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.     

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.     

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.     

Immediate psychological impact on nurses working at 42 government-designated hospitals during COVID-19 outbreak in China: A cross-sectional study

BackgroundDuring an epidemic of a novel infectious disease, frontline nurses suffer from unprecedented psychological stress. This study aimed to assess the immediate psychological impact on frontline nurses in China.MethodsA multicenter, cross-sectional survey of frontline nurses was conducted via online questionnaires. Symptoms of depression, anxiety, somatic disorders, and suicidal ideation were evaluated. Demographic, stress, and support variables were entered into logistic regression analysis to identify the impact factors.FindingsOf the 4,692 nurses who completed the survey, 9.4% (n = 442) were considered to have depressive symptoms, 8.1% (n = 379) represented anxiety, and 42.7% (n = 2,005) had somatic symptom. About 6.5% (n = 306) respondents had suicidal ideation.DiscussionThe study showed that the overall mental health of frontline nurses was generally poor during COVID-19 outbreak, and several impact factors associated with nurses’ psychological health were identified. Further research is needed to ascertain whether training and support strategies are indeed able to mitigate psychological morbidities.     

Prevalence of Workplace Violence Against Chinese Nurses and Its Association with Mental Health: A Cross-sectional Survey

OBJECTIVES

The aim of this study to investigate the prevalence of workplace violence (WPV) in nurses in hospitals in China, and its influence on nurses' mental health.

Health Care Personnel and Workplace Violence in the Emergency Departments of a Volatile Metropolis: Results from Karachi,Pakistan

Background

Workplace violence (WPV) is an important challenge faced by health care personnel in the emergency department (ED).

Study Objectives

To determine the prevalence and nature of WPV reported by physicians and nurses working in the EDs of four of the largest tertiary care hospitals in Karachi, Pakistan and to understand the mental health impact of experiencing WPV.

Methods

This cross-sectional survey was conducted between September and November 2008 using a widely used questionnaire developed by the World Health Organization. Overall, 266 (86% response rate) questionnaires were included in this study.

Results

A total of 44 (16.5%) physicians and nurses said they had been physically attacked, and 193 (72.5%) said that they had experienced verbal abuse in the last 12 months. Among those who reported physical attack, 29.6% reported that the last incident involved a weapon, and in 64% of cases the attacker was a patient's relative. Eighty-six percent thought that the last attack could have been prevented, and 64% said that no action was taken against the attacker. After adjusting for covariates, physicians were less likely than nurses to report physical attack (odds ratio [OR] 0.46; 95% confidence interval [CI] 0.2–1.0), and personnel with greater work experience (OR 4.8; 95% CI 2.0–11.7) and those who said that there were procedures to report WPV in their workplace (OR 3.2; 95% CI 1.6–6.5) were more likely to report verbal abuse. WPV was associated with mental health effects in the form of bothersome memories, super-alertness, and feelings of avoidance and futility.

Conclusion

WPV is an important challenge in the EDs of large hospitals in Karachi. A majority of respondents feel that WPV is preventable, but only a minority of attackers face consequences.     

A Systematic Review and Meta-Analysis of Risk Factors for Unplanned Intraoperative Hypothermia Among Adult Surgical Patients

PurposeUnplanned intraoperative hypothermia (UIH) is a frequent but preventable complication of surgery. Accurate identification of UIH risk factors allows nurses to minimize its negative outcomes. This study aimed to investigate the risk factors for UIH in adult surgical patients.DesignSystematic review and meta-analysisMethodsWe comprehensively searched PubMed, Cochrane Central Register of Controlled Trials, Web of Science, Ovid Embase, and ClinicalTrials.gov from their inception until December 31, 2020 to identify available, related studies in English. Two authors independently extracted data from these studies. Data analysis was performed using Review Manager Version 5.3.ResultsThis meta-analysis included 12 studies involving 15,010 patients. The combined results showed that age [mean difference (MD) = 4.85, P < .0001; I² = 94%], body mass index (MD = ? 0.76, P = .001; I² = 59%), ambient temperature [odds ratio (OR) = 0.82, P < .001; I² = 54%], preoperative systolic blood pressure (MD = ?14.68, P < .00001; I² = 30%), preoperative heart rate (MD = ? 13.25, P < .00001; I² = 0%), duration of anesthesia (>2 h; OR = 2.67, P < .001; I² = 0%), and intravenous fluid administration >1,000 mL (OR = 2.02, P = .01; I² = 77%) were significantly associated with a higher risk of UIH.ConclusionsOur study demonstrated that various risk factors contribute to the development of UIH. Perioperative nurses should understand these risk factors in order to apply evidence-based procedures and improve patient outcomes. Due to the substantial clinical heterogeneity across studies, further studies are needed to verify these findings.     

Emergency nurses’ knowledge and experience with the triage process in Hunan Province,China

IntroductionTriage is implemented to facilitate timely and appropriate treatment of patients, and is typically conducted by senior nurses. Triage accuracy and consistency across emergency departments remain a problem in mainland China. This study aimed to investigate the current status of triage practice and knowledge among emergency nurses in Changsha, Hunan Province, China.MethodA sample of 300 emergency nurses was selected from 13 tertiary hospitals in Changsha and a total of 193 completed surveys were returned (response rate = 64.3%). Surveys were circulated to head nurses, who then distributed them to nurses who met the selection criteria. Nurses were asked to complete the surveys and return them via dedicated survey return boxes that were placed in discreet locations to ensure anonymity.ResultsJust over half (50.8%) of participants reported receiving dedicated triage training, which was provided by their employer (38.6%), an education organisation (30.7%) or at a conference (26.1%). Approximately half (53.2%) reported using formal triage scales, which were predominantly 4-tier (43%) or 5-tier (34%).ConclusionsThe findings highlight variability in triage practices and training of emergency nurses in Changsha. This has implications for the comparability of triage data and transferability of triage skills across hospitals.     

Clinical and Cancer-Related Predictors for Venous Thromboembolism in Cancer Patients Presenting to the Emergency Department

BackgroundThe accurate detection of cancer-associated venous thromboembolism (VTE) can avoid unnecessary diagnostic imaging or laboratory tests.ObjectiveWe sought to determine clinical and cancer-related risk factors of VTE that can be used as predictors for oncology patients presenting to the emergency department (ED) with suspected VTE.MethodsWe retrospectively analyzed all consecutive patients who presented with suspicion of VTE to The University of Texas MD Anderson Cancer Center ED between January 1, 2009, and January 1, 2013. Logistic regression models were used to identify risk factors that were associated with VTE. The ability of these factors to predict VTE was externally validated using a second cohort of patients who presented to King Hussein Cancer Center ED between January 1, 2009, and January 1, 2016.ResultsCancer-related covariates associated with the occurrence of VTE were high-risk cancer type (odds ratio [OR] 3.64 [95% confidence interval {CI} 2.37–5.60], p < 0.001), presentation within 6 months of the cancer diagnosis (OR 1.92 [95% CI 1.62–2.28], p < 0.001), active cancer (OR 1.35 [95% CI 1.10–1.65], p = 0.003), advanced stage (OR 1.40 [95% CI 1.01–1.94], p = 0.044), and the presence of brain metastasis (OR 1.73 [95% CI 1.32–2.27], p < 0.001). When combined, these factors along with other clinical factors showed high prediction performance for VTE in the external validation cohort.ConclusionsCancer risk group, presentation within 6 months of cancer diagnosis, active and advanced cancer, and the presence of brain metastases along with other related clinical factors can be used to predict VTE in patients with cancer presenting to the ED.     

The emotional impact of COVID-19 on Spanish nurses and potential strategies to reduce it

BackgroundAlthough the emotional and psychological impact of nurses’ work had been identified before the COVID-19 pandemic, the pandemic aggravated risk indicators for their mental health.AimThe objective of this study was to analyse the levels of anxiety, depression, post-traumatic stress and burnout of nurses in the Balearic Islands (Spain) during the pandemic to identify possible sociodemographic and related occupational factors.DesignA cross-sectional study of 892 nurses was conducted during four weeks from February to March 2021.MethodsSociodemographic data related to the pandemic were collected and anxiety, depression, burnout and post-traumatic stress were measured with validated scales. A multivariate and predictive analysis was carried out with risk estimates.FindingsAbout 75.6% of the nurses had experience in COVID-19 units, and 49.1% had worked for more than 10 months in a COVID-19 unit. Nurses in COVID-19 units (hospital ward or ICU) were more likely to report emotional fatigue (OR 1.9, p < 0.001) and anxiety (OR 1.5, p = 0.021). In general, moderate post-traumatic stress was evident in general nurses (p = 0.027), and severe post-traumatic stress was evident in ICU nurses (p = 0.027). A 1.24-month reduction in COVID-19 patient care predicted reduced levels of emotional fatigue (5.45 points), depersonalisation (1.87 points) and post-traumatic stress (4.65 points) in nurses.ConclusionGiven the occurrence of new waves of COVID-19, the need to establish preventive strategies that focus on the personal and occupational characteristics related to these indicators and to implement urgent psychological support strategies is demonstrated.ImpactGiven these findings, it is imperative solutions are urgently applied in order to prevent compounding risk to the health system.     

Effectiveness of Clinical Risk Factors in the Detection of Central Pathology in Patients With Isolated Vertigo

BackgroundThere is no clinical guidance for the indications of neuroimaging in patients with isolated vertigo. The differential diagnosis of isolated vertigo can be challenging for emergency physicians.ObjectiveThe aim of this study was to identify the risk factors that increase the likelihood of detecting a central pathology in patients who present with isolated vertigo and in whom peripheral vertigo is considered.MethodsPatients imaged using neuroimaging, including diffusion-weighted magnetic resonance imaging (DW-MRI) with head computed tomography (CT), for isolated vertigo over a 3-year period were identified retrospectively. The patients were divided into two groups—a positive neuroimaging group and a negative neuroimaging group—according to the abnormal lesions in the head CT and DW-MRI results. We reviewed the medical records to identify presenting symptoms and signs, vascular risk factors, history of vertigo, medical comorbidities, and diagnostic imaging results (i.e., head CT and DW-MRI).ResultsTwo hundred and seventy-nine patients were included: 231 in the negative neuroimaging group (82.8%) and 48 in the positive neuroimaging group (17.2%). Univariate and multivariate logistic regression analyses were performed. It was found in the regression analysis that being 65 years or older (odds ratio [OR] 2.53; 95% confidence interval [CI] 1.29–4.96; p = 0.006), having two or more vascular risk factors (OR 2.45; 95% CI 1.10–5.46; p = 0.028), and not responding to the treatment (OR 2.57; 95% CI 1.08–6.14; p = 0.033) increased the likelihood of detecting a pathology in neuroimaging.ConclusionsWe suggest that patients unresponsive to ED treatment, 65 years or older, and with two or more vascular risk factors, should alert physicians for central causes and increase the yield of neuroimaging.     

Risk Factors for Injuries From Physical Violence in African Women in the Gambia

BackgroundPhysical violence against women is a major public health problem in African countries; however, no studies have focused on factors associated with violent injuries to women in Africa.ObjectivesA matched case-control study was conducted to investigate risk factors for injuries from physical violence against African women in The Gambia.MethodsOver a 12-month study period, study participants were recruited from emergency departments of eight government-managed health care facilities. Cases were female patients aged ≥ 15 years who had been violently injured. Matched by the health facility, date of injury, sex, and age, a control patient for each case was selected from those injured due to nonviolent mechanisms.ResultsIn total, 194 case-control pairs were recruited. Results of a conditional logistic regression showed that being a Fula (odds ratio [OR] 2.45; 95% confidence interval [CI] 1.06–5.66), living in an extended family compound (OR 3.07; 95% CI 1.22–7.72), having six or more female siblings (OR 3.10; 95% CI 1.38–6.97), having been raised by grandparents (OR 3.34; 95% CI 1.06–10.51), and having been verbally (OR 3.04; 95% CI 1.56–5.96) or physically abused (OR 3.36; 95% CI 1.34–8.39) in the past 12 months were significantly associated with injury from physical violence.ConclusionMost risk factors identified for violent injury among African women are unique to the studied geography. Violence prevention programs, if designed based on these identified risk factors, may be more effective for this population.     

Work stress and perceived organisational support on young Korean nurses’ care for COVID-19 patients

BackgroundSince the outbreak of COVID-19 worldwide, frontline nurses have faced tremendous stress. Younger nurses in their early-to-mid careers can be more exposed to burnout and work stress, and perceived organisational support can influence the quality of nursing care for vulnerable patients.AimTo identify the impact of younger nurses’ work stress and perceived organisational support on their willingness to care for COVID-19 patients.MethodsThe cross-sectional secondary data analysis included 211 hospital nurses (<35 years) in South Korea with a mean age of 24.60 years (SD=1.90). Multiple logistic regression analysis was used to identify the factors influencing willingness to care.FindingsSupplying personal protective equipment, training in the use of personal protective equipment, lower work stress, and positive perceptions of organisational support significantly increased early-career nurses’ willingness to care. For mid-career nurses, being male and higher work stress significantly increased their willingness to care.DiscussionSupport, including COVID-19-related education or training, should be provided to reduce work stress arising from being exposed to infection or while providing care to critically ill patients, especially among early-career nurses. Support from nurse managers, senior staff, and colleagues could help younger nurses cope better with the challenges of COVID-19, thus increasing their willingness to care.ConclusionPerceived organisational support may facilitate early-career nurses’ organisational commitment. Healthy work environments can relieve early-to-mid-career nurses’ work stress, thus facilitating patient-centred care.     

Nurse workload and inexperienced medical staff members are associated with seasonal peaks in severe adverse events in the adult medical intensive care unit: A seven-year prospective study

ObjectiveOur purpose was to identify potential organizational factors that contributed to life-threatening adverse events in adult intensive care unit.MethodsA prospective, observational, dynamic cohort study was carried out from January 2006 to December 2013 in a 20-bed adult medical intensive care unit. All patients admitted to the intensive care unit and who experienced one or more selected life-threatening adverse events (mainly unexpected cardiac arrest, unplanned extubation, reintubation after planned extubation, and readmission within 48 h of intensive care unit discharge) were included in the analysis. Negative binomial regression was used to model how human resources, work organization, and intensive care activity influenced the monthly rate of selected severe adverse events. Data were collected from local and national databases.ResultsOverall, 638 severe adverse events involving 498 patients were recorded. Adverse events increased seasonally in May, November and December (p < .001 vs other months). The proportion of inexperienced nurses and doctors’ working hours could not explain these seasonal peaks of adverse events. Multivariate analysis identified bed-to-nurse ratio and the arrival of inexperienced residents or senior registrars as being independently associated with the rate of adverse events (incidence risk ratio = 1.36 (95% confidence interval, 1.05–1.75), and 1.07 (95% confidence interval, 1.01–1.13), respectively; p = .01 in both cases). According to this model, a one-unit increase in the day–night shifts carried out by each nurse per month tended to reduce the rate of adverse events (incidence risk ratio = 0.60 (95% confidence interval, 0.36–1.01), p = .05). Severity at intensive care unit admission did not influence the rate of adverse events (incidence risk ratio = 1.02 (95% confidence interval, 1.00–1.04), p = .12).ConclusionsResults identify nurse workload and the arrival of inexperienced residents or senior registrars as risk factors for the occurrence of life-threatening adverse events in the adult medical intensive care unit. Limiting fluctuations in bed-to-nurse ratio and providing inexperienced medical staff members with sufficient supervision may decrease severe adverse events in critically ill patients.     

Psychometric properties assessment of Chinese version of work readiness scale for graduate nurses (WRS-GN) and associated factors of work readiness: Two cross-sectional studies

BackgroundLower work readiness is tied to anxiety, high turnover and nurse transition failure. An assessment of work readiness is necessary. To date, no relative scale exists in China. Thus, a work readiness related scale is urgently needed.ObjectivesTo assess the psychometric properties of the scale, and look into the status of Chinese graduate nurse work readiness and factors associated with work readiness.Design, settings, and participants.Both psychometric assessment and associated factors are designed with cross-sectional studies. 832 and 435 graduate nurses were recruited in the above two studies, respectively.MethodsBrislin's transition model was utilized for the transition process, and a six-expert panel and preliminary survey were conducted for face validity and testing the transition version respectively. Exploratory factor analysis, confirmatory factor analysis, internal consistency reliability and test-retest reliability were applied for reliability and validity testing. Additionally, a linear regression method was carried out for analyzing influencing factors of work readiness of graduate nurses across China.ResultsA 37-item Chinese version scale was proven to have great psychometric qualities. Five factors were extracted by exploratory factor analysis, which can explain 68.637% of the total variance. Furthermore, the confirmatory factor analysis demonstrates the fit indices of a five factors mode: X²/df = 1.769, RMSEA = 0.067, NFI = 0.859, RFI = 0.839, IFI = 0.934, CFI = 0.933, TLI = 0.923. Intra-class correlation coefficient, Cronbach's α and Guttman Split-half were 0.805, 0.960 and 0.903, respectively. Interpersonal relationships, leadership experience, scholarship, work experience and willingness to be nurses were associated with the potential to achieve higher work readiness.ConclusionThe Chinese version of WRS-GN with good validity and reliability can be utilized for assessment of work readiness. Besides, improving work readiness of graduate nurses based on above five associated factors, educators and hospital managers could help graduate nurses having a smooth transition for a stable nursing workforce.