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Richardson Velmans S, Joseph C, Wood L, Billings J. A systematic review and thematic synthesis of inpatient nursing staff experiences of working with high-risk patient behaviours. J Psychiatr Ment Health Nurs 2024; 31:325-339. [PMID: 37874310 DOI: 10.1111/jpm.12987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 08/30/2023] [Accepted: 09/17/2023] [Indexed: 10/25/2023]
Abstract
INTRODUCTION Nursing staff are frequently exposed to high-risk patient behaviours within inpatient health services, yet staff commonly report a lack of training and support in managing these behaviours. AIM The aim of the study was to examine nursing staff experiences of high-risk behaviours in inpatient mental health settings. METHODS Four electronic databases (CINAHL, Medline, PsycINFO, EMBASE) were searched. The protocol for this review was prospectively registered in PROSPERO (Ref: CRD42022334739). A meta-synthesis of nursing staff's experiences of high-risk behaviours in inpatient mental health settings was conducted. RESULTS We identified 30 eligible studies. Six themes were constructed from the meta-synthesis: the social contract of care; the function of risk behaviours; the expectation of risk; risk as a relational concept; navigating contradictions in care; the aftermath. DISCUSSION Nursing staff conceptualize risk as a meaningful behaviour shaped by patient, staff and environmental factors. Managing risk is an ethical dilemma for nursing staff and they require more training and support in ethical risk decision-making. IMPLICATIONS FOR PRACTICE Inpatient mental healthcare services should formulate and manage risk as a relational concept comprising staff, patient and environmental factors. Future research and clinical practice should place further consideration on the varied experiences of different types of risk behaviours. RELEVANCE STATEMENT Nursing staff are frequently exposed to high-risk patient behaviours within inpatient health services, yet staff commonly report a lack of training and support in managing these behaviours. This systematic review offers insights into how high-risk behaviours are experienced by nursing staff and makes recommendations about how to improve the understanding and management of them. Inpatient mental healthcare services should formulate and manage risk as a relational concept comprising staff, patient and environmental factors. Future research and clinical practice should place further consideration on the varied experiences of different types of risk behaviours.
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Affiliation(s)
| | | | - Lisa Wood
- Division of Psychiatry, University College London, London, UK
| | - Jo Billings
- Division of Psychiatry, University College London, London, UK
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Välimäki M, Lantta T, Kontio R. Risk assessment for aggressive behaviour in schizophrenia. Cochrane Database Syst Rev 2024; 5:CD012397. [PMID: 38695777 PMCID: PMC11064887 DOI: 10.1002/14651858.cd012397.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
BACKGROUND Aggressive or violent behaviour is often associated with people with schizophrenia in common perceptions of the disease. Risk assessment methods have been used to identify and evaluate the behaviour of those individuals who are at the greatest risk of perpetrating aggression or violence or characterise the likelihood to commit acts. Although many different interventions have been developed to decrease aggressive or violent incidences in inpatient care, staff working in inpatient settings seek easy-to-use methods to decrease patient aggressive events. However, many of these are time-consuming, and they require intensive training for staff and patient monitoring. It has also been recognised in clinical practice that if staff monitor patients' behaviour in a structured manner, the monitoring itself may result in a reduction of aggressive/violent behaviour and incidents in psychiatric settings. OBJECTIVES To assess the effects of structured aggression or violence risk assessment methods for people with schizophrenia or schizophrenia-like illnesses. SEARCH METHODS We searched the Cochrane Schizophrenia Group's Study-Based Register of Trials, which is based on CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, PubMed, ISRCTN registry, ClinicalTrials.gov, and WHO ICTRP, on 10 February 2021. We also inspected references of all identified studies. SELECTION CRITERIA We included all randomised controlled trials (RCTs) comparing structured risk assessment methods added to standard professional care with standard professional care for the evaluation of aggressive or violent behaviour among people with schizophrenia. DATA COLLECTION AND ANALYSIS At least two review authors independently inspected citations, selected studies, extracted data, and appraised study quality. For binary outcomes, we calculated a standard estimation of the risk ratio (RR) and its 95% confidence interval (CI). For continuous outcomes, we calculated the mean difference (MD) and its 95% CI. We assessed risk of bias in the included studies and created a summary of findings table using the GRADE approach. MAIN RESULTS We included four studies in the review. The total number of participants was not identifiable, as some studies provided number of participants included, and some only patient days. The studies compared a package of structured assessment methods with a control group that included routine nursing care and drug therapy or unstructured psychiatric observations/treatment based on clinical judgement. In two studies, information about treatment in control care was not available. One study reported results for our primary outcome, clinically important change in aggressive/violent behaviour, measured by the rate of severe aggression events. There was likely a positive effect favouring structured risk assessment over standard professional care (RR 0.59, 95% CI 0.41 to 0.85; 1 RCT; 1852 participants; corrected for cluster design: RR 0.59, 95% CI 0.37 to 0.93; moderate-certainty evidence). One trial reported data for the use of coercive measures (seclusion room). Compared to standard professional care, structured risk assessment may have little or no effect on use of seclusion room as days (corrected for cluster design: RR 0.92, 95% CI 0.27 to 3.07; N = 20; low-certainty evidence) or use of seclusion room as secluded participants (RR 1.83, 95% CI 0.39 to 8.7; 1 RCT; N = 20; low-certainty evidence). However, seclusion room may be used less frequently in the standard professional care group compared to the structured risk assessment group (incidence) (corrected for cluster design: RR 1.63, 95% CI 0.49 to 5.47; 1 RCT; N = 20; substantial heterogeneity, Chi2 = 0.0; df = 0.0; P = 0.0; I2 = 100%; low-certainty evidence). There was no evidence of a clear effect on adverse events of escape (RR 0.2, 95% CI 0.01 to 4.11; 1 RCT; n = 200; very low-certainty evidence); fall down (RR 0.33, 95% CI 0.04 to 3.15; 1 RCT; n = 200; very low-certainty evidence); or choking (RR 0.2, 95% CI 0.01 to 4.11; 1 RCT; n = 200; very low-certainty evidence) when comparing structured risk assessment to standard professional care. There were no useable data for patient-related outcomes such as global state, acceptance of treatment, satisfaction with treatment, quality of life, service use, or costs. AUTHORS' CONCLUSIONS Based on the available evidence, it is not possible to conclude that structured aggression or violence risk assessment methods are effective for people with schizophrenia or schizophrenia-like illnesses. Future work should combine the use of interventions and structured risk assessment methods to prevent aggressive incidents in psychiatric inpatient settings.
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Affiliation(s)
- Maritta Välimäki
- School of Public Health, University of Helsinki, Helsinki, Finland
| | - Tella Lantta
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Raija Kontio
- Department of Nursing Science, University of Turku, Turku, Finland
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Andersen LP, Jaspers S, Andersen D, Karlsen I, Aust B. A participatory and comprehensive intervention to improve violence prevention in two high-risk occupations: effect and process evaluation of a stepped wedge cluster randomised trial. BMC Public Health 2024; 24:1043. [PMID: 38622564 PMCID: PMC11017600 DOI: 10.1186/s12889-024-18527-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 04/04/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Work-related violence committed by clients, patients, and customers represents a major occupational health risk for employees that needs to be reduced. METHODS We tested a comprehensive violence prevention intervention involving active participation of both employees and managers in the Prison and Probation Service (PPS) and on psychiatric wards in Denmark. We used a stepped wedge cluster randomised controlled trial design. We measured the degree of implementation of the intervention by registration of fidelity, reach, and dose and used a mixed-effects regression analysis to estimate the effects of the intervention. RESULTS We recruited 16 work units for the intervention, but three work units dropped out. The average implementation rate was 73%. In the psychiatric wards, the intervention led to statistically significant improvements in the primary outcome (an increase in the degree to which managers and employees continuously work on violence prevention practices based on their registration and experiences), but none statistically significant improvements in any of the secondary outcomes. In the PPS units, the intervention did not lead to a statistically significant improvement in the primary outcome, but to statistically significant improvements in three secondary outcomes. CONCLUSION Most work units were able to carry out the intervention as planned. The intervention showed mixed results regarding the primary outcome. Nevertheless, the results indicate improvements also in the sector where a change in the primary outcome was not achieved. The results point at that a participatory and comprehensive approach could be a viable way of working with violence prevention in high-risk workplaces. TRIAL REGISTRATION ISRCTN86993466: 20/12/2017.
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Affiliation(s)
- Lars Peter Andersen
- Department of Occupational Medicine, Danish Ramazzini Centre, University Research Clinic, Goedstrup Hospital, Hospitalsparken 15, 7400, Herning, Denmark.
| | - S Jaspers
- The National Research Centre for the Working Environment, Lersø Parkallé 105, 2100, Copenhagen Ø, Denmark
| | - D Andersen
- Department of Occupational Medicine, Danish Ramazzini Centre, University Research Clinic, Goedstrup Hospital, Hospitalsparken 15, 7400, Herning, Denmark
| | - I Karlsen
- The National Research Centre for the Working Environment, Lersø Parkallé 105, 2100, Copenhagen Ø, Denmark
| | - B Aust
- The National Research Centre for the Working Environment, Lersø Parkallé 105, 2100, Copenhagen Ø, Denmark
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Cooper AL, Best MC, Read RA, Brown JA. Exploring work-related stressors experienced by mental health nurses: A qualitative descriptive study. J Psychiatr Ment Health Nurs 2024. [PMID: 38462894 DOI: 10.1111/jpm.13038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 02/11/2024] [Accepted: 02/27/2024] [Indexed: 03/12/2024]
Abstract
INTRODUCTION The challenging work environments mental health nurses (MHNs) encounter can negatively impact their mental health, psychological well-being and physical health. While these impacts have been investigated in quantitative research, little is known about work-related stress from the perspective of MHNs. AIM To explore the stresses faced by nurses working in mental health settings and to gain an understanding of the underlying workplace context. METHOD A descriptive qualitative study with data collected via semi-structured individual telephone interviews conducted with n = 21 Western Australian MHNs. Data were analysed using reflexive thematic analysis. RESULTS A total of 85 codes were generated that led to the identification of 13 subthemes and 4 main themes: (1) mental health nursing context, (2) work environment stressors, (3) factors that alleviate stress and (4) the impact of workplace stress. DISCUSSION Many of the stressors MHNs were exposed to are modifiable, such as understaffing and poor skill mix. Modifiable stressors increased risk for MHNs, impeded patient care and exacerbated inherent stressors such as patient acuity and complexity. IMPLICATIONS FOR PRACTICE This study collected data that provide rich descriptions of the experiences of MHNs and identify modifiable work-related stressors that could be alleviated through effective leadership and management.
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Affiliation(s)
- Alannah L Cooper
- Centre for Wellbeing and Sustainable Practice, Royal Perth Bentley Group, Perth, Western Australia, Australia
| | - Megan C Best
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Camperdown, New South Wales, Australia
| | - Richard A Read
- Centre for Wellbeing and Sustainable Practice, Royal Perth Bentley Group, Perth, Western Australia, Australia
| | - Janie A Brown
- School of Nursing, Curtin University, Perth, Western Australia, Australia
- St John of God Midland Public and Private Hospital, Midland, Western Australia, Australia
- The Western Australian Group for Evidence Informed Healthcare Practice, Curtin University, Perth, Western Australia, Australia
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Bloemendaal AFT, Kamperman AM, Bonebakker AE, Kool N, Olff M, Mulder CL. Workplace trauma and professional quality of Life in clinical and forensic psychiatry: the CRITIC study. Front Psychiatry 2024; 15:1228335. [PMID: 38495910 PMCID: PMC10940400 DOI: 10.3389/fpsyt.2024.1228335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 02/12/2024] [Indexed: 03/19/2024] Open
Abstract
Background Frontline staff in psychiatry need to perform at a very high professional level in order to ensure patient and community safety. At the same time they are exposed to high levels of stress and workplace trauma. This may have severe consequences for their professional quality of life. In addition, health care workers in general have higher incidence levels of childhood adversity than the general population. The CRITIC (CRITical Incidents and aggression in Caregivers) Study aims to improve increased understanding of the interaction between personal life history (childhood adversity and benevolence), individual capabilities, exposure to trauma and violence at work and Professional Quality of Life (ProQOL). Method The Critic Study is a cross-sectional survey of these aspects in frontline, treatment and administrative staff in clinical and forensic psychiatry. We aim to include 360 participants. Participants will be asked to complete questionnaires on childhood adversity and childhood benevolence (assessing personal life history), professional quality of life, current trauma and violence exposure, current mental health (depression, anxiety and stress), coping, social support, work engagement and resilience. In this study we will examine the moderating role of adverse and benevolent childhood experiences in the association between workplace trauma exposure and professional quality of life. Finally, a theoretical model on the relationships between trauma, stress and coping in the context of professional functioning will be tested using structural equation modelling. Discussion The CRITIC study examines which factors influence the complex relationship between childhood adversity and benevolence, and ProQOL in healthcare workers. It also aims to provide insight into the complex relationship between personal life history, individual characteristics, exposure to trauma and violence at work and ProQOL. The results can be used for designing interventions to increase resilience to trauma and to improve professional quality of life among health care professionals. Trial registration The CRITIC study has been approved by the Medical Ethical Committee of the Erasmus Medical Centre, under trial registration number NL73417.078.20.
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Affiliation(s)
- Anthony F. T. Bloemendaal
- Department of Psychiatry, Erasmus Medical Centre, Rotterdam, Netherlands
- Dual Disorder Treatment Centre, Fivoor, The Hague, Netherlands
| | | | | | - N. Kool
- Dual Disorder Treatment Centre, Fivoor, The Hague, Netherlands
| | - M. Olff
- Amsterdam University Medical Centre (UMC), Department of Psychiatry, University of Amsterdam, Amsterdam Neuroscience and Amsterdam Public Health & ARQ National Psychotrauma Centre, Diemen, Netherlands
| | - C. L. Mulder
- Department of Psychiatry, Erasmus Medical Centre, Rotterdam, Netherlands
- Dual Disorder Treatment Centre, Fivoor, The Hague, Netherlands
- Antes Psychiatric Care, Parnassia Group, Rotterdam, Netherlands
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Fuentes-Olavarría D, Rodríguez-Rivas ME, Romo-Neira J. Workload and psychosocial risks among nurses in mental health and psychiatry in Chile. Int J Ment Health Nurs 2024. [PMID: 38183337 DOI: 10.1111/inm.13286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 12/19/2023] [Indexed: 01/08/2024]
Abstract
The present study aims to explore and compare psychosocial risks and work overload among nursing professionals in the field mental health and psychiatry in Chile. Quantitative, observational and cross-sectional research was designed for this purpose. Nurses from community, ambulatory, hospital and emergency units in mental health and psychiatry in Chile were recruited between January and May 2022. Instruments of psychosocial variables and an occupational psychosocial risk scale based on the Copenhagen Psychosocial Questionnaire were used. Descriptive and correlational statistics were used, as well as independent samples t-tests, Factorial Anova and post-hoc analysis with Bonferroni correction. As a result, 174 nursing professionals were recruited, 79.3% female, average age 33.9 years. One-third belonged to the Metropolitan Region of Chile. The highest psychosocial risk was obtained by nurses over 30 years of age, from the Metropolitan Region, with more than 16 patients under their care, at the hospital or psychiatric emergency level. Significant differences were observed in work overload and psychosocial risks according to personal and work characteristics of the professionals, as well as of the users and health services. The levels of psychosocial risk and work overload of mental health and psychiatric nurses were reported, as well as the comparison of these according to personal, sociodemographic, and work characteristics. In order to improve the quality of work life of these professionals and the quality of these services, it is essential to develop interventions focused on the dimensions addressed, as well as to define norms and policies that ensure a workload in accordance with international standards.
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Harvey G, Carter-Snell C, Kanikwu M. Exploring the meaning of peer support used by undergraduate nursing students who have experienced clinical-related critical incidents: A hermeneutic study. NURSE EDUCATION TODAY 2024; 132:106018. [PMID: 37948974 DOI: 10.1016/j.nedt.2023.106018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/23/2023] [Accepted: 10/30/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Undergraduate nursing students may access support from peers after having experienced critical incidents during experiential learning opportunities. While researchers have addressed peer support relative to academic or day-to-day stress in undergraduate nursing students, there is a paucity of data on the context of clinical related critical incidents. OBJECTIVE To better understand undergraduate nursing students' experiences of using peer support after clinical related critical incidents. DESIGN Experiential learning places undergraduate nursing students at risk of encountering critical incidents. Gadamer's philosophical hermeneutics was the research approach used to explore the meaning of peer support accessed by undergraduate nursing students who had experienced clinical related critical incidents. SETTING Participants were recruited from a Canadian university. PARTICIPANTS A purposive sample was used to recruit nine students who were enrolled in a baccalaureate nursing program. Data collection involved conducting semi-structured interviews over 12 months in 2021-2022. METHOD The interviews with participants were recorded and transcribed and the data was analyzed using the interpretive method of hermeneutics. RESULTS Findings from this research revealed that peer support was an effective informal method of providing immediate assistance to undergraduate nursing students. Inherent in this support was a safe space where students experienced a sense of belonging which normalized the incident and minimized isolation. Support was perceived by some participants as reciprocal as both the traumatized individual and the peer supporter benefited from the organic connection. CONCLUSIONS This study highlighted the importance of nurturing a psychologically safe clinical learning environment where students who experience critical incidents may seek timely support from peers and clinical instructors.
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Affiliation(s)
- Giuliana Harvey
- Mount Royal University, 4825 Mount Royal Gate, Calgary, Alberta T3E 6K6, Canada.
| | | | - Maryjane Kanikwu
- Mount Royal University, 4825 Mount Royal Gate, Calgary, Alberta T3E 6K6, Canada.
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Kernaghan K, Hurst K. Reducing violence and aggression: a quality improvement project for safety on an acute mental health ward. BMJ Open Qual 2023; 12:e002448. [PMID: 38154818 PMCID: PMC10759083 DOI: 10.1136/bmjoq-2023-002448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 12/06/2023] [Indexed: 12/30/2023] Open
Abstract
Violence and aggression (V&A) are identified as an issue on mental health wards that negatively affect staff, patients, care delivery and safety. This project took place on a male acute mental health ward where V&A are known to be an issue with an average of 21.3 incidences per month in the 6 months preceding the project.The aim was to use QI (Quality Improvement) methodology to reduce incidences of V&A by 20% over a 4-month period. A root cause analysis was completed with staff, previous QI projects and literature on interventions for V&A were reviewed. Two changes were introduced via PDSA (plan, do, study, act) cycles; first was a safewards bundle including a training package, weekly emails and noticeboard displays, the second was safety crosses displayed on the ward.There was a reduction in incidences of V&A across the project, mean weekly incidences reduced from 2.5 at baseline audit to 2.0 at the end of the project. This equates to a 20% reduction in V&A. The project did result in an increase of safewards interventions recorded and staff ratings of ward safety improved. There was a statistically significant correlation found between incidences of V&A and rates of restrictive practices.Further analysis of the 20% reduction did not find a special cause variation, so results may be due to a common cause variation rather than the QI interventions. Safety crosses were not found to have an impact on rates of V&A, it is likely these need to be more embedded into communication about V&A on the ward. Potential confounding patient variables such as illicit drug use and history of V&A as well as staffing should be recorded and monitored in future projects. Recommendations to enhance further change should include regular meetings with both staff and patients to support open communication about the topic.
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Affiliation(s)
- Katrina Kernaghan
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Kay Hurst
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK
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Flannery RB, Flannery GJ. Characteristics of International Assaultive Psychiatric Patients: Review of Published Findings, 2017-2022. Psychiatr Q 2023; 94:559-568. [PMID: 37667138 DOI: 10.1007/s11126-023-10050-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/28/2023] [Indexed: 09/06/2023]
Abstract
Since the 1960s, empirical research has focused on a better understanding of the characteristics of assaultive psychiatric patients. International research from 1960 to 2017 indicated that male and female patients with schizophrenia and substance use disorder presented the greatest risk for assault with nursing personnel being at higher risk. This present review of studies sought to assess the latest research findings on assaultive patients for the most recent five-year period, 2017-2022. It was hypothesized that patients with schizophrenia and substance use disorders would present the greatest assault risk for nursing personnel. The studies in this review supported this hypothesis. Assaults by patients with schizophrenia and substance abuse has been a consistent finding worldwide for 62 years of published research. Explanations for these findings, the possible role of posttraumatic stress disorder (PTSD) in assaultive patients, and an updated methodological review are presented.
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Affiliation(s)
- Raymond B Flannery
- University of Massachusetts Chan Medical School The ASAP Program, 7 Westchester Road, Newton, MA, 02458, USA.
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Ose SO, Lohmann-Lafrenz S, Kaspersen SL, Berthelsen H, Marchand GH. Registered nurses' exposure to workplace aggression in Norway: 12-month prevalence rates, perpetrators, and current turnover intention. BMC Health Serv Res 2023; 23:1272. [PMID: 37974173 PMCID: PMC10655393 DOI: 10.1186/s12913-023-10306-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 11/09/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Identifying occupational health hazards among Registered Nurses (RNs) and other health personnel and implementing effective preventive measures are crucial to the long-term sustainability of health services. The objectives of this study were (1) to assess the 12-month prevalence rates of exposure to workplace aggression, including physical violence, threats of violence, sexual harassment, and bullying; (2) to identify whether the perpetrators were colleagues, managers, subordinates, or patients and their relatives; (3) to determine whether previous exposure to these hazards was associated with RNs' current turnover intention; and (4) to frame workplace aggression from an occupational health and safety perspective. METHODS The third version of the Copenhagen Psychosocial Questionnaire (COPSOQ III) was used to assess RNs' exposure to workplace aggression and turnover intention. A national sample of 8,800 RNs in Norway, representative of the entire population of registered nurses in terms of gender and geography, was analysed. Binary and ordinal logistic regression analyses were conducted, and odds for exposure and intention to leave are presented, with and without controls for RNs' gender, age, and the type of health service they work in. RESULTS The 12-month prevalence rates for exposure were 17.0% for physical violence, 32.5% for threats of violence, 12.6% for sexual harassment, and 10.5% for bullying. In total, 42.6% of the RNs had experienced at least one of these types of exposure during the past 12 months, and exposure to more than one of these hazards was common. Most perpetrators who committed physical acts and sexual harassment were patients, while bullying was usually committed by colleagues. There was a strong statistical association between exposure to all types of workplace aggression and RNs' intention to leave. The strongest association was for bullying, which greatly increased the odds of looking for work elsewhere. CONCLUSIONS Efforts to prevent exposure to workplace aggression should be emphasised to retain health personnel and to secure the supply of skilled healthcare workers. The results indicate a need for improvements. To ensure the sustainability of health services, labour and health authorities should join forces to develop effective workplace measures to strengthen prevention, mitigation, and preparedness regarding incidents of workplace aggression in health services and the response and recovery regarding incidents that could not be prevented.
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Affiliation(s)
| | | | | | - Hanne Berthelsen
- Centre for WorkLife and Evaluation Studies, Malmö University, Malmö, Sweden
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Ham E, Hilton NZ, Crawford J, Kim S. Psychiatric inpatient services in Ontario, 2019-2021: a cross-sectional comparison of admissions, diagnoses and acuity during the COVID-19 prerestriction, restriction and postrestriction periods. CMAJ Open 2023; 11:E988-E994. [PMID: 37875314 PMCID: PMC10609896 DOI: 10.9778/cmajo.20220158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic was associated with increased mental health problems in the general population, yet psychiatric hospital admissions decreased. Early evidence suggested that psychiatric admissions normalized within weeks; we sought to examine the longer-lasting impacts on the psychiatric inpatient population beyond this initial period. METHODS We compared Ontario Mental Health Reporting System admission data for patients admitted to 8 psychiatric hospitals in Ontario, Canada, between 3 time periods - before restrictions were imposed (June 22, 2019, to Mar. 16, 2020), during restrictions (Mar. 17 to June 21, 2020) and after restrictions were lifted (June 22, 2020, to Mar. 16, 2021) for changes in involuntary status, diagnoses and clinical presentation using descriptive analysis. For clinical presentation, we extracted scores on 4 Resident Assessment Instrument-Mental Health symptom scales (Depressive Severity Index, Cognitive Performance Scale, Positive Symptoms Scale-Long Version and Social Withdrawal Scale), and 2 behaviour scales (Aggressive Behavior Scale and Violence Sum). RESULTS A cross-sectional sample of 9848 patients was included in the analysis. The mean number of daily admissions decreased 19% from 16.4 (standard deviation [SD] 8.0) before the restriction period to 13.3 (SD 6.1) during the restriction period, and was still 6% below prerestriction levels after restrictions were lifted 15.4 (SD 6.8), with standard error difference of 1.03 (95% confidence interval -0.22 to 2.29). From the pre- to the postrestriction periods, the proportion of involuntary patients increased by 6 percentage points, and the proportions of patients diagnosed with a psychotic disorder or personality disorder increased by 4 percentage points and 1 percentage point, respectively. INTERPRETATION Psychiatric admissions did not fully return to prerestriction levels in absolute rates and patient acuity after COVID-19 restrictions were lifted. Psychiatric services must prepare to appraise and respond to any increased acuity through interventions for patients, workforce planning and mental health support for staff.
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Affiliation(s)
- Elke Ham
- Waypoint Research Institute (Ham, Hilton, Crawford, Kim), Waypoint Centre for Mental Health Care, Penetanguishene, Ont.; Department of Psychiatry (Hilton), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Faculty of Health Sciences (Crawford), Ontario Tech University, Oshawa, Ont.; Psychiatry and Behavioural Neurosciences (Kim), McMaster University, Hamilton, Ont.
| | - N Zoe Hilton
- Waypoint Research Institute (Ham, Hilton, Crawford, Kim), Waypoint Centre for Mental Health Care, Penetanguishene, Ont.; Department of Psychiatry (Hilton), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Faculty of Health Sciences (Crawford), Ontario Tech University, Oshawa, Ont.; Psychiatry and Behavioural Neurosciences (Kim), McMaster University, Hamilton, Ont
| | - Jennifer Crawford
- Waypoint Research Institute (Ham, Hilton, Crawford, Kim), Waypoint Centre for Mental Health Care, Penetanguishene, Ont.; Department of Psychiatry (Hilton), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Faculty of Health Sciences (Crawford), Ontario Tech University, Oshawa, Ont.; Psychiatry and Behavioural Neurosciences (Kim), McMaster University, Hamilton, Ont
| | - Soyeon Kim
- Waypoint Research Institute (Ham, Hilton, Crawford, Kim), Waypoint Centre for Mental Health Care, Penetanguishene, Ont.; Department of Psychiatry (Hilton), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Faculty of Health Sciences (Crawford), Ontario Tech University, Oshawa, Ont.; Psychiatry and Behavioural Neurosciences (Kim), McMaster University, Hamilton, Ont
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Choi H, Shin S, Jeon J, Lee H, Lee J, Seo C, Kim S, Park S, Woo S. Workplace Violence Experienced by Community Mental Health Workers. Issues Ment Health Nurs 2023; 44:726-734. [PMID: 37364259 DOI: 10.1080/01612840.2023.2219753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
A cross-sectional online survey was conducted to 1) investigate the prevalence of workplace violence and workers' emotional distress, 2) explore factors associated with workplace violence, and 3) assess workers' needs for preventive measures. A total of 763 community mental health workers participated in Korea. Among them, 85.85% of workers experienced workplace violence, including verbal (74.31%), emotional (66.45%), infectious (47.44%), informational (42.60%), sexual (32.50%), and physical (23.72%) abuse. Binary logistic regression analysis indicated that sex, occupation, certification, and working institution were significantly associated with workplace violence. Workplace violence affects workers' depression, anger, and anxiety negatively. The most-needed preventive measure is a two-person home visit.
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Affiliation(s)
- Heeseung Choi
- College of Nursing and Research Institute of Nursing Science, Seoul National University, Seoul, Republic of Korea
| | - Soyoun Shin
- College of Nursing and Research Institute of Nursing Science, Seoul National University, Seoul, Republic of Korea
| | - Junhee Jeon
- Hwaseong Community Mental Health Welfare Center, Gyeonggi-do, Republic of Korea
| | - Heewoo Lee
- Department of Psychiatry, Seoul Medical Center, Seoul, Republic of Korea
| | - Jongeun Lee
- Department of Nursing, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - ChongHee Seo
- Hwaseong Youth Mental Health Welfare Center, Gyeonggi-do, Republic of Korea
| | - Sumi Kim
- College of Nursing and Research Institute of Nursing Science, Seoul National University, Seoul, Republic of Korea
| | - Sanghoon Park
- Ulsan Donggu Community Mental Health Center, Ulsan, Republic of Korea
| | - SoHyun Woo
- College of Nursing and Research Institute of Nursing Science, Seoul National University, Seoul, Republic of Korea
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13
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Giusti EM, Veronesi G, Callegari C, Borchini R, Castelnuovo G, Gianfagna F, Iacoviello L, Ferrario MM. Pre-pandemic burnout and its changes during the COVID-19 outbreak as predictors of mental health of healthcare workers: A lesson to be learned. Psychiatry Res 2023; 326:115305. [PMID: 37331071 PMCID: PMC10261975 DOI: 10.1016/j.psychres.2023.115305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 06/08/2023] [Accepted: 06/11/2023] [Indexed: 06/20/2023]
Abstract
The aim of this study was to identify how previously existing burnout and its changes during the pandemic contributed to PTSD symptoms and psychological distress in a cohort of 388 healthcare workers (HCWs). Each HCW was surveyed in Sep 2019 (before COVID-19) and again in Dec 2020-Jan 2021 (during the pandemic) to assess burnout (MBI); and in the second wave only to assess PTSD (PCL-5-SF), psychological distress (GHQ-12) and resilience (CD-RISC-10). Changes in emotional exhaustion (EE) and depersonalisation (DEP) were stronger in HCWs with lower EE and DEP baseline values. HCWs with higher baseline poor personal accomplishment (PPA) improved more than those with lower baseline values. In multivariable-adjusted models, pre-pandemic EE and its changes were equally associated to both outcomes: standardised-βs of 0.52 and 0.54 for PTSD, respectively; and 0.55 and 0.53 for psychological distress. Changes in DEP were associated with PTSD only (0.10). Changes in PPA had a higher association with psychological distress (0.29) than pre-pandemic PPA (0.13). Resilience was associated with lower psychological distress (-0.25). Preventive actions aimed at reducing EE, e.g., addressing organisational dysfunctions, are needed to mitigate the impact of future crises, whereas improving personal accomplishment levels is a key target to protect HCWs from mental health disorders during a pandemic.
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Affiliation(s)
- Emanuele Maria Giusti
- EPIMED Research Center, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Giovanni Veronesi
- EPIMED Research Center, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Camilla Callegari
- Division of Psychiatry, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | | | - Gianluca Castelnuovo
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy; Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Verbania, Italy
| | - Francesco Gianfagna
- EPIMED Research Center, Department of Medicine and Surgery, University of Insubria, Varese, Italy; Mediterranea Cardiocentro, Napoli, Italy
| | - Licia Iacoviello
- EPIMED Research Center, Department of Medicine and Surgery, University of Insubria, Varese, Italy; Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy
| | - Marco Mario Ferrario
- EPIMED Research Center, Department of Medicine and Surgery, University of Insubria, Varese, Italy.
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14
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Fu C, Lv X, Cui X, Huang M, Cao F. The association between fear of future workplace violence and depressive symptoms among nurses based on different experiences of workplace violence: a cross-sectional study. BMC Nurs 2023; 22:123. [PMID: 37061670 PMCID: PMC10105151 DOI: 10.1186/s12912-023-01265-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 03/23/2023] [Indexed: 04/17/2023] Open
Abstract
BACKGROUND Fear of future workplace violence (FFWV) has a negative impact on individuals' health. However, no study has investigated the association between FFWV and depressive symptoms. Nurses with different experiences of workplace violence may have different levels of FFWV and differences in mental health. This study explored the association between FFWV and depressive symptoms among Chinese nurses with different experiences of workplace violence. METHODS A cross-sectional study was conducted involving 1888 Chinese nurses from 12 tertiary hospitals in Shandong Province. The Fear of Future Violence at Work scale was used to measure FFWV. Depressive symptoms were assessed using the 10-item Center for Epidemiologic Studies Depression scale. Multiple logistic regression analysis was used to examine the association between FFWV and depressive symptoms. RESULTS The prevalence of depressive symptoms was 45.9% (no aggression group: 24.3%; non-physical violence group: 46.1%; physical violence group: 63.7%), and 72.8% of nurses had high levels of fear of future workplace violence (no aggression group: 60.2%; non-physical violence group: 75.6%; physical violence group: 70.8%). Compared with low levels of FFWV, high levels of FFWV were associated with more depressive symptoms among nurses in the no aggression group (odds ratio [OR] = 3.269, 95% confidence interval [CI]: 1.102-9.695) and in the non-physical violence group (OR = 2.338, 95% CI: 1.385-3.945). CONCLUSION Nurses who had experienced physical violence had the most depressive symptoms and nurses with experience of non-physical violence had the greatest FFWV. Our findings suggested that there was a significant association between FFWV and depressive symptoms among Chinese nurses in the no aggression and non-physical violence groups. Hospital administrators need to address FFWV needs when developing strategies to reduce depressive symptoms among nurses.
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Affiliation(s)
- Chang Fu
- Department of Health Service and Management, School of Public Health and Management, Binzhou Medical University, Yantai, Shandong, China
| | - Xiaoqin Lv
- Department of Hepatobiliary and Pancreatic Surgery, Binzhou Medical University Hospital, Binzhou, Shandong, China
| | - Xuedan Cui
- Office of Physician Training, Yidu Central Hospital of Weifang, Weifang, Shandong, China
| | - Minxiang Huang
- Department of Pediatric Surgery, Binzhou Medical University Hospital, No.661, 2nd Huanghe Road, Binzhou, 256603, Shandong, China.
| | - Fenglin Cao
- Department of Health Psychology, School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxilu Rd, Jinan, 250012, Shandong, China.
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15
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Flannery RB, Flannery GJ. Characteristics of International Staff Victims of Psychiatric Patient Assaults: Review of Published Findings, 2017-2022. Psychiatr Q 2023; 94:79-88. [PMID: 36705881 PMCID: PMC9880918 DOI: 10.1007/s11126-022-10008-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 10/13/2022] [Accepted: 11/16/2022] [Indexed: 01/28/2023]
Abstract
Psychiatric patient assaults on staff are a worldwide occupational hazard for health care staff that results in medical injury, human suffering, and dollar cost expense. International research through 2000-2017 documented the continued frequency of these assaults and a continuing high risk for nursing personnel. This present paper reviewed the international published literature on staff victims of patient assaults during the next five-year period of 2017-2022. There were 39,034 assaults on 34,679 employee victims. The findings indicate that assaults on staff remain a serious worldwide issue as it has been since the 1990s and that nursing personnel continued to be at greater risk. Aggression management approaches, post-incident interventions, and an updated methodological inquiry are presented.
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Affiliation(s)
- Raymond B Flannery
- University of MA Chan School of Medicine, 7 Westchester Road, 02458, Newton, MA, USA.
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16
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Hwang S, Kwon KT, Lee SH, Kim SW, Chang HH, Kim Y, Bae S, Cheong HS, Park SY, Kim B, Lee S, Park J, Heo ST, Oh WS, Kim Y, Park KH, Kang CK, Oh N, Lim SJ, Yun S, Son JW, Ryoo HW, Chung US, Lee JY, Park HY, Shin JY, Bae SG, Lee JY. Correlates of burnout among healthcare workers during the COVID-19 pandemic in South Korea. Sci Rep 2023; 13:3360. [PMID: 36849638 PMCID: PMC9969371 DOI: 10.1038/s41598-023-30372-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 02/21/2023] [Indexed: 03/01/2023] Open
Abstract
Burnout is a form of negative emotional and physical response to job stress. This study aimed to investigate the prevalence of burnout among healthcare workers responding to the coronavirus disease 2019 (COVID-19) outbreak in Korea and to explore correlates of burnout among healthcare workers. A nationwide questionnaire-based survey was conducted from December 1, 2020, to January 29, 2021 on 1425 healthcare workers who worked in one of the 16 healthcare facilities designated for COVID-19 care, in public health centers, or as paramedics in Korea. Burnout was assessed using 16 Korean-adapted items based on the Oldenburg Burnout Inventory (OLBI). Data were collected using a structured questionnaire and analyzed using the R version 4.1.1 software program. OLBI results indicate clinically exhaustion in 84.5% (1204/1425) and clinically disengagement in 91.1% (1298/1425), and 77.3% (1102/1425) met the score criteria for both the exhaustion and disengagement subscales for burnout. Burnout rate was significantly increased in the group with chronic fatigue symptoms (Fatigue Severity Scale ≥ 3.22) after the outbreak of COVID-19 (OR, 3.94; 95% CI 2.80-5.56), in the female group (OR, 2.05; 95% CI 1.46-2.86), in the group with physical symptoms (Patient Health Questionnaire-15 ≥ 10) after the outbreak of COVID-19 (OR, 2.03; 95% CI 1.14-3.60), in the group with a higher Global Assessment of Recent Stress scale (OR, 1.71; 95% CI 1.46-2.01), in the group with post-traumatic stress symptoms (Primary Care Post-Traumatic Stress Disorder-5 ≥ 2) (OR, 1.47; 95% CI 1.08-2.01), and in the younger age group(OR, 1.45; 95% CI 1.22-1.72). The chronic fatigue symptoms were correlated with cumulative days of care (OR, 1.18; 95% CI 1.02-1.37). The physical symptoms were correlated with average contact hours with COVID-19 patients per day (OR, 1.34; 95% CI 1.17-1.54), and cumulative days of care (OR, 1.21; 95% CI 1.06-1.38). Most Korean healthcare workers suffered from burnout related to excessive workload during the COVID-19 pandemic. During a widespread health crisis like COVID-19, it is necessary to regularly check the burnout status in healthcare workers and reduce their excessive workload by supplementing the workforce and providing appropriate working hours sufficient rest hours.
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Affiliation(s)
- Soyoon Hwang
- grid.258803.40000 0001 0661 1556Division of Infectious Diseases, Department of Internal Medicine, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, 807 Hokuk-ro, Buk-gu, Daegu, 41404 South Korea
| | - Ki Tae Kwon
- Division of Infectious Diseases, Department of Internal Medicine, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, 807 Hokuk-ro, Buk-gu, Daegu, 41404, South Korea.
| | - So Hee Lee
- Department of Psychiatry, National Medical Center, 245 Eulji-ro, Jung-gu, Seoul, 04564, South Korea.
| | - Shin-Woo Kim
- grid.258803.40000 0001 0661 1556Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Kyungpook National University Hospital, Kyungpook National University, Daegu, South Korea
| | - Hyun-Ha Chang
- grid.258803.40000 0001 0661 1556Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Kyungpook National University Hospital, Kyungpook National University, Daegu, South Korea
| | - Yoonjung Kim
- grid.258803.40000 0001 0661 1556Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Kyungpook National University Hospital, Kyungpook National University, Daegu, South Korea
| | - Sohyun Bae
- grid.258803.40000 0001 0661 1556Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Kyungpook National University Hospital, Kyungpook National University, Daegu, South Korea
| | - Hae Suk Cheong
- grid.264381.a0000 0001 2181 989XDivision of Infectious Diseases, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Se Yoon Park
- grid.412674.20000 0004 1773 6524Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, South Korea
| | - Bongyoung Kim
- grid.49606.3d0000 0001 1364 9317Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea
| | - Shinwon Lee
- grid.412588.20000 0000 8611 7824Department of Internal Medicine, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Jiho Park
- grid.411120.70000 0004 0371 843XDepartment of Internal Medicine, Konkuk University School of Medicine, Konkuk University Medical Center, Seoul, South Korea
| | - Sang Taek Heo
- grid.411277.60000 0001 0725 5207Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, Jeju National University, Jeju, South Korea
| | - Won Sup Oh
- grid.412010.60000 0001 0707 9039Division of Infectious Diseases, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, South Korea
| | - Yeonjae Kim
- grid.415619.e0000 0004 1773 6903Division of Infectious Disease, Department of Internal Medicine, National Medical Center, Seoul, South Korea
| | - Kyung-Hwa Park
- grid.14005.300000 0001 0356 9399Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, South Korea
| | - Chang Kyung Kang
- grid.31501.360000 0004 0470 5905Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - NamHee Oh
- Hospital Infection Control Team, Daegu Medical Center, Daegu, South Korea
| | - Su Jin Lim
- Division of Respiratory Diseases, Department of Internal Medicine, Masan Medical Center, Changwon, South Korea
| | - Seongcheol Yun
- Department of Internal Medicine, Andong Medical Center, Andong, South Korea
| | - Ji Woong Son
- grid.411127.00000 0004 0618 6707Department of Internal Medicine, Konyang University Hospital, Daejeon, South Korea
| | - Hyun Wook Ryoo
- grid.258803.40000 0001 0661 1556Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Un Sun Chung
- grid.258803.40000 0001 0661 1556Department of Psychiatry, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Ju-Yeon Lee
- grid.14005.300000 0001 0356 9399Department of Psychiatry, Chonnam National University Medical School, Gwangju, South Korea
| | - Hye Yoon Park
- grid.412484.f0000 0001 0302 820XDepartment of Psychiatry, Seoul National University Hospital, Seoul, South Korea
| | - Ji-Yeon Shin
- grid.258803.40000 0001 0661 1556Department of Preventive Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Sang-geun Bae
- grid.258803.40000 0001 0661 1556Department of Preventive Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Ji-yeon Lee
- grid.440932.80000 0001 2375 5180Department of Counseling Psychology, Hankuk University of Foreign Studies, Seoul, South Korea
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Lu J, Yu Y, Wang B, Zhang Y, Ji H, Chen X, Sun M, Daun Y, Pan Y, Chen Y, Yi Y, Dou X, Zhou L. The mediating role of self-efficacy between workplace violence and PTSD among nurses in Liaoning Province, China: A cross-sectional study. Front Psychol 2023; 14:1090451. [PMID: 36910753 PMCID: PMC9995771 DOI: 10.3389/fpsyg.2023.1090451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 02/06/2023] [Indexed: 02/25/2023] Open
Abstract
Purpose Nurses are at high risk for workplace violence, which can lead to psychological problems. The purpose of this study was to determine the relationship between workplace violence, self-efficacy, and PTSD, and to further explore whether self-efficacy mediates the relationship between workplace violence and PTSD among Chinese nurses. Materials and methods This cross-sectional study was conducted in Liaoning Province, China in 2020. A total of 1,017 valid questionnaires were returned. Each questionnaire included the Workplace Violence Scale, the General Self-Efficacy Scale, the Post-traumatic Stress Disorder Scale (PTSS-10), and demographics information. A hierarchical multiple regression approach was used to explore the mediating role of self-efficacy in the relationship between workplace violence and PTSD. The mediation model was then tested by the PROCESS macro in SPSS. Results A total of 1,017 nurses were included in this study, and the average score of PTSD among Chinese nurses was 26.85 ± 13.13 (mean ± SD). After further adjustment for control variables, workplace violence was positively associated with PTSD, explaining 13% of the variance. High self-efficacy was associated with low PTSD, explaining 18% of the variance. Self-efficacy partially mediated the role of workplace violence and PTSD. Conclusion The high scores of PTSD among Chinese nurses demand widespread attention. Workplace violence is an important predictor of PTSD in nurses. Self-efficacy is a significant factor in improving PTSD in nurses and mediates the relationship between workplace violence and PTSD. Measures and strategies to improve self-efficacy may mitigate the effects of workplace violence on PTSD in nurses.
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Affiliation(s)
- Jiachen Lu
- School of Public Health, Dalian Medical University, Dalian, China
| | - Yingying Yu
- School of Public Health, Dalian Medical University, Dalian, China
| | - Bin Wang
- Department of Nursing, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yanni Zhang
- Laboratory Animal Center, Affiliated Zhongshan Hospital Dalian University, Dalian, China
| | - Haoqiang Ji
- School of Public Health, Shandong University, Jinan, China
| | - Xu Chen
- School of Public Health, Dalian Medical University, Dalian, China
| | - Meng Sun
- School of Public Health, Dalian Medical University, Dalian, China
| | - Yuxin Daun
- School of Public Health, Dalian Medical University, Dalian, China
| | - Yuanping Pan
- School of Public Health, Dalian Medical University, Dalian, China
| | - Yunting Chen
- School of Public Health, Dalian Medical University, Dalian, China
| | - Yaohui Yi
- School of Public Health, Dalian Medical University, Dalian, China
| | - Xiaofeng Dou
- School of Public Health, Dalian Medical University, Dalian, China
| | - Ling Zhou
- School of Public Health, Dalian Medical University, Dalian, China
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18
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Harati H, Mohsenipouya H, Mousavinasab N, Sangani A, Alam MK, Mamun MA. The relationship between spirituality and aggression in the workplace during the COVID-19 pandemic: A cross-sectional study among Iranian nurses. PLoS One 2022; 17:e0279247. [PMID: 36542619 PMCID: PMC9770337 DOI: 10.1371/journal.pone.0279247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 12/04/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Aggression towards nurses in the workplace arises from various reasons, reportedly increasing during the COVID-19 pandemic. Where aggression can be maintained by spiritual well-being, as it is said that spirituality is a coping skill and psychological well-being maintainer-but there is little known, especially during the pandemic. Thus, this study explored the effect of spirituality on aggression among the nurses working in the COVID-19 wards. METHODS This cross-sectional data from 200 nurses involved in the COVID-19 patient treatment were collected using a random sampling method from four hospitals in East Mazandaran province, Iran. Responses were collected based on socio-demographics, Buss-Perry Aggression Questionnaire, and Paloutzian & Ellison Spiritual Well-being Scale. T-test, ANOVA, Pearson correlation coefficient, and multiple linear regression were applied for data analysis. RESULTS The mean age of nurses was 31.49±6.88 (range: 21-48) years. Nurses working in the COVID-19 wards have a mean score of spiritual health of 67.21±12.84 (out of 120), whereas 51.77±10.96 (out of 116) was for aggression. The results showed a significant negative weak correlation between aggression and spiritual health (r = -.285, p<0.01). As per regression analysis, spiritual health [β = -.264], age [β = -.374], and working experience [β = 4.156] were the significant factors associated with aggression (p<0.05). CONCLUSIONS It is evident that nurses who consider spirituality in their life actions are in a state of reduced negative emotions, such as aggression. Thus, policymakers and managers of the healthcare settings are suggested to promote spirituality among the nurses through spiritual care education, providing the ground for promoting spirituality and a positive attitude towards it.
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Affiliation(s)
- Hossein Harati
- Faculty of Nursing, Mazandaran University of Medical Sciences, Sari, Iran
| | - Hossein Mohsenipouya
- Health Education and Promotion, Faculty of Nursing, Mazandaran University of Medical Sciences, Sari, Iran
- * E-mail: (HM); (MAM)
| | - Nouraddin Mousavinasab
- Department of Biostatistics, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran
| | - Alireza Sangani
- Department of Cultural Psychopathology, Farabi, Psychological Sciences Research Center, Mazandaran, Iran
| | - Md. Khorshed Alam
- Department of Information Management, The United Nations Refugee Agency (UNHCR), Dhaka, Bangladesh
| | - Mohammed A. Mamun
- CHINTA Research Bangladesh, Dhaka, Bangladesh
- Department of Public Health and Informatics, Jahangirnagar University, Dhaka, Bangladesh
- * E-mail: (HM); (MAM)
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19
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Saragih ID, Tarihoran DETAU, Rasool A, Saragih IS, Tzeng H, Lin C. Global prevalence of stigmatization and violence against healthcare workers during the COVID-19 pandemic: a systematic review and meta-analysis. J Nurs Scholarsh 2022; 54:762-771. [PMID: 35819267 PMCID: PMC9349814 DOI: 10.1111/jnu.12794] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 05/18/2022] [Accepted: 06/03/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE During COVID-19, stigmatization and violence against and between professional healthcare workers worldwide are increasing. Understanding the prevalence of such stigmatization and violence is needed for gaining a complete picture of this issue. Therefore, the purpose of this review was to update estimates of the prevalence of stigmatization and violence against healthcare workers during the pandemic. DESIGN A systematic review and meta-analysis was conducted. METHODS This review followed PRISMA guidelines and encompassed these databases: PubMed, Academic Search Complete, CINAHL, Web of Science, MEDLINE Complete, OVID (UpToDate), and Embase (from databases inception to September 15, 2021). We included observational studies and evaluated the quality of the study using the Joanna Briggs Institute methodology. Further, a random effects model was used to synthesis the pooled prevalence of stigmatization and violence in this study. FINDINGS We identified 14 studies involving 3452 doctors, 5738 nurses, and 2744 allied health workers that reported stigmatization and violence during the pandemic. The pooled prevalence was, for stigmatization, 43% (95% confidence interval [CI]: 21% to 65%) and, for violence, 42% (95% CI: 30% to 54%). CONCLUSIONS Stigmatization and violence during the COVID-19 pandemic were found to have affected almost half the studied healthcare workers. Healthcare professionals are more prone to be stigmatized by the community and to face workplace violence. CLINICAL RELEVANCE Health administrators and policymakers should anticipate and promptly address stigmatization and violence against and between healthcare workers, while controlling the spread of COVID-19. Health care systems should give serious attention to the mental health of all health providers.
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Affiliation(s)
| | - Dame Elysabeth Tuty Arna Uly Tarihoran
- School of Nursing, Faculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand
- School of NursingKrida Wacana Christian University, UKRIDAJakartaIndonesia
| | - Akhtar Rasool
- Department of Environmental Sciences, UCSOsmania UniversityHyderabadIndia
| | | | - Huey‐Ming Tzeng
- School of NursingThe University of Texas Medical Branch at GalvestonGalvestonTexasUSA
| | - Chia‐Ju Lin
- College of NursingKaohsiung Medical UniversityKaohsiungTaiwan
- Department of Medical Research, Kaohsiung Medical University HospitalKaohsiungTaiwan
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20
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Chowdhury SR, Kabir H, Das DC, Chowdhury MR, Chowdhury MR, Hossain A. Workplace violence against Bangladeshi registered nurses: A survey following a year of the COVID-19 pandemic. Int Nurs Rev 2022; 70:219-228. [PMID: 36190769 PMCID: PMC9874904 DOI: 10.1111/inr.12802] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 08/22/2022] [Indexed: 01/27/2023]
Abstract
AIMS To investigate the prevalence of workplace violence and its associated factors among Bangladeshi registered nurses. BACKGROUND Workplace violence is prevalent among nurses, particularly in developing countries. However, the issue has never been examined in Bangladeshi nurses. METHODS Between February 26 and July 10, 2021, this cross-sectional survey involving 1264 registered nurses was conducted. Workplace violence was determined by the Workplace Violence Scale (WVS). A multivariable logistic regression model was fitted to find the factors associated with workplace violence. This study complies with the EQUATOR (STROBE) checklist. RESULTS Of the 1264 nurses, 885 (70%) nurses reported being exposed to workplace violence in the previous year. Three hundred twenty-four (324; 25.6%) nurses reported physical violence, whereas 902 (71.4%) nurses reported nonphysical violence. According to the multivariable logistic regression model, male nurses, nurses in the Sylhet division, emergency department nurses, nurses working extended hours, and non trained nurses to tackle workplace violence were prone to physical violence. Furthermore, public hospital nurses and non trained nurses to tackle workplace violence were more likely to be exposed to nonphysical violence. Nurses who had not been exposed to workplace violence were satisfied with their current job, but those who had been exposed to workplace violence were dissatisfied and intended to leave their current job. CONCLUSIONS AND IMPLICATIONS FOR NURSING AND HEALTH POLICY High prevalence of workplace violence underscores nurses' current working conditions, which are particularly poor in public hospitals and emergency departments. Moreover, the COVID-19 pandemic put unprecedented pressure on the whole healthcare system and caused various difficulties for healthcare workers. To develop a zero-violence practice environment, health authorities should implement policy-level interventions. Healthcare staff should be guided to deal more successfully with patients and coworkers to create a positive working environment.
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Affiliation(s)
- Saifur Rahman Chowdhury
- Department of Public HealthNorth South UniversityDhakaBangladesh,Department of Health Research Methods, Evidence, and Impact (HEI)McMaster UniversityHamiltonOntarioCanada
| | - Humayun Kabir
- Department of Public HealthNorth South UniversityDhakaBangladesh,Department of Health Research Methods, Evidence, and Impact (HEI)McMaster UniversityHamiltonOntarioCanada
| | | | | | | | - Ahmed Hossain
- Health Services AdministrationCollege of Health SciencesUniversity of SharjahSharjahUnited Arab Emirates
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21
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Doedens P, Vermeulen J, Ter Riet G, Boyette LL, Latour C, de Haan L. Association between characteristics of nursing teams and patients' aggressive behavior in closed psychiatric wards. Perspect Psychiatr Care 2022; 58:2592-2600. [PMID: 35505593 PMCID: PMC9790403 DOI: 10.1111/ppc.13099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/24/2022] [Accepted: 04/12/2022] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Estimate the effect of nursing, shift, and patient characteristics on patients' aggression. DESIGN AND METHODS Follow-up study on a closed psychiatric ward was performed to estimate the effect of nursing team characteristics and patient characteristics on the incidence of aggression. FINDINGS The incidence of aggression (n = 802 in sample) was lower in teams with >75% male nurses. Teams scoring high on extraversion experienced more verbal aggression and teams scoring high on neuroticism experienced more physical aggression. Younger patients and/or involuntarily admitted patients were more frequently aggressive. PRACTICE IMPLICATIONS These findings could stimulate support for nurses to prevent aggression.
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Affiliation(s)
- Paul Doedens
- Department of Psychiatry, Amsterdam UMC, location Academic Medical Center, Amsterdam, The Netherlands.,Urban Vitality - Centre of Expertise, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Jentien Vermeulen
- Department of Psychiatry, Amsterdam UMC, location Academic Medical Center, Amsterdam, The Netherlands
| | - Gerben Ter Riet
- Urban Vitality - Centre of Expertise, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.,Department of Cardiology, Amsterdam UMC, location Academic Medical Center, Amsterdam, The Netherlands
| | - Lindy-Lou Boyette
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Corine Latour
- Urban Vitality - Centre of Expertise, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Lieuwe de Haan
- Department of Psychiatry, Amsterdam UMC, location Academic Medical Center, Amsterdam, The Netherlands.,Arkin, Amsterdam, The Netherlands
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22
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Ham E, Seto MC, Rodrigues NC, Hilton NZ. Workplace stressors and PTSD among psychiatric workers: The mediating role of burnout. Int J Ment Health Nurs 2022; 31:1151-1163. [PMID: 35574982 DOI: 10.1111/inm.13015] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/26/2022] [Indexed: 11/28/2022]
Abstract
Critical workplace events (e.g., assaults), chronic stressors, burnout, and work conditions all affect nurse well-being. The present study investigated associations among these sources of stress and posttraumatic stress disorder (PTSD) symptoms in psychiatric nurses, hypothesizing that burnout would mediate the paths between workplace stressors and PTSD. Surveys were completed by 611 psychiatric nurses or allied health staff working on inpatient units in three psychiatric hospitals. Participants reported on critical events and chronic stressors specific to providing psychiatric care and completed the Maslach Burnout Inventory (MBI), Areas of Worklife Survey (AWS) (work conditions), and PTSD Checklist for DSM-5. Data were analysed using structural equation modelling. Burnout had a direct relation to PTSD symptoms and partially mediated the effect of exposure to critical events, but not chronic stressors, on PTSD symptoms. Chronic stressors related to patients' disturbing behaviour (e.g., flooding room, eating non-food items) had a direct effect on PTSD symptoms, but those related to resisting care (e.g., screaming constantly, physically resisting care) had no significant association. Worklife conditions had a negative direct effect on Burnout and indirect effect on PTSD, whereby participants reporting poorer alignment of work conditions with their expectations had higher Burnout and PTSD symptom scores. Different sources of workplace stress have different relations to PTSD symptoms, and Burnout has both direct and mediation effects. Interventions aimed at reducing patients' aggressive and disturbing acts and improving healthcare providers' burnout and worklife factors in hospitals may all be needed to reduce PTSD among psychiatric staff.
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Affiliation(s)
- Elke Ham
- Waypoint Centre for Mental Health Care, Penetanguishene, ON, Canada
| | - Michael C Seto
- University of Ottawa's Institute of Mental Health Research, Ottawa, Canada
| | | | - N Zoe Hilton
- Waypoint Centre for Mental Health Care, Penetanguishene, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
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23
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Wang J, Zeng Q, Wang Y, Liao X, Xie C, Wang G, Zeng Y. Workplace violence and the risk of post-traumatic stress disorder and burnout among nurses: a systematic review and meta-analysis. J Nurs Manag 2022; 30:2854-2868. [PMID: 36122417 DOI: 10.1111/jonm.13809] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 09/03/2022] [Accepted: 09/14/2022] [Indexed: 11/28/2022]
Abstract
AIM This review examined the association between workplace violence and the risk of post-traumatic stress disorder (PTSD) and burnout among nurses. BACKGROUND The extent to which workplace violence is associated with an increased risk of PTSD and burnout in nurses remains unclear. EVALUATION We searched nine electronic databases (PubMed, Cochrane, Embase, Web of Science, CINAHL, PsycINFO, Chinese Biomedical, China National Knowledge Internet, and WANFANG). KEY ISSUES Overall, 114 full-text studies were identified; 43 met the inclusion criteria, of which 10 were included in the meta-analysis. Compared to their counterparts with non-exposure to workplace violence, nurses experiencing it had 2.13 and 2.25 times higher odds of reporting PTSD and burnout after adjusting the confounding factors. Additionally, the moderator and mediator factors might help reduce the risk of both in this population. CONCLUSION This study indicated that workplace violence increases the risk of PTSD and burnout. IMPLICATIONS FOR NURSING MANAGEMENT Our review identified the magnitude of the association between exposure to workplace violence and the reported symptoms of PTSD and burnout in nurses. Furthermore, multi-targeted efforts directed at the identified social/organisational, task-related, and individual resources might help mitigate their harmful impact in the aforementioned population.
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Affiliation(s)
- Jinfeng Wang
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qinglin Zeng
- School of Clinical Medicine, Sichuan College of Traditional Chinese Medicine, Mianyang, China
| | - Yuqiang Wang
- School of Stomatology, Shanxi Medical University, Taiyuan, China
| | - Xinqi Liao
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Caixia Xie
- Nursing research center, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Guofu Wang
- Chengdu Fifth People's Hospital, Chengdu, China
| | - Yanli Zeng
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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24
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Cranage K, Foster K. Mental health nurses' experience of challenging workplace situations: A qualitative descriptive study. Int J Ment Health Nurs 2022; 31:665-676. [PMID: 35347822 PMCID: PMC9314796 DOI: 10.1111/inm.12986] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 02/16/2022] [Accepted: 02/21/2022] [Indexed: 11/26/2022]
Abstract
Mental health nursing is acknowledged internationally as being a demanding profession; however, little is known about the range of experience and complexity of workplace challenges or their impacts on mental health nurses (MHN). This qualitative descriptive study aimed to examine and describe the range of challenging workplace situations experienced by MHN and is reported according to the Standards for Reporting Qualitative Research. An online cross-sectional survey collected demographic data and open-ended descriptions of workplace challenges experienced by n = 374 Australian MHN. Using a modified a priori framework, four categories of experience were derived through content analysis: consumer-related, colleague-related, nursing role-related, and organizational service-related challenges. Many accounts described a complex interplay of challenges. The findings extend prior knowledge on MHN experiences. Frequent workplace challenges included violence and aggression from consumers, bullying from colleagues, low staffing levels, and poor skill mix. Further extending the evidence, key challenges rarely described in prior literature were the psychological impacts of suicides and murder; the personal nature of threats from consumers; moral distress and concerns with colleagues' quality of practice; and exacerbation of practice-related issues by lack of support from colleagues and/or the organization. These have important implications for the profession and can inform targeted strategies to reduce stressors where possible, build staff well-being, support workforce retention, and improve the provision of quality care. The implementation of targeted policy and initiatives that focus on reducing key stressors and supporting practice are vital to staff retention and ensuring a high standard of practice in complex mental health workplaces.
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Affiliation(s)
- Kylie Cranage
- Australian Catholic University, Melbourne, Victoria, Australia
| | - Kim Foster
- Australian Catholic University & North Western Mental Health, Parkville, Victoria, Australia
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25
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Bock C, Zimmermann T, Kahl KG. The impact of post-traumatic stress on the mental state of university hospital physicians - a cross sectional study. BMC Psychiatry 2022; 22:85. [PMID: 35114970 PMCID: PMC8815118 DOI: 10.1186/s12888-022-03719-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 01/20/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Hospital physicians have an increased risk for post-traumatic stress caused by work-related trauma. This study examines the frequency of reported traumatic events (TE), post-traumatic stress (PTS) and its possible consequences for the mental state and work ability of physicians at a university hospital. METHODS As part of the mandatory psychological risk assessment, n = 145 physicians (n = 56 female; 38.6%) were examined at a university hospital in Germany in a cross sectional study. TE, PTS and symptoms of depression and anxiety were assessed using the self-report questionnaires "Freiburger Screening Fragebogen to identify patients at risk for the development of a post-traumatic stress disorder in the group of severely injured patients" (PTBS-13), the "Patient Health Questionnaire" (PHQ-2) and the "Generalized Anxiety Disorder scale" (GAD-2). Work ability was assessed using a modified version of the questionnaire for workplace analysis (KFZA). The response rate was 52%. RESULTS Traumatic events were experienced by n = 125 physicians (86.2%) throughout their whole career. Of these, 19 physicians (15.2%) reported PTS. PTS is reported by 12 of 56 female physicians (63.2%), compared to 7 of 89 reports of PTS by male physicians (36.8%). Physicians with PTS symptoms had higher depression scores (p = 0.007) compared to physicians without TE or with TE, but without PTS. Physicians with PTS reported significantly reduced work ability caused by constantly interrupted work (p = 0.03). Female gender was the greatest risk factor for the development of PTS. (p = 0.001). CONCLUSIONS Physicians - especially females - with PTS may have an increased risk of developing depressive symptoms. Therefore, interventions aimed at reducing trauma-related stress symptoms may be helpful in improving mental health of hospital physicians. Further studies with more physicians from different hospitals are necessary to support the results.
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Affiliation(s)
- Christian Bock
- Department of Occupational Safety, Hannover Medical School, Hannover, Germany.
| | - Tanja Zimmermann
- grid.10423.340000 0000 9529 9877Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Kai G. Kahl
- grid.10423.340000 0000 9529 9877Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
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26
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Chen Y, Wang P, Zhao L, He Y, Chen N, Liu H, Liu Y, Liu T, Tang YL, Jiang F, Zhu J. Workplace Violence and Turnover Intention Among Psychiatrists in a National Sample in China: The Mediating Effects of Mental Health. Front Psychiatry 2022; 13:855584. [PMID: 35782425 PMCID: PMC9240432 DOI: 10.3389/fpsyt.2022.855584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 05/13/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Workplace violence (WPV) in healthcare has received much attention worldwide. However, scarce data are available on its impact on turnover intention among psychiatrists, and the possible mechanisms between WPV and turnover intention have not been explored in China. METHODS A cross-sectional survey was conducted among psychiatrists in 41 tertiary psychiatric hospitals from 29 provinces and autonomous regions in China. A stress-strain-outcome (SSO) model was adopted to examine the effects of WPV on mental health and turnover intention. The association and mediation by burnout and stress were examined by multivariate logistic regression (MLR) and generalized structure equation modeling (GSEM). RESULTS We invited 6,986 psychiatrists to participate, and 4,520 completed the survey (64.7% response rate). The prevalence of verbal and physical violence against psychiatrist in China was 78.0 and 30.7%, respectively. MLR analysis showed that psychiatrists who experienced verbal violence (OR = 1.15, 95% CI = 1.10-1.21) and physical violence (OR = 1.15, 95% CI = 1.07-1.24) were more likely to report turnover intention. GSEM analysis showed that burnout (β = 4.00, p < 0.001) and stress (β = 1.15, p < 0.001) mediated the association between verbal violence and turnover intention; similarly, burnout (β = 4.92, p < 0.001) and stress (β = 1.80, p < 0.001) also mediated the association between physical violence and turnover intention. CONCLUSIONS Experience of WPV is a significant contributor to turnover intention among psychiatrists. Mental health status, such as burnout and stress level significantly mediated the association. Policy makers and hospital administrators need to be aware of this association. Action is needed to promote mental health among the psychiatrists to improve morale and workforce sustainability.
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Affiliation(s)
- Yanhua Chen
- Vanke School of Public Health, Tsinghua University, Beijing, China.,School of Medicine, Tsinghua University, Beijing, China
| | - Peicheng Wang
- School of Medicine, Tsinghua University, Beijing, China
| | - Lina Zhao
- Institute for Hospital Management, Tsinghua University, Beijing, China
| | - Yanrong He
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Nuoya Chen
- Health Related Activity Recognition System Based on IoT Project, University of Macerata, Macerata, Italy
| | - Huanzhong Liu
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China.,Anhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Yuanli Liu
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Tingfang Liu
- Institute for Hospital Management, Tsinghua University, Beijing, China
| | - Yi-Lang Tang
- Mental Health Service Line, Atlanta VA Medical Center, Decatur, GA, United States.,Addiction Psychiatry Fellowship Program, Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, United States
| | - Feng Jiang
- School of International and Public Affairs, Shanghai Jiao Tong University, Shanghai, China.,Institute of Healthy Yangtze River Delta, Shanghai Jiao Tong University, Shanghai, China
| | - Jiming Zhu
- Vanke School of Public Health, Tsinghua University, Beijing, China.,Institute for Healthy China, Tsinghua University, Beijing, China
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27
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Liyanage S, Addison S, Ham E, Hilton NZ. Workplace interventions to prevent or reduce post-traumatic stress disorder and symptoms among hospital nurses: A scoping review. J Clin Nurs 2021; 31:1477-1487. [PMID: 34636115 DOI: 10.1111/jocn.16076] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 09/14/2021] [Accepted: 09/17/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim of this study was to identify literature on evaluated workplace interventions to prevent or reduce the prevalence or impact of work-related post-traumatic stress disorder (PTSD) and PTSD symptoms among hospital nurses. A second objective was to summarise and compare the characteristics and effectiveness of these interventions. BACKGROUND A substantial proportion of nurses report PTSD symptoms. Previous reviews have synthesised interventions to address PTSD in military and other high-risk populations, but similar work focusing on nurses has yet to be conducted. METHODS We conducted a scoping review with the question: What interventions have been studied to prevent or treat PTSD symptoms or PTSD among nurses working in hospitals? We followed the PRISMA Scoping Review Checklist using an unregistered protocol. We searched in twelve academic and grey literature databases (e.g. MedLine, CINAHL) with no language restrictions. We included publications reporting on interventions which were evaluated for measurable impacts on PTSD and PTSD symptoms among nursing staff working in inpatient settings from 1980 to 2019, and charted study characteristics in a spreadsheet. RESULTS From 7746 results, 63 studies moved to full-text screening, and six studies met inclusion criteria. Methodologies included three randomised controlled studies, one quasi-experimental study, one pre-post feasibility study and one descriptive correlational study. Four studies reported a significant reduction in PTSD scores in intervention groups compared with baseline or comparison, when using debriefing, guided imagery or mindfulness-based exercises. CONCLUSIONS This review identified six studies evaluating hospital-based interventions to reduce PTSD and PTSD symptoms among hospital nurses, with some positive effects reported, contributing to a preliminary evidence base on reducing workplace trauma. Larger studies can compare nurse subpopulations, and system-level interventions should expand the focus from individuals to organisations. RELEVANCE TO CLINICAL PRACTICE This review can inform nursing and hospital leaders developing evidence-based interventions for PTSD among nurses.
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Affiliation(s)
- Sugee Liyanage
- Waypoint Centre for Mental Health Care, Penetanguishene, Ontario, Canada
| | - Sonja Addison
- Waypoint Centre for Mental Health Care, Penetanguishene, Ontario, Canada
| | - Elke Ham
- Waypoint Centre for Mental Health Care, Penetanguishene, Ontario, Canada
| | - N Zoe Hilton
- Waypoint Centre for Mental Health Care, Penetanguishene, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
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