'On the slope of an erupting volcano': A qualitative study on the workplace violence experiences of psychiatric nurses.

WHAT IS KNOWN ON THE SUBJECT?: Workplace violence is common in healthcare. Workplace violence remains a complex and serious occupational hazard in healthcare. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Since there is no study examining detailed explanations of experiences and perspectives of workplace violence among psychiatric nurses, this study will act as a guide for psychiatric nurses. This study provides information about how psychiatric nurses evaluate the concept of workplace violence from their perspective, what it means to them and the effects of workplace violence. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Considering the effects of workplace violence, a preventive, systematic and holistic approach should be used in psychiatry and community mental health centres. Supportive interventions should be used to improve the health and safety of psychiatric nurses and patients. ABSTRACT: INTRODUCTION: Workplace violence is common in healthcare and remains a complex and serious occupational hazard. AIM: This research was conducted to assess the workplace violence experiences and perspectives of psychiatric nurses. METHOD: This study was a qualitative study conducted using a grounded theory approach method. The study was conducted between November 2022 and January 2023. The purposeful sampling method was used, and 11 psychiatric nurses were interviewed. Data were collected with an information form and a semi-structured interview form. The data were analysed using content analysis, and themes were created. FINDINGS: The ages of the psychiatric nurses ranged from 38 to 57 years. Themes and sub-themes related to the workplace violence experiences and perspectives of psychiatric nurses included the way of violence (rising tension, eruption of the volcano, unintentional violence and turning to ash) and empowerment (ash cloud and ring of fire). CONCLUSION: Psychiatric nurses stated that they were exposed to verbal and physical violence for many reasons, that this situation seriously affected their physical, mental and social health and that in addition to the devastating effects of violence, they became stronger by developing various skills to protect against violence. IMPLICATIONS FOR PRACTICE: Supportive interventions should be used to improve the health and safety of psychiatric nurses and patients. Strategies can be developed to include psychiatric nurses in occupational health nursing courses.

Workplace violence in the Australian and New Zealand midwifery workforce: A scoping review.

AIM: The aim of the study is to identify and map what is known about workplace violence involving midwives in Australia and New Zealand. BACKGROUND: Research from the United Kingdom demonstrates that workplace violence within maternity services is a pervasive issue with significant and wide-ranging clinical, individual and organisational consequences. To date, little is known about this issue within Australian and New Zealand maternity services. EVALUATION: A scoping review, guided by Arksey and O'Malley's framework, was conducted. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. Just one identified study aimed to explore midwives' experiences of workplace violence. A further nine arrived at related results or themes. KEY ISSUES: Workplace violence is present in a variety of forms across maternity services in Australia and New Zealand. Its prevalence is, however, yet to be understood. Workplace violence causes physical and mental health issues for midwives, premature workforce attrition, and jeopardizes the quality and safety of maternity care. CONCLUSIONS: Workplace violence has been acknowledged as one of the key contributing factors towards premature attrition from the midwifery profession, with new graduate midwives most likely to leave. With the midwifery workforce ageing and evidence of serious clinical implications emerging, workplace violence needs urgent research and organisational attention. IMPLICATIONS FOR NURSING MANAGEMENT: Workplace violence is a key contributing factor towards recruitment and retention challenges for managers. To help tackle this, managers have a key role to play in identifying and effectively addressing workplace violence by acting as positive role models, taking a zero-tolerance approach and fostering collegial relationships. Managers, holding key clinical leadership positions, are pivotal to ensuring all complaints raised are handled with transparency and consistency regardless of one's position within the clinical hierarchy and organisational structure.

Understanding Australian female chiropractors' experiences of inappropriate patient sexual behaviour: a study using Interpretive Phenomenological Analysis.

INTRODUCTION: Female practitioners are often subjected to inappropriate patient sexual behaviour (IPSB). Adverse consequences of such sexual harassment include for the practitioner psychological stress effects and negative work-related consequences that contributes to career dissatisfaction and burnout. Confronting the issue within the healthcare context has been shown to be problematic because practitioners feel an obligation to protect the therapeutic relationship above their own personal discomfort. There is an absence of research on this topic with respect to female chiropractors and we proposed a qualitative study aimed to explore female chiropractors lived experiences of managing incidents of IPSB. METHOD: An Interpretive Phenomenological Analysis methodology was chosen for this study. In June and July of 2018 female chiropractors in Western Australian were recruited via Facebook sites and invited to participate in face-to-face interviews for an Honours degree study exploring the lived experience of IPSB. RESULTS: Participants were seven female chiropractors currently practicing in Western Australia, who had experienced an incident of IPSB. Four super-ordinate themes emerged from the analysis; (1) familiar but inarticulable, (2) the cost of conflict, (3) I'm used to it, and (4) the element of surprise. Overall, the participants recognised the incidents as inappropriate but chose to ignore the situation as a means to avoid conflict in the treatment room. Recommendations are made to better manage IPSB including greater patient awareness of appropriate behaviour, specific curriculum content and assertiveness training in undergraduate programs and continuing professional education, as well as the creation of ethical guidelines for patient behaviour by regulatory bodies. CONCLUSION: This is the first study to give a forum for female chiropractors to discuss their experiences of IPSB. The domain of private practice is not immune to incidents IPSB and although similar to day-to-day non-clinical life is nonetheless surprising and impactful.

Association Between Witnessing and Justifying Workplace Violence Towards Nurses in Israel.

BACKGROUND: Workplace violence perpetrated by patients and their families towards nurses has become a global problem. PURPOSE: The present study explores associations between individuals' having witnessed violent incidents in the past and holding attitudes justifying violence in the present, and their intention to behave violently in a nurse-patient interaction at a healthcare facility. DESIGN: A cross-sectional study sampled 1,350 participants from among the general public in Israel. METHODS: A self-administered questionnaire measured attitudes regarding violence towards nurses and confronted the participants with two vignettes eliciting verbal and physical violence towards nurses. Multiple logistic regression was conducted to explore the association between attitudes and intention to act violently. A mediation analysis (using the PROCESS macro) was conducted to explore the mediation factors. RESULTS: Over half of the participants witnessed an incident of verbal violence in health care and substantially fewer witnessed a physically violent event (51.5% and 16.1%, respectively). An attitude of highly justifying violence was found to be directly associated with the intention to act verbally and physically violent. Past witnessing of verbal or physical violence in healthcare settings had an indirect association through an attitude that justifies violence, which served as a mediating factor for the intention to act verbally and physically violent in a situation presented via the vignettes. CONCLUSIONS: Witnessing a violent event in healthcare systems has social consequences that may cause normalization of violence and lead to the intention to use verbal or even physical violence towards nurses. CLINICAL RELEVANCE: Nurses should be encouraged to report incidents of violence, while healthcare and judicial systems must address this issue seriously. It is recommended that systems alerting for risk indicators be applied, to identify patients with a potential for violence in healthcare facilities. Healthcare policymakers and workers must act to promote an environment of zero tolerance for violence in order to minimize such events. In order to prevent violence towards healthcare staff, a holistic multisystem approach should be implemented, involving a focus by sociocultural elements on social values and structures, as violence in healthcare reflects violence in society at large.

Midwifery students' experiences of bullying and workplace violence: A systematic review.

BACKGROUND: Workplace violence directed at registered midwives in the maternity setting has been a recognised issue since the early 1990s. More recently it has become evident that midwifery students are also victims of bullying and harassment whilst on clinical placement. Due to the short and long-term impacts this has on students, it is likely to have a detrimental effect on the future and sustainability of the midwifery profession. As a basis for designing a response, it is important to understand what is currently known about this phenomenon. AIM: To systematically review the literature to identify what is known about workplace violence and bullying experienced by midwifery students whilst on clinical placement. METHOD: Reporting of this review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search was undertaken of all primary research that focussed upon workplace violence and bullying involving midwifery students whilst on clinical placement, published between January 1990 and December 2019. Pre-defined terms were used to search the following five databases: CINAHL, Web of Science, MEDLINE, Embase, supplemented with Google Scholar. Additional manual searches of reference lists were conducted. An assessment of the quality of each eligible study was then undertaken using an appropriate mixed methods appraisal tool (MMAT). Extracted data were then synthesised using thematic synthesis. FINDINGS: Nine articles met the criteria for inclusion in the review. Studies were primarily qualitative, with some reporting descriptive statistics that do not enable key issues such as prevalence to be reliably addressed. The synthesis identified four main themes that related to workplace violence and bullying of midwifery students whilst on clinical placement. Results were clustered around the role of power in bullying, prevalence and impacts, the culture of compliance, and the victim's response. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: A broader understanding of the nature of workplace violence and bullying and how it manifests itself is beginning to emerge, but more and higher quality research is required to establish an empirical base on which to design interventions. Studies suggest that bullying is common and has significant impacts at both a personal and professional level.  This strongly reinforces a need for greater policy and organisational responses to bullying in the clinical education context, in order to break the bullying cycle and ensure the midwives of the future remain in the profession and sustain the workforce.

The Effects of Biofeedback Training and Smartphone-Delivered Biofeedback Training on Resilience, Occupational Stress, and Depressive Symptoms among Abused Psychiatric Nurses.

Psychiatric ward (PW) nurses are at a higher risk to encounter workplace violence than are other healthcare providers, and many interventions have been developed to improve their mental health. We compared the effectiveness of biofeedback training (BT) and smartphone-delivered BT (SDBT) interventions on occupational stress, depressive symptoms, resilience, heart rate variability, and respiration rate in a sample of abused PW nurses. This was a quasi-experimental study. Structured questionnaires were administered before and six weeks after the intervention. Data were collected from April 2017 to October 2017. A total of 159 abused PW nurses were randomly assigned to BT, SDBT, and control groups, and 135 of them completed all processes of our protocol, with the study consisting of 119 females (88.1%) and 16 males (11.9%) and their age range being from 22 to 59 with the mean age of 35.61 and a standard deviation of 8.16. Compared to the controls, both the BT and the SDBT intervention groups experienced significant improvements in depressive symptoms, resilience, and respiration rate; and the SDBT group experienced significant reductions in occupational stress. Considering the cost, accessibility, restrictions time and space, SDBT be used as an effective intervention in people with resilience or occupational stress.

Sexual Trauma Screening for Men and Women: Examining the Construct Validity of a Two-Item Screen.

The Veterans Health Administration (VHA), the largest integrated healthcare system in the United States, has conducted universal screening for military sexual trauma (MST) to facilitate MST-related care since 2002. VHA defines MST as sexual assault or repeated, threatening sexual harassment that occurred during military service. Evidence of construct validity, the degree to which the screen is measuring what it purports to measure (i.e., MST), was examined using the 23-item Sexual Experiences Questionnaire-Department of Defense (SEQ-DoD). Results showed individuals who endorsed no SEQ-DoD items screened MST negative. Those who had experienced more SEQ-DoD behaviors with greater frequency, and across all four SEQ-DoD domains, were more likely to screen MST positive. Findings were similar for men and women. These findings contribute to the validity evidence for the VHA MST screen.

Violence at work: determinants & prevalence among health care workers, northwest Ethiopia: an institutional based cross sectional study

BACKGROUND: Workplace violence is the intentional use of power, threatened or actual, against another person or against a group, in work-related circumstances, that either results in or has a high degree of likelihood of resulting in injury, death, psychological harm, mal development, or deprivation. The aim of this study is to assess magnitude and predictors of workplace violence among healthcare workers in health facilities of Gondar city. METHODS: Institutional based cross sectional study design was employed to conduct this study. The study conducted in Gondar town from February 21 to march 21, 2016. Five hundred fifty three health care workers selected from health facilities of Gondar City administration. A stratified sampling technique was used for selecting the study subjects through simple random sampling. Data was collected by structured self administered questionnaire which is adapted from ILO/ICN/WHO/PSI after it is pretested & prepared in Amharic. The data was coded and entered in to EPI info version 7 and exported to SPSS version 20 software for analysis. The degree of association for variables was assessed using odds ratios with 95% confidence interval and p-value ≤0.05. RESULTS: The prevalence of workplace violence was found to be 58.2% with [95% confidence interval (CI): (53.7, 62.3)] in which verbal abuse 282(53.1%) followed by physical attack 117(22.0%) and 38(7.2%) sexual harassment. Working at emergency departments [AOR = 3.99,95% CI:(1.49,10.73)], working at shifts [AOR = 1.98,95%, CI: (1.28,3.03)],short experiences [AOR = 3.09,95% CI: (1.20,7.98)], being nurse or midwife [AOR = 4.06, 95% CI: (1.20,13.74)] were positively associated with workplace violence. The main sources of violence are visitors/patient relatives followed by colleagues and patients. CONCLUSION: workplace violence is major public health problem across health facilities and the Ministry of Health should incorporate interventions in its different health sector development & management safety initiative.

Midwifery student reactions to workplace violence.

PROBLEM: Workplace violence, incidents against people in their workplaces, is a growing problem in Australia causing untold personal suffering as well as costing Australian businesses in productivity. Midwives have been highlighted as a group particularly at risk, yet in Australia there is little research into workplace violence against midwives and even less into midwifery students. AIM: This study aimed to explore Australian midwifery students' responses to workplace violence as well as to gauge the impact of workplace violence on them. METHODS: Cross-sectional survey design was employed. Second and third year students were invited to participate at the end of a scheduled lecture. Fifty-two female midwifery students who had completed their work placement completed a survey indicating their immediate responses to workplace violence as well as the Impact of Event Scale. Data were analysed using descriptive statistics. FINDINGS: Most students notified a co-worker immediately after a workplace violence incident, yet few completed an incident form or received official debriefing. DISCUSSION: There is a need for the reporting of workplace violence against midwifery students to be made easier to access thereby ensuring they can receive the assistance they require. Midwifery students need to understand the processes and supports in place for managing instances of workplace violence. CONCLUSION: Clinical placements can impact on midwifery students' future careers. Universities need to prepare students for the possibility of workplace violence and arm them with appropriate strategies for safely dealing with it.

Paramedic and midwifery student exposure to workplace violence during clinical placements in Australia - A pilot study.

OBJECTIVES:   The objective of this pilot study was to identify the type of workplace violence experienced by undergraduate paramedic and midwifery students. METHODS: The study used a cross-sectional methodology with the self-administered paper-based Paramedic Workplace Violence Exposure Questionnaire to elicit undergraduate paramedic and midwife responses to workplace violence whilst on clinical placements. There were 393 students eligible for inclusion in the study. A convenience sample was used. The anonymous questionnaire took 10 to 20 minutes to complete. Descriptive statistics are used to summarise the data with a two-tailed t-test used to compare groups. RESULTS: The main form of workplace violence was verbal abuse 18% and intimidation 17%.  There was a statistically significant difference between midwifery and paramedic students for intimidation (t(134)=-3.143, CI: -0.367 to -0.082, p=0.002) and between females and males for sexual harassment (t(134)=2.029, CI: 0.001 to 0.074, p=0.045), all other results were not statistically different. CONCLUSIONS: This pilot study is the first of its kind in Australia and internationally to identify exposure rates of workplace violence by undergraduate paramedic students during clinical placements and one of very few to identify midwifery students' exposure rates of workplace violence. The study identified that students were exposed to a range of workplace violence acts from verbal abuse through to sexual harassment. These findings highlight a need for investigation of workplace violence exposure of medical, nursing and allied health students during the clinical phase of their studies.

Midwifery student exposure to workplace violence in clinical settings: An exploratory study.

Evidence indicates that nurses regularly experience bullying within the workplace which has the potential for health and social effects, as well as worker attrition. Literature suggests that nursing students are exposed to workplace violence during clinical placements including from health professionals and mentors, however little is known about midwifery students. This study sought to examine undergraduate midwifery students' experiences of workplace violence during clinical placements. A cross-sectional approach using a paper-based survey, the Paramedic Workplace Questionnaire, was used to solicit the information. Students were exposed to workplace violence with the main act being intimidation (30%), verbal abuse (17%), physical abuse (3%), and sexual harassment (3%). In more than three-quarters of the incidents the students had some level of apprehension or were frightened as a result of the violence. Students responded to the acts of violence with changes to emotions, self-confidence, and a desire to "give up". This paper demonstrates ways in which midwifery students are vulnerable to potential workplace violence from various sources. Support mechanisms need to be developed to ensure this can be minimised.

How nurse managers in Japanese hospital wards manage patient violence toward their staff.

AIM: This study explores nurse managers' experiences in dealing with patient/family violence toward their staff. BACKGROUND: Studies and guidelines have emphasised the responsibility of nurse managers to manage violence directed at their staff. Although studies on nursing staff have highlighted the ineffectiveness of strategies used by nurse managers, few have explored their perspectives on dealing with violence. METHODS: This qualitative study adopted a grounded theory approach to explore the experiences of 26 Japanese nurse managers. RESULTS: The nurse managers made decisions using internalised ethical values, which included maintaining organisational functioning, keeping staff safe, advocating for the patient/family and avoiding moral transgressions. They resolved internal conflicts among their ethical values by repeating a holistic assessment and simultaneous approach consisting of damage control and dialogue. They facilitated the involved persons' understanding, acceptance and sensemaking of the incident, which contributed to a resolution of the internal conflicts among their ethical values. CONCLUSIONS: Nurse managers adhere to their ethical values when dealing with patient violence toward nurses. Their ethical decision-making process should be acknowledged as an effective strategy to manage violence. IMPLICATIONS FOR NURSING MANAGEMENT: Organisational strategies that support and incorporate managers' ethical decision-making are needed to prevent and manage violence toward nurses.

Work schedule and client characteristics associated with workplace violence experience among nurses and midwives in sub-Saharan Africa.

Violence against health care workers perpetrated by clients and/or their friends and family (Type II) is a growing problem that can severely impact health care delivery. We examined the prevalence of Type II workplace violence among nurses and midwives in sub-Saharan Africa and its association with work status, schedule, and client characteristics. Nurses and midwives (n = 712) completed an anonymous survey while attending nursing meetings. Generalized estimating equation models, accounting for clustering within residing countries, were employed. Participants who were exposed to risky client characteristics (aOR = 1.39-1.78, p < .001), and those who worked more than 40 hours a week were more likely to have experienced Type II workplace violence (aOR = 1.72-2.15, p < .05). Findings will inform policy and organization level interventions needed to minimize nurses' and midwives' exposure to Type II workplace violence by identifying risky clients and addressing long work hours.