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.     

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.     

Incidence and risk factors of workplace violence against nurses in a Chinese top-level teaching hospital: A cross-sectional study

PurposeTo investigate the incidence of workplace violence involving nurses and to identify related risk factors in a high-quality Chinese teaching hospital.MethodsA cross-sectional study design was used. The final sample comprised responses from 1831 registered nurses collected with a whole-hospital survey from June 1 to June 15, 2016. The demographic characteristics of the nurses who had experienced any form of violence were collected, and logistic regression analysis was applied to evaluate the risk factors for nurses related to workplace violence.ResultsOut of the total number of nurses surveyed, 904 (49.4%) nurses reported having experienced any type of violence in the past year. The frequencies of exposure to physical and non-physical violence were 6.3% (116) and 49.0% (897), respectively. All the incidence rates of violence were lower than those of other studies based on regional hospitals in China and were at the same level found in developed countries and districts. Binary logistic regression analysis revealed that nurses at levels 2 to 4 and female nurses in clinical departments were the most vulnerable to non-physical violence. For physical violence, the two independent risk factors were working in an emergency department and having 6–10 years of work experience.ConclusionsWorkplace violence directly threatens nurses from high-quality Chinese teaching hospitals. However, the incidence of WPV against nurses in this teaching hospital was better than that in regional hospitals. This study also provides reference material to identify areas where nurses encounter relatively high levels of workplace violence in high-quality Chinese teaching hospitals.     

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.     

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.     

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.     

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.     

北京市三级甲等医院急诊科护士职业暴露与防护行为的现状调查

目的 了解北京市三级甲等医院急诊科护士锐器伤、血液暴露及工作场所暴力3种职业暴露的发生状况及防护行为现状。方法 便利抽取21所北京市三级甲等医院,依据每所医院急诊科排班整群抽取1组护士作为调查对象,采用自制问卷进行调查,问卷内容包括一般资料及锐器伤、采血过程中血液暴露、工作场所暴力的发生现状及防护行为,调查对象匿名填写问卷。结果 共收集问卷1 150份,有效问卷1 102份,有效回收率为95.83%。在过去1年中,急诊科护士至少经历过1次锐器伤、采血中的血液暴露、语言暴力、身体暴力及性骚扰的发生率分别为37.8%、36.4%、68%、12%和5.3%;急诊科不同的工作区域,锐器伤（χ ²=16.805,P=0.010）、语言暴力（χ ²=98.509,P<0.001）、身体暴力（χ ²=79.916,P<0.001）发生率不同。在发生职业暴露的护士中,92.8%的护士在发生锐器伤后能够挤血,同时用流动水冲洗并消毒;69.8%的护士在采血过程发生血液暴露后能够冲洗暴露部位并消毒;在工作场所暴力发生时,41.3%的护士耐心解释,30.0%的护士忍让回避。3种职业暴露的上报率均较低（<30%）。结论 急诊科职业暴露发生率相对较高,管理者需要重视急诊科的工作环境建设,加强采血过程和工作场所暴力的职业防护培训,同时增强对3种职业暴露的上报管理。     

Violence in New South Wales emergency departments.

In 1999 the International Council of Nurses recognised workplace violence as a significant issue in nursing. During the same year the Australian Institute of Criminology reported that health was the most violent industry. This study examined the nature and extent of violence in NSW hospital emergency departments. Emergency nurses experienced violent incidents in their department, in the wards and outside the hospital setting. Every respondent (n=266) experienced some form of violence at least weekly. Ninety-two incidents involved lethal weapons. Ninety-two percent of perpetrators were patients or their relatives, however other staff members were also implicated. Non-reporting of violence is an issue as over 70% of incidents were not referred to authorities. Drugs, alcohol and emergency department waiting times are the most significant predisposing factors. Most emergency nurses are not satisfied with the response of administration to violent incidents within hospitals.     

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.     

医院工作场所暴力对急诊科护士心理健康的影响

目的探讨医院工作场所暴力对急诊科护士心理健康的影响。方法根据世界卫生组织（WHO）发布的工作场所暴力定义设计调查表及应用症状自评量表（SCL-90）,对广州市6所三级甲等综合医院96名急诊科护士在半年内遭受过工作场所暴力后进行问卷调查。结果急诊科护士遭受工作场所暴力事件42．16％发生在深夜凌晨,心理暴力发生率为72．55％,患者和患者家属是主要肇事者,暴力事件的危险因素依次为患者或家属的要求未得到满足、对服务不满意、肇事者酗酒。遭受工作场所暴力后,急诊科护士在躯体化、强迫症状、抑郁、焦虑、敌对、恐怖、精神病性等方面的因子得分均高于国内常模,差异有统计学意义（t分别为4．676,3．745,2．892,8．236,2．796,8．012,5．177,23．801;P〈0．05或P〈0．01）。结论工作场所暴力对急诊科护士的心理健康有严重影响,应采取有效措施预防和控制工作场所暴力的发生。     

Workplace violence against nurses,job satisfaction,burnout, and patient safety in Chinese hospitals

BackgroundMost nurses have experienced some form of workplace violence, which could lead to physical or psychological harm and reduced job performance. Previous studies have examined the effects of workplace violence on nurses' job satisfaction and patient safety, but there have been very few examinations of whether workplace violence affects patient safety through nurse job satisfaction and burnout.PurposeTo investigate the relationships among workplace violence, nurse outcomes and patient safety. To explore whether nurse burnout and job satisfaction play mediating roles in the association of workplace violence and patient safety.MethodsA cross-sectional survey was conducted in 23 hospitals in Guangdong province in China to collect data from 1502 nurses. A structural equation model design was tested with validated measurement instruments.FindingsNurse-reported workplace violence was found to be associated directly with higher incidences of burnout, less job satisfaction, lower patient safety and more adverse events. Nurse burnout was associated directly with lower patient safety and more adverse events. Higher nurse job satisfaction was associated directly with higher patient safety. Nurse burnout and job satisfaction played mediating roles in workplace violence and patient safety. The model explained 19.8% and 35.0% of nurse-reported patient safety and adverse events, respectively.DiscussionIt is important for administrators to consider how to protect nurses from workplace violence, to improve their wellbeing at work, and to deliver safe patient care. When nurses experience workplace violence, it is necessary to pay attention to their emotional reactions and job attitudes, and to provide them with support in order to avoid adverse impacts on patient safety. Further practices and research initiatives to support nurses' safety at work are recommended.     

Prevalence of verbal and physical workplace violence against nurses in psychiatric hospitals in China

ObjectiveWorkplace violence (WPV) is common in mental health services in China, but its multi-center prevalence measured using standardized rating scales has rarely been reported. This study aimed to explore the prevalence of verbal and physical violence against nurses working in psychiatric hospitals and examine its independent socio-demographic correlates in China.MethodsThis was a cross-sectional study conducted in 11 major psychiatric hospitals in China using a 9-item self-reported workplace violence scale.ResultsA total of 1906 psychiatric nurses were recruited to participate in this study. The one-year prevalence of verbal and/or physical workplace violence (WPV) was 84.2% (95% CI: 82.4–85.8). The prevalence rates of verbal abuse, threats and physical violence were 79.3% (95% CI: 77.4–81.1), 70.9% (95% CI: 68.8–73.0) and 57.9% (95% CI: 55.7–60.2), respectively. Multiple logistic regression analysis revealed that working in department of psychiatry (OR = 3.42, P < 0.001), having moderate (OR = 2.05, P = 0.009), severe (OR = 2.04, P = 0.015) or extremely severe (OR = 3.21, P < 0.001) anxiety level of WPV and working in hospitals with a WPV reporting system (OR = 1.88, P < 0.001) were significantly associated with WPV.ConclusionWPV against nurses is a serious occupational and public health concern in Chinese psychiatric hospitals. Appropriate preventive measures should be undertaken to reduce the risk of WPV in healthcare settings.