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.     

Workplace violence experienced by nursing students: A UK survey

AimsTo appreciate the nature and scope of workplace violence amongst a sample of the UK nursing student population during clinical placement and to recommend strategies universities can implement to successfully manage the impact.BackgroundWorkplace violence is defined as a violent act(s) directed toward workers and can include physical, psychological or verbal behaviour. It is prevalent in nursing and causes victims work-based stress that can affect not only the individual but also the quality of care. Similar negative experiences amongst students can have a direct impact on the development of future professional skills.DesignThis study employed a cross-sectional survey design. Questions were uploaded in the format of a commercial internet survey provider (SurveyMonkey.com) and distributed across a sample of nursing schools in the UK. The survey was voluntary and employed a validated tool to assess workplace violence and was based on a similar study in Australia. The number of respondents was 657. This paper reports on the quantitative results.FindingsNearly half of the students (42.18%) indicated they had experienced bullying/harassment in the past year while on clinical placement. One-third (30.4%) had witnessed bullying/harassment of other students and 19.6% of incidents involved a qualified nurse. The unwanted behaviours made some students consider leaving nursing (19.8%). Some respondents said the standard of patient care (12.3%) and their work with others (25.9%) were negatively affected.ConclusionsWorkplace violence can influence nursing students' attitude toward the profession and their level of satisfaction with the work. Whilst it was reassuring to note that the majority of the participants knew where/how to report, only one fifth had actively reported an episode of bullying/harassment. Current students are the nurses and leaders of the future and have a key role in shaping the culture of generations to come. Universities and clinical providers need to work together to reduce the incidence and impact of workplace violence in order to improve the culture of practice.     

The impact of training program on nurses' attitudes toward workplace violence in Jordan

BackgroundNurses' attitudes toward workplace violence are still inadequately explored, and possess an impact in preventing, and managing the violent incidents and the quality of nursing care. Creating a demand for an effective intervention program to improve nurses' knowledge of and attitudes toward workplace violence.ObjectiveTo study the impact of the training program on nurses' attitudes toward workplace violence in a military hospital in Jordan.MethodsOne group before–after design was employed. A stratified random sample of 100 nurses working in three shifts was recruited. Data were collected earlier and after the preparation program using the Attitudes Toward Patient Physical Assault Questionnaire. “The Framework Guidelines for addressing workplace violence in the health sector”, was adopted in this work. The preparation sessions were for one day each week over five weeks. The post-test assessment was over five weeks using the same questionnaire.ResultsA total of 97 nurses completed the survey. The outcomes demonstrated the significant impact of the training program on nurses' attitudes towards workplace violence (t = 6. 62, df = 96, p = 0.000). The prevalence of verbal abuse by patients and visitors was 63.9% and for physical abuse, 7.2% were from patients and 3.1% of visitors. Most violent incidents occurred during day duty and during delivering nursing care (40.2% and 32%, respectively). Major source of emotional support for abused nurses was from the nursing team (88.7%), while the legal support was from nursing management (48.5%).ConclusionThe study highlights a general concern among nursing staff about workplace violence. Confirming that violence prevention education for staff is a necessary step forward to deescalate the problem. A significant effect of the training program was evident in this study.     

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 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.     

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.

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 effectiveness of a training program for emergency department nurses in managing violent situations

An Australian Institute of Criminology report (1999) highlighted the health industry as the most violent industry in Australia with registered nurses recording the second highest number of violence-related workers compensation claims, ranking higher than prison and police officers. Workplace violence has become such a common phenomenon that many nurses accept it as a part of nursing. Nurses employed in emergency departments (EDs) are considered to be especially vulnerable to workplace violence. Although there have been a number of studies reporting on the incidence of workplace violence and its consequences upon nurses, to date there have been no empirical studies that have evaluated interventions which are thought to reduce its occurrence and impact. This study investigated the effectiveness of a one-day training program in which ED nurses participated. In particular, their knowledge, skills and attitudes relating to management of workplace violence were examined. Results show that a training program has many positive outcomes which enhance nurses' ability to manage aggressive behaviours. With some basic training, ED nurses can be more prepared to manage violent and potentially violent situations, and by doing so may in fact reduce the incidence of aggression in their workplace by 50%. This has largely been achieved by raising the awareness of ED nurses to the nature of the problem, developing their knowledge and skills in managing aggressive behaviour, and improving their attitudes toward potentially violent patients.     

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.     

Prevention and management of occupational violence and aggression in healthcare: A scoping review

BackgroundWorkplace violence is prevalent in healthcare, and significant resources have been invested in its prevention and management. Internationally, guidance materials developed by government and non-government bodies advise on the management of workplace violence, yet a dearth of research to support these interventions exists.AimTo examine the evidence relating to the effectiveness of interventions to prevent and manage workplace violence perpetrated by consumers in healthcare.MethodsA scoping review method was used. Scopus, OVID Medline, PubMed, CINAHL Plus, ProQuest Central, and Google Scholar were searched and 2276 results were retrieved. Following screening by title and abstract, 126 papers were retrieved for full-text review, and 20 papers were included in the final study. Meta-analysis could not be undertaken due to variation in study design. Therefore data are reported using a narrative framework.FindingsInterventions which reduced workplace violence included consumer risk assessment, staff education, and aggression management teams. Increasing visibility, in conjunction with other measures, also reduced the incidence of workplace violence. Post-incident support, in the form of group debriefing, increased the incidence of violent incidents, but this may be due to increased awareness of the importance of reporting. No evidence was found in relation to the use of duress alarms, incident reporting, or zero tolerance policies.DiscussionThere is clear evidence underpinning some interventions used to manage workplace violence in healthcare, further research is needed to demonstrate the effect of widely used interventions such as zero tolerance policies, incident reporting and duress alarms.     

Fostering graduate nurse practice readiness in context

BackgroundThe healthcare environment is highly pressured, dynamic and demanding of staff. Existing research indicates that when graduate nurses begin work, they are not practice ready and struggle to adapt and manage their responsibilities as registered nurses.AimAs part of a larger study, this paper examines the impact of the healthcare environment on graduate nurses’ practice readiness and the factors that assist them to become practice ready.MethodMultiple case study design with 67 participants from four different professional groups employed in four healthcare institutions in one state in Australia. Grounded theory methods of data analysis, document review, and cross case analysis were utilised in this study.FindingsThe healthcare system, workplace environment and quality of workplace interactions impact on actual and perceived graduate nurse performance. Graduate nurses develop practice readiness progressively along a transition continuum and attaining practice readiness is reliant on factors present in both the education and workplace environments.DiscussionEducation and workplace factors collectively create the right environment for graduate nurses to flourish. Education and practice sectors need to work together to ensure graduate readiness over a four-year timeline from the commencement of nursing studies through to the end of the graduate year to ensure practice readiness.ConclusionCreating positive workplace environments that support nursing students and graduate nurses to develop practice readiness can enhance the quality of care they provide, promote their retention in the health workforce and contribute to improved healthcare practice and outcomes.     

Violence against nurses in the triage area: An Italian qualitative study

AimThis qualitative study aims to investigate the feelings experienced by nurses following episodes of violence in the workplace.BackgroundNumerous studies show that healthcare professionals are increasingly finding themselves victims of violence; of all professionals, nurses in the Emergency Department and especially those performing triage are one of the staff categories which most frequently experience these episodes during their work.IntroductionIn Italy, this phenomenon has been studied very little in comparison to other countries but has recently been gaining increasing attention. Few studies have investigated the feelings experienced by nurses following episodes of violence in the workplace.MethodsFor this study a phenomenological approach was used. Assumptions and previous findings were set aside (bracketing). A purposive sample of 9 nurses coming from 7 different Emergency Department in the region of Tuscany, Italy was interviewed during a focus group meeting. The data analysis was carried out using the Colaizzi method.ResultsData analysis revealed 10 significant themes/responses. The quality of reporting was guaranteed by adopting the COREQ criteria.DiscussionData analysis revealed that nurses feel that violent episodes are “inevitable” and that they feel they have grown accustomed to high levels of violence, that they suffer feelings of “inadequacy” but also that they are aware that they themselves can trigger conflict with patients, and again suffer the feeling of “being alone” in facing these problems and a sense of “being left on their own” by the institution and feeling “hurt”, “scared”, “angry” and have a sense that “it is not fair”. Last but not least, “the gender difference” appears to play an important role in the emotional response.ConclusionsTo suffer episodes of violence has serious and severe “hidden costs” which are just as important as the direct, tangible costs.     

Incivility in nursing practice education in the operating room

BackgroundIncivility toward nursing students has been identified as a contributor to negative experiences in clinical education and may cause a weakened learning environment, anxiety, depression and workplace violence. However, few data with regard to uncivilized behavior toward nursing students in the operating room are available. The operation room is a special place where the tempo is fast and the risk is high. Nursing students may have to face pressure from different people, such as anesthesiologists, surgeons, clinical instructors, and staff nurses.ObjectivesTo explore uncivilized behavior toward nursing students in the operating room and to discuss the source of uncivilized behavior and the attitude of clinical instructors when it occurs.MethodA total of 215 nursing students in the operating room of the Second XiangYa Hospital from January to December 2018 were investigated. The uncivilized behavior in clinical nursing education tool and self-designed questionnaire were used.ResultsThe incivility mean score was (4.6 ± 6.7). In all, 122 (56.7%) participants had experienced various degrees of uncivilized behavior in the operating room. There were significant differences in incivility toward students according to degree of education and age. The most frequent uncivilized behavior toward students was raising of the voice when speaking to students (41.9%), followed by inappropriate tone (36.7%), being embarrassed in front of others (36.3%), and snide remarks (34.4%). Surgeons (59%) were considered as the most important source of uncivil behaviors, followed by staff nurses (46.7%). When students experienced uncivilized behavior, 61.5% clinical instructors defended and comforted them, 23% comforted them privately, 13.1% ignored them, and 2.5% even criticized them together with the uncivil behavior actor.ConclusionNursing managers and instructors should pay more attention to the incivility toward students and take actions to foster a healthy, civilized and respectful work environment in the operating room for students.