Nurse exposure to physical and nonphysical violence,bullying, and sexual harassment: A quantitative review

Objectives

This paper provides a quantitative review that estimates exposure rates by type of violence, setting, source, and world region.

Design

A quantitative review of the nursing violence literature was summarized.

Data sources

A literature search was conducted using the CINAHL, Medline and PsycInfo data bases. Studies included had to report empirical results using a nursing sample, and include data on bullying, sexual harassment, and/or violence exposure rates. A total of 136 articles provided data on 151,347 nurses from 160 samples.

Procedure

Articles were identified through a database search and by consulting reference lists of review articles that were located. Relevant data were coded by the three authors. Categories depended on the availability of at least five studies. Exposure rates were coded as percentages of nurses in the sample who reported a given type of violence. Five types of violence were physical, nonphysical, bullying, sexual harassment, and combined (type of violence was not indicated). Setting, timeframe, country, and source of violence were coded.

Results

Overall violence exposure rates were 36.4% for physical violence, 66.9% for nonphysical violence, 39.7% for bullying, and 25% for sexual harassment, with 32.7% of nurses reporting having been physically injured in an assault. Rates of exposure varied by world region (Anglo, Asia, Europe and Middle East), with the highest rates for physical violence and sexual harassment in the Anglo region, and the highest rates of nonphysical violence and bullying in the Middle East. Regions also varied in the source of violence, with patients accounting for most of it in Anglo and European regions, whereas patents’ families/friends were the most common source in the Middle East.

Conclusions

About a third of nurses worldwide indicated exposure to physical violence and bullying, about a third reported injury, about a quarter experienced sexual harassment, and about two-thirds indicated nonphysical violence. Physical violence was most prevalent in emergency departments, geriatric, and psychiatric facilities. Physical violence and sexual harassment were most prevalent in Anglo countries, and nonphysical violence and bullying were most prevalent in the Middle East. Patients accounted for most physical violence in the Anglo region and Europe, and patient family and friends accounted for the most in the Middle East.     

A multi-center study of horizontal violence in United States military nursing

Horizontal violence refers to repeated behaviors over time that intimidate or demean another. These behaviors may negatively impact the nursing workplace. The purpose of this study was to describe horizontal violence occurrence in the United States military nursing workplace and to determine the effectiveness of an educational intervention. Using a one group before-after design, survey data on horizontal violence behaviors, personal effects, perpetrators, job satisfaction and intention to leave were collected before and after a 30-min educational intervention. Reported horizontal violence behaviors and personal effects from horizontal violence averaged once to twice in a three month period. Staff nurses (peers) were the most frequent perpetrators. Job satisfaction and intent to leave significantly correlated with horizontal violence. There were no significant differences in overall horizontal violence before and after the intervention. Within the United States military nursing workplace horizontal violence does occur, although less frequently than in the United States civilian nursing population. Education on horizontal violence may not be sufficient as a sole intervention.     

Intimate Partner Violence Screening in the Emergency Department: A Quality Improvement Project

IntroductionIntimate partner violence is a serious public health issue that can be addressed through identification and early intervention. Although screening for intimate partner violence in health care settings is recommended by medical and nursing organizations, it is underperformed. The project objectives were to increase intimate partner violence screening rates, identification, and the referrals/resources provided.MethodsThis project was a quality improvement intervention. Intimate partner violence screening training was provided to emergency nurses along with a computer prompt for screening in the emergency department, with a standard referral process to a social service agency. The project data included patient ED visits, partner violence screening rates, positive and negative screening rates, and the number of referrals/resources provided to the patients.ResultsThere was no increase in the screening rates (28%). Although the screening rates varied considerably from week to week, the highest rate of screening was during the intimate partner violence training week. Pre- and postintervention data showed a significant increase in the number of positive screens obtained per week after the nurse intimate partner violence training (7.80 vs 5.22, t = –4.33, P < 0.01). In addition, the referrals/resources provided to the patients doubled from 9 to 18 after the training, which is clinically significant for patient care.DiscussionThis project demonstrates that nurse training along with a computer prompt intervention and standard referral process can contribute to intimate partner violence identification and the referrals/resources provided to the patients. Ultimately, the patients exposed to partner violence may benefit from increased identification and delivery of the referrals/resources.     

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.     

Effects of hospital nurses' internalized dominant values,organizational silence,horizontal violence,and organizational communication on patient safety

Recent studies have identified common problems with patient safety in hospitals and medical institutions have responded, prioritizing service quality and performance, including patient safety. However, the factors influencing safety for hospital patients are still being examined and clarified. We aimed to investigate how hospital nurses' internalized dominant values, organizational silence, horizontal violence, and organizational communication satisfaction can affect patient safety and to construct and verify a hypothetical model describing the relationships between these factors. The participant sample included 301 hospital nurses from four large (≥500 beds) general hospitals in Gyeonggi-do, South Korea. Data were collected through questionnaires from October to November 2018 and analyzed using SPSS 25.0 and AMOS 22.0. Factors that had direct effects on patient safety were organizational silence (β = −.130, p < .05) and organizational communication satisfaction (β = .209, p < .001). Factors that had indirect effects on patient safety were internalized dominant values and horizontal violence. The explanatory power of these variables for patient safety was 7.9%. The results indicate that organizational silence, horizontal violence, and organizational communication satisfaction fully mediated the relationship between nurses' internalized dominant values and patient safety. Our findings may be useful to hospital administrators and managers in identifying and analyzing these organizational characteristics in their institutions. Further, the model described in the results may be used to inform the development of educational programs and strategies to improve patient safety by reducing organizational silence and horizontal violence and improving organizational communication.     

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.     

Experience of Violence from the Clients and Coping Methods Among Intensive Care Unit Nurses Working in a Hospital in South Korea

Purpose

It is difficult to develop a good defense system that can prevent nurses from experiencing physical and verbal violence from patients and families in intensive care units, which are closed spaces. This study aimed to identify intensive care nurses' experience of violence from patients and families and investigate their coping methods, if there are any, in a tertiary hospital in South Korea.

Levels of Violence Among Nurses in Cape Town Public Hospitals

BACKGROUND.  The paper presents findings from a study examining violence in nursing.
DESIGN.  A combined ethno-phenomenology was identified as the most appropriate approach. Ethnography is to understand the culture of nursing that permits violence to occur within the profession. Phenomenology is to explore and capture nurse-on-nurse experiences of violence. The population is all nurses registered with the South African Nursing Council. The research participants are nurses employed in eight public hospitals in Cape Town during 2005.
METHOD OF DATA COLLECTION.  The first stage of data collection was the distributions of confidential questionnaires to nurses employed in eight hospitals and willing to participate in the study.
ANALYSIS.  Responses to close-ended questions were analyzed using Microsoft Excel. Responses to open-ended questions were grouped per question. The qualitative data were then compared for similarities and differences in information provided.
CONCLUSIONS.  Six levels of violence exist among nurses. The highest forms of violence among nurses occurred at the psychological level, with the least at the physical level of interaction. The other four levels of violence among nurses were vertical, horizontal, covert, and overt. All categories of nurses in the study had resorted to one or more levels of violence against other nurses during their nursing career. Professional nurses and senior nurse managers were identified as the main category of nurses that frequently resort to mistreating other nurses. However, auxiliary nurses were identified as the main perpetrators of physical violence against other nurses.     

Female caregivers' perceptions of reasons for violent behaviour among nursing home residents

Threats and violence against professional caregivers present a growing health and safety problem in elderly care. We aimed to explore female caregivers' perceptions of reasons for violent behaviour among nursing home residents. Forty-one caregivers at three nursing homes were interviewed and their responses were subjected to qualitative content analysis, which revealed three content areas of perceived reasons for patient violence: patient characteristics, caregiver approach and environmental aspects. The caregivers' perceptions were formulated in three core statements: 'they (the residents) are not who they used to be', 'we (the caregivers) have acted inappropriately' and 'we (residents and caregivers) are all surrounded by disorder'. Our findings indicate that the reasons for violence are complex and multifactorial, so interventions should be individually tailored. Caregivers involved in a violent situation need to see the person behind the behaviour, try to interpret what the behaviour is meant to communicate and adjust the intervention according to individual need.     

The validity and utility of violence risk assessment tools to predict patient violence in acute care settings: An integrative literature review

To examine risk assessment tools to predict patient violence in acute care settings. An integrative review of the literature. Five electronic databases – CINAHL Plus, MEDLINE, OVID, PsycINFO, and Web of Science were searched between 2000 and 2018. The reference list of articles was also inspected manually. The PICOS framework was used to refine the inclusion and exclusion of the literature, and the PRISMA statement guided the search strategy to systematically present findings. Forty‐one studies were retained for review. Three studies developed or tested tools to measure patient violence in general acute care settings, and two described the primary and secondary development of tools in emergency departments. The remaining studies reported on risk assessment tools that were developed or tested in psychiatric inpatient settings. In total, 16 violence risk assessment tools were identified. Thirteen of them were developed to assess the risk of violence in psychiatric patients. Two of them were found to be accurate and reliable to predict violence in acute psychiatric facilities and have practical utility for general acute care settings. Two assessment tools were developed and administered in general acute care, and one was developed to predict patient violence in emergency departments. There is no single, user‐friendly, standardized evidence‐based tool available for predicting violence in general acute care hospitals. Some were found to be accurate in assessing violence in psychiatric inpatients and have potential for use in general acute care, require further testing to assess their validity and reliability.     

Workplace aggression as cause and effect: Emergency nurses’ experiences of working fatigued

IntroductionEmergency nursing requires acute attention to detail to provide safe and effective care to potentially unstable or critically ill patients; this requirement may be significantly impaired by physical and mental fatigue. There is a lack of evidence regarding the effects of fatigue caused by factors other than a sleep deficit (e.g., emotional exhaustion). Fatigue affects nurses’ ability to work safely in the emergency care setting and potentially impacts their health and quality of life outside of work.MethodsThis was the qualitative arm of a mixed methods study; we used a qualitative exploratory design with focus group data from a sample of 16 emergency nurses. Themes were identified using an inductive approach to content analysis.Results/discussionThe following themes were identified: “It’s a weight on your back;” “Competitive nursing;” “It’s never enough;” “You have to get away;” and “Engagement as a solution.”ConclusionsOur participants reported high levels of fatigue, which compromised patient care, had a negative effect on their personal lives, and created a toxic unit environment. They reported lateral violence as both the cause and effect of mental and emotional fatigue, suggesting that unit culture affects nurses and the patients they care for.     

Individual and organizational risk factors of work‐related violence in the Danish elder care

Scand J Caring Sci; 2010; 24; 332–340
Individual and organizational risk factors of work‐related violence in the Danish elder care Aim: The aim of this study was to explore individual and organizational risk factors of exposure to violence in the Elder Care Sector. Methods: A questionnaire study conducted among 8134 health‐care workers in the elder care in 36 municipalities was carried out between October 2004 and May 2005. Participation in the study was voluntary and data were treated confidentially. Results: Individual factors such as low age and seniority seemed to increase the risk of violence. Type of institution (nursing homes), occupation (health care assistants), shift‐work, evening or night work, frequent physical contact with clients, higher emotional demands, a lower level of involvement at the workplace, lower leadership quality, and more role conflicts increased the risk of work‐related violence. On the other hand, the study also demonstrated that the least violence was found at workplaces with high leadership quality, no role conflicts and high involvement in the workplace. Study strengths and limitations: The strengths of the study are that it is a large representative study consisting of Danish elder care workers in 36 municipalities and has a high response rate. A limitation is that the study is cross‐sectional making it impossible to decide the direction of causal relationships. Conclusion: The results of the study indicate that there is a possibility of reducing the prevalence of violence towards care‐workers in the elder care if policies and resources to improve the working environment are implemented.     

Intimate Partner Violence and Patient Screening across Medical Specialties

Objectives: The aims of this study were to compare rates of intimate partner violence (IPV) across different medical specialties and health care sites in one metropolitan area, describe demographic characteristics of women with abusive partners, characterize health care provider assessment of IPV, and describe patient characteristics associated with health care assessment for partner violence. Methods: Women (N= 2,465) completed written surveys about partner violence and health care screening for violence in the waiting rooms of five types of health care settings (obstetrician/gynecologist office, emergency department, primary care office, pediatrics, and addiction recovery) across eight different hospitals in the greater Boston area. Results: The overall survey response rate was 62%. The 12‐month prevalence rate of IPV was 14%, with 37% disclosing lifetime prevalence. The highest rates of recent IPV were disclosed in the hospital‐based addiction recovery unit (36%) and in emergency departments (17%). Adjusted demographic risk characteristics for IPV included age (younger than 24 years), low income, and unemployment. Health care providers were more likely to discuss IPV with low‐income women than with middle‐ or high‐income women but were no more likely to assess violence within the youngest age group. Among women who disclosed abuse to their health care provider, 50% reported receiving direct interventions or services as a result. Conclusions: Using the same instrument and protocol, different rates of IPV and detection of IPV were found across medical departments, with the highest rates in emergency departments and an addiction recovery program. It is especially important for assessment of IPV to include young women who present to medical departments.     

The impact of horizontal violence on the individual nurse: A qualitative research study

AimHorizontal violence (HV) is a familiar term used in nursing. Certain populations of nurses are more susceptible to HV than others. Graduate nurses (nurses within their first 12 months of practice) are widely considered a vulnerable population in the profession and thus more at risk for HV. The purpose of this qualitative study was to explore how HV affects graduate nurses (GNs).DesignInductive thematic analysis was used in the design of this study.MethodsParticipants included eight Canadian GNs or Registered Nurses (RNs), all of whom had experience with HV in their first 12 months of practice. Data collection was done via one-on-one interviews.ResultsTwo main themes were revealed from the data collected - Toxic Nursing Culture and Fear. Several subthemes were also identified – cycle of violence, nurses eating their young, shame, drowning, isolation and vulnerability. The findings indicate that HV is prevalent in the first year of practice and is destructive to the mental health of the individual nurse. Horizontal violence poses a serious challenge for GNs entering nursing and is often touted as the reason new nurses leave the profession altogether.ConclusionThis study highlighted the personal and professional challenges that are heightened for a GN when they experience HV in their first year of practice. These experiences emphasize the impact that HV can have on the mental health of nurses and their ability to deliver safe patient care.     

Emotional intelligence and nursing: An integrative literature review

Aim

The purpose of this paper is to present findings of an integrative literature review related to emotional intelligence (EI) and nursing.

Background

A large body of knowledge related to EI exists outside nursing. EI theory and research within nursing is a more recent phenomenon. A broad understanding of the nature and direction of theory and research related to EI is crucial to building knowledge within this field of inquiry.

Method

A broad search of computerized databases focusing on articles published in English during 1995–2007 was completed. Extensive screening sought to determine current literature themes and empirical research evidence completed in nursing focused specifically on emotional intelligence.

Results

39 articles are included in this integrative literature review (theoretical, n = 21; editorial, n = 5; opinion, n = 4 and empirical, n = 9). The literature focuses on EI and nursing education, EI and nursing practice, EI and clinical decision-making, and EI and clinical leadership. Research that links EI and nursing are mostly correlation designs using small sample sizes.

Conclusion

This literature reveals widespread support of EI concepts in nursing. Theoretical and editorial literature confirms EI concepts are central to nursing practice. EI needs to be explicit within nursing education as EI might impact the quality of student learning, ethical decision-making, critical thinking, evidence and knowledge use in practice. Emotionally intelligent leaders influence employee retention, quality of patient care and patient outcomes. EI research in nursing requires development and careful consideration of criticisms related to EI outside nursing is recommended.     

An exploratory account of registered nurses'' experience of patient aggression in both mental health and general nursing settings

Until relatively recently, aggression and violence in nursing has been an area of little discussion (Poster & Ryan 1993). Today, concerns are rising about escalating levels of violence towards nurses (Wykes 1994, Whittington 1997). In response, this paper explores registered nurses' experiences of patient aggression encountered in the acute inpatient general and mental health settings. Critical incidents from registered nurses in both areas are examined and analyzed in relation to existing literature. The aim of the research is to ascertain if differences exist or similarities prevail. Findings reveal that the two areas have similar problems in terms of types of aggression. Verbal and 'minor' types of aggression are the most problematic. Also, the 'biomedical model' of care is evident in both settings and possibly underpins chosen approaches to aggression management. The repeated use of chemical and physical restraint is apparent. The main comparison identified between the two groups relates to nursing control over situations involving violent patients. Mental health nurses seem to consistently take control of aggressive situations whilst general nurses tend to rely more heavily upon the input of others (medical staff, mental health teams and the police) when intervening. These two nursing specialties therefore have much to learn from each other in terms of nursing experience and possible future approaches to the management of aggressive patients.     

Horizontal violence in nursing

Horizontal or lateral violence is considered an act of aggression among nursing professionals. Horizontal violence creates a negative work environment impairing teamwork and compromising patient care. The effects of horizontal violence and strategies for prevention and management are addressed.