Workplace violence: Differences in perceptions of nursing work between those exposed and those not exposed: A cross-sector analysis

Experience of Workplace Violence from the Patients among Mental Health Nurses in Indonesia: A Mixed Method Study

Background: Workplace violence by patients and visitors (PVV) against nurses is regarded a devastating occupational issue around the world. The most frequent perpetrators of violence against nurses were patients, followed by their families and other healthcare professionals. Aim:This study aimed to use a mixed method to analyze violence by patients and visitors against nurses in mental health hospital in Indonesia. Methods: The 250 mental health nurses at two general public hospitals in Bandung were recruited with stratified convenience sampling by years of working experience. Result: All nurses experienced workplace violence from both patients and their families. At least nurses experienced more than 3 types of violence with the most frequent type of violence were verbal and physical violence. The six themes were emerged including variation of violence in nurse, traumatic impact of violence, impacts of violence on profession, violence not only come form patients but also family, reason of violence, and spiritual coping. Conclussion: It is necessary to prioritize more efficient and approachable methods for nurses to deal with patients’ aggresive behavior, and to establish constant training program.

Australian nurses' perceptions about workplace violence management, strategies and support services

AIMS

This study ascertained nurses' perceptions about workplace violence management, strategies and support services.

BACKGROUND

Nurses regularly encounter verbal and physical violence in their workplace. Workplace violence has long-term consequences on nurses' personal lives and professional work ability. However, more needs to be known about nurses' perceptions of violence management and interventions used.

METHODS

Ninety-eight nurses from a regional public hospital in Queensland, Australia, completed a survey about workplace violence. Nurses worked in the Emergency Department, Intensive Care Unit or Mental Health Department.

RESULTS

Ninety-five per cent of nurses stated that all violence should be reported, but 18% would take no action, and 22% would not complete an incident from. Perceptions and preferred responses differed for verbal and physical violence. Low-level interventions and aggression management training were preferred by nurses. Nearly all nurses felt that they should be involved in the development of workplace violence policies.

CONCLUSIONS

Nurses rate aggression management training highly, and they desire more input into violence policies. The under-reporting of violent incidents remains an issue for future management.

IMPLICATIONS FOR NURSING MANAGEMENT

Understanding nurses' perceptions of workplace violence management enables the identification of gaps when applying policy and adopting practical approaches to reduce the incidence and severity of workplace violence.

Violence exposure and burnout in healthcare sector: mediating role of work ability

BACKGROUND

One of the most difficult problems faced by health care professionals is experiencing verbal and physical abuse from patients and their family members. Some studies have shown that health care workers, especially nurses, are up to 16 times more likely to be subject to violence than other workers.

AIMS

The aim of this study was to analyze the relationship between exposure to violence, work ability and burnout.

METHODS

Data were collected through a questionnaire to investigate health care workers' exposure to violence (Violent Incident Form), burnout (Maslach Burnout Inventory) and work ability (Work Ability Index). A sample of 300 nurses was obtained for the study.

RESULTS

A total of 36% of nurses indicated that they had been a victim of violence in the past 12 months. The data analysis highlighted highly significant differences in work ability, emotional exhaustion and depersonalization between health care workers who had been victims of violence and those who had not experienced violence. Finally, work ability was shown to have a mediating effect on emotional exhaustion (indirect effect: b = 2.7, BCa CI: 1.37-4.33) and depersonalization (indirect effect: b = 1.1, BCa CI: 0.48-1.87).

DISCUSSION

This study is one of the first to consider the mediation effect of work ability between workplace violence experienced and burnout in the healthcare sector; it reports the complexity and severity of the consequences of workplace violence in this sector.

Impact of emotional labour and workplace violence on professional quality of life among clinical nurses

AIM

We examined Korean nurses professional quality of life, emotional labour and workplace violence to guide development of interventions to improve nurses professional quality of life.

BACKGROUND

Nurses face heavy exposure to emotional labour and workplace violence. Stress experienced by nurses reduces compassion satisfaction and increases compassion fatigue.

METHODS

Participants comprised 399 clinical nurses chosen by convenience sampling. Questionnaires measured demographic characteristics, emotional labour, workplace violence and professional quality of life.

RESULTS

Nurses professional quality of life was affected by emotional labour and workplace violence. Graduate educational level, emotional exposure and emotional supervision were associated with compassion satisfaction. Burnout was commonly associated with emotional exposure, experience and supervision of workplace violence. Secondary traumatic stress was associated with emotional exposure and experience of workplace violence.

CONCLUSIONS

We elucidated the relationship between professional quality of life, emotional labour and workplace violence. Raising professional quality of life among nurses requires regular analysis of emotional labour and provision of organizational-level interventions. Counselling programmes that address violence prevention education and comprehensive response strategies among nurses and policies that foster an organizational culture of respect and cooperation in hospitals are needed.

Hashtags and heroes: perceptions of nursing on Twitter following a high profile nurse arrest

PURPOSE

The purpose of this research was to extract the perceptions of nursing by analyzing Twitter tweets following a high-profile nurse arrest.

BACKGROUND

A Utah registered nurse arrest was covered extensively on national and international news programming and social media, including Twitter.

METHODS

Tweets related to arrest were retrieved and analyzed by text analysis techniques, Latent Dirichlet Allocation models and sentiment analysis.

RESULTS

56,931 consisting of 14,150 unique tweets we retrieved. Twelve topics were identified, of which four related to nursing: nurses as protector, protecting the protector, nurses as innocent victim, and nurses as important team member. "Trust" (44.3%) was assigned to the majority of tweets.

IMPLICATIONS

To our knowledge, this is the first study examining the perceptions of nursing in Tweets. Social media provides a powerful resource to strengthen general perceptions of the nursing profession and has implications for education and outreach.

The effect of violence prevention strategies on perceptions of workplace safety: A study of medical-surgical and mental health nurses

AIMS

To explore associations between specific violence prevention strategies and nurses' perceptions of workplace safety in medical-surgical and mental health settings.

BACKGROUND

Workplace violence is on the rise globally. Nurses have the highest risk of violence due to the nature of their work. Violence rates are particularly high among USA and Canadian nurses. Although multiple violence prevention strategies are currently in place in public healthcare organizations in British Columbia, Canada, it is unknown whether these approaches are associated with nurses' perceptions of workplace safety.

DESIGN

This is an exploratory correlational design using secondary data.

METHODS

Using data obtained from a province-wide survey of nurses between March 2017 - January 2018, this study included 771 nurses from medical-surgical and 189 nurses from mental health settings. Data were analysed using ordinal logistic regressions.

RESULTS

For medical-surgical and mental health nurses, greater perceptions of workplace safety were related to employers listening to them with respect to violence prevention strategies. Nurses in both settings were more likely to feel safe when they were not expected to physically intervene during a code white situation. Medical-surgical nurses were more likely to feel safe when code white incident reviews were conducted and fixed alarms were used. Mental health nurses were more likely to report feeling safe when they had enough properly trained code white responders on their unit.

CONCLUSION

Nurse-employer engagement is critical to nurses' perceptions of feeling safe at work. Engagement opportunities include nurses' involvement in discussions about appropriate violence prevention strategies, collaborative debriefing after violent incidents and co-development and updates of patients' behavioural care plans.

Iceberg of workplace violence in health sector of Bangladesh

Objectives

‘Negligence of Physicians’ and ‘Wrong Treatment’ have become commonly-used phrases in print and electronic media of Bangladesh, while violence against healthcare workers has always been under-reported. Unfortunately, there is little evidence regarding physical violence against healthcare workers, while there is no data on the magnitude of psychological violence. The objective of this study was to quantify and explore the magnitude of workplace violence in health sector of Bangladesh to guide future research and adopt preventive policies.

Results

The Majority (96%, n = 54) of the violence cases were physical in nature and 91% violence (n = 51) took place in public healthcare settings. More than one-third (39%) of the violence cases occurred at primary healthcare level and one-third (39%) at tertiary healthcare level. It was mostly (61%) the entry-level physicians who were affected by violence. The report reveals the tip of the iceberg of workplace violence in health sector of Bangladesh. Further studies should be undertaken to assess the prevalence, magnitude, and associated factors for workplace violence against healthcare workers.

Organizational Determinants of Workplace Violence Against Hospital Workers

OBJECTIVE

To identify organizational factors contributing to workplace violence in hospitals.

METHODS

A questionnaire survey was conducted in 2013 among employees in a Midwestern hospital system (n = 446 respondents). Questions concerned employees' experiences of violence at work in the previous year and perceptions of the organizational safety climate. Logistic regressions examined staff interaction and safety climate factors associated with verbal and physical violence, respectively.

RESULTS

Interpersonal conflict was a risk factor for verbal violence (OR 1.49, 95% CI 1.04 to 2.12, P < 0.05) and low work efficiency was a risk factor for physical violence (OR .98, 0.97 to 0.99). A poor violence prevention climate was a risk factor for verbal (OR 0.48, 0.36 to 0.65, P < .001) and physical (OR 0.60, 0.45 to 0.82, P < .05) violence.

CONCLUSIONS

Interventions should aim at improving coworker relationships, work efficiency, and management promotion of the hospital violence prevention climate.

Media Depictions of "Unacceptable" Workplace Violence Toward Nurses

Violence and aggression toward nurses are global concerns. Despite repeated research on causal factors and widespread zero tolerance campaigns, rates of violence and aggression have not declined. Violence and aggression toward nurses can negatively affect their health and ultimately patient care. Media reporting of violence and aggression toward nurses might shape people's perceptions of the profession, perhaps impeding nurse recruitment and retention efforts in the face of global nursing shortages. The purpose of this study was to determine how print media in Scotland depicted reports of violence and aggression toward nurses. We used qualitative thematic analysis of newspaper articles and online news reporting of incidents of violence and aggression toward nurses between June 1, 2006 and May 31, 2016. Searches of Nexis and British Broadcasting Corporation (BBC) News Online databases returned 92 relevant newspaper articles. Standards for reporting qualitative research informed presentation of results. Key themes included blame (of perpetrator or senior management), helplessness (of nurses specifically or victimization), culture (social or organizational), and prevention and reduction measures. We concluded that media coverage of violence and aggression was overwhelmingly negative and reductionist. Normalization of violence and aggression was an accepted and acceptable part of the nursing role. We conclude with recommendations for policy and call for nurse leaders to challenge this culture of acceptability, especially to support recruitment and retention of nursing staff.

Nursing curriculum and bullying: An integrative literature review

OBJECTIVES

The purpose of this integrative review was to identify and synthesize key concepts that inform curriculum which increase nursing students' competence, skills and strategies when addressing bullying. Specifically, the authors sought to examine the concepts informing educational interventions, skills, and strategies, which addressed the bullying of nursing students.

DESIGN

Integrative literature review.

DATA SOURCES

A search of the electronic databases CINAHL, MEDLINE, ERIC, PsycINFO, Proquest, and PubMed was conducted in January 2016 using search terms such as 'bully' 'nursing student' 'education' and 'curriculum'.

REVIEW METHODS

Articles were screened for relevance and eligibility and extracted onto a table. Critical appraisal was conducted using multiple tools. Papers were analysed using constant comparison and concept mapping.

RESULTS

61 articles were included in the synthesis. Concepts identified included: empowerment, socialization, support, self-awareness, awareness about bullying, collaboration, communication, and self-efficacy. All concepts linked to empowerment. Social Cognitive Theory was used by many studies. Active teaching methods which gave students opportunities to practice skills were the most effective.

CONCLUSIONS

Empowered nursing students have the potential to address bullying more effectively and competently. Empowerment of nursing students is a powerful concept that educators must consider when developing curriculum and educational interventions to address bullying.

Postincident Support for Healthcare Workers Experiencing Occupational Violence and Aggression

PURPOSE

To investigate the relative contributions of workplace type, occupational violence and aggression (OVA) strategies and interventions along with perceptions of the occupational health and safety (OHS) environment on the likelihood of receiving postincident support following the experience of OVA.

DESIGN

We used a cross-sectional study design with an online survey to collect data from employees in nursing and midwifery in Victoria, Australia.

METHODS

Survey data collected from 3,072 members of the Australian Nursing and Midwifery Federation (Victorian branch) were analyzed using logistic regression.

FINDINGS

Of the 3,072 respondents who had experienced OVA in the preceding 12 months, 1,287 (42%) reported that they had received postincident support. Hierarchical logistic regression revealed that the OHS environment was the dominant factor that predicted the likelihood of workers receiving postincident support. Working in a positive OHS environment characterized by higher levels of leading indicators of OHS, prioritization of OHS, supervisor support for safety, and team psychological safety was the stronger predictor of postincident support. Being employed in a workplace that offered training in the management and prevention of OVA also increased the likelihood of receiving postincident support.

CONCLUSIONS

While training in the management and prevention of OVA contributed to the likelihood of receiving postincident support, a greater emphasis on the OHS environment was more important in predicting the likelihood that workers received support.

CLINICAL RELEVANCE

This study identifies workplace practices that facilitate the provision of postincident support for healthcare workers. Facilitating effective postincident support could improve outcomes for workers, their patients and workplaces, and society in general.

Détresse chez les préposés aux bénéficiaires en centre d'hébergement exposés à des symptômes comportementaux

ABSTRACTCare aides working in nursing homes are often exposed to responsive behaviours in older adults living with Alzheimer's disease. As these behaviors may induce psychological distress, the current research aims to estimate the contribution of a set of variables on the psychological distress reported by care aides. Variables include perceived frequency of responsive behaviours, primary and secondary cognitive appraisal, and coping strategies. A total of ninety-two day care aides were recruited in nursing homes in the Quebec City area. Standard multiple regression was completed and findings show that frequency of responsive behaviours, primary appraisal of threat, secondary appraisal (feeling incapable of changing the situation) and seeking emotional support contribute to care aides' psychological distress. This study highlights the importance of responsive behaviours on the units and discusses the psychological mechanisms used by care aides.

Experience of violence from the clients and coping methods among ICU nurses working a hospital in South Korea

PURPOSE

It is difficult to develop a good defense system that can prevent nurses from experiencing physical and verbal violence from patients and families in intensive care units, which are closed spaces. This study aimed to identify intensive care nurses' experience of violence from patients and families and investigate their coping methods, if there are any, in a tertiary hospital in South Korea.

METHODS

This study used a mixed methods design utilizing both a survey for collecting quantitative data and individual interviews for a qualitative one. A total of 200 intensive care nurses participated in the survey, with thirty of them taking part in individual interviews. Survey data were analyzed using SPSS 21.0 program, and qualitative data with qualitative content analysis method.

RESULTS

In the survey, 99.5% of the nurses reported that they had experienced violence from the patients and 67.5% from their visitors (families or relatives). Verbal violence were reported more than physical ones. They showed moderate or severe responses to violence, scoring an average of 2.98±0.63 out of 5. The qualitative data were analyzed to draw 4 themes, 8 categories, and 17 subcategories. The four themes were perception of violence, coping with violence experience, coping resources, and caring mind after violence experience.

CONCLUSION

While intensive care nurses experience unpredicted violence from patients and their visitors, they fail to cope well with the experience. The safe working environment of intensive care units is expected to contribute to quality care and an improvement of expertise in nursing.

Psychosocial Work Hazards, Self-Rated Health and Burnout: A Comparison Study of Public and Private Sector Employees

OBJECTIVES

To compare psychosocial work conditions and health status between public and private sector employees and to examine if psychosocial work conditions explained the health differences.

METHODS

Two thousand four hundred fourty one public and 15,589 private sector employees participated in a cross-sectional survey. Psychosocial work hazards, self-rated health (SRH), and burnout status were assessed by questionnaire.

RESULTS

As compared with private sector employees, public sector employees reported better psychosocial work conditions and better SRH, but higher risk of workplace violence (WPV) and higher levels of client-related burnout. Regression analyses indicated that higher psychosocial job demands, lower workplace justice, and WPV experience were associated with poor SRH and higher burnout. The public-private difference in client-related burnout remained even with adjustment of psychosocial work factors.

CONCLUSION

Greater risks of WPV and client-related burnout observed in public sector employees warrant further investigation.

Study on factors inducing workplace violence in Chinese hospitals based on the broken window theory: a cross-sectional study

OBJECTIVES

To explore the potential components of hospital workplace violence (HWPV) from the perspectives of hospital administrators and patients, and put forward corresponding strategies for its prevention and control.

SETTING

Using convenience sampling methods, 116 hospitals in 14 provinces of China were surveyed using a self-designed questionnaire.

METHODS

A cross-sectional study was used.

PARTICIPANTS

Hospital administrators and patients from 116 hospitals in 14 provinces of China.

RESULTS

First, hospital administrators point of workplace factors included six factors, with the following weighting coefficients: hospital administrator factors (29.40%), patient-related factors (20.08%), hospital environmental factors (19.45%), policy and institutional factors (11.92%), social psychological factors (10.26%), objective events factors (8.89%). Second, patients from the hospital workplace predisposing factors included three common factors. The weight coefficients of these were hospital-related factors (60.27%), social and governmental factors (23.64%) and patient-related factors (16.09%).

CONCLUSIONS

A wide range of factors according to hospital administrators, patients and in the hospital environment play important roles in HWPV. From the perspectives of hospital administrators, communication skills and attitude to the service are important factors for inducing HWPV. From the perspective of patients, the characteristics of staff personalities and medical cognition are more important inducing factors. As far as social factors are concerned, economic compensation of medical malpractice is an important inducing factor for HWPV. In terms of environmental factors, management of Chinese medical hospitals, medical procedures and the layout of departments are all potential factors for the occurrence of violence. Corresponding defects were exposed in the health legal system and the supervision system for influencing public opinion.

Encouraging employees to report verbal violence in primary health care in Serbia: A cross-sectional study

Introduction

Workplace violence is a serious and multidimensional problem that adversely affects professional and personal lives of employees. The aim of this study was to assess the prevalence and characteristics of verbal violence as a part of psychological violence among employees in primary health care in Belgrade, and to identify contributing factors of verbal violence in the workplace.

Methods

In this cross-sectional study, the final analysis included 1526 employees, using multi-stage sampling. Data were collected using the questionnaire Workplace Violence in the Health Sector Country Case Studies Research, developed by ILO/ICN/WHO/PSI. Descriptive statistics and logistic regression analysis were used to analyse the data. The general response rate was 86.8% (1526/1757).

Results

It was found that 47.8% of the participants were subjected to verbal violence. The main source of verbal violence was patient/client, 55.6% of employees did not report the incident. Among those who did not report the incident, 74.9% believed that reporting violence was useless. The interaction with patients (OR, 1.45; 95% CI, 1.02-2.06) and work between 6pm and 7am (OR, 1.27; 95% CI, 1.01-1.60) were significant contributing factors of verbal violence.

Conclusion

The results are indicative of a high prevalence of verbal violence against employees in primary health centres, which could have undesirable consequences. Conducting a better organizational measure and encouraging employees to report workplace violence could reduce the prevalence of verbal violence.

Validity and Reliability of the Persian Practice Environment Scale of Nursing Work Index

Background:

The practice environment pivotal role in patients and nurses better outcomes is evident. Practice Environment Scale of Nursing Work Index (PES-NWI) is widely utilized to assess nursing work environments. The present study was conducted to demonstrate the validity and reliability of the Persian version of PES-NWI.

Materials and Methods:

The instrument was translated and its psychometrics were investigated by content, construct validity (factor analysis), and homogeneity (internal consistency and intraclass correlation) on a sample of 350 nurses at educational hospitals in East Azerbaijan, Iran.

Results:

The 30 items loaded onto 4 factors explained 34.95–50.06% of the variance. The items across the factors differed slightly from those reported by the original author of the PES-NWI. Cronbach's alpha and Pearson coefficient for the entire instrument and also for extracted factors was 0.70–0.96.

Conclusions:

The Persian version of PES-NWI has an appropriate level of validity and reliability in the Iranian setting for nurses. The subscale of Nursing Foundations for quality care needs modification.

The impact of training program on nurses' attitudes toward workplace violence in Jordan

BACKGROUND

Nurses' attitudes toward workplace violence are still inadequately explored, and possess an impact in preventing, and managing the violent incidents and the quality of nursing care. Creating a demand for an effective intervention program to improve nurses' knowledge of and attitudes toward workplace violence.

OBJECTIVE

To study the impact of the training program on nurses' attitudes toward workplace violence in a military hospital in Jordan.

METHODS

One group before-after design was employed. A stratified random sample of 100 nurses working in three shifts was recruited. Data were collected earlier and after the preparation program using the Attitudes Toward Patient Physical Assault Questionnaire. "The Framework Guidelines for addressing workplace violence in the health sector", was adopted in this work. The preparation sessions were for one day each week over five weeks. The post-test assessment was over five weeks using the same questionnaire.

RESULTS

A total of 97 nurses completed the survey. The outcomes demonstrated the significant impact of the training program on nurses' attitudes towards workplace violence (t=6. 62, df=96, p=0.000). The prevalence of verbal abuse by patients and visitors was 63.9% and for physical abuse, 7.2% were from patients and 3.1% of visitors. Most violent incidents occurred during day duty and during delivering nursing care (40.2% and 32%, respectively). Major source of emotional support for abused nurses was from the nursing team (88.7%), while the legal support was from nursing management (48.5%).

CONCLUSION

The study highlights a general concern among nursing staff about workplace violence. Confirming that violence prevention education for staff is a necessary step forward to deescalate the problem. A significant effect of the training program was evident in this study.

Prevalence and Correlates of Psychological Symptoms in Chinese Doctors as Measured with the SCL-90-R: A Meta-Analysis

Poor mental health in doctors appears to be a global phenomenon, but there are limited data on changes in doctors' psychological symptoms over time in mainland China. Through a detailed meta-analysis of cross-sectional studies, our aim was to examine the prevalence of psychological symptoms in Chinese physicians as measured with the Symptom Checklist 90-R (SCL-90-R) and to explore the factors associated with doctors' mental health. A comprehensive search was performed in major English and Chinese databases. Thirty studies involving a total of 6,099 subjects were included in the meta-analysis. The pooled estimates of psychological symptoms including somatization, obsession-compulsion, interpersonal-sensitivity, depression, anxiety, hostility, phobic anxiety, and paranoid ideation among doctors were significantly higher than those in the general population. Only psychoticism was similar in prevalence to Chinese population norms. The prevalence increased with the study year but decreased with physicians' increasing age. Doctors from central and western China experienced more mental health symptoms than those from eastern China. Psychiatrists scored significantly less favorably than other doctors on most subscales of the SCL-90-R. Doctors' mental health may be associated with age discrepancy, quantitative workload, effort-reward ratio, doctor-patient relationships, professional identity, and individual traits. To minimize the risk of poor mental health in doctors, screening and professional intervention services should be provided at early career stages to raise physicians' awareness about the importance of maintaining psychological well-being and to reduce the prevalence of psychological symptoms.

Extent, Nature, and Risk Factors of Workplace Violence in Public Tertiary Hospitals in China: A Cross-Sectional Survey

Using a cross-sectional survey design from 11 public tertiary hospitals (a specialist hospital, four Chinese medicine hospitals, and six general hospitals) in the urban areas of Heilongjiang, we determined the nature of workplace violence that medical staff have encountered in Chinese hospitals and identified factors associated with those experiences of violence. A total of 1129 health workers participated. The specialist hospital had the highest prevalence of physical violence (35.4%), while the general hospitals had the highest prevalence of non-physical violence (76%). Inexperienced medical staff (p < 0.001) were more likely to suffer non-physical violence than physical violence in Chinese medicine hospitals compared to experienced staff. Medical units (p = 0.001) had a high risk of non-physical violence, while surgical units (p = 0.005) had a high risk of physical violence. In general hospitals, staff with higher levels of anxiety about workplace violence were more vulnerable to both physical violence (1.67, 95% CI 1.36–2.10) and non-physical violence (1.309, 95% CI 1.136–1.508) compared to those with lower levels of anxiety, while rotating shift workers had a higher odds of physical violence (2.2, 95% CI 1.21–4.17) and non-physical violence (1.65, 95% CI 1.13–2.41) compared to fixed day shift workers. Thus, prevention should focus not only on high-risk sections of hospitals, but also on the nature of the hospital itself.

Psychological violence in the health care settings in iran: a cross-sectional study

BACKGROUND

Psychological violence is the most common form of workplace violence that can affect professional performance and job satisfaction of health care workers. Although several studies have been conducted in Iran, but there is no consensus regarding current status of such violence.

OBJECTIVES

This study aimed to investigate the prevalence of psychological violence among healthcare workers employed at teaching hospitals in Iran.

PATIENTS AND METHODS

In this cross-sectional study, 5874 health professionals were selected using multistage random sampling. Data were collected using a self-administered questionnaire developed by the International Labor Organization, International Council of Nurses, World Health Organization, and Public Services International. Descriptive statistics were used to analyze the data.

RESULTS

It was found that 74.7% of the participants were subjected to psychological violence during the past 12 months. Totally, 64.5% of psychological violence was committed by patients' families, but 50.9% of participants had not reported the violence, and 69.9% of them believed that reporting was useless.

CONCLUSIONS

The results are indicative of high prevalence of psychological violence against healthcare workers. Considering non-reporting of violence in more than half of participants, use of an appropriate reporting system and providing training programs for health professionals in order to prevent and manage workplace violence are essential.

The development and psychometric testing of the horizontal violence scale

Inappropriate behaviors of healthcare workers can threaten the delivery of safe, quality care. The purpose of this research was to develop a research instrument specific to the construct of horizontal violence and conduct foundational psychometric testing of the newly developed instrument. The overall findings on the fit indices suggest that this model does adequately measure the underlying construct of horizontal violence. The instrument can be used as a way to determine the existence and extent of horizontal violence in practice settings and used to augment the study of the work environment, particularly in relation to healthy work environments.

The Aggression Observation Short Form identified episodes not reported on the Staff Observation Aggression Scale--Revised

The purpose of this study is to evaluate the underreporting of violence and aggression on the Staff Observation Aggression Scale-Revised (SOAS-R) when compared to a simpler assessment: the Aggression Observation Short Form (AOS). During a period of one year, two open and two closed wards gathered data on both the SOAS-R and the AOS for all of their patients. The 22-item SOAS-R is to be filled out after each violent episode. The 3-item AOS is to be filled out during each shift and should also record the absence of violence. The SOAS-R registered 703 incidents and the AOS registered 1,281 incidents. The agreement between the SOAS-R and the AOS was good (kappa = 0.65, 95% CI = 0.62-0.67). Among the 1,281 AOS episodes, 51% were also registered on the SOAS-R. For the 176 AOS episodes with harm, 42% were also registered on the SOAS-R. We found 44% missing registrations on the AOS, primarily for open wards and for patients with short admission lengths. Standard instruments such as the SOAS-R underreport aggressive episodes by 45% or more. Underreporting can be reduced by introducing shorter instruments, but it cannot be completely eliminated.

Patient and visitor assault on nurses and midwives: an exploratory study of employer 'protective' factors

Most Australian public health-care services have established a range of initiatives designed to help 'protect' nurses and midwives from patient and visitor assault (PVA); however, few studies have specifically examined their effectiveness. The present study is part of a larger survey that explored nurses' and midwives' experiences of PVA using the Department of Human Services, Victoria (2007) definition of occupational violence and bullying. Participants were asked about the presence of 'protective' factors in their workplace and the importance of having these factors to prevent and manage workplace aggression. Binary logistic regression was applied to ascertain the association between 'protective' factors and the occurrence of PVA, with adjusted odds ratios and their reported 95% confidence intervals for ascertaining the significance of the associations. The study found more 'protection' from assault when there was a high standard of patient facilities, sufficient staffing, effective enforcement of policies, and when staff were provided with personal protective equipment. Working in private health care, and being a registered nurse, also conferred 'protection'. A higher occurrence of staff assault was associated with specific clinical settings, and being on rotation and on night duty. Findings point to important insights into factors associated with 'protection' for PVA.

Queensland nursing staffs' perceptions of the preparation for practice of registered and enrolled nurses

INTRODUCTION

In Australia, unlike other countries, programmes which lead to registration as a registered or enrolled nurse (called "entry to practice" programmes) are carried out solely in the tertiary sector. In Australian nursing and the wider community, there continues to be a debate over the place of preparation and the "work readiness" of graduates.

BACKGROUND

Despite several opinion papers on the preparation of registered nurses, there is a dearth of published research on the perceptions of the clinical nursing workforce on the suitability of the current preparation for practice models.

METHODS

Data were collected from approximately 3000 nurses in Queensland, Australia in 2007 and 2010. The aim of these studies was to ascertain issues around nursing work. This paper reports on qualitative data that were collected as part of that larger survey. Specifically this paper provides the thematic analysis of one open-ended question: "what are the five key issues and strategies that you see could improve nursing and nursing work?" as it was apparent when we undertook thematic analysis of this question that there was a major theme around the preparation of nurses for the nursing workforce. We therefore carried out a more detailed thematic analysis around this major theme.

RESULTS

The major sub-themes that we identified from comments on the preparation of the nursing workforce were: perceptions of lack of clinical exposure and the need to increase the amount of clinical hours; the design of the curriculum, the place of preparation (solely within industry or a great focus on industry), financial consideration (students to be paid for their work); and in 2007 only, the need for students to have better time management.

DISCUSSION

The findings suggest that a majority of respondents believed there should be changes to the entry to practice preparation for nurses. The major focus of these comments was the perception of insufficient clinical experience and inappropriate curriculum content. Thus, graduates are not "work ready".

CONCLUSION

The attitude of clinical nurses, who work closely with student nurses, influences the workplace experience of student nurses. It is apparent from the statements of respondents in this study, that there is a need for stronger industry/academic partnerships, particularly around the design and implementation of the entry-to-practice curriculum.

Workplace violence in a large correctional health service in New South Wales, Australia: a retrospective review of incident management records

Background

Little is known about workplace violence among correctional health professionals. This study aimed to describe the patterns, severity and outcomes of incidents of workplace violence among employees of a large correctional health service, and to explore the help-seeking behaviours of staff following an incident.

Methods

The study setting was Justice Health, a statutory health corporation established to provide health care to people who come into contact with the criminal justice system in New South Wales, Australia. We reviewed incident management records describing workplace violence among Justice Health staff. The three-year study period was 1/7/2007-30/6/2010.

Results

During the period under review, 208 incidents of workplace violence were recorded. Verbal abuse (71%) was more common than physical abuse (29%). The most (44%) incidents of workplace violence (including both verbal and physical abuse) occurred in adult male prisons, although the most (50%) incidents of physical abuse occurred in a forensic hospital. Most (90%) of the victims were nurses and two-thirds were females. Younger employees and males were most likely to be a victim of physical abuse. Preparing or dispensing medication and attempting to calm and/or restrain an aggressive patient were identified as ‘high risk’ work duties for verbal abuse and physical abuse, respectively. Most (93%) of the incidents of workplace violence were initiated by a prisoner/patient. Almost all of the incidents received either a medium (46%) or low (52%) Severity Assessment Code. Few victims of workplace violence incurred a serious physical injury – there were no workplace deaths during the study period. However, mental stress was common, especially among the victims of verbal abuse (85%). Few (6%) victims of verbal abuse sought help from a health professional.

Conclusions

Among employees of a large correctional health service, verbal abuse in the workplace was substantially more common than physical abuse. The most incidents of workplace violence occurred in adult male prisons. Review of the types of adverse health outcomes experienced by the victims of workplace violence and the assessments of severity assigned to violent incidents suggests that, compared with health care settings in the community, correctional settings are fairly safe places in which to practice.

Factors associated with resident aggression toward caregivers in nursing homes

PURPOSE

Caregivers in nursing homes often experience aggressive behavior of residents. The aim of this study was to explore the caregivers' experiences with aggressive behavior from residents and to identify environmental factors as well as caregiver and resident characteristics related to aggressive behavior in Swiss nursing homes.

DESIGN

A retrospective cross-sectional survey was conducted between November 2010 and April 2011 with a sample of caregivers working in various nursing homes in the German-speaking part of Switzerland. In total, 814 caregivers (response rate 51.8%) of 21 nursing homes participated in the study.

METHODS

Data were collected using the German version of the Survey of Violence Experienced by Staff (SOVES-G-R). Standard descriptive statistics were used to describe and summarize the date. To identify risk factors related to the experience of aggression by residents, multilevel logistic regression analysis was applied.

FINDINGS

The prevalence of participants reporting an aggressive incident during the 12-month period prior to data collection was 81.6%. Of these, 76.5% had experienced verbal aggression, 27.6% threats, and 54.0% physical aggression. The predictive variables in the multiple regression model for physical aggression were: staff education level (odds ratio [OR]= 1.82), gender (OR = 1.82), age (< 30 years vs. 30-45 years: OR = 1.46; < 30 years vs. > 45 years: OR = 2.13), and confidence in managing physical aggression (OR = 1.49). The predictive variables for threatening behavior were staff education level (registered nurses vs. non-registered nurses: OR = 1.70; nonstudent vs. student: OR = 1.89) and age (< 30 years vs. 30-45 years: OR = 2.00; < 30 years vs. > 45 years: OR = 2.04).

CONCLUSIONS

Caregivers in nursing homes are at high risk for experiencing aggressive behavior. The identified risk factors are in line with earlier investigations, but some contradictory results also were observed.

CLINICAL RELEVANCE

The high risk for registered nurses exposed to aggressive behavior and the increased risk for caregivers who feel confident in managing aggressive behavior cast a critical light on the content and aim on present programs for management of aggressive behavior. Caregivers in nursing homes should be qualified in understanding resident aggression in a comprehensive way. A critical point in this topic seems to be the interaction between caregiver and resident during basic care activities. This topic should be investigated in further research projects.

Violence towards health care workers in a Public Health Care Facility in Italy: a repeated cross-sectional study

BACKGROUND

Violence at work is one of the major concerns in health care activities. The aim of this study was to identify the prevalence of physical and non-physical violence in a general health care facility in Italy and to assess the relationship between violence and psychosocial factors, thereby providing a basis for appropriate intervention.

METHODS

All health care workers from a public health care facility were invited to complete a questionnaire containing questions on workplace violence. Three questionnaire-based cross-sectional surveys were conducted. The response rate was 75% in 2005, 71% in 2007, and 94% in 2009. The 2009 questionnaire contained the VIF (Violent Incident Form) for reporting violent incidents, the DCS (demand/control/support) model for job strain, the Colquitt 20 item questionnaire for perceived organizational justice, and the GHQ-12 General Health Questionnaire for the assessment of mental health.

RESULTS

One out of ten workers reported physical assault, and one out of three exposure to non-physical violence in the workplace in the previous year. Nurses and physicians were the most exposed occupational categories, whereas the psychiatric and emergency departments were the services at greatest risk of violence. Workers exposed to non-physical violence were subject to high job strain, low support, low perceived organizational justice, and high psychological distress.

CONCLUSION

Our study shows that health care workers in an Italian local health care facility are exposed to violence. Workplace violence was associated with high demand and psychological disorders, while job control, social support and organizational justice were protective factors.

Violence towards health care workers in a Public Health Care Facility in Italy: a repeated cross-sectional study

Background

Violence at work is one of the major concerns in health care activities. The aim of this study was to identify the prevalence of physical and non-physical violence in a general health care facility in Italy and to assess the relationship between violence and psychosocial factors, thereby providing a basis for appropriate intervention.

Methods

All health care workers from a public health care facility were invited to complete a questionnaire containing questions on workplace violence. Three questionnaire-based cross-sectional surveys were conducted. The response rate was 75 % in 2005, 71 % in 2007, and 94 % in 2009. The 2009 questionnaire contained the VIF (Violent Incident Form) for reporting violent incidents, the DCS (demand/control/support) model for job strain, the Colquitt 20 item questionnaire for perceived organizational justice, and the GHQ-12 General Health Questionnaire for the assessment of mental health.

Results

One out of ten workers reported physical assault, and one out of three exposure to non-physical violence in the workplace in the previous year. Nurses and physicians were the most exposed occupational categories, whereas the psychiatric and emergency departments were the services at greatest risk of violence. Workers exposed to non-physical violence were subject to high job strain, low support, low perceived organizational justice, and high psychological distress.

Conclusion

Our study shows that health care workers in an Italian local health care facility are exposed to violence. Workplace violence was associated with high demand and psychological disorders, while job control, social support and organizational justice were protective factors.