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.     

Violence in hospitals and burnout among nursing staff

BackgroundNursing staff, especially in violence-prone emergency departments (ED), are at high risk of burnout. Frequently experienced violence is expected to have a strong impact on the nursing staff's burnout. This study aimed to examine the differences in the level of burnout between nursing staff who work in the ED and nursing staff who work in other inpatient departments, and its relationship with violence in various hospitals in Israel.MethodA cross-sectional study that utilized a three-part questionnaire: demographic data, degree of burnout, and frequency occurrence of violence events against nurses.Results150 nurses in EDs (N = 75) and inpatient departments (N = 75) were sampled. Significant differences were found between the two groups: Nurses in EDs experienced a higher degree of burnout than nurses in other hospital departments, and the degree of burnout was found to have a positive relationship with exposure to both verbal and physical workplace violence.ConclusionsNursing staff in EDs could develop a high degree of burnout, and exposure to workplace violence could exacerbate it. The physical and emotional safety of the staff is an important aspect in preventing burnout, and creating a secure work environment.     

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.     

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.     

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.     

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.     

Patient aggression in intensive care: A qualitative study of staff experiences

BackgroundWorkplace violence comprises abuse, assaults, threats, and harassment. Reaching epidemic proportions in healthcare, workplace violence compromises staff and patient safety and service efficiency and effectiveness. Although workplace violence is a nontrivial problem in intensive care, little is known about circumstances in which violence occurs in this setting.ObjectiveThe objective of this study was to describe and reflect upon aggression towards staff in the intensive care unit (ICU) from the perspectives of staff members.MethodsWe investigated workplace violence in a qualitative study with data collected from semistructured interviews with 19 staff members of a 10-bed ICU, analysed using a framework approach.FindingsAll participants reported witnessing or experiencing physical and/or verbal aggression. While acknowledging that ‘any patient’ could become aggressive, participants differentiated ‘any patients admitted for treatment of somatic illnesses’ from ‘dangerous’ patients and interpreted violence differently dependent on characteristics of perpetrators. ‘Dangerousness’ was associated with patients who had a comorbid mental illness. Aggression of ‘dangerous patients’ was construed as intentional and/or ‘normal aberrant’ behaviour for the individual. Staff reported feeling ill-prepared to work effectively with this cohort and having difficulty responding empathically. Mental health services were considered ‘responsible’ for managing patients' drug use, personality, and psychiatric problems.ConclusionPerceived knowledge and skill deficits, as well as stigma when engaging with certain subpopulations, contribute to workplace violence in the ICU setting. ICU staff members seek education and support to improve management of patients and reduce risk of violence. However, effectiveness depends on robust service and organisational commitment and strategies to promote workplace health and safety.     

Incidence,Type, Related Factors,and Effect of Workplace Violence on Mental Health Nurses: A Cross-sectional Survey

OBJECTIVE

Workplace violence and its impact on mental health nurses have yet to be thoroughly explored in China. This study aims to investigate the incidence, type, related factors, and effects of workplace violence on mental health nurses as well as identifying coping strategies.

Workplace violence: A qualitative study drawing on the perspectives of UK nursing students

BackgroundWorkplace violence (WV) remains problematic and highly prevalent in healthcare with nursing students being particularly vulnerable.AimTo investigate the impact of WV from the perspective of nursing students.MethodsA qualitative design was employed. A total of 444 nursing students in the UK participated in the study.FindingsThe qualitative data were analysed, coded and three main themes emerged; (1) violence culture in nursing, (2) tolerating violence and (3) the impact of violence.DiscussionThe undesirable truth is each year nearly more than half of the students face WV in environments where such a behaviour becomes culturally embedded and passed between generations of nurses. This process of normalisation requires intervention that will break this cycle to enable more appropriate workplace behaviours to flourish.ConclusionThe impact of WV can be extremely destructive for the individual, the profession and ultimately patient care with large numbers choosing to leave at a time when there is a national shortage of qualified staff.     

护士工作场所暴力的现状调查与分析

目的:调查护士工作场所暴力水平并分析原因,为今后干预护士工作场所暴力提供依据。方法:采用医院工作场所暴力调查量表对广州市5家三级甲等医院的护士进行调查。结果:60.8%的护士在过去一年中遭受过工作场所暴力,其中,辱骂、威胁、语言性骚扰、躯体攻击(无损伤)、躯体攻击(轻度损伤)、躯体攻击(明显损伤)、性袭击的发生率分别是57%、39%、13.1%、8.8%、3.7%、1%、2.5%。80.2%的急诊科护士在过去一年中遭受过工作场所暴力,45%在过去一年中遭受过工作场所暴力。结论:护士遭受高水平工作场所暴力,暴力的形式主要是非身体暴力,急诊科护士较非急诊科护士遭受更多工作场所暴力。     

Patient‐related violence against emergency department nurses

In a finding that reflects international experiences, nurses in Australia have been identified as the occupation at most risk of patient‐related violence in the health‐care sector. A search of the literature was undertaken to explore this concept, with a focus on the emergency department and triage nurses. Significant findings included the fact that nurses are subjected to verbal and physical abuse so frequently that, in many instances, it has become an accepted part of the job. This attitude, combined with the chronic under‐reporting of violent incidents, perpetuates the normalization of violence, which then becomes embedded in the workplace culture and inhibits the development of preventative strategies and the provision of a safe working environment. Nurses are entitled to a safe workplace that is free from violence under both the occupational health and safety legislation and the zero‐tolerance policies that have been adopted in many countries including Australia, the UK, Europe, and the USA. Therefore, policy‐makers and administrators should recognize this issue as a priority for preventative action.     

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.