Workplace Violence and Bullying Faced by Health Care Personnel at the Emergency Department of a Tertiary Care Hospital of Karachi,Pakistan: A Cross-Sectional Study

IntroductionThe emergency department is the most affected by physical and verbal abuse and bullying in health care. Violence against health care workers not only affects their safety, but also their performance and motivation. This study aimed to determine the prevalence and associated determinants of violence against health care personnel.MethodsA cross-sectional study design was used with 182 health care personnel at the emergency department tertiary care hospital of Karachi, Pakistan. Data were collected through a questionnaire comprised of 2 sections: (1) demographic questions and (2) statements to identify the prevalence of workplace violence and bullying among health care personnel. Nonprobability purposive sampling was used for recruitment. Binary logistic regression was used to identify the prevalence and determinants of violence and bullying.ResultsMost participants were younger than 40 years of age (n = 106, 58.2%). Participants were mainly nurses (n = 105, 57.7%) and physicians (n = 31, 17.0%). Participants reported experiencing sexual abuse (n = 5, 2.7%), physical violence (n = 30, 16.50%), verbal abuse (n = 107, 58.8%), and bullying (n = 49, 26.9%). The odds of experiencing physical violence were 3.7 times greater (confidence interval = 1.6-9.2) when there was not a procedure for reporting workplace violence compared to when there was a procedure.DiscussionAttention is required to identify the prevalence of workplace violence. Creating effective policies and procedures for a reporting system would potentially lead to lowering violence rates and positively impacting health care workers’ well-being.     

Violence Against Nurses in the Triage Area: A Mixed-Methods Study

IntroductionWorkplace violence is a serious occupational problem among nurses in emergency departments. The aim of this study was to better understand workplace violence experienced by triage nurses.MethodsA mixed-methods study was carried out with 27 Italian nurses involved in the triage area of an emergency department. Quantitative data were collected using the Violent Incident Form and qualitative data were obtained from 3 focus groups.ResultsNinety-six percent of triage nurses had suffered an episode of violence during the previous year. Participants reported that perpetrators of violence were primarily patients' relatives or friends (62%), usually male and in a lucid state of consciousness. The aggressor was a male patient in 31% of violent episodes. Male nurses reported only verbal abuse, unlike female nurses who suffered both physical and verbal episodes. Females received assistance from other staff during the aggression event more frequently than males, and females more frequently suffered from physical injury. Only physical and verbal aggressions were associated with physical injury. Four main themes emerged from the focus groups.DiscussionNurses reported that high exposure to workplace violence in triaging had significant consequences on their psychological well-being and on their behavior at work and at home. Violence, perceived as a personal and/or professional injury owing to insufficient organizational support, led professionals to experience feelings of resignation and to believe that abuse was an inevitable part of the job. Nevertheless, in our study, the precipitating factors were investigated, suggesting several possible solutions to limit this phenomenon.     

Pediatric emergency nurses’ workplace violence experiences: A qualitative study

IntroductionWorkplace violence is a crucial problem experienced by health workers who serve at the emergency service. The identification of emergency nurses’ workplace experiences is of importance to the prevention of violence and the development of solutions.PurposeThis study was performed to identify the workplace violence experiences of the nurses working for the pediatric emergency units.MethodA total of 20 nurses who experienced violence at the emergency service participated in the study that was conducted as qualitative research. The data were collected with the semi-structured interview form and were evaluated by using thematic analysis.ResultsFive themes, namely, “the characteristics of violence”, “the causes of violence”, “the approach during/after the violence”, “the consequences of the violence for the person”, and the “consequences of the violence for the profession”, were identified. Nurses stated that they often experienced verbal violence due to patient relatives’ unmet expectations, the failure of patient relatives to understand treatments and practices, and the heavy workload, they endeavored to eliminate violence by trying to communicate with perpetrators of the violence, calling the security staff, and reporting the violence to their managers, and they were individually and professionally affected by the violence.ConclusionNurses are negatively affected by workplace violence. Pediatric emergency nurses should be supported with training programs and policies to be developed for the prevention and solution of violence.     

Emergency nurses' perspective of workplace violence in Jordanian hospitals: A national survey

BackgroundEmergency departments are considered high-risk areas, where violence against nurses is a serious and prevalent problem. Such violence has negative effects on nurses, and therefore on the quality of care provided.Aims of the studyTo explore the risk factors behind violence, and to specify reasons for the level of low reporting of violence among Jordanian nurses in emergency departments.MethodA cross-sectional design through conducting a survey in emergency departments in Jordanian hospitals.ResultsThe total number of emergency department nurses who participated in the study was 227. Of these, 172 (75%) had experienced some form of violence. Verbal violence was the most reported (63.9%), compared to physical violence (48%). The most reported reasons for violence from the nurses' perspective were waiting time, overcrowding, and patient and family expectations not being met, with frequencies of 54.3%, 53.3%, and 46% respectively. The treatment room was the most common place where the violence occurred. Only 16.6% of the nurses who experienced violence actually reported it. Being accustomed to workplace violence is the most stated reason for not reporting violence to the hospital administration or the authorities.ConclusionViolence against emergency department nurses is a significant issue that cannot be ignored. There are multiple reasons. The key point in dealing with the problem is to treat its specific causes.     

Workplace violence against nurses – Prevalence and association with hospital organizational characteristics and health-promotion efforts: Cross-sectional study

Purpose/objectivesTo determine the prevalence of workplace violence and explore the role of hospital organizational characteristics and health promotion efforts in reducing hospital violence among nurses in Taiwan.DesignCross-sectional survey.SettingOne hundred hospitals across Taiwan.SampleThe final sample in our study comprised responses from 26,979 nurses.MethodsThe data were obtained from a nationwide hospital survey, Physical and Mental Health and Safety Needs in Full-Time Health Care Staff, which was developed and conducted by the Bureau of Health Promotion, Taiwan, in 2011.Main research variablesThe main dependent variable was whether nurses had experienced violence within the past year. Physical violence, threatened or intimidated personal safety, verbal violence or sexual harassment were all included.FindingsOf the 26,979 nurses, 13,392 nurses (49.6%) had experienced at least one episode of any type of violence in the past year; 5150 nurses (19.1%) had been exposed to physical violence, and 12,491 nurses (46.3%) had been exposed to non-physical violence. The prevalence of having experienced any violence varied widely and ranged from the highest (55.5%) in an emergency room or intensive care unit to the lowest (28.3%) among those aged 55–65 years. After adjusting for other characteristics, younger nurses were significantly more likely to be exposed to any violent threat. Nurses working in public hospitals had a significantly higher risk of workplace violence than those working in private hospitals. Significant variations were also observed among work units. Although nurses working in a certified health promoting hospital (HPH) did not have a lower risk of workplace violence, those working in an outstanding HPH had a significantly lower risk of workplace violence. A similar pattern was observed for non-physical violence.ConclusionsWorkplace violence is a major challenge to workplace safety for nurses in hospitals. This large scale nurse survey identified individual, work and hospital characteristics associated with workplace violence among hospital nurses. Preventive efforts in reducing hospital violence shall be targeted these high risk groups and settings.Implications for nursingThis nationwide nurse survey assisted us in more clearly understanding the scope of the hospital violence facing nurses and identifying critical risk factors. The findings not only identified the most common locations of violence in hospitals but also suggested that extensive investments and efforts by hospitals in health promotion are crucial.     

Report and Prevent: A Quality Improvement Project to Protect Nurses From Violence in the Emergency Department

IntroductionMost nurses experience some form of workplace violence resulting in a stressful work environment, employee injury, and turnover. The aims of this project were to develop and evaluate strategies to improve the reporting of workplace violence as well as to empower emergency nurses to prevent assaults and protect themselves.MethodsThis quality improvement project had 2 phases. The phase I educational intervention focused on the importance of reporting workplace violence. Pre- and postintervention surveys measured experiences with workplace violence and reporting. The phase II educational intervention focused on de-escalation and self-protection strategies, training, safety, confidence, and emergency nurses’ preparedness to defend themselves. Responses were analyzed using Wilcoxon signed-rank and McNemar tests.ResultsTwenty-five emergency nurses participated in phase I, with >90% reporting that they had been assaulted in the past month. Most did not report a workplace assault, which was unchanged after the intervention. Thirty-four emergency nurses participated in phase II, with a postintervention increase reported in the perceived helpfulness of learning self-protection techniques for the emergency nurses’ work life (Z = –2.179, P = 0.029).DiscussionThis study was consistent with the literature in that emergency nurses often do not report workplace assaults. Most of the emergency nurses surveyed had been assaulted. Although the educational interventions did not achieve the desired outcome, it is clear that additional interventions for individual nurses and institutions need to be developed and refined to increase reporting and prevent workplace assaults.     

A Systematic Review of Violence Risk Assessment Tools Currently Used in Emergency Care Settings

IntroductionViolence risk assessment is commonplace in mental health settings and is gradually being used in emergency care. The aim of this review was to explore the efficacy of undertaking violence risk assessment in reducing patient violence and to identify which tool(s), if any, are best placed to do so.MethodsCINAHL, Embase, Medline, and Web of Science database searches were supplemented with a search of Google Scholar. Risk of bias assessments were made for intervention studies, and the quality of tool development/testing studies was assessed against scale development criteria. Narrative synthesis was undertaken.ResultsEight studies were included. Three existing violence risk assessment tools featured across the studies, all of which were developed for use with mental health patients. Three newly developed tools were developed for emergency care, and 1 additional tool was an adaptation of an extant tool. Where tested, the tools demonstrated that they were able to predict patient violence, but did not reduce restraint use. The quality issues of the studies are a significant limitation and highlight the need for additional research in this area.DiscussionThere is a paucity of high-quality evidence evaluating the psychometric properties of violence risk assessment tools currently used along the emergency care pathway. Multiple tools exist, and they could have a role in reducing violence in emergency care. However, the limited testing of their psychometric properties, acceptability, feasibility, and usability in emergency care means that it is not possible to favor one tool over another until further research is conducted.     

Staff Duress Alarms for Workplace Violence in the Emergency Department: A Mixed-Methods Evaluation

IntroductionComplex personal duress alarms may be implemented as part of a multicomponent approach to preventing and mitigating workplace violence in emergency departments. Evaluation of duress alarms after implementation has been identified as a gap in the literature. The purpose of this quality improvement project was to examine the impact of a duress alarm system on workplace violence and user experience in an urban emergency department.MethodsA comprehensive system evaluation was performed using a mixed-methods approach, which included retrospective data review, key informant interviews, observations, and a survey. Forty clinical staff at an emergency department in North Carolina were interviewed and provided feedback on the duress system.ResultsFindings indicated that the duress system was not associated with a decrease in workplace violence, and that the majority of clinical staff did not even wear the duress alarm. Staff indicated that the primary barriers to use of the alarm were the bulky design of the alarm badge, inadequate education about the alarm device and process, and the lack of a reliable and timely response from security.DiscussionOngoing engagement of clinical staff is critical to the success of health care technology implementations. Staff feedback, periodic re-education, and recurring process evaluations are vital to ensuring the continued relevance of systems, especially when staff safety is the intended purpose.     

The relationship between workplace violence,job satisfaction and turnover intention in emergency nurses

BackgroundEmergency department personnel are exposed to high risk of workplace violence (WPV) and nurses are the main victims. Few researchers have investigated the effects of WPV on job satisfaction and turnover intention among nurses.AimsTo describe WPV, job satisfaction and turnover intention of emergency nurses and clarify the relationship between them.MethodsA cross-sectional study was used to collect data on WPV, job satisfaction and turnover intention among 385 nurses working in emergency department in 13 general hospitals in Beijing. Structural equation modeling was used to test the relationship between them.ResultsAmong them, 89.9% had experienced WPV in the previous year. WPV had short-term and long-term impacts on over 80% of them. The score of job satisfaction and turnover intention was 2.48 ± 0.49, 2.75 ± 0.58 respectively. WPV had significant direct effect on turnover intention (β = 0.105) and job satisfaction (β = −0.161). Job satisfaction had a significant negative effect on turnover intention (β = −0.604) and it mediated the relationship between WPV and turnover intention.ConclusionEmergency nurses in China are at great risk of WPV. Their job satisfaction is low and turnover intention is high. Job satisfaction plays the mediator role between WPV and turnover intention among emergency nurses.     

急诊护士遭受工作场所暴力后对工作倦怠的影响

目的探讨急诊护士工作倦怠与遭受工作场所暴力之间的关系,为采取干预措施提供依据。方法采用护士职业倦怠调查表及遭受工作场所暴力情况问卷,对北京市4家三级甲等医院的166名护士进行调查。结果急诊护士遭受暴力组在情绪衰竭、去人格化、个人成就感丧失的维度得分高于未遭受暴力组,2组个人成就感丧失比较差异有统计学意义（P〈0．05）,而情绪衰竭、去人格化比较差异无统计学意义（P〉0．05）。躯体冲突严重影响了护士的心理健康（P〈0．01）。结论工作场所暴力事件可以导致急诊护士工作倦怠的产生,对护士造成严重的心理伤害,应采取有效预防措施控制工作场所暴力的发生,减少护士对工作及患者的倦怠不满,确保护士的心理健康。