Patient Mistreatment Research Articles

Patient mistreatment, emotional exhaustion and work-family conflict among nurses: a moderated mediation model of social sharing of negative work events and perceived organizational support

BackgroundNursing literature suggested that patient mistreatment has significant impacts on nurses’ emotions and job burnout. Yet, further research is needed to understand the underlying mechanism and the spillover effect on nurses’ families. Leveraging the goal progress theory, this study aimed to examine the association between patient mistreatment, nurses’ emotional exhaustion, and work-family conflict, as well as the mediating role of social sharing of negative work events and the moderating role of perceived organizational support.MethodsDuring the COVID-19 pandemic in China, a cross-sectional study was conducted with a sample of 1627 nurses from the Hematology Specialist Alliance of Chongqing from October to November 2022. Questionnaires were administered to measure patient mistreatment, perceived organizational support, social sharing of negative work events, emotional exhaustion, and work-family conflict. Hierarchical linear regression and conditional processes were used for statistical analyses.ResultsPatient mistreatment was positively associated with emotional exhaustion (β = 0.354, p < 0.001) and work-family conflict (β = 0.314, p < 0.001). Social sharing of negative work events played a partial mediating role in the relationship between patient mistreatment and emotional exhaustion (effect = 0.067, SE = 0.013), and work-family conflict (effect = 0.077, SE = 0.014). Moderated mediation analysis found that the mediation effect was stronger when the perceived organizational support was high.ConclusionOur findings reveal the amplifying effect of social sharing of negative work events on nurses’ emotional exhaustion and work-family conflict. Perceived organizational support strengthens the positive effect of patient mistreatment on the social sharing of negative work events, thus resulting in increased emotional exhaustion and work-family conflict. We also discuss practical implications, limitations, and directions for future research.

Patient mistreatment, social sharing of negative events and emotional exhaustion among Chinese nurses: the combined moderating effect of organizational support and trait resilience

BackgroundAs a primary form of work-related violence in the healthcare sector, patient mistreatment negatively impacts nurses’ well-being. To date, there has yet reached a definitive conclusion on the mediating mechanism and boundary conditions behind the influence of patient mistreatment on nurses’ emotional exhaustion.MethodsThis study employed a convenience sampling method to recruit a sample of 1672 nurses from public hospitals in Western China. The data were collected through anonymous self-report questionnaires and analyzed using hierarchical regression and conditional processes to investigate a theoretical framework encompassing patient mistreatment, emotional exhaustion, social sharing of negative events, organizational support, and trait resilience.ResultsPatient mistreatment led to emotional exhaustion among nurses (β = 0.625, p <.001), and social sharing of negative events mediated this positive relationship (effect = 0.073, SE = 0.013). The combined effects of organizational support and resilience moderated the mediating effect of the social sharing of negative events between patient mistreatment and emotional exhaustion (β=-0.051, p <.05). Specifically, nurses with a high level of resilience would benefit from organizational support to alleviate emotional exhaustion caused by patient mistreatment.ConclusionsThis study validated a significant positive association between patient mistreatment and emotional exhaustion, which aligns with previous research findings. Integrating conservation of resources theory and goal progress theory, we addressed previous contradictory findings on the impact of social sharing of negative events on emotional exhaustion. Social sharing of negative events served as a mediator between patient mistreatment and emotional exhaustion. Additionally, the moderating effect of organizational support on the relationship between social sharing of negative events and emotional exhaustion depended on individual trait of resilience.

Adopting a Novel Approach to Prevent and Address Patient Mistreatment of Staff in a Community Mental Health Center.

Verbal mistreatment of staff by patients is common in health care settings. Experiencing or witnessing mistreatment can have harmful psychological impacts, affecting well-being and clinical practice. As part of an effort to become an antiracist organization, an academic community mental health center based in Connecticut developed an initiative to address verbal mistreatment. Training in the Expect, Recognize, Address, Support, Establish (ERASE) framework was provided to 140 staff members. This training and subsequent actions to enhance the culture of safety were perceived as helpful by staff. Further development of the initiative is proceeding as the center's primary performance improvement program.

Patient mistreatment and new nurse adjustment: The role of rumination and work engagement

During organizational entry, newcomers often draw upon internal resources like coworkers and supervisors to navigate their roles. Could external interactions with customers or patients hold the key to newcomer adjustment in certain job contexts? Our study, rooted in the conservation of resources theory, identifies a critical link between mistreatment from external parties and newcomer adjustment—a connection that is explained by rumination and work engagement. Through two studies involving new nurses in China (Study 1: four-wave cross-lagged panel design, N = 181; Study 2: four-wave time-lagged design, N = 198), we uncover that mistreatment from patients results in rumination among newcomers, leading to diminished task mastery and role clarity, as mediated by reduced work engagement. This ripple effect of external mistreatment persists even when accounting for internal mistreatment (abusive supervision and coworker incivility). Our results illustrate how negative interactions with external entities can hinder newcomer adjustment—a revelation with far-reaching implications for practitioners and future research.1

The impacts of patient mistreatment on healthcare workers’ role behaviors: a study in Chinese Fangcang shelter hospitals

BackgroundFangcang shelter hospitals have played an important role in the battle against the COVID-19 epidemic in China. Patients’ verbal and physical attacks on medical workforce are prone to occur in such hospitals. This study explored the impacts of patient mistreatment on healthcare workers’ role behaviors (service performance and patient-oriented organizational citizenship behavior).MethodsWe examined the influence of patient mistreatment on service performance and patient-oriented organizational citizenship behavior, as well as the mediating effect of emotional exhaustion and the moderating effect of displaced aggression by patients, using hierarchical linear regression and conditional process analysis.ResultsPatient mistreatment was positively associated with emotional exhaustion among healthcare workers, while emotional exhaustion was negatively associated with service performance and patient-oriented organizational citizenship behavior. Mediation analysis revealed that emotional exhaustion mediated the association between patient mistreatment and both types of role behaviors. Moderated mediation analysis found that the mediation effect was weaker when the displaced aggression by patients was high.ConclusionsThe findings clarified the relationship among patient mistreatment, emotional exhaustion, service performance, and patient-oriented organizational citizenship behavior. Additional assistance should be provided to healthcare workers dealing with patient mistreatment. Displaced aggression by patients attenuates the positive effects of patient mistreatment on the emotional exhaustion of healthcare workers. Our findings reveal the mechanism and boundary conditions of patient mistreatment affecting healthcare workers' service performance and patient-oriented organizational citizenship behavior.

Exploring Mistreatment of Medical Students by Patients: A Qualitative Study.

Mistreatment of medical students by patients has not been qualitatively explored in the literature. The authors sought to develop a rich understanding of the impact and consequences of medical students' experiences of mistreatment by patients. This exploratory descriptive qualitative study was conducted at a large Canadian medical school from April-November 2020. Fourteen medical students were recruited for semistructured interviews. Students were asked about their experiences of mistreatment by patients and how they responded to these experiences. Transcripts were thematically analyzed using an inductive approach, and the authors interwove critical theory into their conceptual interpretation of the data. Fourteen medical students (median age = 25.5; 10, 71.4% self-reported male; 12, 85.7% self-identified visible minority) participated in this study. Twelve (85.7%) participants had personally experienced patient mistreatment and 2 (14.3%) had witnessed mistreatment of another learner. Medical students described being mistreated by patients based on their gender and race/ethnicity. Although all participants were aware of the institution's official mechanism for reporting mistreatment, none filed an official report. Some participants described turning to their formal (faculty members and residents) and informal (family and friends) social supports to cope with mistreatment by patients. Participants described resenting and avoiding patients who mistreated them and struggling to maintain empathy for, openness to, and overall ethical engagement with discriminatory patients. Students often described a need to be stoic toward their experiences of mistreatment by patients, often seeing it as their "professional duty" to overcome and thus suppress the negative emotions associated with mistreatment. Medical schools must proactively develop multifaceted mechanisms to support medical students who experience mistreatment by patients. Future research can further uncover this neglected dimension of the hidden curriculum to better develop responses to incidents of mistreatment that commit to antiracism, antisexism, patient care, and learner care.

"There's not enough studies": Views of black breast and ovarian cancer patients on research participation.

Black breast and ovarian cancer patients are underrepresented in clinical cancer trials disproportionate to the prevalence of these cancers in Black females. Historically, lower enrollment has been attributed to individualized factors, including medical mistrust, but more recently structural factors, including systemic racism, have received additional scrutiny. We interviewed Black women with a personal or family history of breast and ovarian cancer to understand their views and experiences related to research participation. Qualitative interviews were conducted via telephone or video conference and transcribed verbatim. Transcripts were qualitatively analyzed for iterative themes related to the offer and participation in cancer clinical trials and research studies, impact on cancer care, and recommendations to increase enrollment of Black patients. Sixty-one Black women completed an interview. Participants expressed that Black women are underrepresented in cancer research, and that this negatively impacted their own care. Many cited past historical abuses, including the Tuskegee syphilis trial, as a potential factor for lower enrollment but suggested that lower enrollment was better understood in the context of the entirety of their healthcare experiences, including present-day examples of patient mistreatment or dismissal. Participants suggested that proactive community engagement, transparency, and increased representation of Black research team members were strategies likely to foster trust and bolster research participation. Medical mistrust is only a partial factor in the lower participation of Black patients in cancer research. Researchers should implement the strategies identified by our participants to promote diverse enrollment and ensure that Black patients are included in future therapeutic advances.

How Does Customer Mistreatment Lead to Employee Retaliation? From The Lens of Self-Threat

Customer mistreatment is a serious issue faced by employees and significantly undermines their service behaviors. Previous studies have identified two mechanisms underlying the negative effects of customer mistreatment—by generating negative emotions and injustice perceptions. In this paper, we advance a new mechanism and argue that customer mistreatment engenders a threat for how employees feel about themselves—defined as self-threat—which further undermines their customer-oriented behaviors and leads to sabotage against customers. With an online experiment, we show that self-threat mediates the effect of customer mistreatment on reduced customer-oriented behaviors and increased customer-directed sabotage, especially for those whose self-worth is contingent on their workplace performance. A field experiment with medical professionals further shows that self-affirmation intervention attenuated the effect of patient mistreatment on medical professionals’ self-threat and further decreased their sabotage against patients. This paper contributes to research of customer mistreatment by illuminating a new mechanism, highlighting the risk group impacted by customer mistreatment and suggesting a new way to alleviate negative impacts of customer mistreatment.

Patient mistreatment of health care professionals

BackgroundMistreatment of health care professionals by patients is an ongoing problem. We aimed to construct and evaluate a curriculum that would prepare health care professionals for mistreatment by patients.MethodsLessons learned from 15 interviews and 2 focus groups with health care professionals were distilled into a multi-modal curriculum including didactics, simulation videos and role-play scenarios aimed to improve confidence in addressing mistreatment. This curriculum was disseminated at five educational workshops to health care professionals of various training groups and experience levels. Pre- and post-surveys were distributed to assess changes in participant’s perspectives on readiness to address mistreatment. The signed-rank test was implemented to compare pre- and post- data.ResultsParticipants were more likely to agree post-workshop that they had the right words to say, had a plan for what to do, and were more willing to speak up when they themselves or someone else was mistreated (p < .001). They were also more likely to agree post-workshop that there was something they could do to address patient mistreatment (p < .001).ConclusionsParticipant familiarity and confidence in responding to patient mistreatment increased. Our curriculum may serve as a foundation for institutions seeking to equip their educators, health care professionals, and trainees with strategies for addressing this important issue.

When does witnessing patient mistreatment hurt nurses' performance? Gauging the moderation roles of self-concern and other-orientation

PurposeResearch has found that the effects of directly experiencing mistreatment at work are consistently negative; however, results from studies examining employees' reactions to witnessing mistreatment are less consistent. This study focuses on nurses witnessing patient mistreatment in order to examine how third parties respond when witnessing patients mistreating co-workers. We argue that nurses high on other-orientation are less likely to experience emotion exhaustion in the face of witnessing patient mistreatment, whereas nurses high on self-concern are more likely to experience emotional exhaustion. We further argue that the indirect effect of witnessing patient mistreatment on job performance through emotional exhaustion is moderated by other-orientation and self-concern.Design/methodology/approachWe used data collected at two time points, with six months apart, from 287 nurses working in a hospital. The study tests the hypotheses by using multiple regression analyses.FindingsEmotional exhaustion mediated the relationships between witnessing patient mistreatment and two forms of job performance: patient care behaviors and counterproductive work behaviors. Furthermore, other-orientation moderated these indirect relationships such that the indirect relationships were weaker when other-orientation was high (vs. low). Self-concern did not moderate these relationships.Practical implicationsService and care-oriented businesses may protect their employees from the risk of burnout by promoting prosocial orientation among their patient and customer-facing employees.Originality/valueThis study contributes to the literature by demonstrating the detrimental effects of witnessing patient mistreatment on nurses' performance. It also extends the current understanding of why and when witnessing patient mistreatment is related to performance by demonstrating the joint effects of witnessing patient mistreatment and an individual difference construct, other-orientation on employees' performance.

Protecting Nurses from Mistreatment by Patients: A Cross-Sectional Study on the Roles of Emotional Contagion Susceptibility and Emotional Regulation Ability.

In recent years, patient mistreatment of healthcare workers, especially nurses, has been frequent, endangering the interests of organizations while also threatening nurses’ own development. This study aims to examine from the perspective of nurses’ personal interests whether mistreatment by patients decreases nurses’ workplace well-being and career commitment, and how their susceptibility to emotional contagion and emotional regulation ability might mitigate these negative effects. This study adopted a cross-sectional study design (data were collected through self-reported questionnaires with a two-month time lag between the months of August–October 2017). A total of 289 nurses from three hospitals in Shandong province, China, were recruited to participate in our study. The results reveal that mistreatment by patients is negatively related to nurses’ workplace well-being and career commitment. Emotional contagion susceptibility moderates the relationships between mistreatment by patients and career commitment, while there is no significant buffering effect of mistreatment by patients on workplace well-being. Emotional regulation ability moderates the relationships between mistreatment by patients and both workplace well-being and career commitment. These results suggest that improvements in nurses’ emotional regulation ability and susceptibility to emotional contagion can alleviate the harmful impacts of mistreatment by patients.

ERASE-ing Patient Mistreatment of Trainees: Faculty Workshop.

Mistreatment of physicians by patients is a long-standing phenomenon that has garnered increased attention recently. Medical students and residents also experience mistreatment, and many supervising physicians do not know how to recognize it or respond appropriately. Little guidance exists as to how faculty should best address these situations. We developed, taught, and evaluated a stepwise approach to help faculty physicians manage patient mistreatment of trainees (residents and students). Our approach is summarized by the acronym ERASE: (1) Expect that mistreatment will occur. (2) Recognize episodes of mistreatment. (3) Address the situation in real time. (4) Support the learner after the event. (5) Establish/encourage a positive culture. We designed an interactive, case-based educator development session to teach ERASE and surveyed participants before and after to evaluate the session. Sixty-nine participants attended one of four workshops between November 2017 and January 2018. Nearly 80% of attendees reported having received no prior training in managing mistreatment of trainees by patients. Participants noted significant changes in their confidence in recognizing and responding to episodes of mistreatment after the session compared with just prior to it. ERASE fills an important void in medical education by introducing a novel, easy-to-understand approach that faculty can employ to manage mistreatment of trainees. We have continued to disseminate this model to faculty and residents in various departments around our medical center and at national conferences. This resource will allow educators to disseminate the ERASE model at their home institutions.

Missed opportunities in the way medical schools evaluate the ethical domain in clerkship rotations.

BackgroundSeveral lines of evidence indicate that medical schools have been failing to adequately nurture empathy and the ethical dimension in their graduates, the lack of which may play a central role in the genesis of medical errors, itself a major source of avoidable deaths, incapacity and wasted resources. It has been widely proposed that medical schools should adopt evaluation strategies as a means to promote a culture of respectful relationships. However, it is not clear if evaluation strategies in medical schools have addressed key domains related to that aim, such as ethics, through the perspective of their students. Hence, we conducted a national survey of instruments used by Brazilian medical schools to assess clerkship rotations from the perspective of students, with a main focus on the ethical domain.MethodsThe authors invited 121 randomly selected institutions to participate in the study. Key informants answered a questionnaire about clerkship rotations and sent copies of any instrument used to assess the quality of clerkship rotations according to the students’ perspectives.ResultsTwenty-six (53%) of 49 participating schools used an instrument to assess the quality of clerkship rotations according to the perspective of students. Just 13 (27%) schools had instruments containing at least one question encompassing the ethical domain. Only 2 (4%) schools asked students specifically about the occurrence of any negative experience concerning the ethical domain during rotations. Merely 1 (2%) school asked students about having witnessed patient mistreatment and none asked about mistreatment against students themselves.ConclusionsThere are several missed opportunities in the way medical schools assess the quality of clerkship rotations regarding the ethical domain. Closing the gap between usual institutional discourses regarding ethics and how that dimension is assessed within clerkship rotations might represent an important step towards the improvement of medical education and healthcare systems.

The Captive Lab Rat: Human Medical Experimentation in the Carceral State

Human medical experimentation using captive, vulnerable subjects is not a relic of our American past. It is part of our present. The extensive history of medical experimentation on the disabled, the poor, the mentally ill, and the incarcerated has been little explored. Its continuance has been even less discussed, especially in the legal literature. The standard narrative of human medical experimentation ends abruptly in the 1970’s, with the uncovering of the Tuskegee syphilis study. My research shows, however, that this narrative is incorrect and incomplete. The practice of experimenting on the captive and vulnerable persists, not just then but now. Our current approach to human medical experimentation disregards informed consent and privacy, allowing the pharmaceutical and medical industries to play an outsized role in shaping clinical research. The confusing amalgam of laws, rules and codes loosely governing such research almost entirely fail to regulate or prevent patient mistreatment and abuse. Acquiring a true understanding of our system of mass incarceration requires us to unearth the hidden contours of our current experiments on the poor, the disabled, and the confined, and calls for a wholesale revision of the flawed legal and medical regime overseeing human medical experimentation.

ERASE: a New Framework for Faculty to Manage Patient Mistreatment of Trainees.

ERASE: a New Framework for Faculty to Manage Patient Mistreatment of Trainees.

Alterations in the parameters of classic, global, and innovative assays of hemostasis caused by sample transportation via pneumatic tube system

BackgroundPneumatic tube system (PTS) is an integral part of large medical facilities providing rapid interconnection between units within the hospital and often used to transport blood samples. The aim of our study was to compare a wide variety of hemostasis assays to identify assays sensitive to this transport method and diagnostic relevance of the alterations. MethodsRoutine coagulation and platelet tests (APTT, PT, TT, fibrinogen, light transmission aggregometry (LTA) with ADP, collagen, ristomycin and epinephrine), whole blood flow cytometry platelet function test (levels of CD42b, CD61, CD62P, PAC1, annexin V binding and mepacrine release) and global coagulation tests (thromboelastography (TEG), thrombin generation (TGT), thrombodynamics (TD), thrombodynamics-4D (TD-4D)) were determined in PTS- and manually transported samples of 10 healthy volunteers. ResultsThere were no significant differences between the values of APTT, PT, TT or fibrinogen between the samples transported by PTS or manually. The results for LTA demonstrated increase in the collagen-induced aggregation (84 ± 7% versus 73 ± 5%), while the response to epinephrine was decreased (58 ± 20% versus 72 ± 7.4%). Flow cytometry-based platelet function test showed a pre-activation of platelets by PTS-transportation while all integral assays of coagulation tested in the present study (TEG, TGT, TD, TD-4D) demonstrated a hypercoagulation shift. ConclusionsTransportation by PTS caused significant shifts in parameters of functional and integral assays that exceeded parameter variation values and sometimes even were comparable to normal ranges. The results obtained in this study indicate that using of PTS for such assays may cause sufficient alterations of results and can lead to patient's mistreatment.

Measurement of patient mistreatment and its impact on job satisfaction of nurses

Objective To introduce the Patient Mistreatment Scale into the field of nursing research, and to explore the influence of patient mistreatment on job satisfaction. Methods A total of 573 nurses were investigated by using a questionnaire survey. Exploratory factor analysis and multiple linear hierarchical regression analysis were used for data analysis. Results The patient mistreatment scale included 16 items under two dimensions; the internal consistency coefficient of scale was 0.935; experiences of patient mistreatment of nurses had a significantly negative prediction on their job satisfaction (β=-0.482, P<0.01). Conclusions The patient mistreatment scale has a good reliability and validity, meanwhile, nurses suffering a high frequency of patient mistreatment will have more less level of job satisfaction. Key words: Nursing staff; Patient mistreatment; Scale; Job satisfaction

Legislating for advocacy: The case of whistleblowing.

The role of nurses as patient advocates is one which is well recognised, supported and the subject of a broad body of literature. One of the key impediments to the role of the nurse as patient advocate is the lack of support and legislative frameworks. Within a broad range of activities constituting advocacy, whistleblowing is currently the subject of much discussion in the light of the Mid Staffordshire inquiry in the United Kingdom (UK) and other instances of patient mistreatment. As a result steps to amend existing whistleblowing legislation where it exists or introduce it where it does not are underway. This paper traces the development of legislation for advocacy. The authors argue that while any legislation supporting advocacy is welcome, legislation on its own will not encourage or enable nurses to whistleblow.

Dentists and undergraduate dental students require more information relating to child abuse

OBJECTIVE: To evaluate the preparation for, and the appropriate approach of dentists to the diagnosis of patient mistreatment. METHOD: This investigation was conducted among sixty randomly selected dentistry students: twenty 1st year students, ten 5th year students at our institution, ten 5th year students at the Faculty of Dentistry, Lisbon University, sixteen dentists at the University Clinic of our institution, and four dentists with private offices. Students and dentists took part voluntarily. The exclusion criteria were (a) prior attendance of another degree, (b) cooperation with social organizations; and, for professionals, less than five years of experience. Data analysis was performed through descriptive and inferential statistics (chi-squared test) for a confidence level of 95%. RESULTS: Among dentists, 38% do not know which area of the organism is the most affected, 43% know it is proper to officially report the fact; out of these, 48% know that the information may be provided anonymously. There are 47% who state that they received no undergraduate training in this area. However, 60% of the students in the last year declare they did receive training. CONCLUSIONS: Dentists are not sufficiently familiar with the subject of child abuse. A regular approach to this matter in undergraduate education is important. It will be very useful to create a working tool unifying the criteria for screening, diagnosing, and registering such events.

Exposing poor care is for the greater good of all patients

Margaret Haywood, whose undercover film footage exposed patient mistreatment in an NHS hospital, has been cleared by the Nursing and Midwifery Council (NMC) of two misconduct charges (news December 3). A third charge will continue to be heard next year. It is a long drawn-out process.