii) suggestions to cope with verbal violence. The most felt emotions in the face of verbal violence were feeling sad, unsafe and worthless. Nurses common behaviours, in response to verbal abuse were ignoring, getting used to, and wishing to get away. The examples of missed care included using non-therapeutic communication, postponing care or withdrawing from care.

CONCLUSION

Verbal violence caused negative emotional and behavioural responses in nurses, which, in turn, negatively affected the nurse-patient interaction. These findings mean that verbal violence may pave the way for missed nursing care.

IMPLICATIONS FOR NURSING POLICY

According to these findings, an uninterrupted nursing care process needs to focus on preventive measures against verbal violence and increase the administrative and legal support offered to nurses.

Student nurses' experiences of workplace violence: A mixed methods systematic review and meta-analysis

OBJECTIVES

To identify the prevalence of student-directed violence on clinical placement and description of their related experience during clinical placements.

DESIGN

Mixed methods systematic review and meta-analysis conducted following Joanna Briggs Institute guidelines and reported according to Preferred Reporting of Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

DATA SOURCES

CINAHL, Embase, Medline, Proquest, PsycINFO and Google Scholar.

REVIEW METHODS

Included studies were peer reviewed, published primary studies where pre-registration nursing students were surveyed about their experiences of physical, verbal, or sexual aggression, bullying or racism during clinical placement. Studies were quality assessed but not excluded based on the result. A convergent segregated approach to synthesis and integration was undertaken. Prevalence data were extracted and pooled using both random and quality effects models; separate analyses were conducted by violence type, source, and region. Qualitative data were thematically analysed.

RESULTS

14,894 student nurses from 42 studies were included across the meta-analyses. There was substantial heterogeneity in the included data. Pooled prevalence rates ranged from racism 12.2 % to bullying 58.2 %. Bullying (38.8 %) and physical aggression (10.2 %) were most perpetrated by nurses whereas sexual aggression was perpetrated mostly by patients (64.2 %) and physicians (18.6 %). Qualitative findings identified students' descriptions of reasons for, effects of, strategies for dealing with and higher education establishments' responsibilities with regards to workplace violence.

CONCLUSIONS

Student nurses commonly experience violence during their clinical placements. Given the potential debilitating physical and psychological sequelae of all forms of violence then this study further emphasises the need to use multiple strategies to prevent violence and to better equip student nurses to manage potentially violent incidents, their responses to violence, and to whistle blow or report when they are subject to violence.

Exploring workplace violence on surgical wards in Sweden: a cross-sectional study

BACKGROUND

Workplace violence is a global threat to healthcare professionals' occupational health and safety and the situation has worsened during the COVID-19 pandemic. This study aimed to explore workplace violence directed against assistant and registered nurses working on surgical wards in Sweden.

METHODS

This cross-sectional study was conducted in April 2022. Using a convenience sampling procedure, 198 assistant and registered nurses responded to an online questionnaire developed for this specific study. The questionnaire comprised 52 items and included, among other items, subscales from validated and previously used instruments. Data analysis included descriptive statistics, the chi-square test, and independent-samples t-test.

RESULTS

The most frequently reported type of workplace violence was humiliation (28.8%), followed by physical violence (24.2%), threats (17.7%), and unwanted sexual attention (12.1%). Patients and patients' visitors were reported as the main perpetrators of all kinds of exposure. Additionally, one third of the respondents had experienced humiliation from colleagues. Both threats and humiliation showed negative associations with work motivation and health (p < 0.05). Respondents classified as working in a high- or moderate-risk environment were more frequently exposed to threats (p = 0.025) and humiliation (p = 0.003). Meanwhile, half of the respondents were unaware of any action plans or training regarding workplace violence. However, of those who indicated that they had been exposed to workplace violence, the majority had received quite a lot or a lot of support, mainly from colleagues (range 70.8-80.8%).

CONCLUSION

Despite a high prevalence of workplace violence, and especially of humiliating acts, there appeared to be low preparedness within the hospital organizations to prevent and/or handle such incidents. To improve these conditions, hospital organizations should place more emphasis on preventive measures as part of their systematic work environment management. To help inform such initiatives, it is suggested that future research should focus on the identification of suitable measures regarding different types of incidents, perpetrators, and settings.

A Literature Review: Violence and Aggression in Neuroscience Nursing

ABSTRACT

BACKGROUND: Violence and aggression is commonly encountered in nursing worldwide and is an increasing concern, although it is largely underreported by staff. Violence and aggression can take many forms, from verbal and physical abuse to sexual assault. This study aims to define agitation, violence, and aggression and to explore the prevalence of violence and aggression among neuroscience patients. This review also examines why violence and aggression occurs for neuroscience patients and to determine the effects on the patients, the environment, and the nursing staff. METHODS: A review of articles was conducted using CINAHL, PubMed, the Cochrane Database, and Google Scholar between 2012 and 2022. DISCUSSION: Agitation can escalate to violence and aggression. The reasons a neuroscience patient may become agitated are multifactorial. An injury to the brain may not cause agitation; however, the effect on the frontal lobe, hypothalamus, and hippocampus may cause a lack of self-control, impulsivity, an inability to control emotions, and an uncontrolled release of hormones, leading to a heightened sympathetic response. The effects of violence and aggression can be detrimental to the patient and include isolation, increased sedation, reduced observations, and even death. The effects on the nurse are profound including a decline in productivity at work, an increased risk of drug errors, and posttraumatic stress disorder or burnout as longer-term consequences. CONCLUSION: Violence and aggression is commonly experienced within neuroscience nursing, and the contributing factors are multifactorial. The effects for the patients and staff can be profound, and this is why prevention of agitation is fundamental to ensure the safety and retention of nursing staff.

Workplace violence against nurses working in the public hospitals in Giresun, Turkey: Prevalence, risk factors, and quality of life consequences

PURPOSE

The aim of this study is to determine the prevalence and risk factors of workplace violence (WPV) against nurses working in public hospitals and to evaluate for associations between WPV with the quality of life (QOL).

DESIGN AND METHODS

A cross-sectional study design was carried out from April to May 2021. The study population consisted of 890 nurses working in public hospitals in Giresun, Turkey.

FINDINGS

The prevalence of WPV was found to be 54.8%, consisting of verbal abuse (38.4%), followed by bullying/mobbing (37.5%), physical violence (6.2%), and sexual harassment (1.7%). Moreover, the WPV was found to be related to poor QOL among the nurses.

PRACTICE IMPLICATIONS

Violence prevention, preparedness, and response arrangements should be established and maintained in all hospitals.

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

AIM

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

BACKGROUND

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

EVALUATION

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

KEY ISSUES

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

CONCLUSIONS

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

IMPLICATIONS FOR NURSING MANAGEMENT

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

Reducing Patient Aggression Through a Nonviolent Patient De-escalation Program: A Descriptive Quality Improvement Process

BACKGROUND

Patients commonly display aggressive and violent behaviors toward nursing staff, contributing to severe consequences. Healthcare institutions must develop and implement systems addressing this global safety problem.

AIM

To improve clinical practice safety for inpatient acute care settings by providing healthcare teams throughout a large academic medical center with a Behavioral Emergency Response Team (BERT) program, that is, a system for reporting and de-escalating aggressive patient encounters.

METHODS

This descriptive quality improvement process took place within two inpatient acute care departments using simulation-based training, patient safety rounds, and a BERT activation system. Participant groups included nursing personnel who completed a baseline survey (n = 302), telecommunication dispatchers (n = 20), BERT responders (n = 78), and bedside nursing staff (n = 43) recipients of BERT program resources. Methods included a baseline questionnaire, pre- and post-intervention surveys, formal reports of aggressive patient encounters, documentation from patient safety rounds, and records of activated BERT responses. Data analysis included descriptive statistics, boxplots, and the Wilcoxon signed-rank test.

RESULTS

This project mitigated patient aggression episodes by successfully designing and implementing an evidence-based BERT program. Findings suggested bedside nursing program participants felt more confident and capable of managing aggressive patient behaviors. A strong partnership between security officers and nursing staff limited the risk of harm to clinical staff by identifying and intervening with 41 potentially aggressive patients. Finally, formal reports of patient aggression episodes did not increase during this project, which may have indicated early prevention and detection of aggression while reflecting the broader problem of aggression under-reporting in nursing.

LINKING EVIDENCE TO ACTION

Healthcare organizations need to have robust systems to manage aggressive patient encounters. Comprehensive strategies for managing patient aggression include simulation-based training, the use of BERT responders, and a strong partnership between nursing and security officer teams.

Workplace violence from the perspective of hospital ward managers in Sweden: A qualitative study

AIM

The aims of the study are to explore workplace violence perpetrated by patients or visitors from the perspective of hospital ward managers and to describe how ward managers perceive their leadership role and manage related incidents.

BACKGROUND

Few studies focus on workplace violence from the perspective of ward managers even though they are the closest managers to the operational staff.

METHOD

Fifteen semistructured interviews were analysed using qualitative content analysis.

RESULTS

Four categories emerged: the face of workplace violence, a two-fold assignment, strive towards readiness to act, and managing incidents.

CONCLUSION

While the most common acts of workplace violence are considered less serious and related to patients' medical conditions or dissatisfied visitors, hospital organizations focus on serious but rarely occurring incidents. Consequently, ward managers have limited opportunities to ensure a safe work environment on an everyday basis.

IMPLICATIONS FOR NURSING MANAGEMENT

To support ward managers' occupational safety and health management, workplace violence prevention and management should be acknowledged as an important responsibility for senior management in hospitals. It is important to identify incidents that most likely will occur at the wards and to create strategies related to those incidents. Strategies could include risk assessments, prevention, evaluation, education and reflection combined with, for example, scenario training.

Hospital-Based Healthcare Workers Victims of Workplace Violence in Italy: A Scoping Review

The aim of this scoping review is to synthesize the available evidence on the prevalence rates of healthcare workers being victims of violence perpetrated by patients and visitors in Italy. PubMed, Scopus, Web of Science and CINAHL were systematically searched from their inception to April 2021. Two authors independently assessed 1182 studies. All the scientific papers written in English or in Italian reporting primary quantitative and/or qualitative data on the prevalence of aggression or sexual harassment perpetrated by patients or visitors toward healthcare workers in Italy were included. Thirty-two papers were included in the review. The data extracted were summarized in a narrative synthesis organized in the following six thematic domains: (1). Methodology and study design; (2). Description of violent behavior; (3). Characteristics of health care staff involved in workplace violence (WPV); (4). Prevalence and form of WPV; (5). Context of WPV; and (6). Characteristics of violent patients and their relatives and/or visitors. The proportion of studies on WPV differed greatly across Italian regions, wards and professional roles of the healthcare workers. In general, the prevalence of WPV against healthcare workers in Italy is high, especially in psychiatric and emergency departments and among nurses and physicians, but further studies are needed in order to gather systematic evidence of this phenomenon. In Italy, and worldwide, there is an urgent need for governments, policy-makers and health institutions to prevent, monitor and manage WPV towards healthcare professionals.

Violence Against Healthcare Workers at Primary Care Centers in Dammam and Al Khobar, Eastern Province, Saudi Arabia, 2019

Purpose

Workplace violence is common throughout the world. It causes many serious problems in the healthcare sector, where it significantly impacts healthcare workers, the services provided, and organizations as a whole. However, few studies have investigated these issues in Saudi Arabia. This study examined the prevalence of violence against healthcare workers at primary care centers in Dammam and Al Khobar, in the Eastern Province of Saudi Arabia. The study also assessed the types, perpetrators, perceived causes, and consequences related to such violence. Here, the aim was to understand how healthcare workers responded to violence and gauge their awareness of a reporting system.

Patients and Methods

A total of 360 healthcare workers (180 each from primary care centers in Dammam and Al Khobar) were invited to complete structured, self-administered questionnaires. As such, this study employed a cross-sectional analytical design.

Results

The prevalence of workplace violence among all participating health workers was 46.9%, with approximately 90% of these workers reporting verbal violence, 34.3% having been subject to intimidation, and 3% reporting physical violence. Approximately 75% reported that violent events were initiated by patients, while 45.6% reported that the events were initiated by patients' companions. Healthcare workers' reactions included reporting events to their supervisors or the police, but 46.7% said they did nothing; the most common reason was perceived inefficacy. Finally, only 36.4% of all participants were aware of a violence reporting system.

Conclusion

This study showed that healthcare workers were commonly exposed to different forms of violence, but often either did not react to it or did not report it. Further, there was relatively little awareness of how to manage and report workplace violence, thus indicating the need for healthcare workers to receive relevant education and training. A national program should also be established to track and prevent workplace violence.

Identification of processes that mediate the impact of workplace violence on emergency department healthcare workers in the USA: results from a qualitative study

OBJECTIVES

Violence towards emergency department healthcare workers is pervasive and directly linked to provider wellness, productivity and job satisfaction. This qualitative study aimed to identify the cognitive and behavioural processes impacted by workplace violence to further understand why workplace violence has a variable impact on individual healthcare workers.

DESIGN

Qualitative interview study using a phenomenological approach to initial content analysis and secondary thematic analysis.

SETTING

Three different emergency departments.

PARTICIPANTS

We recruited 23 emergency department healthcare workers who experienced a workplace violence event to participate in an interview conducted within 24 hours of the event. Participants included nurses (n=9; 39%), medical assistants (n=5; 22%), security guards (n=5; 22%), attending physicians (n=2; 9%), advanced practitioners (n=1; 4%) and social workers (n=1; 4%).

RESULTS

Five themes emerged from the data. The first two supported existing reports that workplace violence in healthcare is pervasive and contributes to burn-out in healthcare. Three novel themes emerged from the data related to the objectives of this study: (1) variability in primary cognitive appraisals of workplace violence, (2) variability in secondary cognitive appraisals of workplace violence and (3) reported use of both avoidant and approach coping mechanisms.

CONCLUSION

Healthcare workers identified workplace violence as pervasive. Variability in reported cognitive appraisal and coping strategies may partially explain why workplace violence negatively impacts some healthcare workers more than others. These cognitive and behavioural processes could serve as targets for decreasing the negative effect of workplace violence, thereby improving healthcare worker well-being. Further research is needed to develop interventions that mitigate the negative impact of workplace violence.