Sexual Harassment in Clinical Practice—A Cross-Sectional Study Among Nurses and Nursing Students in Sub-Saharan Africa

Prevalence and predictors of workplace violence against nurses in Africa: A systematic review and meta-analysis

Background and Aims

Workplace violence (WPV) against nurses is a pervasive global issue, yet the extent of this phenomenon in the African context remains insufficiently explored. This review aimed to synthesize the available literature to identify the prevalence and predictors of WPV against nurses in Africa.

Methods

A systematic search was conducted across MEDLINE, CINAHL, PsycINFO, and Scopus, to identify studies published from 2000 to October 2023. The pooled prevalence of WPV and it subtypes were estimated using random-effect meta-analysis. Heterogeneity between studies was quantified with I 2 statistics. Subgroup analysis and meta-regression were performed to identify sources of heterogeneity.

Results

This review included 27 studies, involving 9831 nurses. The pooled prevalence of WPV was 62.3% (95% confidence interval [CI]: 51.6-72.0). Verbal abuse emerged as the most common form of WPV, with a prevalence rate of 51.2% (95% CI: 41.3-61.1), followed by threat 23.3% (95% CI: 6.5-57.2), bullying 22.9% (95% CI: 14.0-35.2), physical abuse 15.1% (95% CI: 11.0-20.4), and sexual harassment 10.3% (95% CI: 5.9-17. 5). The proportion of WPV varied across geographical areas in Africa; however, the differences were not significant. The predictors of WPV encompassed demographic factors, personal habits, workplace characteristics, and nurses' past experience.

Conclusion

WPV against nurses is prevalent in Africa and transcends geographical boundaries in this region. This underscores the urgent need for targeted interventions and policy changes to address this issue in Africa.

A peek behind the curtain: An integrative review of sexual harassment of nursing students on clinical placement

AIMS AND OBJECTIVES

This integrative review aimed at systematically searching, analysing and synthesising multiple sources of evidence, to build a temporal understanding of nursing students' experiences of sexual harassment whilst on clinical placement, and to discuss the social context which enables this.

BACKGROUND

Sexual harassment is highly prevalent in workplaces globally. Contemporary social understandings contextualise sexual harassment as a significant form of interpersonal violence. This is the first literature review to go beyond prevalence to synthesise the experience, implications and responses to sexual harassment encountered by student nurses on clinical placement.

DESIGN

Whittemore and Knafl's (2005) integrative review methodology is used to structure a rigorous analysis and synthesis of evidence.

METHODS

The PRISMA checklist supported sound reporting of the search strategy. Three databases (CINAHL, Scopus and Medline) were searched using a Boolean strategy. Papers with a significant focus on sexual harassment of nursing students in the clinical setting were included with no limitation on publication date. Papers were excluded if they were not published in English or were only published as abstracts.

RESULTS

A synthesis of 26 papers demonstrated that sexual harassment has significant impacts on student nurses and the nursing profession. The intimacy of close body care, dominant social perceptions of nursing as women's work and the sexualisation of nurses increase student vulnerability to sexual harassment. Workplace power imbalances further exacerbate sexual harassment and shape responses to incidents.

CONCLUSIONS

Sexual harassment of nursing students is widespread and impacts student well-being and learning.

RELEVANCE TO CLINICAL PRACTICE

Education is a strong protective factor and should target students, clinicians, clinical facilitators and academics. Attention to workplace culture, and processes that support disclosure and reporting, is also required to meaningfully address the sexual harassment of nursing students.

Stakeholders' perceptions of continuing professional development among Nepalese nurses: A focus group study

AIM

This study explores perceptions of Continuing Professional Development (CPD) opportunities among stakeholders in the profession of nursing in Nepal.

DESIGN

Qualitative study using focus group discussions (FGDs).

METHODS

Eight FGDs were conducted in three major cities of Nepal with nursing stakeholders including nurse managers, matrons and directors/managers of private and public nursing colleges, representatives of nursing organizations, government officials, nursing academics and practitioners from the government and private sectors. The data were analysed thematically using Creswell's six steps of analysis and the Standards for Reporting Qualitative Research (SRQR) guideline was followed.

RESULTS

The study generated three major themes: (a) policy level including the national situation of CPD, political influence and training guided by the policy; (b) organizational level incorporating perceptions towards forms of CPD, staff shortage, poor staff retention, seniority for training, financial constraints and lack of continuity of training; and (c) individual level including motivation for training and lack of relevant training.

Sexual Harassment and Associated Factors Among Female Nurses: The Case of Addis Ababa Public Hospitals

Background

Sexual harassment of female nurses at work is an issue that is receiving more attention globally and is progressively being acknowledged as a form of gender discrimination in the workplace. Africa’s situation is getting worse every day, especially in Sub-Saharan Africa. Determining the prevalence of workplace sexual harassment and associated factors among female nurses working in Addis Ababa public hospitals was the aim of this study.

Methods

A cross-sectional research design was conducted in August 2021 GC and 339 randomly selected female nurses working in an Addis Ababa public hospital were selected. The data were collected using a pre-tested, semi-structured questionnaire. EPI-Info 7 was used to enter the data, which was then exported to SPSS version 26 for further analysis.

Results

Forty six (46.6) percent of workplaces reported having experienced sexual harassment. One hundred sixty seven (49.3%) of all cases involved physical sexual harassment, while 79 (51.2%) involved verbal sexual harassment. Sexual harassment was 4.64 times more likely to happen to single female nurses than to married people (AOR= 4.64, 95% CI [2.6, 8.4]). Female nurses in the 20–25 age group were roughly 4.7 times more likely to suffer sexual harassment than those in the >40 age group (AOR=4.69, 95% CI [2.44, 9.03]). Alcohol consumers had a 4.5-fold higher chance of experiencing sexual harassment than non-consumers (AOR=4.50, 95% CI [2.40, 8.50]).

Conclusion

Violence among female nurses was demonstrated in this study. It demands a particular focus from the involved bodies. Age, marital status, and alcohol consumption were found to statistically significantly correlate with sexual harassment. Female nurses must get training that emphasizes behavior modification, and healthcare facilities must foster a pleasant atmosphere for nurses, patients, and other staff members.

Bitter silence allows sexual harassment to continue in workplace: A qualitative study in Iranian nurses

Background

Sexual harassment in the workplace is continuing. However, the rate of sexual harassment disclosure is low, which causes many problems. Non-disclosure of sexual harassment can cause nurses' psychological distress and physical harm, and affect their productivity and quality of care. Therefore, the present study aimed to investigate the reasons why Iranian nurses stayed silent and did not disclose sexual harassment in their workplace.

Method

This qualitative descriptive-explorative study was conducted to investigate the reasons why Iranian nurses (n = 18) stayed silent on sexual harassment. Conventional content analysis and purposeful sampling method were used in this study. Data was collected through in-depth semi-structured interviews. Maximum variance in terms of age, sex, work experience, education level, marital status, and type of hospital and ward was considered in order to obtain rich information. Guba and Lincoln criteria were used to increase the study's trustworthiness, while the Graneheim and Lundman approach was used to analyze the content.

Results

The research data indicated 112 codes, a major category, 4 subcategories, and 9 primary categories. The major category, "The missing link is bitter silence; sexual harassment is still going on," includes four subcategories: fear of social stigmas, organizational and legal barriers, family barriers, and personal barriers.

Conclusions

Nurses cannot break their silence on sexual harassment because they are afraid that disclosure of sexual harassment has negative consequences for their personal and professional lives. Policies and strategies should be developed to encourage nurses to disclose sexual harassment. This issue must be studied socially, culturally, and politically.

Strategies to prevent workplace sexual harassment among Iranian nurses: A qualitative study

Background

Sexual harassment in the workplace has many negative consequences for nurses and the delivery of patient care. Appropriate policies and strategies can help to create a safe work environment for nurses. Therefore, the present study aimed to investigate Iranian nurses’ strategies for preventing sexual harassment in the workplace.

Materials and methods

This qualitative descriptive-explorative study used conventional content analysis to investigate how Iranian nurses cope with sexual harassment (n = 22). Participants were selected using a purposeful sampling method. Data was collected through in-depth, semi-structured interviews from September 2020 to April 2021. In order to obtain rich information, maximum variation was considered (age, sex, work experience, level of education, marital status, and type of hospital and ward). The Guba and Lincoln criteria were used to increase the study’s trustworthiness, while the Graneheim and Lundman approach was used to analyze the content.

Results

One hundred and twelve codes, one main category, four categories, and 12 subcategories were extracted. The main category, strategies to prevent sexual harassment among nurses in the workplace, includes four categories: behavioral response, working conditions adjustment, informing, and performance of hospital security guards. The most common strategy used by nurses was behavioral response.

Conclusion

Basic measures are required to prevent sexual misconduct against nurses, which is an obvious part of the professional organizational culture. Managers and policymakers should develop workplace ethics, legal accountability, and safety. They should also develop training programs and prevention strategies to help nurses improve their coping skills. Further quantitative and qualitative research in other healthcare groups is required to confirm the findings of this study.

Iranian Nurses' Experiences with Sexual Harassment in Workplace: a Qualitative Study

Background

Sexual harassment has become a worldwide issue in recent years. Nursing, like other professions, is vulnerable to this type of harm. Sexual harassment impairs nurses' ability to provide comprehensive care, resulting in psychological discomfort, diminished work commitment, absenteeism, and job termination. The current study was carried out to investigate Iranian nurses' experiences with sexual harassment in the workplace.

Materials and Methods

This qualitative study used conventional content analysis with a descriptive exploratory approach to investigate the experiences of Iranian nurses. Between September 2020 and April 2021, we conducted semi-structured and in-depth interviews with 22 employed nurses, recruited via a purposeful method. Age, sex, work experience, degree of education, marital status, and hospital and ward type were observed to acquire rich information.

Results

The study's data produced 354 codes, 1 main category, 5 s categories, and 23 sub categories. The main category of nurses' sexual harassment in the workplace is divided into five categories: verbal, physical, visual, seduction, and cybersexual harassment. The most and least common types of harassment were verbal and cybersexual harassment, respectively. Nurse harassment was perpetrated by patients and their families, physicians, colleagues, and other hospital personnel.

Conclusion

According to the findings of this study, the majority of nurses have been subjected to sexual harassment in the workplace in various forms. Given the negative consequences of workplace harassment, managers and policymakers should develop guidelines in the areas of workplace ethics, legal accountability, and workplace safety. There is also a need to develop training programs for nurses to improve their coping skills. More quantitative and qualitative research in other healthcare groups is needed to confirm the findings of this study.

Loss of Individual and Social Identity: Consequences of Sexual Harassment of Iranian Nurses in the Workplace

Background: Sexual harassment in the workplace is a common event with negative consequences for victims. Working conditions become unstable because of sexual harassment, and workplace insecurity causes psychological distress and physical problems, as well as a reduction in the quality of care. Therefore, the current study sought to investigate the effects of sexual harassment in the workplace on Iranian nurses. Materials and Methods: This qualitative study used conventional content analysis with a descriptive-explorative approach to investigate the consequences of sexual harassment in Iranian nurses (n = 22). The purposeful sampling method was used. Semi-structured and in-depth interviews were used to collect data. Maximum diversity in terms of age, sex, work experience, level of education, marital status, and type of hospital and ward was observed in order to obtain rich information. The Guba and Lincoln criteria were used to improve the study's trustworthiness and rigor, and the Graneheim and Lundman method was used to analyze the content. Results: Two hundred and twenty-seventh number codes, one main category, four subcategories, and eighteen primary categories were extracted from the data in this study. The main category of "loss of individual and social identity: the consequences of sexual harassment in nurses" is divided into four subcategories: "psychological trauma," "detrimental effects of work," "physical problems," and "disintegration of warm family relationships." Sexual harassment had a greater psychological impact on victims. Conclusion: Sexual harassment has a number of negative consequences for nurses' personal and professional lives and can impose a significant burden on the healthcare system due to decreased productivity and loss of active labor. Therefore, it requires increased attention and focus.

Sexual harassment and organisational silencing in nursing: a cross-sectional study in Greece

OBJECTIVE

This study investigates the frequency of sexual harassment among female nurses in the Greek health system and the nurses' reluctance to report their experiences.

DESIGN

Cross-sectional study.

SETTING

Greece.

PARTICIPANTS

1264 female nurses of working age across different settings responded to the Sexual Experiences Questionnaire (SEQ) web-based format between October 2020 and February 2021. The period investigated by the SEQ was the participant's entire professional life. The final sample consisted of 1217 nurses with valid data on the frequency of sexually harassing behaviours (gender harassment, unwanted sexual attention, sexual coercion) and the reasons for not reporting sexual harassment.

MAIN OUTCOME MEASURES

The frequency of sexual harassment was measured in a 5-point Likert Scale (1: very often, 2: often, 3: occasionally, 4: rarely, 5: never), the decision to report/not report sexual harassment was measured in a yes/no format and the impact of sexual harassment on the physical, mental and job-related performance was measured in a 5-point Likert Scale (1: very positively, 2: positively, 3: moderately, 4: negatively, 5: very negatively).

RESULTS

70% of the nurses have experienced sexual harassment at least once in their working lives, while the most frequent type is gender harassment. Male doctors are the most common perpetrators. T-tests and analysis of variance showed that private and younger nurses were more likely to experience sexual harassment while divorced nurses with 1-5 years of experience dealt with sexually coercive behaviours more frequently. 30% did not report sexual harassment because of the fear of negative consequences and beliefs that no action will be taken against the perpetrator. Multiple regression analyses showed that unwanted sexual attention and sexual coercion explain the victim's physical and job-related adverse outcomes. Cronbach's α was 0.939.

CONCLUSIONS

The results show that sexual harassment rates are high in the Greek health system, while many victims do not report their experiences to the authorities. This emphasises the need to implement drastic measures on behalf of the National Health Service (NHS) policy makers towards helping victims speak up without the fear of negative consequences. Nurse managers are called to implement effective policies against sexual harassment.

Are male nurses sexually harassed? A cross-sectional study in the Greek Health System

BACKGROUND

The #MeToo and #Times Up movements have put a global spotlight on the phenomenon of sexual harassment in healthcare. Yet, most studies have explored sexual harassment among female professionals. This study departs from current research practices and investigates the frequency of sexual harassment in male nurses working in the Greek NHS and the reasons for not reporting their experiences.

METHODS

A cross-sectional study was conducted using the Sexual Experiences Questionnaire (SEQ) to collect data from 507 male nurses working in Greece's various settings during October and February 2021. The electronic survey was sent to male nurses (n=3,091 registered with the Hellenic Association of Nurses. Survey items were consent form, demographics, three-dimensions of sexual harassment, silencing and negative consequences. Questions were measured using five-point Likert scales, binary scale and multiple-choice questions. ANOVA and T-tests were used to investigate whether specific groups more frequently dealt with sexual harassment. Multiple regression analyses were conducted to investigate the association between independent variables (sexually harassing behaviours) and the dependent variable (participants' negative physical, mental, and job-related outcomes).

RESULTS

40% of male nurses have experienced sexual harassment at least once in their working lives, and the most common form of sexual harassment faced was gender harassment, followed by unwanted sexual attention. Male doctors and male nurses were the most common perpetrators. Private and younger male nurses with up to 5 years of experience experienced more frequent sexual harassment. 30% did not report sexual harassment due to the fear that no one would believe them, and because of beliefs, no action would be taken against the wrongdoer. Multiple regression analyses showed that unwanted sexual attention and sexual coercion were associated with physical and job-related outcomes. Cronbach Alpha was 0.91.

CONCLUSION

A high proportion of male nurses have experienced sexual harassment during their careers. Being younger with limited working experience and working in the private sector were positively associated with sexual harassment. Policymakers and health managers should focus on sexual harassment prevention strategies and report-enabling policies.

Comparative analysis of sexual harassment between male and female nurses: A cross-sectional study in Greece

AIMS

The aims of this work are to compare the frequency of sexual harassment among male and female nurses in Greece and capture the reasons for not reporting sexual harassment.

BACKGROUND

The #MeToo and #TimesUp movements have emphasized the ubiquity of sexual harassment in health care. Yet, limited studies have explored sexual harassment among male and female nurses and the reasons for not reporting it.

METHODS

An online cross-sectional survey was conducted using the Sexual Experiences Questionnaire (SEQ) to collect data from 1.264 female nurses and 507 male nurses.

RESULTS

Sixty-seven per cent of female nurses have experienced sexual harassment at least once in their working lives, whereas male nurses' exact figure was 41%. The most common type of sexual harassment for both groups was gender harassment, followed by unwanted sexual attention and sexual coercion. Female nurses experienced more severe adverse consequences, whereas male nurses experienced moderate negative consequences.

CONCLUSIONS

Policymakers and hospital managers should create mechanisms to allow victims to report their experiences and establish an independent committee to assess victims' complaints.

IMPLICATIONS FOR NURSING MANAGEMENT

Managers are called to change how hospitals deal with sexual harassment cases, modernize their management style, and support sexual harassment victims to break their silence without fear of negative consequences.