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Gigli KH, Gonzalez JD. Experiences of Workplace Violence in Graduate Nursing Clinical Education. Nurse Educ 2024:00006223-990000000-00423. [PMID: 38502561 DOI: 10.1097/nne.0000000000001630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
BACKGROUND Exposure to workplace violence (WPV) is common in health care, and little is known about nurse practitioner (NP) students' experiences during graduate nursing clinical education. PURPOSE This study described experiences of WPV among NP students during their clinical education. METHODS We conducted a cross-sectional, quantitative survey of a random sample of NPs licensed in Texas examining graduate nursing education experiences. RESULTS A total of 334 NPs responded, a 12% response rate. More than a quarter (27%) experienced WPV during their graduate nursing clinical experience. Preceptors were the most reported perpetrators (44%). Most NPs remained in their clinical site after their WPV experience (55%); a majority felt they had no alternative clinical placement option. CONCLUSIONS Nurse practitioner students experience WPV, and there may be implications for educational persistence and their careers. Future work should attempt to reduce the frequency of student WPV experiences and examine implications for NP careers.
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Affiliation(s)
- Kristin H Gigli
- Assistant Professor (Dr Gigil), Graduate Nursing, College of Nursing and Health Innovation, The University of Texas at Arlington, Arlington, Texas; and Associate Professor (Dr Gonzalez), School of Nursing, The University of Texas Medical Branch, Galveston, Texas
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Ose SO, Lohmann-Lafrenz S, Kaspersen SL, Berthelsen H, Marchand GH. Registered nurses' exposure to workplace aggression in Norway: 12-month prevalence rates, perpetrators, and current turnover intention. BMC Health Serv Res 2023; 23:1272. [PMID: 37974173 PMCID: PMC10655393 DOI: 10.1186/s12913-023-10306-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 11/09/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Identifying occupational health hazards among Registered Nurses (RNs) and other health personnel and implementing effective preventive measures are crucial to the long-term sustainability of health services. The objectives of this study were (1) to assess the 12-month prevalence rates of exposure to workplace aggression, including physical violence, threats of violence, sexual harassment, and bullying; (2) to identify whether the perpetrators were colleagues, managers, subordinates, or patients and their relatives; (3) to determine whether previous exposure to these hazards was associated with RNs' current turnover intention; and (4) to frame workplace aggression from an occupational health and safety perspective. METHODS The third version of the Copenhagen Psychosocial Questionnaire (COPSOQ III) was used to assess RNs' exposure to workplace aggression and turnover intention. A national sample of 8,800 RNs in Norway, representative of the entire population of registered nurses in terms of gender and geography, was analysed. Binary and ordinal logistic regression analyses were conducted, and odds for exposure and intention to leave are presented, with and without controls for RNs' gender, age, and the type of health service they work in. RESULTS The 12-month prevalence rates for exposure were 17.0% for physical violence, 32.5% for threats of violence, 12.6% for sexual harassment, and 10.5% for bullying. In total, 42.6% of the RNs had experienced at least one of these types of exposure during the past 12 months, and exposure to more than one of these hazards was common. Most perpetrators who committed physical acts and sexual harassment were patients, while bullying was usually committed by colleagues. There was a strong statistical association between exposure to all types of workplace aggression and RNs' intention to leave. The strongest association was for bullying, which greatly increased the odds of looking for work elsewhere. CONCLUSIONS Efforts to prevent exposure to workplace aggression should be emphasised to retain health personnel and to secure the supply of skilled healthcare workers. The results indicate a need for improvements. To ensure the sustainability of health services, labour and health authorities should join forces to develop effective workplace measures to strengthen prevention, mitigation, and preparedness regarding incidents of workplace aggression in health services and the response and recovery regarding incidents that could not be prevented.
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Affiliation(s)
| | | | | | - Hanne Berthelsen
- Centre for WorkLife and Evaluation Studies, Malmö University, Malmö, Sweden
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Veronesi G, Ferrario MM, Giusti EM, Borchini R, Cimmino L, Ghelli M, Banfi A, Luoni A, Persechino B, Di Tecco C, Ronchetti M, Gianfagna F, De Matteis S, Castelnuovo G, Iacoviello L. Systematic Violence Monitoring to Reduce Underreporting and to Better Inform Workplace Violence Prevention Among Health Care Workers: Before-and-After Prospective Study. JMIR Public Health Surveill 2023; 9:e47377. [PMID: 37955961 PMCID: PMC10682923 DOI: 10.2196/47377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 07/14/2023] [Accepted: 09/26/2023] [Indexed: 11/14/2023] Open
Abstract
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.
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Affiliation(s)
- Giovanni Veronesi
- Research Center in Epidemiology and Preventive Medicine, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Marco Mario Ferrario
- Research Center in Epidemiology and Preventive Medicine, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Emanuele Maria Giusti
- Research Center in Epidemiology and Preventive Medicine, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Rossana Borchini
- Occupational and Preventive Medicine, Azienda Socio-Sanitaria Territoriale Lariana, Como, Italy
| | - Lisa Cimmino
- Research Center in Epidemiology and Preventive Medicine, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Monica Ghelli
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers Compensations Authority (INAIL), Roma, Italy
| | - Alberto Banfi
- Struttura Complessa Qualità, Risk Management e Accreditamento, Azienda Socio-Sanitaria Territoriale dei Sette Laghi, Varese, Italy
| | - Alessandro Luoni
- School of Specialization in Occupational Medicine, University of Insubria, Varese, Italy
| | - Benedetta Persechino
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers Compensations Authority (INAIL), Roma, Italy
| | - Cristina Di Tecco
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers Compensations Authority (INAIL), Roma, Italy
| | - Matteo Ronchetti
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers Compensations Authority (INAIL), Roma, Italy
| | - Francesco Gianfagna
- Research Center in Epidemiology and Preventive Medicine, Department of Medicine and Surgery, University of Insubria, Varese, Italy
- Mediterranea Cardiocentro, Napoli, Italy
| | - Sara De Matteis
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Gianluca Castelnuovo
- Psychology Research Laboratory, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico, Milano, Italy
- Department of Psychology, Catholic University of the Sacred Heart, Milano, Italy
| | - Licia Iacoviello
- Research Center in Epidemiology and Preventive Medicine, Department of Medicine and Surgery, University of Insubria, Varese, Italy
- Department of Epidemiology and Prevention, Istituto di Ricovero e Cura a Carattere Scientifico Neuromed, Pozzilli, Italy
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Quinn JM, Koopman JM. Violence Risk Assessment in the Emergency Department. J Emerg Nurs 2023; 49:352-359.e1. [PMID: 37150561 DOI: 10.1016/j.jen.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 02/12/2023] [Accepted: 02/15/2023] [Indexed: 05/09/2023]
Abstract
INTRODUCTION Workplace violence is a prevalent problem in health care, with mental health and emergency departments being the most at-risk settings. The aim of this evidence-based practice project was to pilot use of a violence risk assessment tool, the Broset Violence Checklist, to assess for risk of type II violence and record the interventions that nurses chose to implement to mitigate the situation. Additionally, reports made to the hospital reporting system were tracked and compared to previous reporting frequency. METHODS Following staff education, nurses were instructed to complete checklists for all patients who have a score of 1 or higher, which indicates the presence of at least 1 high-risk behavior, and continue hourly scoring until the score returned to 0 or the patient was dispositioned. The number of incidents recorded, time of day, scores, interventions applied to mitigate violence, and change in scores after interventions were evaluated. The number of Broset Violence Checklist scoring sheets submitted and reports made via the hospital reporting system were compared. RESULTS Incidents were most frequent from 11 am until 3 am. The highest scores occurred in the late evening and early morning hours. There were significantly more incidents captured with the use of the Broset Violence Checklist as compared to the hospital reporting system. Incidents significantly associated with higher scores included providing comfort measures, addressing concerns, and applying restraints. DISCUSSION The Broset Violence Checklist was used successfully in the emergency department setting to identify behaviors associated with violence. Under-reporting to the hospital report system was identified in this project, consistent with reports in the literature. Specific interventions were not associated with a decrease in Broset Violence Checklist scores.
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