Workplace Violence In Healthcare Research Articles

Understanding the Experience of Workplace Violence in Hospitals as Documented by Nursing Staff: Using the READ Approach.

Background: Workplace violence has a significant impact on patients, families, and staff safety. Workplace violence can produce traumatic results for those involved; the importance of preventive measures needs to be paramount in health service policy and process. Health care staff are required to document their experiences of violent incidents after every occasion, usually via an incident reporting system, which allows for a free text description of the event. There is a lack of understanding of how health care staff document reports of violence and how they explain the events. Methods: This study aims to determine the circumstances surrounding workplace violent events as documented by health care staff. The four-step Review, Extract, Analyze, and Document (READ) approach to document analysis was used to examine workplace violence incident reports over 12 months (September 2021-September 2022) in a tertiary referral hospital. Findings: Six categories of workplace violence were found: (a) "Escalation Dynamics"-patterns and progression of how violence incidents intensify; (b) "Warning Behaviors"-verbal or non-verbal signals that may foreshadow physical violence if not addressed; (c) "Authoritative Institutional Interventions"-how aggression correlates to protocols involving security personnel or law enforcement; (d) "Care Delivery Methods"-how certain treatment procedures and approaches might inadvertently elicit violence; (e) "Situational Stressors"-external circumstances or changes that act as triggers for violence; and (f) "Unprovoked triggers"-sudden and seemingly unprovoked violent outbursts. Conclusions and application to practice: Workplace violence in health care is a multifaceted interplay of events with the nurse involved in all aspects of the process. These findings can be used by occupational health nurses in education and policy development. The findings can be used to focus education on how violent incidents may escalate and provide more opportunities for de-escalation by health care staff.

Staff Safety Alert Banner Program Against Workplace Violence at an Urban American Hospital.

Workplace violence (WPV) in healthcare has become an issue worldwide, with increasing prevalence after the COVID-19 pandemic. Notably, WPV in any setting has individual and systemic repercussions. However, despite extensive literature reporting the prevalence of WPV in healthcare worldwide, effective, standardized prevention policies have not been established. We developed and piloted a WPV initiative at an urban hospital in the state of Maryland. Here, we aim to describe our program development methods and implementation. The 6-month program utilized a reporting tool developed within patients' electronic medical records (EMRs) to request the display of a Staff Safety Alert (SSA) banner to alert healthcare professionals of patients who engaged in violent behavior and are at increased risk of subsequent behavior. This tool was piloted on 21 patient care units. A review committee either approved or denied case requests filed by frontline workers, with holistic consideration involving patient status, potential biases, and communication flaws. Twenty-one banner requests were filed during the course of the pilot. Of which, eight were approved, and 13 were denied. The multi-trauma intermediate care floor filed the most case requests for a safety banner. Our pilot program offers a patient-centered intervention program where extensive personnel training and patient-focused considerations were applied prior to the approval or denial of a banner display. The SSA program was the initial step in institutionally combatting WPV in healthcare as staff are encouraged to officially document unsafe events followed by careful action in response.

Educating a new generation of nurses about workplace violence using an innovative virtual simulation module

Workplace violence (WPV) continues to be a pervasive and burdensome issue. Nurses spend more time with patients and families increasing their WPV risk. Unfortunately, nursing programs do not routinely provide education or training on de-escalation or management of WPV. Future and current nurses should acknowledge and receive education for the prevention and mitigation of WPV as well as frequent reviews and updates on current trends and strategies. The purpose of this study was to evaluate the impact of education on knowledge of WPV among pre-nursing students at a Midwestern university. This study used a pre-and post-tests, quasi-experimental design with 99 students. A brief knowledge test was completed by participants both before and after the intervention. Pre- and post-test scores were collected across sections. Analysis of paired sample t-tests demonstrated a 20% average increase in post-test scores with a statistically significant increase from pre-test scores (t=-11.357, p<0.001). Results indicated that the innovative, virtual simulation module increased participants’ knowledge of workplace violence in healthcare. Increased knowledge of and preparation for the WPV workplace would strengthen students’ safety readiness for practice with the persistence of WPV against nurses. Prevention and response of WPV education must be an essential component of every undergraduate nursing program following licensure.

Workplace Violence in Healthcare: Effects and Preventive Measures and Strategies

Workplace Violence in Healthcare: Effects and Preventive Measures and Strategies

The prevalence of harassment of diagnostic radiography and radiation therapy students whilst on clinical placement in the Republic of Ireland

Objective To determine if student radiographers and radiation therapists experience harassment (verbal, physical or sexual) while on clinical placement and their awareness of policies in place to report such incidents. Methods An online questionnaire developed from the World Health Organisation’s questionnaire on workplace violence in healthcare and the higher education authority (HEA) national survey of student experiences of sexual violence and harassment in Irish HEIs was used. Undergraduate and postgraduate diagnostic radiography and radiation therapy students in the Republic of Ireland to be included and have completed a minimum of four weeks of clinical placement. Our of 256 students, 98 filled out the survey. Results Forty-one per cent (n = 40) of students reported experiencing at least one incident of harassment. Thirteen per cent reported experiencing two forms of harassment, and 2 students reported experiencing verbal, physical and sexual harassment. Verbal harassment (n = 33) and sexual (n = 16) were the most common form of harassment while physical harassment was experienced 7 participants. Ninety-one per cent (n = 88) of participants reported they don’t believe they have received sufficient training in dealing with incidents of physical, verbal or sexual harassment. Conclusion Harassment of student radiographers and radiation therapists is occurring while on placement. Male patients are the modal perpetrator, and most incidents go unreported. Students are not empowered to report an incident of harassment and are sometimes unaware of how to report harassment.

Addressing Workplace Violence With Evidence.

The purpose of this article is to describe how regional community assessment survey data specific to healthcare workers' (HCWs') attitudes and actions related to workplace violence (WPV) from 1 participating urban tertiary hospital was compared with current evidence to identify evidence-based interventions to promote a safer work environment. The regional survey assessed real-time data regarding the state of WPV and its impact on HCWs, and to drive proposed interventions to prevent and reduce WPV in the healthcare community. Incidents of WPV in healthcare continue to increase, resulting in calls for action from staff, leadership, and regulatory organizations. Data were collected from the HCWs who completed the survey. Experiences with WPV were analyzed. Qualitative data were evaluated for themes. A review of external evidence was conducted to identify best practices in preparing proposed next steps for the organization. Healthcare worker attitudes and practices related to WPV were described as unreported and not addressed. Violence was more readily perceived as a part of the job. External evidence indicated that education and training alone seemed to have minimal effect on preventing WPV. Evidence from best practices and staff feedback were recommended to be incorporated into plans for the organization.

Assessing the pharmacy workforce's preparedness for a workplace violence event.

The purpose of this article is to describe the planning, implementation, and findings of a "person with a weapon" exercise for an inpatient pharmacy department. There has been an increased focus on workplace violence in healthcare within the last few years. The health-system pharmacy workforce should take an active role in planning for workplace violence events by completing a risk assessment analysis and performing tabletop and functional exercises. This study provides an example of how health-system pharmacists collaborated with an emergency management team, security, and communications to carry out a person with a weapon exercise in an inpatient hospital pharmacy. Areas for improvement were identified for pharmacy, communications, and security during education sessions and the tabletop and functional exercises, demonstrating the importance of a multidisciplinary approach when planning for a person with a weapon event. As a result of this exercise, there was increased awareness of the "run, hide, fight" tactic, an increase in workplace violence education and staff awareness, and an enhancement of security measures, including technology improvements. This workplace violence exercise provides an example of how the pharmacy workforce can engage in emergency preparedness planning and risk mitigation for a workplace violence event. Other health systems can use the action plan, findings, and improvements to raise awareness and train about workplace violence events and support the safety of the pharmacy workforce.

Workplace Violence in Healthcare Service

Violence in the workplace is an act or threat of violence against workers, both inside and outside the workplace, ranging from insults, threats, intimidation, and physical assault to murder. Although violence in the workplace has become a global concern, the true extent of this problem is still underreported due to low awareness and lack of awareness of the issues within the body. Therefore, if violence in the workplace is not addressed, especially in the health sector, it will become a global phenomenon that will disrupt the peace and stability of the working community and pose a risk to the health and welfare of society. Therefore, this review aims to identify the risk factors and impacts of workplace violence in health care and demonstrate the collaborative efforts needed to support managing and preventing violence in the workplace. Keywords: Violence, workplace, Healthcare worker.

Workplace Violence Against Nurses in Canada: A Legal Analysis.

Workplace violence against nurses is a significant global occupational health problem, with incidents of violence increasing in frequency since the COVID-19 pandemic began. In this article, we provide a review of recent legislative amendments meant to bolster workplace safety in health care in Canada, analyze legal cases where nurses were the victims of violence, and discuss what these legal reforms and decisions reveal about how nurses' work is treated within the Canadian legal system. Under criminal law, the limited number of cases we could find with oral or written sentencing decisions show that, historically, the fact a victim was a nurse was not always considered an aggravating factor on sentencing. Recent legislative amendments make this a specified aggravating factor and it is important to track the impact of these amendments when judges exercise their discretion in sentencing. Under employment law, it appears that, despite the government's efforts to increase the deterrence factor under legislation with significantly increased fines for employers who fail to protect their employees from injury, courts remain reluctant to impose such sanctions. In these cases, it is also important to track the impact of harsher penalties. We conclude that combating the widespread normalization of workplace violence in health care, and specifically against nurses, is acutely needed to help ensure that these ongoing legal reforms aimed at improving the safety of health workers are effective.

Identifying Type II workplace violence from clinical notes using natural language processing.

Type II workplace violence in health care, perpetrated by patients/clients toward home healthcare nurses, is a serious health and safety issue. A significant portion of violent incidents are not officially reported. Natural language processing can detect these "hidden cases" from clinical notes. In this study, we computed the 12-month prevalence of Type II workplace violence from home healthcare nurses' clinical notes by developing and utilizing a natural language processing system. Nearly 600,000 clinical visit notes from two large U.S.-based home healthcare agencies were analyzed. The notes were recorded from January 1, 2019 to December 31, 2019. Rule- and machine-learning-based natural language processing algorithms were applied to identify clinical notes containing workplace violence descriptions. The natural language processing algorithms identified 236 clinical notes that included Type II workplace violence toward home healthcare nurses. The prevalence of physical violence was 0.067 incidents per 10,000 home visits. The prevalence of nonphysical violence was 3.76 incidents per 10,000 home visits. The prevalence of any violence was four incidents per 10,000 home visits. In comparison, no Type II workplace violence incidents were recorded in the official incident report systems of the two agencies in this same time period. Natural language processing can be an effective tool to augment formal reporting by capturing violence incidents from daily, ongoing, large volumes of clinical notes. It can enable managers and clinicians to stay informed of potential violence risks and keep their practice environment safe.

Nurses’ rationale for underreporting of patient and visitor perpetrated workplace violence: a systematic review

BackgroundPatient and visitor perpetrated workplace violence (WPV) is a problem within healthcare and is known to be underreported by nurses and other healthcare workers. However, there are multiple and diverse reasons identified in the literature as to why nurses do not report. This systematic review aimed to investigate nurses’ reasons and rationale related to underreporting of violence that occurs in the workplace.MethodsFollowing PRISMA guidelines for systematic review reporting, studies conducted between 2011 and early 2022 were identified from MEDLINE, CINAHL, APA PsychInfo, and Psychological and Behavioral Sciences Collection via EBSCOHost. Quantitative studies related to patient and visitor perpetrated violence containing explanations, reasons, or rationale related to underreporting were included.ResultsAfter quality appraisals, 19 studies representing 16 countries were included. The resulting categories identified nursing, management, and organizational factors. The most prominent nursing factors included nurses’ fear of consequences after reporting, nurses’ perceptions, and their lack of knowledge about the reporting process. Common management factors which contributed to nursing underreporting included lack of visible changes after reporting, non-supportive culture in which to report, and the lack of penalties for perpetrators. Organizational factors included the lack of policies/procedures/training for WPV, as well as a lack of an efficient and user-friendly reporting system. Supportive interventions from management, organizations, and community sources were summarized to provide insight to improve nurse reporting of WPV events.ConclusionUnderreporting of WPV is a complex and multi-faceted problem. An investigation into the rationale for underreporting a workplace violent event illustrates nurses, management, and organizations contribute to the problem. Clear and actionable interventions such as educational support for staff and the development of a clear and concise reporting processes are recommended to encourage staff reporting and to help address WPV in healthcare.

Exploring verbal and physical workplace violence in a large, urban emergency department

BackgroundViolence directed at healthcare workers (HCWs) is common and may be more frequent in the emergency department (ED). In addition to physical injury, other consequences of workplace violence in the ED include an increased risk of burnout, post-traumatic stress disorder, reduced job satisfaction, and feelings of avoidance and futility. Understanding behaviors underlying workplace violence is the first step to employing mitigation strategies. The objective of this descriptive study was to assess the prevalence and types of violence against HCWs in a large, urban ED. MethodsThis study took place in the ED of an urban hospital with an annual ED census of approximately 100,000. A previously existing general patient safety incident “dropbox” for HCWs was utilized to capture workplace violence reports. At the completion of the study period, all data was collated into the electronic database and each report was categorized based on the nature and severity of the abuse. Further, all events were also coded as either involving or not involving specifically racist, sexist, or homophobic content. The primary outcomes were the number of reported events over the study period, and the percentage of total events that fell into each category. The secondary outcomes were the overall prevalence and ratio of events that included racist, sexist, or homophobic language or provocation. ResultsOver the 5-month survey period, 130 reports of workplace violence were recorded, on average 0.85 per day. Perpetrators were mostly male, and most victims were nurses. Hospital security was involved in 26% of cases. At least 37% of incidents involved patients that were intoxicated and/or had history of psychiatric illness. Type I events (swearing provocatively, shouting, and legal threats) were the most common at 44% of encounters while 22% involved physical violence. Racist, sexist, and homophobic comments were involved in 8 (6%), 18 (14%), and 3 (2%) incidents respectively. ConclusionWe found that workplace violence against HCWs was common in this study, and sometimes involved a component of racist, sexist, or homophobic bias. Consistent with previous ED literature, we found that abusive events occurred almost daily and that approximately 20% of events involved physical violence. Future efforts toward policy change to address workplace violence in health care is needed at local, state, and national levels.

Keeping Healthcare Workers Safe Through Policy Initiatives

Keeping Healthcare Workers Safe Through Policy Initiatives

Narrative Research on Understanding Workplace Violence in Healthcare: Insights from Healthcare Professionals

Background: Narrative research provides a unique and insightful approach to understanding personal experiences and narratives. This interviewing method allows participants ample time and scope to reflect upon their stories, enabling a deeper examination of the transformative elements within their narratives. We conducted narrative interviews in the form of a survey among healthcare professionals, focusing on the pressing issue of workplace violence (WPV). Our primary aim was to emphasize the significance and effectiveness of narrative interviews, especially when dealing with sensitive topics. Methodology: A multicentric, cross-sectional study was conducted across India, using narrative interviews with healthcare professionals for a period of three months of duration (July 2022 to September 2022). An interview guide was designed and validated, and narrative interviews were conducted in a hybrid mode. The transcribed interviews were subjected to narrative analysis. Results: Thirty-one healthcare professionals participated in the study, all of whom had either witnessed or experienced WPV. The participants identified inadequate communication, high patient-doctor ratio, and inadequate security measures as the primary factors contributing to WPV. These incidents result in adverse psychological effects and a decrease in work performance in healthcare providers. The participants expressed the importance of increasing awareness about the prevalence and detrimental effects of WPV, as well as the need to implement effective strategies to prevent and address it through narrative research. Conclusion: Narrative research is a powerful tool to understand the in-depth feelings and perceptions of people on sensitive topics. In this study, healthcare professionals perceived WPV as an important area of concern in clinical practice. Poor communication skills and, a high patient-doctor ratio were the key causes.

Workplace violence and its associated factors among nurses working in public hospitals of eastern Ethiopia: a cross-sectional study

BackgroundWorkplace violence is one of the global health concerns. Although nurses are the backbone of the health care provision, they are highly subjected to workplace violence in healthcare. Nevertheless, there is a paucity of evidence on the extent of workplace violence against nurses in Ethiopia in general and Eastern Ethiopia in particular. Hence, this study aimed to assess the extent of workplace violence against nurses and its associated factors among nurse professionals working at public hospitals in eastern Ethiopia.MethodsHospital-based cross-sectional study was conducted among 603 nurses working in public hospitals in eastern Ethiopia. Nurses were recruited using a simple random sampling method at their workplace (health facilities). A pretested self-administered questionnaire was used to collect data. Descriptive, binary and multivariable logistic regression analyses were performed. The adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to declare significant association.ResultsAmong the 620 estimated sample, 603(97.3%) of the nurses gave consent and completed the self-administered questionnaire. The prevalence of workplace violence against nurse professionals in the last 12 months was 64.0% (95%CI: 60.2–67.7%). Nurses who were working in surgical (AOR: 2.30, 95%CI: 1.01–5.26), psychiatric (AOR: 3.06, 95%CI: 1.11–8.46), emergency (AOR: 3.62, 95%CI: 1.46–8.98), and medical wards (AOR: 5.20, 95%CI: 2.40–11.27); being worried of workplace violence (AOR: 1.71, 95%CI: 1.09–2.69); witnessed of physical workplace violence (AOR: 5.31, 95%CI: 3.28–8.59); claimed “absence/not-aware” of reporting procedure on workplace violence (AOR: 2.24, 95%CI: 1.45–3.46); and claimed “absence/not-aware” of institutional policies against workplace violence (AOR: 2.68, 95%CI: 1.73–4.13) were factors associated with nurses’ experience of workplace violence in eastern Ethiopia.ConclusionsWorkplace violence against nurses was found to be unacceptably high in the study area (eastern Ethiopia). We suggest that stakeholders could work on early risk identification and management of violent incidents, establish violence reporting and sanction mechanisms using contextual strategies to prevent workplace violence against nurse professionals.

Healthcare Workplace Violence: Hurting Those Who Try to Help.

Healthcare Workplace Violence: Hurting Those Who Try to Help.

Profiles of lateral violence in nursing personnel of the Spanish public health system.

BackgroundWorkplace violence in healthcare settings has long been studied in scientific literature, particularly in the nursing profession. Research has explored mostly user violence probably for its high prevalence and impact on health and job satisfaction. Yet this focus may overshadow another dangerous type of workplace violence: coworker violence. Exerted by co-workers with similar status, lateral violence differs from that yielded by a co-worker with a higher rank, known as vertical. This study aims to deepen the knowledge about lateral violence perceived by nurses and its interaction with other variables commonly associated with workplace violence in healthcare: burnout, job satisfaction, and self-perceived health.MethodA random block sampling was performed, prompting a total sample of 925 nursing professionals from 13 public hospitals located in the southeast of Spain. The sample distribution (mean and standard deviation) and the response percentages according to the study variables of the ad-hoc questionnaire were analyzed and classified with cluster analysis.ResultsThrough the cluster analysis, two subgroups were obtained: Cluster 1, composed of 779 participants, with low scores in the variables used for the classification, high levels of both extrinsic and intrinsic satisfaction, low levels of emotional exhaustion and cynicism, and low rates of somatization, anxiety, social dysfunction and depression; and Cluster 2, composed of 115 participants and characterized by moderate-high scores in the variables used for the classification, moderate extrinsic satisfaction, and low intrinsic satisfaction, high emotional exhaustion and cynicism and lower somatization, anxiety, social dysfunction, and depression scores. Excluded cases amounted to 31.ConclusionNursing professionals who experience lateral violence reveal a lower intrinsic satisfaction, feeling less self-accomplished in their job, and less positive work experience. Emotional exhaustion rises as a concerning progressive and long-term outcome of experiencing this type of violence.

Working intentions of medical students in response to healthcare workplace violence and descending resources reform in China

BackgroundIn order to curb healthcare workplace violence (WPV) and better allocate healthcare resources, China launched the descending resources reform in 2013 and tightened the anti-violence legal environment simultaneously. Medical students are expected to reconsider their working intentions of entering the medical market (inter-market effect) and choosing high- or low-level hospitals (intra-market effect) in response to the evolving WPV. The goal of this study was to explore the link between the perceived WPV incidence and medical students’ willingness to practice medicine in the context of China’s descending resources reform.MethodMedical students were selected with cluster sampling from 8 medical colleges in Zhejiang Province, China, and 1497 valid questionnaires were collected by using a five-point unbalanced scale, to perform cross-sectional empirical research using the ordered logit model (OLM).ResultsThe perceived WPV incidence negatively correlate with the willingness of medical students to practice medicine but positively correlate with their willingness to practice in low-level hospitals, indicating the existence of inter- and intra-market effects. The anti-violence legal environment has no direct link with working intention but contributes to the perceived decline in the incidence of violence. Descending resources reform has simultaneous opposite effects on medical students, with the coexistence of prudent motives driven by reform costs and optimistic expectations of sharing external benefits.ConclusionsSafety needs and risk aversion motive play an important role in medical students’ career choice when facing severe WPV. Tightening of the anti-violence legal environment and the descending resources reform could drive medical students to low-level hospitals.

Improving Policy and Legislation Related to Healthcare Workplace Violence

Abstract Our group conducted the first known New Hampshire survey on healthcare staff experience of workplace violence. Study questions focused on experiences of workplace violence, incident reporting mechanisms, and the availability and benefit of workplace violence training programs. Results were consistent with recently published literature: violence against healthcare workers remains a serious public health problem that is under-reported, understudied, “tolerated and largely ignored.” We will discuss the aspects of policy and legislative responses to workplace violence that have been insufficient to address this problem. We also will present some strategies that, if implemented, could lead to improved policy and legislation that may be more proactive in reducing such violence.

The public's mixed emotional responses to violence directed at nurses: A mixed methods study.

To understand whether exposure to an incident of violence directed at nurses, evoke among the public a sense of identification with the victim or with the perpetrator. Worldwide, evidence regarding workplace violence (WPV) in healthcare systems, explored the characteristics of the perpetrator, the healthcare settings and staff. Nevertheless, no studies examine the emotions of the public towards WPV in the healthcare systems. A convergent mixed method parallel design. A structured questionnaire was distributed among 925 adults. Two scenarios were presented, with verbal and physical violence towards nurses. The participants rated how intensely they felt positive and negative emotions regarding the nurse and the perpetrator (quantitative stage). Sixty participants were also interviewed concerning their emotions regarding violence committed towards nurses (qualitative stage). Paired samples t-test were used to compare the emotions that were aroused regarding the perpetrator and the nurse. The effect size and Bonferroni correction for multiple comparisons were calculated. Constant comparative analysis method was used to analyzed the qualitative data. The STROBE checklist for cross-sectional studies and the COREQ guidelines for qualitative studies were used for reporting. Positive emotions were significantly higher towards the nurse than the perpetrator. Nevertheless, there were both positive and negative emotions towards the perpetrator and the nurse. The qualitative findings yielded two themes: (1) Mixed emotions towards the perpetrator, and (2) Mixed emotions towards the nurse. The public may emotionally identify with both the nurse and the perpetrator while positive and negative emotions are intertwined. Likewise, positive emotions are more intensely felt for the victims in both verbally and physically violent scenarios. These complemented findings highlight the need for campaigns promoting positive emotions toward healthcare professionals in an attempt to reduce and eliminate WPV in healthcare.