Prevalence of Workplace Violence Against Healthcare Workers During the COVID-19 Pandemic: A Systematic Review and Meta-Analysis

Pharmacist homicides in the United States: A retrospective review of NVDRS data from 2003 to 2020

PURPOSE

Workplace and work-related violence are growing concerns in the healthcare community and among healthcare professionals. A gap exists in our understanding of the most extreme form of violence, homicide, against pharmacists and the contributing factors leading to their tragic deaths. The objective of this study was to identify homicides of pharmacists and characterize potential patterns, including, but not limited to, the connection to pharmacists' work.

METHODS

Data from the Centers for Disease Control and Prevention's National Violent Death Reporting System (NVDRS) were analyzed to explore the number and characteristics of homicides of pharmacists that occurred between 2003 and 2020.

RESULTS

Between 2003 and 2020, 33 homicides of pharmacists were reported to the NVDRS. A slight majority (n = 17, 52%) of victims were female. Six (18%) were determined to be workplace or work-related homicides; only 2 homicides were related to the work of a pharmacist. Nearly two-thirds (n = 21, 64%) were perpetrated with a firearm. The suspects for most of these homicides were male (n = 28, 85%), and many were either a current or former partner of the decedent (n = 14, 42%).

CONCLUSION

In the US, homicides of pharmacists occur infrequently relative to the general population. Homicides in pharmacists' workplaces are uncommon, and homicides of pharmacists appear to be tied most often to domestic violence and firearms.

Relationships between workplace violence, psychological symptoms, and adverse events: a nationwide cohort study of Chinese nurses

BACKGROUND

Nurses in China are disproportionately exposed to workplace violence. Rates of psychological symptoms and adverse events among Chinese nurses have increased in recent years. To evaluate whether workplace violence is associated with psychological symptoms and adverse events among nurses.

METHODS

This study is a cross-sectional analysis using baseline data from the Nurses' Mental Health Study (NMHS), conducted across 67 tertiary hospitals in 31 regions of China to assess the mental health of nurses. Workplace violence (WPV) from patients and their relatives was assessed using the Workplace Violence Scale (WVS). Outcomes included depressive symptoms (PHQ-9), anxiety (GAD-7), obsessive-compulsive symptoms (SCL-90-R), burnout, insomnia, and adverse events. To reduce selection bias, propensity score matching was applied, followed by multivariable logistic regression to examine associations between WPV, psychological symptoms, and adverse events.

RESULTS

A total of 105,614 nurses participated, with 93.1 % female and 66.0 % married. WPV was reported by 30.3 % (n = 32,027). Before matching, the prevalence of depression, anxiety, obsessive-compulsive symptoms, burnout, and insomnia was 53.0 %, 36.5 %, 74.2 %, 42.4 %, and 22.1 %, respectively. Adverse events were reported by 32.3 % of nurses. Nurses exposed to WPV were significantly more likely to report psychological symptoms and adverse events than those who were not.

CONCLUSIONS

WPV from patients and their relatives was significantly associated with increased psychological symptoms and adverse events among Chinese nurses. Reducing WPV in healthcare settings may improve both nurse well-being and patient safety.

Workplace Violence in the Emergency Department: A Bibliometric Analysis

INTRODUCTION

Workplace violence against health care workers is a widespread global issue, particularly in emergency departments. This study aimed to identify and visualize research on workplace violence in the emergency department and reveal global trends in this field.

METHODS

Publications related to workplace violence in the emergency department were retrieved from the Web of Science Core Collection database. VOSviewer, CiteSpace, and Scimago Graphica were used for bibliometric analysis and visualization.

RESULTS

A total of 348 articles were selected for this study. These articles were published across 50 countries from November 1, 1988 to December 31, 2024, with the United States, Australia, and China leading in publication output. These articles were featured in 142 journals, with the Journal of Emergency Nursing publishing the most (n = 33). Gillespie is both the most prolific author and among the most frequently cited in this field. Keyword clustering analysis identified 4 distinct research themes, including factors associated with the occurrence of violence, prevention strategies for workplace violence, its psychological and occupational impacts on emergency department staff, and different forms of violence. In addition, keyword burst analysis revealed emerging trend topics, notably "COVID-19," "experience," and "qualitative research."

DISCUSSION

Despite a growing body of research on workplace violence in the emergency department in recent years, incidents of violence continue to arise. This bibliometric study is the first to comprehensively summarize the research developments and trends in this field, identifying research frontiers and hotspots. The findings offer new perspectives on workplace violence in the emergency department and may inform future research on violence prevention strategies.

Nonfatal Injuries Among Skilled Nursing and Residential Care Facility Workers Treated in U.S. Emergency Departments, 2015-2022

INTRODUCTION

Skilled nursing and residential care facilities (SNRCFs) report among the highest nonfatal occupational injury rates compared to the overall working population. This cross-sectional study reports nonfatal emergency department (ED)-treated injury national estimates among U.S. SNRCF workers.

METHODS

Nonfatal ED-treated occupational injury data were analyzed (2015-2022) from the National Electronic Injury Surveillance System, Occupational Supplement, a national probability sample of approximately 67 U.S. EDs. Occupational injuries in SNRCFs were selected using relevant U.S. Census Bureau industry codes. National estimates and rates per 10,000 worker full-time equivalents (FTEs) were calculated using the U.S. Current Population Survey. Piecewise linear regression models examined temporal trends in biannual injury rates.

RESULTS

An estimated 569,800 (95% confidence interval 420,400-719,200) injuries occurred from 2015 to 2022, a rate of 302 (223-382) per 10,000 FTEs. Most injuries occurred among females (81%). The most prevalent injury events were overexertion and bodily reaction [38%; 116 (85-147) per 10,000 FTEs], violence [24%; 73 (46-100) per 10,000 FTEs], and falls, slips, and trips [16%; 49 (35-63) per 10,000 FTEs]. SNRCF injury rates were higher than the rest of the healthcare industry and all industries. SNRCF injury rates declined from 2015-2021 [average biannual change -9.6% (-13.3%, -5.9%), p <.001]. Following a 2021 trend change, there was a non-significant increase in injury rates.

CONCLUSIONS

Among the working population, SNRCF workers experience a high rate of nonfatal ED-treated occupational injuries. Future research should confirm trends and study effectiveness and uptake of evidence-based injury prevention interventions across settings.

Perceptions of participants and organisers of a social prescribing programme for hospital staff through horticulture (SP4S-H) in the community hospitals in Singapore: a qualitative study

OBJECTIVES

Hospital workers face multiple biopsychosocial stressors in the course of their work, which could potentially be addressed by social prescribing of horticultural activities. However, the effectiveness of such interventions has not been evaluated. We conducted a qualitative study to understand the perceptions of participants and organisers of a horticulture-based social prescribing intervention for staff (SP4S-H) in three community hospitals in Singapore.

DESIGN

The RE-AIM Planning and Evaluation Framework was used to develop our semistructured interview guides and guided our thematic analysis. Indepth interviews were conducted with subsequent transcribing, coding and iterative analysis until thematic saturation was reached.

SETTING

Three community hospitals in Singapore, between May 2022 and June 2024.

PARTICIPANTS

26 hospital staff.

RESULTS

SP4S-H was perceived to have a positive impact on staff, including increasing their knowledge on horticulture, team bonding, positive emotions and self-help skills. Barriers to participation included participants preferring not to spend time outside working hours (ie, lunch hours) for SP4S-H or attending physical meetings. Appealing to the interest of staff, overcoming barriers in their attendance, organising the events and improving the working culture of participants were found to influence the reach, implementation and sustainability of SP4S-H.

CONCLUSION

SP4S-H was perceived to be beneficial by hospital workers in improving social connectedness and their ability to cope with stress. The importance of having the support of senior management, adequacy of resources and deliberate staff engagement in rolling out this initiative cannot be underestimated.

Exploring the Impact of Workplace Violence in Urban Emergency Departments: A Qualitative Study

Background: Workplace violence (WPV) in healthcare, particularly in emergency departments (EDs), is a growing and complex issue that significantly impacts healthcare providers (HCPs). Following the COVID-19 pandemic, the rates of WPV have increased globally, contributing to increased burnout, reduced morale, and heightened challenges in staff retention within EDs. Objective: This study aimed to explore HCPs' perspectives on WPV in EDs. The insights gathered were intended to inform targeted interventions in a quality improvement initiative focused on addressing WPV in our healthcare institutions. Methods: A qualitative study involving semi-structured interviews was conducted with 52 HCPs across two urban EDs at a multi-site academic health center. Participants from various roles and shifts shared experiences related to safety, leadership, training, and security. Interviews were recorded, transcribed, anonymized, and thematically analyzed to identify key themes surrounding WPV in EDs. Results: The thematic analysis identified four main themes, including (1) Violence is Part of the Job, (2) Leadership Dynamics regarding WPV, (3) Disconnect Among ED Staff During WPV Response, and (4) Enhancing Systems and Culture for Effective WPV Management. These themes provide a comprehensive view of HCPs' experiences and offer actionable recommendations for healthcare organizations seeking to address WPV. Conclusions: The study provides valuable qualitative insights into WPV in EDs, emphasizing the importance of addressing cultural, structural, and procedural gaps. These findings can guide the development of more supportive and effective strategies to create a safer environment for ED staff. Further rounds of interviews are planned post-intervention to assess changes in HCPs' perceptions and experiences.

Revisiting Alcohol Consumption Among Nurses After the COVID-19 Pandemic: A Qualitative Descriptive Study

The COVID-19 pandemic continues to cause nurses stress and trauma, with alcohol potentially being used to manage this stress. Prior studies of nurses' alcohol consumption during the COVID-19 pandemic have shown increases in alcohol consumption to manage stress associated with the pandemic. The aim of this paper is to explore perceptions of alcohol consumption and stress among nurses, particularly since the declared end of the COVID-19 pandemic. We used semi-structured interviews with Australian nurses (n = 55), using a qualitative-descriptive study design, conducted between October 2023 and January 2024. Data were analysed using structural coding and reported in accordance with CORE-Q guidelines. Four key themes emerged from the data: (1) Alcohol consumption in response to ongoing role stress, (2) Alcohol consumption in response to incidents, (3) The lasting impact of the COVID-19 pandemic and (4) Do nurses feel comfortable seeking help for alcohol use? High-risk alcohol consumption has persisted beyond the end of the COVID-19 pandemic to manage the stress associated with clinical environments. Alcohol was also used in response to incidents, and the ongoing trauma and impact of the pandemic was described as a significant source of stress and anxiety. Not all nurses in our study felt comfortable seeking help for alcohol use, with participants describing concern for their nursing registration if they self-reported their alcohol consumption. Participants reported stronger links between stressful working environments and increased alcohol consumption. Nurses in our study do not feel safe seeking help or self-reporting alcohol consumption for fear of the regulatory body instituting sanctions that lead to loss or suspension of their registration. These factors require urgent attention to ensure workforce wellbeing and sustainability.

Effectiveness of Interventions to Improve Coping and Resilience of Frontline Mental Healthcare Professionals Towards Workplace Violence on Psychiatric Wards-A Systematic Review

Workplace violence (WPV) is a harmful phenomenon happening in psychiatric wards. Despite preventive efforts, mental health services cannot eliminate WPV. If mental health services can increase the coping and resilience of frontline mental healthcare professionals (FMHPs) towards WPV, it could contribute to their mental health and well-being. To perform a systematic review of comparative studies on interventions to improve coping and resilience towards WPV aimed at FMHPs working in psychiatric wards. Systematic review on comparative intervention studies, with electronic searches in MEDLINE, Embase, Cochrane CENTRAL, PsycINFO and CINAHL. We registered our protocol in PROSPERO (CRD42022373757). Performing a meta-analysis seemed not to be feasible, so we provided a narrative summary of the included studies, methodological quality and results. We included nine studies, with interventions focused on positive behavioural support, resilience enhancement and aggression management training. Most studies reported positive effects, though with a moderate to high risk of bias. Positive behavioural support, biofeedback and aggression management training are promising interventions in our review. Biofeedback interventions and positive behavioural support could be valuable additions to existing training programmes to improve coping and resilience. Future studies should focus on demonstrating the robustness of effects, the mechanism of increasing coping and resilience regarding WPV and the development and implementation of effective interventions.

Association of COVID-19-related violence and harassment with visiting nurses' mental health and intention to resign: A cross-sectional study in Japan

BACKGROUND

Prejudice related to the coronavirus disease 2019 (COVID-19) reportedly led to violence against healthcare workers by clients and their families. However, the impact of such violence and harassment on the mental health of visiting nurses during the pandemic remains unclear.

AIM

We aimed to examine the association of violence and harassment against visiting nurses with their mental health and intention to resign during the COVID-19 pandemic.

METHOD

We conducted an anonymous self-administered cross-sectional questionnaire survey to gain insight into the victimization, mental health, and personal resources (i.e., coping profiles and work engagements) among visiting nurses in Osaka. A multiple regression analysis and logistic regression analysis were used to identify associations between COVID-19-related violence and harassment and mental health or the intention to resign. Open-ended question data were assessed using content analysis to describe the details of the violence.

RESULTS

Visiting nurses were victimized by various people, such as clients and their families, residents in communities they visited, their colleagues, and their own neighbors. COVID-19-related violence and harassment was not significantly associated with subjective psychological well-being but was significantly associated with the intention to resign.

CONCLUSION

Visiting nurses experienced a comprehensive range of COVID-19-related violence and harassment during the pandemic, which may have affected their intention to resign. Coping strategies may be a possible way to mitigate the impact of such violence and harassment. During a novel infectious disease outbreak, adopting a new perspective is crucial, and managing mood swings may be helpful as an emotional coping mechanism.

Misaligned Supports: Differences in Reported Health Care Worker Well-being Supports Provided and Needed During the COVID-19 Pandemic

PURPOSE

To describe the well-being supports provided to health care workers (HCWs) during the COVID-19 pandemic in health centers and hospitals.

DESIGN

Cross-sectional qualitative interviews before and after implementation of a peer-based support intervention.

SETTING

Purposively sampled hospitals and health centers across the US.

PARTICIPANTS

28 site leaders and 56 HCWs sampled from 16 hospitals and 12 health centers.

METHOD

Site leaders and HCWs were asked to describe supports available to HCWs during the COVID-19 pandemic. Thematic and content coding and analysis of interview responses were conducted using Dedoose.

RESULTS

Both site leaders and HCWs identified a range of support resources available. Communication resources were the most frequently cited in both groups. Health care workers reported bi-directional communication, while one-way communication was emphasized by site leaders. Hospitals highlighted counseling support, particularly Employee Assistance Programs (EAP), while health centers prioritized community support. Wellness activities were more prevalent in hospital settings, while health centers offered specific workplace-provided training for HCWs. Health care workers encountered barriers when accessing support, including limited time, fear of stigma, and disruptions to their existing support networks attributable to the pandemic.

CONCLUSION

While there are resources for HCWs, the available supports may not align with their needs and barriers to access may limit the effectiveness of these supports. Continued engagement between leaders and HCWs could help better align resources with needs.

Measuring the Risk of Violence Through Health Surveillance

Workplace violence (WV) is a ubiquitous, yet under-reported and under-studied phenomenon. Prevention measures may be ineffective because risk assessment is often based on unvalidated algorithms. After monitoring the risk of WV in a healthcare company for over 20 years, this paper presents the results collected in 2023 and details of the methodology used. Monitoring WV in health surveillance can involve three actions: (1) asking all the workers who attend periodic medical examinations in the workplace whether they have suffered physical aggression, threats, or harassment in the previous year; (2) investigating WV at the end of workplace inspections by setting up participatory ergonomics groups (PEGs) to suggest solutions; (3) investigating the characteristics and consequences of WV through anonymous online questionnaires. In 2023, 6.9% of the healthcare workers (HCWs) reported having experienced one or more physical attacks during the previous year; 12.7% reported having been threatened, and 12.9% reported other types of violent, harassing behavior. The HCWs observed an increase in violence after the pandemic years and, in the PEGs, suggested using different preventive measures in different health departments. The online survey provided further information on the characteristics of WV and its consequences. The risk of WV can be effectively characterized and measured through health surveillance.

Professional and personal experiences of workplace violence among Italian mental health nurses: A qualitative study

Background

Violence against healthcare workers in psychiatric settings is a concern in the literature. Violence effects for healthcare professionals and organizations include an absence from work due to injury or illness, a decreased job satisfaction, and a lower quality of work. The aim of this study is to identify the consequences of violence on the health, work habits, and performance of nurses working with psychiatric patients.

Methods

The study was conducted using semi-structured interviews with 18 nurses from different hospitals and territorial psychiatric settings in Southern Italy. The interviews were conducted from July to December 2020 by telephone and were recorded with the consent of the participants. The collected data were transcribed and analyzed.

Results

The narratives revealed five main themes: (1) Feelings about the violence experienced; (2) the effects of violent incidents on nurses; (3) features of the mental health setting related to the phenomenon of the assault; (4) the care and organizational aspects to prevent the assault; and (5) the care in psychiatric settings during the COVID-19 pandemic. The aggressions resulted in a change in the nurses' work habits and performances; they were more careful after the aggression and modified their approach to the patient. Additionally, the nurses discussed developing skills and strategies to protect themselves and avoid aggression.

Conclusions

Aggression has a negative impact on the health and work performance of nurses. Adopting personal and nursing strategies in place to prevent aggression allows them to improve the patient care and to protect themselves from such incidents. The creation of a safer work environment by healthcare organizations in which professionals work can improve their health, job performance, and the effectiveness of psychiatric nursing care.

Protective and risk factors of workplace violence against nurses: A cross-sectional study

AIMS

To describe how workplace violence (WPV) is experienced by nurses in hospitals and community services and identify protective and risk factors.

METHODS

An online cross-sectional national study was conducted from January to April 2021 in Italy. Hospitals and community services were involved in the study. The survey combined the adapted and validated Italian version of the Violence in Emergency Nursing and Triage (VENT) questionnaire, which explores the episodes of WPV experienced during the previous 12 months, the Practice Environment Scale of the Nursing Work Index (PES-NWI) and some additional questions about staffing levels extracted from a previous RN4CAST study. Nurses working in all clinical settings and community services were invited to participate in the survey. Descriptive and inferential statistics were used for data analysis. We adhered to the STROBE reporting guidelines.

RESULTS

A total of 6079 nurses completed the survey, 32.4% (n = 1969) had experienced WPV in the previous 12 months, and 46% (n = 920) reported WPV only in the previous week. The most significant protective factors were nurses' age, patients' use of illegal substances, attitude of individual nurses and considering effective the organization's procedures for preventing and managing episodes of violence. The most significant risk factors included workload, recognizing violence as an inevitable part of the job, patients' cultural aspects and patients' agitated behaviour. The frequency of WPV was significantly higher in certain areas, such as the emergency department and in mental health wards.

CONCLUSION

Workplace violence (WPV) against nurses is a very frequent and concerning issue, especially in hospitals and community services. Based on our findings, integrated and multimodal programmes for prevention and management of WPV are recommended. More attention and resources need to be allocated to reduce WPV by improving the quality of nurses' workplace environment and implementing violence-free policies for hospitals.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Impact Workplace verbal and physical violence is a widespread phenomenon, both in hospital and community settings, and even during COVID-19 pandemic. This problem is exacerbated by the lack of effective reporting systems, fear of retaliation and the tendency to consider violence as an inevitable part of the job. The characteristics of professionals, patients, work environment and organizational factors are involved in the spread of workplace violence, determining its multifactorial nature. Integrated and multimodal programmes to prevent and manage of workplace violence are probably the only way to effectively counteract workplace violence against nurses. Healthcare policymakers, managers of hospital and community services need to proactively prevent and effectively manage and monitor episodes of violence. Nurses need to feel protected and safeguarded against any form of verbal or physical violence, to provide high-quality care in a totally safe environment.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

A Cross-Sectional Study Exploring the Impact of Violence on Healthcare Employees' Work Engagement and Meaningful Work

AIM

This study aims to determine the prevalence of workplace violence against healthcare professionals and its effects on work engagement and meaningful work in healthcare settings.

DESIGN

This study is designed as an analytical cross-sectional study.

METHODS

This study surveyed 676 healthcare professionals in Turkiye between June and December 2022, using face-to-face and online methods. Scales measured exposure to and witnessing violence, work engagement, and meaningful work. The study has adhered to STROBE guidelines. Statistical analyses included descriptive, correlation, and linear regression.

RESULTS

According to the results, shouting and cursing by patients and their companions were determined as the most common type of violence encountered by healthcare professionals. The effect of healthcare professionals' exposure to violence from patients' companion on work engagement and witnessing to violence from colleagues on meaningful work were found to be negative and significant.

DISCUSSION

The findings emphasise the urgent need for interventions addressing workplace violence against healthcare professionals. Since workplace violence significantly reduces work engagement and the sense of meaningful work in healthcare setting.

IMPACT

By highlighting the prevalence of workplace violence and its negative impact on both work engagement and meaningful work in healthcare setting, this study provides critical evidence for policymakers and healthcare administrators.

PATIENT OR PUBLIC CONTRIBUTION

The participants in this study were healthcare professionals who had direct contact with patients and their relatives.

Tracking Workplace Violence over 20 Years

Introduction. Violence against healthcare workers (HCWs) is a widespread, underreported, and inadequately prevented problem. Only a few companies have efficient systems for assessing the extent of the phenomenon. Methods. In 2005, the health surveillance service of a public health company introduced a system that monitored violence experienced by HCWs by means of three items from the Violent Incident Form (VIF) integrated with departmental in-depth analyses using the participatory ergonomics group technique. Results. In 2005, the annual rate of physical assaults was 8.2%, that of threats was 12.0%, and the harassment rate was 19.6%. Over the past twenty years of observation (2005-2024), the percentage of workers who reported experiencing a physical attack in the previous year at their periodic medical examination has fluctuated between 5.8% and 11.1%, except for the years 2020 and 2021 when, during the COVID-19 pandemic, the rate was 3.9% and 3.2%, respectively. During the same pandemic period, the annual threat rate, which ranged from 9.4% to 20.1%, dropped to 7.7%, while the prevalence of harassment, which was between 13.5 and 19.6, fell to 7.2%. HCWs believe that (i) limiting visitor access, (ii) a better balance of the demand for services, and (iii) a better attitude towards HCWs were the causes of the reduced rate of violence during the pandemic. Conclusions. Recording the violence experienced during health surveillance is an economical, reliable, and sustainable risk assessment method.

The Prevalence and Determinants of Mental Health Problems in Lebanon: A Meta-Analytic Study of 3957 Healthcare Workers

OBJECTIVE

Healthcare workers are continuously exposed to challenging environments, making them liable for poor mental health. The COVID-19 pandemic exacerbated this problem, however available data in Lebanon is scarce. We conducted this investigation to provide comprehensive evidence on the mental health of Lebanese healthcare workers.

METHODS

In this systematic review, we analyzed 3957 workers reported in 15 cross-sectional studies (10 during and five before the pandemic), identified after searching four databases. Examined mental health problems included depression, anxiety, stress, posttraumatic stress disorder (PTSD), and poor sleep quality. STATA software was used to pool the prevalence across studies. Subgroup analyses were performed based on the pandemic status, severity of mental health problems, and healthcare worker type. Gender and marital status were analyzed as potential risk factors. The methodological quality of all included studies was good as per the National Institute of Health risk of bias tool.

RESULTS

Anxiety, depression, stress, PTSD, insomnia, and poor sleep quality were reported in 50%, 52%, 50%, 35%, 45%, and 41% of the population, respectively. Most cases had mild anxiety (40%), mild depression (45%), but severe stress (27%). Depression and anxiety were highest among pharmacists (69% and 56%) and nurses (49% and 45%), respectively. Compared to the pre-pandemic period, depression (36% vs. 62%) and anxiety (30% vs. 56%) rates were higher during the pandemic, while stress levels were lower (62% vs. 45%). Both gender and marital status were insignificant predictors of depression, anxiety, stress, or PTSD.

CONCLUSIONS

Depression, anxiety, posttraumatic stress, insomnia, and poor sleep quality are experienced by approximately one in every two Lebanese healthcare workers. The rate of depression and anxiety almost doubled during the pandemic with higher rates among pharmacists and nurses than physicians and residents. Both gender and marital status were deemed insignificant predictors of reported mental health problems.

Violent encounters on the front line: Sequential explanatory mixed-methods investigation of physical violence factors in the prehospital setting

OBJECTIVE

Workplace violence (WPV) is an important issue in prehospital care, especially for emergency medical technicians ( EMTs) who are at increased risk of physical violence due to the nature of their work. This study aimed to shed light on the specific factors that contribute to the underlying causes of physical WPV in the prehospital context through direct experience and insight into the work of EMTs.

METHODS

Sequential explanatory mixed methods were applied in five western provinces of Iran from 2022 to 2023. In total, 358 EMTs that met the criteria for the quantitative phase were selected using a multi-stage clustering method. In the quantitative phase, the researchers used a questionnaire on workplace violence in the healthcare sector. Based on the results of the quantitative phase, 21 technicians who had experienced physical violence in the past 12 months were invited for in-depth interviews in the qualitative phase.

RESULTS

The average age of the EMTs was 33.96 ± 6.86 years, with an average work experience of 10.57 ± 6.80 years. More than half (53.6%) of the staff worked 24-hour shifts. In addition, most EMTs were located in urban bases (50.3%), and 78 (21.8%) reported having experienced physical violence. No significant correlations were found between the demographic characteristics of the technicians and the frequency of physical violence, except base location in the last 6 months. The qualitative study also created one theme (the complexity of WPV in the prehospital setting), four categories, and ten subcategories.

CONCLUSION

The study's results emphasize the need for comprehensive WPV factors in the prehospital setting. These factors can lead to identifying and improving strategies such as organizational support, improving communication and collaboration between responders, and training in de-escalation techniques. In addition, it is crucial to address the root causes of WPV such as poverty and lack of education in the community to create a safer and more supportive environment for patients and staff.

Poor Work Ability Is Associated with Workplace Violence in Nurses: A Two-Wave Panel Data Analysis

Healthcare personnel must deal with two problems of growing importance: violence in the workplace and the loss of work ability due to the aging of the workforce. Our objective was to evaluate, with a two-wave perspective design, the relationships of work ability, social support, and occupational stress with workplace violence in nurses. In an Italian public health company, we asked nurses to self-assess their work ability using the Work Ability Index (WAI) and we analyzed the relationship between this indicator and the violence experienced in the previous and following years. A total of 321 out of 344 nurses (99.3%) participated. In a logistic regression model, the WAI score was a significant protective factor for violence experienced in the previous year (OR = 0.94 CI95% = 0.90; 0.98 p < 0.01) and in the following year (OR = 0.88 CI95% = 0.84; 0.92 p < 0.01). In a hierarchical logistic regression model, social support acted as a protective factor (OR = 0.87 CI95% = 0.79; 0.95 for violence experienced in the previous year), while occupational stress was a significant determinant of the risk of aggression (OR = 3.65 CI95% = 1.90; 7.03 in the previous year, OR = 3.54 CI95% = 1.801; 6.947 in the following year). The difficulties that nurses encounter in carrying out their growing work demands in an environment that is not promptly adapted to their changing physical and mental states can lead to an increased risk of violence. Prevention of workplace violence should include organizational and ergonomic measures that reduce stress and increase staff support and work ability.

The Ethical Obligation to Treat Infectious Patients: A Systematic Review of Reasons

During pandemics, healthcare providers struggle with balancing obligations to self, family, and patients. While HIV/AIDS seemed to settle this issue, coronavirus disease 2019 (COVID-19) rekindled debates regarding treatment refusal. We searched MEDLINE, Embase, CINAHL Complete, and Web of Science using terms including obligation, refusal, HIV/AIDS, COVID-19, and pandemics. After duplicate removal and dual, independent screening, we analyzed 156 articles for quality, ethical position, reasons, and concepts. Diseases in our sample included HIV/AIDS (72.2%), severe acute respiratory syndrome (SARS) (10.2%), COVID-19 (10.2%), Ebola (7.0%), and influenza (7.0%). Most articles (81.9%, n = 128) indicated an obligation to treat. COVID-19 had the highest number of papers indicating ethical acceptability of refusal (60%, P < .001), while HIV had the least (13.3%, P = .026). Several reason domains were significantly different during COVID-19, including unreasonable risks to self/family (26.7%, P < .001) and labor rights/workers' protection (40%, P < .001). A surge in ethics literature during COVID-19 has advocated for permissibility of treatment refusal. Balancing healthcare provision with workforce protection is crucial in effectively responding to a global pandemic.

Surveillance of Health Care-Associated Violence Using Natural Language Processing

BACKGROUND AND OBJECTIVES

Patient and family violent outbursts toward staff, caregivers, or through self-harm, have increased during the ongoing behavioral health crisis. These health care-associated violence (HAV) episodes are likely under-reported. We sought to assess the feasibility of using nursing notes to identify under-reported HAV episodes.

METHODS

We extracted nursing notes across inpatient units at 2 hospitals for 2019: a pediatric tertiary care center and a community-based hospital. We used a workflow for narrative data processing using a natural language processing (NLP) assisted manual review process performed by domain experts (a nurse and a physician). We trained the NLP models on the tertiary care center data and validated it on the community hospital data. Finally, we applied these surveillance methods to real-time data for 2022 to assess reporting completeness of new cases.

RESULTS

We used 70 981 notes from the tertiary care center for model building and internal validation and 19 332 notes from the community hospital for external validation. The final community hospital model sensitivity was 96.8% (95% CI 90.6% to 100%) and a specificity of 47.1% (39.6% to 54.6%) compared with manual review. We identified 31 HAV episodes in July to December 2022, of which 26 were reportable in accordance with the hospital internal criteria. Only 7 of 26 cases were reported by employees using the self-reporting system, all of which were identified by our surveillance process.

CONCLUSIONS

NLP-assisted review is a feasible method for surveillance of under-reported HAV episodes, with implementation and usability that can be achieved even at a low information technology-resourced hospital setting.

Nurses' Perspectives on Risk Factors and Strategies to Control Workplace Violence: A National Survey in Vietnam

Background

We aimed to describe nurses' perspectives on risk factors and strategies to control workplace violence.

Methods

To accomplish the study objectives, an online cross-sectional questionnaire-based investigation was conducted. The scales were developed in accordance with the guidelines provided by reputable organizations such as the International Labour Office (ILO), International Council of Nurses (ICN), WHO, and Public Services International (PSI), as well as previous scholarly works. Prior to implementation, the validity and reliability of the Likert scales were rigorously tested. The survey, conducted from March to May 2022, encompassed 163 public hospitals in Vietnam and was completed by 2,280 nurses employed in these institutions.

Results

According to nurses' perceptions, several key risk factors contribute to workplace violence (WPV). These include low socio-cultural awareness among patients and their family members, overcrowding in hospitals, non-compliance with hospital regulations, unrealistic expectations regarding treatment outcomes, communication issues among staff members. To effectively control WPV, nurses propose a range of strategies. These include enhancing the quality of hospital services and the hospital environment, fostering a positive workplace culture, establishing a comprehensive system for reporting and responding to incidents of WPV and developing patient care protocols. These strategies are believed to mitigate the occurrence and impact of WPV, ensuring a safer and more secure work environment for nurses.

Conclusion

Workplace violence in healthcare settings is influenced by organizational, clinical, and environmental risk factors. Nurses adopt a multi-component approach to manage workplace violence. This study provides valuable insights for developing effective strategies to combat workplace violence in Vietnam.

Worldwide Trends in COVID-19-Related Attacks Against Healthcare: A Review of the Safeguarding Health in Conflict Coalition Database

During the COVID-19 pandemic, violence targeting healthcare reportedly increased. Attacks against healthcare can severely hamper the public health response during a pandemic. Descriptive data analysis of these attacks may be helpful to develop prevention and mitigation strategies. This study aimed to investigate trends regarding COVID-19-related attacks against healthcare from January 2020 until January 2023. COVID-19-related incidents occurring between January 2020 and January 2023 were extracted from the Safeguarding Health in Conflict Coalition database and screened for eligibility. Included incidents were linked to COVID-19 health measures or were attacks directly interfering with COVID-19 healthcare, including conflict-related attacks. Data collected per incident included temporal factors; country; setting; attack and weapon type; perpetrator; motive; number of healthcare workers (HCWs) killed, injured, or kidnapped; and health facility damage. The study identified 255 COVID-19-related attacks against healthcare, with 18 HCWs killed, 147 HCWs injured, and 86 facilities damaged. The highest attack frequency was reported during the beginning of the pandemic and predominantly concerned stigma-related attacks against healthcare. Reported incidents in 2021 included attacks targeting vaccination campaigns, as well as conflict-related attacks interfering with COVID-19 healthcare. COVID-19-related attacks against healthcare occurred in heterogeneous contexts throughout the pandemic. Due to underreporting, the data presented are a minimum estimate of the actual magnitude of violence. The findings of this study emphasize the importance of public education campaigns, improved coordination between healthcare organizations and law enforcement, and the possible need to bolster the security of medical facilities and health workers.

The paradox of workplace violence in the intensive care unit: a focus group study

BACKGROUND

Conflicts with patients and relatives occur frequently in intensive care units (ICUs), driven by factors that are intensified by critical illness and its treatments. A majority of ICU healthcare professionals have experienced verbal and/or physical violence. There is a need to understand how healthcare professionals in ICUs experience and manage this workplace violence.

METHODS

A qualitative descriptive analysis of four hospitals in Sweden was conducted using semi-structured focus-group interviews with ICU healthcare professionals.

RESULTS

A total of 34 participants (14 nurses, 6 physicians and 14 other staff) were interviewed across the four hospitals. The overarching theme: "The paradox of violence in healthcare" illustrated a normalisation of violence in ICU care and indicated a complex association between healthcare professionals regarding violence as an integral aspect of caregiving, while simultaneously identifying themselves as victims of this violence. The healthcare professionals described being poorly prepared and lacking appropriate tools to manage violent situations. The management of violence was therefore mostly based on self-taught skills.

CONCLUSIONS

This study contributes to understanding the normalisation of violence in ICU care and gives a possible explanation for its origins. The paradox involves a multifaceted approach that acknowledges and confronts the structural and cultural dimensions of violence in healthcare. Such an approach will lay the foundations for a more sustainable healthcare system.

The growing burden of workplace violence against healthcare workers: trends in prevalence, risk factors, consequences, and prevention - a narrative review

Workplace violence (WPV) against healthcare workers (HCW) is a globally growing problem in healthcare systems. Despite decades of research and interventions violent incidents are rising in their severity and frequency. A structured review of PubMed and Scopus databases and supplementary internet searches, resulted in a synthesis of evidence covering multiple countries and healthcare worker populations. High rates of WPV are increasingly common due to unmet patient expectations, poor communication, long wait times and organizational factors such as resourcing and infrastructure. We highlight links between WPV and poor worker health outcomes, staff turnover, reduced patient safety and medical errors. Few prevention and mitigation activities have shown sustained effects, highlighting the challenges in understanding and addressing the complex interplay of factors that drive violence against HCWs. The rapidly rising incidence of WPV requires special consideration and action from multiple stakeholders including patients and visitors, healthcare providers, law enforcement, media and policy makers.

Medicolegal analysis of physical violence toward physicians in Egypt

This study analyzed physical violence against physicians in Egypt from a medicolegal perspective. 88%, 42%, and 13.2% of participants were exposed to verbal, physical, and sexual violence. Concerning the tools of violence, 75.2% of attackers used their bodies. Blunt objects (29.5%), sharp instruments (7.6%), and firearm weapons (1.9%) were used. The commonest manners of attacks were pushing/pulling (44.8%), throwing objects (38.1%), and fists (30.5%). Stabbing (4.8%) and slashing (2.9%) with sharp instruments were also reported. Traumas were mainly directed towards upper limbs (43.8%), trunks (40%), and heads (28.6%). Considering immediate effects, simple injuries were reported that included contusions (22.9%), abrasions (16.2%), and cut wounds (1.9%). Serious injuries included firearm injuries (4.8%), internal organs injuries (3.8%), fractures (2.9%), and burns (1.9%). Most (90.5%) of injuries healed completely, whereas 7.6% and 1.9% left scars and residual infirmities, respectively. Only 14.3% of physicians proceeded to legal action. The current study reflects high aggression, which is disproportionate to legal actions taken by physicians. This medicolegal analysis could guide protective measures for healthcare providers in Egypt. In addition, a narrative review of studies from 15 countries pointed to violence against physicians as a worldwide problem that deserves future medicolegal analyses.

Exploring nurses' emotional reactions to and reporting of patient-on-nurse workplace violence: A mixed-methods study

BACKGROUND

Workplace violence, including violent, intimidating, and disruptive acts, commonly occurs in healthcare settings. Type 2 workplace violence in nursing refers to patient/visitor behaviors directed toward clinicians, contributing to physical and psychological harm. Nurse victims often do not report these events to employers or law enforcement, making it challenging to address workplace violence.

OBJECTIVES

Our research examined nurse reactions to Type 2 workplace violence by identifying what behaviors they perceived as aggressive and reportable. Specific aims included: 1) developing and testing video vignettes to portray realistic patient aggression scenarios; 2) identifying nurse understandings of aggressive events that prompt affective reactions, and; 3) examining clinical characteristics related to the nurse victim's likelihood to report.

DESIGN

Through a sequential mixed-methods design, we qualitatively developed novel video vignettes portraying Type 2 workplace violence to experimentally examine how nurses interpreted them within a quantitative repeated measures survey.

METHODS

Two expert nurse research panels (n = 10) created five vignettes, from which nurses (n = 282) completed a survey with 1382 unique responses. Analyses included descriptive statistics and repeated measures ANOVA/regression models.

RESULTS

Video vignettes realistically portrayed workplace violence events, eliciting negative emotional responses among nurses that increased in magnitude with statistical significance as the level of displayed aggression escalated. Statistically significant factors influencing nurse reporting of workplace violence included; 1) the level of aggression displayed by the patient; 2) the level of harm received by the nurse; 3) whether the nurse felt the patient's actions were intentional, and; 4) the nurse's perceived frequency of exposure to workplace violence.

CONCLUSIONS

Results suggested that nurse victims of Type 2 workplace violence experience depression, anger, fear, and anxiety, which may contribute to long-term mental health consequences. Findings also identified factors related to nurse reporting behaviors, which may help mitigate workplace violence in healthcare settings by informing research and promoting workplace practices that encourage reporting and safety.

REGISTRATION

Not registered.

TWEETABLE ABSTRACT

Nurse reactions to workplace violence: Video vignettes reveal escalating aggression's impact on reporting. #EndNurseAbuse #WorkplaceViolence.

Factors Contributing to Increased Workplace Violence Against Nurses During COVID-19 in the Healthcare Settings of a Lower Middle-income Country: A Qualitative Study

PURPOSE

The aim of this study was to provide the perceptions of nurses, nursing supervisors, and nursing administrators about factors contributing to increased workplace violence (WPV) against nurses within the healthcare settings in Pakistan during the first wave of the COVID-19 pandemic.

METHODS

This study used a Descriptive Qualitative design, with a purposive sampling technique. From September to December 2021, In-depth interviews of 45 to 60 minutes, using a semistructured interview guide, we collected data from a private and a public healthcare setting in Pakistan. Given the travel restrictions during the COVID-19 pandemic, these interviews were conducted online, using Zoom audio features. Bedside nurses, nursing supervisors, and nursing administrators with at least six months of work experience participated in this study.

RESULTS

The qualitative data analysis steps suggested by Braun and Clarke (2013) were used for thematic analysis. The overarching theme emerging from the data was "Factors perceived by nurses that contributed to increased WPV in their work settings during the first wave of COVID-19, in a lower middle-income country" The subthemes from the participants' narrations were (a) highly stressed patients, attendants, and healthcare workers; (b) the financial burden on patients and their families; (c) lack of resources and shortage of staff; (d) restricted visiting policy and a weak security system; (e) lack of awareness about the seriousness of COVID-19; (f) misconceptions about COVID-19 vaccines and nurses' role in disseminating awareness.

CONCLUSIONS

The current pandemic increased the intensity of WPV against nurses in healthcare settings in Pakistan. Despite any supposed reasons for WPV, exposure to violence should never be an acceptable part of nursing. The healthcare system in Pakistan needs to pay equal attention to funding, resource provision, and ensuring a safe working environment for healthcare workers.

Hazard Flagging as a Risk Mitigation Strategy for Violence against Emergency Medical Services

Paramedics are increasingly being subjected to violence, creating the potential for significant physical and psychological harm. Where a patient has a history of violent behavior, hazard flags-applied either to the individual, their residential address, or phone number-can alert paramedics to the possibility of violence, potentially reducing the risk of injury. Leveraging a novel violence reporting process embedded in the electronic patient care record, we reviewed violence reports filed over a thirteen-month period since its inception in February 2021 to assess the effectiveness of hazard flagging as a potential risk mitigation strategy. Upon reviewing a report, paramedic supervisors can generate a hazard flag if recurrent violent behavior from the patient is anticipated. In all, 502 violence reports were filed, for which paramedic supervisors generated hazard flags in 20% of cases (n = 99). In general, cases were not flagged either because the incident occurred at a location not amenable to flagging or because the supervisors felt that a hazard flag was not warranted based on the details in the report. Hazard flagging was associated with an increased risk of violence during subsequent paramedic attendance (Odds Ratio [OR] 6.21, p < 0.001). Nevertheless, the process appears to reliably identify persons who may be violent towards paramedics.

Sexist, Racist, and Homophobic Violence against Paramedics in a Single Canadian Site

Violence against paramedics is widely recognized as a serious, but underreported, problem. While injurious physical attacks on paramedics are generally reported, non-physical violence is less likely to be documented. Verbal abuse can be very distressing, particularly if the harassment targets personal or cultural identities, such as race, ethnicity, gender, or sexual orientation. Leveraging a novel, point-of-event reporting process, our objective was to estimate the prevalence of harassment on identity grounds against paramedics in a single paramedic service in Ontario, Canada, and assess its potentially differential impact on emotional distress. In an analysis of 502 reports filed between 1 February 2021 and 28 February 2022, two paramedic supervisors independently coded the free-text narrative descriptions of violent encounters for themes suggestive of sexism, racism, and homophobia. We achieved high inter-rater agreement across the dimensions (k = 0.73-0.83), and after resolving discrepant cases, we found that one in four violent reports documented abuse on at least one of the identity grounds. In these cases, paramedics were 60% more likely to indicate being emotionally distressed than for other forms of violence. Our findings offer unique insight into the type of vitriol paramedics experience over the course of their work and its potential for psychological harm.

Factors associated with workplace violence against Chinese healthcare workers: an online cross-sectional survey

Objectives

Workplace violence (WPV) against healthcare workers (HCWs) has reached significant levels globally, impeding the quality and accessibility of healthcare systems. However, there is limited available knowledge regarding the determinants linked with WPV among HCWs and the discrepancies observed across various levels of hospitals in China. The objective of the present research was to investigate the factors linked to WPV and job satisfaction among HCWs in China.

Methods

A self-developed questionnaire based on WeChat was employed to collect data. The questionnaire consisted of demographic information as well as occupational factors. To measure WPV, the Chinese version of the Workplace Violence Scale was utilized. Career satisfaction was assessed through two questions regarding career choices. The collected data was analyzed using descriptive analyses, chi-square tests, and multivariate logistic regressions.

Results

A total of 3,781 valid questionnaires (1,029 doctors and 2,752 nurses) were collected. Among all participants, 2,201 (58.2%) reported experiencing at least one form of WPV in the past year, with emotional abuse being the most frequent occurrence (49.7%), followed by threats (27.9%). The multivariate logistic regression analysis revealed several risk factors associated with WPV, including male gender, shift work, senior professional title, bachelor's degree education, employment in secondary-level hospitals, and working over 50 h per week (p < 0.05). Career satisfaction among HCWs who experienced high levels of WPV was low, with only 11.2% remaining confident in their profession, and a mere 2.0% supporting their children pursuing careers in healthcare.

Conclusion

WPV poses a significant challenge within the Chinese healthcare system. Efforts should be made to address the identified risk factors and promote a safe and satisfying working environment for HCWs.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Factors affecting intent to perpetrate violence against nurses: Theory of Planned Behavior approach

BACKGROUND

The Theory of Planned Behavior (TPB) has been found to predict target behaviors. The literature examining this model lacks attention to violence toward nurses.

PURPOSE

To explore the association between the public's exposure to violence and intention to employ violence toward nurses, under the TPB framework.

METHODS

A cross-sectional study (705 participants) employed a self-report questionnaire. Path analysis assessed TPB variables' mediation between prior exposure to violence and violent intent toward nurses.

DISCUSSION

The TPB variables, that is attitudes, subjective norms, and perceived control, mediated only the association between exposure to physical violence and intention to act violently. Subjective norms were the strongest mediator. The explained variance was 31%.

CONCLUSION

When addressing violence against nurses, policymakers must consider attitudes, subjective norms, and perceived control among patients and their attendants. Violence directed at nurses and health care workers reflects societal violence and the "upstream approaches" needed to mitigate violence in health care settings.

Guiding principles for the conduct of the Violence Study of Healthcare Workers and System (ViSHWaS): Insights from a global survey

BACKGROUND

Although many studies worldwide have reported on violence against health care workers, there is a lack of homogeneous data for understanding the current state of the issue. Conducting a global survey required a robust team organisation structure, unique dissemination strategies, and continual networking to maintain and propagate the pool of survey collaborators and responders. Here we aimed to describe the strategies that helped us carry out a global survey-based study, the lessons learned, and provide a practical roadmap for future large-scale cross-sectional studies.

METHODS

We conducted this cross-sectional survey-based study from 6 June to 9 August 2022, basing it on the 'Hub and Spoke' model, with a single core team and subgroups in different regions managed by country leads. The key steps included team organisation, strategy formulation for survey dissemination and data collection, social media launch, and conducting a post-survey analysis amongst the collaborators. The core team convened weekly via video conference to discuss the modus operandi. The language barrier was managed through audio translation or by shifting to 'an interviewer-administered' questionnaire.

RESULTS

The core team included 11 members from seven countries, followed by 28 country leads from 110 countries. We also gathered 80 regional collaborators who provided feedback and spread the message. The Violence Study of Healthcare Workers and Systems (ViSHWaS) returned 5500 responses globally. Guiding principles garnered through this collaborative project include focusing on effective team organisation, ensuring external validation of survey tool, personalised communication, global networking, timely communication for maintaining momentum, and addressing regional limitations. The post-survey analysis showed that WhatsApp messaging was the most common modality used for survey dissemination, followed by in-person meetings and text messaging. We noted that the successful techniques were direct communication with respondents, regular progress updates, responsiveness to regional and country lead needs, and timely troubleshooting. The most common barriers for the respondents were limitations in language proficiency, technical fallouts, lack of compliance with, and difficulty understanding the questionnaire.

CONCLUSIONS

In this global survey-based study of more than 5500 responses from over 110 countries, we noted valuable lessons in team management, survey dissemination, and addressing barriers to collaborative research.

Workplace violence in radiology: results of a systematic review

BACKGROUND

Workplace violence (WPV) is a growing issue in health care with far-reaching consequences for health workers' physical and psychological well-being. While some medical specialities like emergency medicine have always been considered at higher risk for WPV, several studies have also reported its occurrence in radiology.

AIMS

This systematic review aimed to comprehensively synthesize the types of WPV in radiology, its psychological impact, and the underlying risk and protective factors.

METHODS

We searched five electronic databases (PubMed, Web of Science Core Collection, Scopus, PsycINFO and CINAHL) and additional literature, including grey literature, and established weekly search alerts. Two reviewers independently conducted all methodological steps, involving a third reviewer in case of disagreement.

RESULTS

Of the 12 205 retrieved records, 103 full-text articles were evaluated, and 15 studies were included. Across studies, verbal aggression, sexual harassment (mostly against women) and physical violence were experienced by up to 100%, 85% and 46% of health workers, respectively. Perpetrators were patients and patients' caregivers, followed by co-workers. Victims suffered from various psychological symptoms, such as anxiety (22%-54%), fear (6%-39%), depression (32%) and repeated disturbing memories (21%). Risk factors included female gender, understaffing, worker inexperience, poor communication and lengthy waiting times. Social support and security personnel presence were among the identified protective factors.

CONCLUSIONS

Health workers are at high risk of experiencing WPV in the radiological setting, with a strong psychological impact. Radiological departments should create a safe healthcare environment that actively manages the identified risk factors and offers psychological support to affected workers.

Experiences of Patient Bigotry Among Doctor of Audiology Graduate Clinicians: A Review and Recommendations

PURPOSE

Students in audiology clinical doctorate programs in the United States are required to participate in direct patient care under the supervision of a licensed precepting audiologist during their schooling. Audiology student clinicians commonly rotate through a variety of clinical settings with their own organizational structure, policies, and precepting clinicians. Systemic prejudice and stigma cause many of these student clinicians to experience bigotry from the patients they work with.

METHOD

This review discusses the populations of audiology students at highest risk of patient bigotry and discusses the intersectionality of students with several historically marginalized identities.

RESULTS

Little scholarship exists in the field of audiology on the bigotry that graduate student clinicians experience. The effects of bigotry are reviewed, and practical guidance on preparing for and responding to bigotry from patients is provided.

CONCLUSIONS

As health care workers, these students are essential workers contributing to the health and health care of the population, making their well-being a critical public health concern. Bigotry from others has been shown to contribute to mental illness, burnout, and poorer physical health among the people experiencing it.

Occupational violence in a tertiary emergency department: A retrospective descriptive study

OBJECTIVE

Occupational violence in emergency departments (EDs) impacts staff and patients. Most hospitals have a response mechanism called a 'Code Black' or similar. We aimed to determine the incidence of Code Black activations in a tertiary ED and describe contributory factors, management strategies and adverse events.

METHODS

Descriptive study in a tertiary ED in South-East Queensland in 2021. Adult patients for who a Code Black had been activated were eligible. Data were obtained from a prospectively collected Code Black database, supplemented with retrospective electronic medical records.

RESULTS

There were 386 Code Black events. The incidence of Code Black activation was 11.0 per 1000 adult ED presentations. Individuals requiring Code Black activation were 59.6 % male with a mean age of 40.9 years. The primary diagnosis was mental illness related in 55.1 %. Alcohol was a suspected factor in 30.9 %. When Code Black activation occurred, median length of stay increased. Restraint including physical, chemical or both were used in 54.1 % of Code Blacks.

CONCLUSION

Occupational violence occurs at a three-fold greater incidence within this ED than reported elsewhere. This study reinforces other literature suggesting an increase in occupational violence, demonstrating the need for dedicated preventative strategies for patients at risk of agitation.

Utilization and effects of security technologies in mental health: A scoping review

Violence in healthcare is an urgent and increasing issue. Mental health settings are particularly affected, with severe negative impacts on staff, patients, and organizations. Security technologies could help maintain and improve safety in this field. However, knowledge of their utilization and effectiveness in mental health is lacking. A scoping review was conducted using the methodology recommended by the Joanna Briggs Institute to map research on the utilization and effects of security technologies in mental health, identify how research is currently performed, and highlight gaps in the existing knowledge. Literature search for peer-reviewed publications was performed on PubMed, CINAHL, PsycInfo, Embase, and Scopus. Following the screening process and the eligibility criteria, 22 articles were included in this review. The publication range was 2002-2020, many studies were surveys, and European countries were the most investigated, especially the United Kingdom. Overall, the use of 10 different technologies was reported 46 times. The most represented category was alarms, followed by video cameras, other technologies (such as wearable sensors), and metal detectors. More than half of the included papers reported positive effects of these measures on safety. This review indicates that several security technologies are available in mental health settings, with encouraging positive safety outcomes for both patients and healthcare professionals, especially nurses. However, research on the topic is still emerging, with a limited number of sources and a few high-quality designed studies. Therefore, future research should focus on producing evidence on the availability and effectiveness of these measures in mental health settings across countries.

The role of sense of coherence in workplace violence directed at nurses in the shadow of COVID-19: A cross-sectional study

AIMS

To explore (a) the associations between sense of coherence (SOC), previous exposure to COVID-19, and the intention to act violently towards nurses, and (b) the role of SOC and sociodemographic variables as risk or protective factors involved in the intention to act violently.

DESIGN

A cross-sectional study with a convenience sample.

METHODS

A structured self-report questionnaire was distributed from February to March 2022. The questionnaire included socioeconomic variables, previous exposure to COVID-19, and a validated questionnaire on SOC. Three vignettes (online shaming, verbal and physical violence) describing nurse-patient communication conflicts were presented to participants. A multinomial logistic regression was conducted to explore the associations with acting violently by comparing three options of no/sometimes/high intention to act violently. The study adhered to STROBE guidelines.

RESULTS

Questionnaires were completed by 808 adults. SOC and religiosity were revealed as protective factors in the three vignettes. Verbal violent behaviour was found to be a risk factor for online and physical violent behaviour intention. Previous exposure to COVID-19, non-academic education, and ethnicity were found to be risk factors for the intention to behave violently toward nurses.

CONCLUSION

The findings suggest that training nurses in practical SOC dimensions (enhancing comprehensible, manageable and meaningful treatment processes) may reduce patients' lack of understanding and frustration and, in turn, reduce the tendency to behave violently.

IMPACT

This study focused on SOC as a variable that may affect the intention to act violently towards nurses. The results reveal that SOC may be a protective factor, where people with higher SOC will have less intention to behave violently towards nurses. The results can provide an insight for nurses, nurse leaders and policymakers, towards supplying coherent and cultural competency treatment processes for patients and assisting nurses in dealing with stressful situations during normal routines and pandemics.

PATIENT OR PUBLIC CONTRIBUTION

The questionnaire was distributed among the general public by master's degree nursing students. The students distributed the questionnaires among their friends and acquaintances using a snowball-sampling approach.

Systematic Violence Monitoring to Reduce Underreporting and to Better Inform Workplace Violence Prevention Among Health Care Workers: Before-and-After Prospective Study

BACKGROUND

Monitoring workplace violence (WPV) against health care workers (HCWs) through incident reporting is crucial to drive prevention, but the actual implementation is spotty and experiences underreporting.

OBJECTIVE

This study aims to introduce a systematic WPV surveillance in 2 public referral hospitals in Italy and assess underreporting, WPV annual rates, and attributes "before" (2016-2020) and "after" its implementation (November 2021 to 2022).

METHODS

During 2016-2020, incident reporting was based on procedures and data collection forms that were neither standardized between hospitals nor specific for aggressions. We planned and implemented a standardized WPV surveillance based on (1) an incident report form for immediate and systematic event notification, adopting international standards for violence definitions; (2) second-level root cause analysis with a dedicated psychologist, assessing violence determinants and impacts and offering psychological counseling; (3) a web-based platform for centralized data collection; and (4) periodic training for workforce coordinators and newly hired workers. We used data from incident reports to estimate underreporting, defined as an observed-to-expected (from literature and the "before" period) WPV ratio less than 1, and the 12-month WPV rates (per 100 HCWs) in the "before" and "after" periods. During the latter period, we separately estimated WPV rates for first and recurrent events.

RESULTS

In the "before" period, the yearly observed-to-expected ratios were consistently below 1 and as low as 0.27, suggesting substantial violence underreporting of up to 73%. WPV annual rates declined in 1 hospital (from 1.92 in 2016 to 0.57 in 2020) and rose in the other (from 0.52 to 1.0), with the divergence being attributable to trends in underreporting. Available data were poorly informative to identify at-risk HCW subgroups. In the "after" period, the observed-to-expected ratio rose to 1.14 compared to literature and 1.91 compared to the "before" period, consistently in both hospitals. The 12-month WPV rate was 2.08 (95% CI 1.79-2.42; 1.52 and 2.35 in the 2 hospitals); one-fifth (0.41/2.08, 19.7%) was due to recurrences. Among HCWs, the youngest group (3.79; P<.001), nurses (3.19; P<.001), and male HCWs (2.62; P=.008) reported the highest rates. Emergency departments and psychiatric wards were the 2 areas at increased risk. Physical assaults were more likely in male than female HWCs (45/67, 67.2% vs 62/130, 47.7%; P=.01), but the latter experienced more mental health consequences (46/130, 35.4% vs 13/67, 19.4%; P=.02). Overall, 40.8% (53/130) of female HWCs recognized sociocultural (eg, linguistic or cultural) barriers as contributing factors for the aggression, and 30.8% (40/130) of WPV against female HCWs involved visitors as perpetrators.

CONCLUSIONS

A systematic WPV surveillance reduced underreporting. The identification of high-risk workers and characterization of violence patterns and attributes can better inform priorities and contents of preventive policies. Our evaluation provides useful information for the large-scale implementation of standardized WPV-monitoring programs.

Patients' opinion on violence against healthcare workers and their level of satisfaction in emergency department in Turkey: A cross-sectional study

BACKGROUND

Violence, with an increasing rate of cases in the health care system which adversely affects the quality of provision of services, has become a social health issue that also has negative impacts both on healthcare workers and patients. This study was conducted to determine the opinion of patients, who had been admitted to the emergency department, towards violence against healthcare workers, and their level of satisfaction with health services.

METHODS

The study employed a cross-sectional design and was conducted with 348 patients who had received healthcare services in the adult emergency department in Turkey. The Emergency Department Patient Satisfaction Survey and An eight-item questionnaire prepared by the researchers consisting of the patient's characteristics and their statements on violence were used to collect the data.

RESULTS

Among the patients, 26.7% stated that they had been violent toward healthcare workers. It was determined that 91.4% of the cases were verbal and 8.6% were physical. Among the patients, 82.2% had not known about the legal sanctions for violence against healthcare workers. The low level of propensity for violence in patients who were satisfied with the emergency department service was statistically significant (p < 0.05).

CONCLUSIONS

As a result of the study, it was found that one in four patients had been violent to healthcare workers, and the vast majority had a lack of information about legal sanctions. Policymakers should take deterrent measures to prevent the occurrence of violence and develop more critical sanctions.

New registered nurse and registered psychiatric nurse graduates' transition-to-practice amid the pandemic: An art-based grounded theory study

BACKGROUND

According to the Transition Shock theory, new Registered Nurses face formidable obstacles within their first year of practice. However, little is known about the experience of new Registered Psychiatric Nurses entering the workforce.

OBJECTIVES

The aim was to explore how new graduates from nursing and psychiatric nursing experience their transition into the workplace that included identifying mediating factors that assist or challenge these entry-level professionals within their transition.

DESIGN

Constructivist grounded theory methodology developed by Charmaz was utilized to explore the first-year transition period using art-based methods.

PARTICIPANTS AND SETTING

A total of 13 new graduates practicing as Registered Nurses and Registered Psychiatric Nurse in a western Canadian province were recruited to participate in the study. Three art-based workshops occurred at four, eight, and 12-months starting in the fall of 2020 through the Spring of 2021 during the novel coronavirus pandemic with subsequent member checks in the Spring of 2022.

METHODS

A total of 38 interview and focus group data were collected. Art-based activities included sand tray and figurine object exercises, collaging, reflective and thematic writing, as well as group concept mapping. Through co-creation of knowledge using Charmaz's methodology, participants selected the major themes throughout their first year of transition with guided researcher facilitation. Data were analyzed using the constant comparative method of analysis for each workshop drawing on the art creations, discussion, and narrative reflective writing pieces generated by participants.

RESULTS

Participants were in a basic psychosocial process of growing personal and professional self. Through co-construction of knowledge with the participants, three substantive interconnected categories were identified: (1) Being thrown into the fire; (2) Adjusting and adapting to the team environment; and (3) Nurturing self and others.

CONCLUSIONS

The findings revealed many recommendations for employers hiring new graduates and nursing education programs preparing graduates for the practice arena.

Spillover effects of violent attacks and COVID-19 exposure on mental health of health professionals: A two-phase quasi-natural experiments study in Northwest China

The aims of this study were to examine the spillover effects of violent attacks, coronavirus disease-2019 (COVID-19) exposure, and their interactions on health professionals' mental health, and the role of organizational support in their relationships in China. A two-phase survey data (n = 10,901) before and after the first outbreak of COVID-19 was integrated with regional macro data on the number of lawsuit cases of violent attacks and COVID-19 cases. Three studies were designed to isolate the general spillover impact of violent attacks on the mental health of health professionals, how COVID-19 affects the mental health of health professionals, and whether organizational support moderates the relationship between violent attacks and mental health through econometric regressions. Violent attacks and COVID-19 are negatively associated with the mental health of health professionals, and the outbreak of COVID-19 adversely deteriorates the spillover effects of violent attacks. Physicians, not nurses, are the most affected group. Better perceived support from hospitals can significantly mitigate the adverse effects of COVID-19, violent attacks, and their interactions on the mental health of health professionals. COVID-19 deteriorates the adverse effects of violent attacks on the mental health of health professionals, while better organizational support is helpful to mitigate these effects.

Health professionals who have worked in COVID-19 immunization centers suffer the effects of violence

Background

The phenomenon violence against health professionals has received increasing attention in recent years because of its frequency and significant impact on victims' mental health and disruption of health services. Despite this attention, little is known about the incidence of workplace violence in the highly politicized immunization services. Therefore, we decided to examine the prevalence of workplace violence in the COVID-19 immunization campaign, the risk and protective factors, and the impact on victims' mental health.

Methods

Between March and April 2022, we conducted an anonymous online survey among health professionals working in COVID-19 vaccination centers in the Friuli-Venezia Giulia Region (Italy). We used the Questionnaire for Workplace Violence in Healthcare Settings and the Impact of Event Scale-Revised.

Results

Of the 200 participants, 93 (46.5%) reported being victims of an act of violence during the vaccination campaign, 60 of them verbally and 7 physically. In 35.5% of cases, the IES score indicated a possible post-traumatic stress reaction in the victim. Opinions on measures to prevent violence and support workers in the workplace differed according to the sex of the health professional, with women emphasizing the need for self-defense training and improvement of security arrangements (p < 0.001).

Conclusion

One-third of health professionals involved in the COVID-19 immunization campaign reported that their mental health was affected by workplace violence. Public health professionals dealing with politicized and debated issues such as immunization should receive more attention, as should the implementation of a more structured and multidisciplinary approach to the problem within healthcare organizations.

Workplace violence against healthcare workers: an umbrella review of systematic reviews and meta-analyses

OBJECTIVES

The aim of this umbrella review of systematic reviews and meta-analyses was to address workplace violence (WPV) against healthcare workers (HCWs). Several systematic reviews exist in the literature, but the diversity of settings, population considered, and type of violence investigated make it difficult to gain insight and use the vast amount of available data to implement policies to tackle WPV. With this in mind, we conducted an umbrella review of systematic reviews and meta-analyses on WPV against HCWs to examine the global prevalence of the phenomena and its features.

STUDY DESIGN AND METHODS

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, PubMed, Scopus, and ISI Web of Science were searched for relevant systematic reviews and meta-analyses published in English up to November 2022. Data on authors, year, country, violence type, prevalence (pooled and not), setting, population, and specific considerations were extracted.

RESULTS

A total of 32 systematic reviews were included, 19 of which performed a meta-analysis, investigating overall, physical, and non-physical violence. Even considering the variability of the data, the COVID-19 pandemic has exacerbated the scale of the problem. From our review, we found that overall violence prevalence among HCWs was reported to be as high as 78.9%, and nurses working in psychiatric wards were the professionals most impacted.

CONCLUSION

In conclusion, this umbrella review revealed a high prevalence of WPV among HCWs, which varies between countries, population subgroups, and detection methods. Strengthening recognition of the problem could lead to appropriate local and international strategies to address it.

Anger and Aggression in Relation to Psychological Resilience and Alcohol Abuse among Health Professionals during the First Pandemic Wave

Mental health problems, behavior changes, and addictive issues have been consistently documented among healthcare workers during the pandemic. The objective of this study was to investigate the levels of anger and aggression in relation to psychological resilience and alcohol abuse among healthcare workers during the first wave of the COVID-19 pandemic. A total of 120 physicians and 123 nurses completed an online survey of the Dimensions of Anger Reactions-5 (DAR-5), the Brief Aggression Questionnaire (BAQ), the Brief Resilience Scale (BRS), and the Alcohol Screening questionnaire CAGE which is an acronym for the focus of the questions (Cutting down, Annoyance by criticism, Guilty feeling, and Eye-openers). Demographic and professional data were also recorded. A total of 53 men and 190 women participated in the study. Almost one-third of the participants had a positive score on the DAR-5 scale and one out of ten respondents presented with current problematic alcohol use. Male participants demonstrated lower scores on the DAR-5 scale compared to females. Individuals with current problematic alcohol use displayed higher scores on the BAQ compared to those without alcohol use disorders. Regression analysis revealed that 16.4% of the variance in the BAQ scores can be attributed to scores on the DAR-5, 5.9% to the BRS scores, 2.1% to the CAGE scores, 1.7% to gender, and 1.2% to years of work experience. Mediation analysis highlighted the role of psychological resilience as a negative mediator in the DAR-5 and BAQ relationship. Professional experience and alcohol abuse emerged as positive and negative risk factors contributing to aggression and psychological resilience. The findings hold practical implications for implementing interventions to strengthen resilience in order to compensate for aggressive tendencies and discourage addictive issues.

Effects of infection prevention and control measures on patient and visitor violence against health workers in China during COVID-19 pandemic

Objective

To examine trends in patient and visitor violence (PVV) among large public hospitals from 2016 to 2020 in China, and investigate the effects of infection prevention and control (IPC) measures on PVV during the COVID-19 pandemic.

Methods

The hospital-level data of PVV used in this study from 2016 to 2020 in three cities in northern China were extracted from the database of the Medical Quality and Safety Notification System from 41 public hospitals. The difference-in-difference (DID) method was used to estimate the effects of IPC measures on PVV. The empirical strategy was to compare changes in the incidence rate of PVV in public hospitals where IPC measures were stricter to relatively weaker hospitals.

Results

From 2019 to 2020, the incidence rate of PVV decreases from 4.59 to 2.15% for high-IPC measure level hospitals and increases from 4.42 to 4.56% for medium-IPC measure level hospitals. The results from the DID models showed that as the IPC measure level increased, the incidence rate of PVV (β = -3.12, 95% CI = -5.74 ~ -0.50) decreased more significantly based on controlling for hospital fixed effects and time trends.

Conclusion

The multi-dimensional and comprehensive IPC measures throughout the pandemic in China have not only controlled the pandemic, but also directly or indirectly reduced the incidence rate of PVV by alleviating the stress of health workers and the crowded working environment, creating a good order of admission, and reducing patient waiting time.