Analysing workplace violence towards health care staff in public hospitals using alternative ordered response models: the case of north-eastern Turkey

The main objective of this article is to determine key factors that may have a significant effect on the verbal abuse, emotional abuse and physical assault of health care workers in north-eastern Turkey. A self-administered survey was completed by 450 health care workers in three well-established hospitals in Erzurum, Turkey. Because of the discrete and ordered nature of the dependent variable of the survey, the data were analysed using four distinctive ordered response models. Results revealed that several key variables were found to be a significant determinant of workplace violence, such as the type of health institution, occupational position, weekly working hours, weekly shift hours, number of daily patient contacts, age group of the respondents, experience in the health sector, training against workplace violence and current policies of the hospitals and the Turkish Ministry of Health.     

Workplace violence intervention effectiveness: A systematic literature review

This is a systematic review of literature published since 1992, to determine the effectiveness of interventions in preventing workplace violence and to suggest interventions that need further evaluation research. The health care industry is the topic of 54% of the papers, the retail industry is the topic of 11% of the papers, and the remaining papers address the workplace in general or other situations. This finding drives the organization of this review: the first group of papers discussed in this review evaluates interventions to prevent workplace violence in the retail industry – mostly to prevent robbery and violence to retail workers. Singly or in combination, environmental designs in the retail industry, such as increased lighting to improve visibility and a limited cash-handling policy, can make workers safer, but more research is needed to overcome the barriers to implementation of environmental designs, especially in small businesses. The second group of papers in this review is about interventions to prevent violence to health care workers – mostly training and techniques of dealing with combative patients. Training health care workers to better cope with violent patients and to avoid injury is becoming standard practice, but research is needed to identify specific aspects of training and patient management programs that are most effective.     

Environmental evaluation for workplace violence in healthcare and social services

PROBLEM: Federal policy recommends environmental strategies as part of a comprehensive workplace violence program in healthcare and social services. The purpose of this project was to contribute specific, evidence-based guidance to the healthcare and social services employer communities regarding the use of environmental design to prevent violence. METHOD: A retrospective record review was conducted of environmental evaluations that were performed by an architect in two Participatory Action Research (PAR) projects for workplace violence prevention in 2000 and, in the second project in 2005. Ten facility environmental evaluation reports along with staff focus group reports from these facilities were analyzed to categorize environmental risk factors for Type II workplace violence. RESULTS: Findings were grouped according to their impact on access control, the ability to observe patients (natural surveillance), patient and worker safety (territoriality), and activity support. DISCUSSION: The environmental assessment findings reveal design and security issues that, if corrected, would improve safety and security of staff, patients, and visitors and reduce fear and unpredictability. IMPACT ON INDUSTRY: Healthcare and social assistance employers can improve the effectiveness of violence prevention efforts by including an environmental assessment with complementary hazard controls.     

The role of burnout syndrome as a mediator for the effect of psychosocial risk factors on the intensity of musculoskeletal disorders: a structural equation modeling approach

This study examined the hypothesis that burnout syndrome mediates effects of psychosocial risk factors and intensity of musculoskeletal disorders (MSDs) among hospital nurses. The sample was composed of 415 nurses from various wards across five hospitals of Iran's Hamedan University of Medical Sciences. Data were collected through three questionnaires: job content questionnaire, Maslach burnout inventory and visual analogue scale. Results of structural equation modeling with a mediating effect showed that psychosocial risk factors were significantly related to changes in burnout, which in turn affects intensity of MSDs.     

Violence‐prevention climate,exposure to violence and aggression,and prevention behavior: A mediation model

This study explored mechanisms underlying employees' behaviors targeted at preventing workplace physical violence and verbal aggression. Poor psychological violence‐prevention climate perceptions and previous exposure to violence and aggression represent stressors that were associated with increased strains and reduced motivation. Strains and motivation, in turn, were related to prevention behaviors. We collected data from employee and coworker dyads, and structural equation modeling results supported that clear organizational policies, prompt management responses to assaults, and putting safety as a priority contributed positively to prevention behaviors through reduced strains and increased motivation. On the other hand, prior experiences of being attacked were related to more strains and lower motivation, which were related to lower prevention compliance. Our results inform future interventions for violence prevention. Copyright © 2011 John Wiley & Sons, Ltd.     

Patient demands,lack of reciprocity,and burnout: a five‐year longitudinal study among general practitioners

This study among a sample of 207 general practitioners (GPs) uses a five‐year longitudinal design to test a process model of burnout. On the basis of social exchange and equity theory, it is hypothesized and found that demanding patient contacts produce a lack of reciprocity in the GP–patient relationship, which, in turn, depletes GPs' emotional resources and initiates the burnout syndrome. More specifically, structural equation analyses confirmed that—both at T1 and T2—lack of reciprocity mediates the impact of patient demands on emotional exhaustion. Emotional exhaustion, in turn, evokes negative attitudes toward patients (depersonalization), and toward oneself in relation to the job (reduced personal accomplishment). Moreover, this process model of burnout was confirmed at T2, even after controlling for T1‐scores on each of the model components. Finally, T1 depersonalization predicted the intensity and frequency of T2 patient demands, after controlling for T1 patient demands. This major finding suggests that GPs who attempt to gain emotional distance from their patients as a way of coping with their exhaustion, evoke demanding and threatening patient behaviors themselves. The theoretical and practical implications of these findings are discussed. Copyright © 2000 John Wiley & Sons, Ltd.     

Frequency and determinants of recommended workplace violence prevention measures

PROBLEM: Limited information exists concerning adoption of workplace violence prevention measures by employers and the factors influencing their adoption. METHODS: A weighted sample of North Carolina workplaces (n=210) in operation January 1994 through March 1998 was used to estimate prevalence of 18 measures and identify community and workplace predictors of having >/=5 recommended measures. RESULTS: Location in a metropolitan area most strongly predicted presence of >/=5 administrative safety measures while a history of workplace violence and being in a high crime area were negatively associated. Belonging to an industry considered to be high-risk for workplace homicide was most strongly associated with having >/=5 environmental safety measures. DISCUSSION: Factors influencing high prevalence of violence prevention measures were related to business type, violence history, and location. Knowledge of factors influencing adoption of recommended workplace violence prevention measures can help tailor interventions to diverse industry settings. IMPACT ON INDUSTRY: An important contribution to the understanding and mitigation of workplace homicide is knowledge of the extent of implementation of recommended workplace violence prevention guidelines and factors influencing their adoption. Identifying factors that influence the prevalence and adoption of workplace violence safety interventions can help to tailor development of interventions to address the issue of workplace homicide across diverse industry settings.     

Evaluation of the National Electronic Injury Surveillance System – All injury program’s self-directed violence data,United States, 2018

Introduction: National estimates for nonfatal self-directed violence (SDV) presenting at EDs are calculated from the National Electronic Injury Surveillance System – All Injury Program (NEISS–AIP). In 2005, the Centers for Disease Control and Prevention and Consumer Product Safety Commission added several questions on patient characteristics and event circumstances for all intentional, nonfatal SDV captured in NEISS–AIP. In this study, we evaluated these additional questions along with the parent NEISS–AIP, which together is referred to as NEISS–AIP SDV for study purposes. Methods: We used a mixed methods design to evaluate the NEISS–AIP SDV as a surveillance system through an assessment of key system attributes. We reviewed data entry forms, the coding manual, and training materials to understand how the system functions. To identify strengths and weaknesses, we interviewed multiple key informants. Finally, we analyzed the NEISS–AIP SDV data from 2018—the most recent data year available—to assess data quality by examining the completeness of variables. Results: National estimates of SDV are calculated from NEISS–AIP SDV. Quality control activities suggest more than 99% of the cause and intent variables were coded consistently with the open text field that captures the medical chart narrative. Many SDV variables have open-ended response options, making them difficult to efficiently analyze. Conclusions: NEISS–AIP SDV provides the opportunity to describe systematically collected risk factors and characteristics associated with nonfatal SDV that are not regularly available through other data sources. With some modifications to data fields and yearly analysis of the additional SDV questions, NEISS–AIP SDV can be a valuable tool for informing suicide prevention. Practical Applications: NEISS-AIP may consider updating the SDV questions and responses and analyzing SDV data on a regular basis. Findings from analyses of the SDV data may lead to improvements in ED care.     

Violence in the workplaces in Finland

The aim of this study was to describe violence in Finnish workplaces by comparing it with leisure-time violence. The data were derived from 13,762 interviews made from a representative sample of the Finnish population in 1988. The subjects were asked to report all the violent incidents they had encountered during the previous 12 months. There were 394 victims of violence in workplaces, that is, 40.6 victims per 1,000 workers. The rate of occupational violence was almost identical for males (40.6) and females (40.5). The most hazardous occupations were prison guard, police officer, and mental health nurse. The main reasons for violence at work were related to refusal of an authority's order to go away or to the relationship between doctor or nurse and patient. A typical assailant was an unaccompanied man who was under the influence of alcohol.     

Does safety climate moderate the influence of staffing adequacy and work conditions on nurse injuries?

PROBLEM: Hospital nurses have one of the highest work-related injury rates in the United States. Yet, approaches to improving employee safety have generally focused on attempts to modify individual behavior through enforced compliance with safety rules and mandatory participation in safety training. We examined a theoretical model that investigated the impact on nurse injuries (back injuries and needlesticks) of critical structural variables (staffing adequacy, work engagement, and work conditions) and further tested whether safety climate moderated these effects. METHOD: A longitudinal, non-experimental, organizational study, conducted in 281 medical-surgical units in 143 general acute care hospitals in the United States. RESULTS: Work engagement and work conditions were positively related to safety climate, but not directly to nurse back injuries or needlesticks. Safety climate moderated the relationship between work engagement and needlesticks, while safety climate moderated the effect of work conditions on both needlesticks and back injuries, although in unexpected ways. DISCUSSION AND IMPACT ON INDUSTRY: Our findings suggest that positive work engagement and work conditions contribute to enhanced safety climate and can reduce nurse injuries.     

Exploring differences in the workplace violence experiences of young workers in middle and late adolescence in the United States

Problem: Young workers, typically characterized as 15–24 years of age, are commonly employed in jobs where the risk of workplace violence is high. It is unknown how these young workers, at varying stages of development, might understand and respond to workplace violence differently. We set out to explore whether the experiences and understandings of young workers varied between those in middle (ages 15–17) and late (ages 18–24) adolescence. Method: Separate focus groups were conducted with working students (n = 31), ages 15–17 and ages 18–24, who had either experienced or witnessed workplace violence. A focus group guide was used to facilitate the sessions which were recorded, transcribed, and content analyzed for themes. Results: Those in the older group experienced more severe episodes of sexual harassment and physical assault, reported using formal mechanisms for reporting, and noticed an employer focus on customer satisfaction over employee safety, while the younger participants tended to report to their parents. Both groups reported negative effects of experiencing workplace violence including depression, anxiety, feelings of worthlessness, and spill over into personal life. Discussion: Findings suggest that young workers at different developmental stages may experience and respond to workplace violence differently. Further research is needed to see if these results are generalizable. Summary: It is imperative that we understand the distinct differences between these subsets of young workers and how they experience and respond to workplace violence in order to improve research, policy development, and prevention/intervention mechanisms. Practical Applications: Understanding that differences exist among young workers based on age due to developmental stage, lack of experience, education, and social awareness can enable employers, companies, policy makers, and researchers the opportunity to better address the issue of workplace violence in this population.     

Staff burnout in a psychiatric hospital: A cross-lagged panel design

Previous research has shown that burnout in staff members at psychiatric hospitals is significantly associated with state anxiety and collegial support. The directionality of these relationships may be inferred using a cross-lagged panel design. To do this, 35 staff members representing various clinical disciplines completed measures of burnout, support, and anxiety twice, eight months apart. Burnout comprised three factors: emotional exhaustion, depersonalization, and personal accomplishment. Findings from one cross-lagged panel suggested that emotional exhaustion causes state anxiety. The second panel showed that lack of collegial support caused depersonalization. Understanding causes and effects of burnout for inpatient psychiatric staff may lead to training and resource development that will improve the quality of their work environment.     

Organizational safety: which management practices are most effective in reducing employee injury rates?

PROBLEM: While several management practices have been cited as important components of safety programs, how much does each incrementally contribute to injury reduction? This study examined the degree to which six management practices frequently included in safety programs (management commitment, rewards, communication and feedback, selection, training, and participation) contributed to a safe work environment for hospital employees. METHOD: Participants were solicited via telephone to participate in a research study concerning hospital risk management. Sixty-two hospitals provided data concerning management practices and employee injuries. RESULTS: Overall, the management practices reliably predicted injury rates. A factor analysis performed on the management practices scale resulted in the development of six factor scales. A multiple regression performed on these factor scales found that proactive practices reliably predicted injury rates. Remedial measures acted as a suppressor variable. DISCUSSION: While most of the participating hospitals implemented reactive practices (fixing problems once they have occurred), what differentiated the hospitals with low injury rates was that they also employed proactive measures to prevent accidents. IMPACT ON INDUSTRY: The most effective step that hospitals can take is in the front-end hiring and training of new personnel. They should also ensure that the risk management position has a management-level classification. This study also demonstrated that training in itself is not adequate.     

The spillover effects of coworker,supervisor, and outsider workplace incivility on work‐to‐family conflict: A weekly diary design

This study used an experience sampling design to examine the spillover effects of experienced workplace incivility from organizational insiders (coworkers and supervisors, respectively) and organizational outsiders (patients and their visitors) on targets' work‐to‐family conflict and to test the mediating effect of burnout and the moderating effect of display rules. Data collected over five consecutive weeks from 84 full‐time nurses showed that within individuals, weekly experiences of coworker incivility and outsider incivility were positively related to weekly experience of work‐to‐family conflict, and burnout mediated these relationships while controlling for initial level of burnout before participants started a week's work. In addition, display rules, defined as the extent to which individuals perceive they are expected to display desired positive emotions and suppress negative emotions at work, moderated the relationship between outsider incivility and burnout; specifically, the positive relationship between weekly outsider incivility and burnout was stronger for individuals who perceived a higher level of display rules. Our findings contribute to the literature by demonstrating the mediating effect of burnout and the moderating effect of perceived display rules in the relationship between workplace incivility from multiple sources and work‐to‐family conflict from a resource perspective.     

A graduate level course: Teaching stress management skills to occupational health physicians and practitioners

The WHO Study Group on Training and Evaluation in Occupational Medicine has recently emphasized the importance of incorporating theoretical and practical aspects of stress prevention and management in the professional training of occupational health practitioners. Such a course was developed for the Tel-Aviv University Medical School graduate program in occupational health. The course objectives are consistent with the current call for improved training in psychosocial issues in medical care. Twenty-three occupational health practitioners (physicians, nurses, hygienists and social workers) participated in a bi-semester course. The first part included a stress management and prevention program based on the RET (Rational-Emotive Training) model. The second involved developing and implementing a field project on primary and secondary prevention of stress and its outcomes. Pre-, mid-and post-course questionnaires showed significantly improved psychosocial ability and reduced irrational/dysfunctional thinking, considered a causal factor in stress and burnout. Acquiring such anti-stress resources may benefit practitioners and clients/patients, both potential victims of occupational stress alike. We recommend the inclusion of such extended courses to the professional training of occupational health practitioners.     

Multiple interactions of hazard exposures, role stressors and situational factors, and burnout among nurses.

This was a cross-sectional study which looked into the interaction between situational factors, role stressors, hazard exposure and personal factors among 135 nurses in the Philippine General Hospital. More than half (58.5%) of the respondents reported being ill due to work in the past year, and 59.3% missed work because of an illness. Regression showed factors associated with burnout were organizational role stress, hazard exposure, self-efficacy, age, number of working years, illness in the past 12 months, migraine, dizziness, sleep disorder, cough and colds, and diarrhea. After multiple regression analysis, organizational role stress (p = .000), migraine (p = .001), age (p = .018) and illness in the past 12 months (p = .000) were found to be significant predictors of burnout. The contribution of the study is in advancing new concepts in the already existing framework of burnout, and thus, assisting nurses and hospital administration in on controlling this problem.     

Workplace violence: a study of Turkish workers

This research was conducted to address the experience of workplace violence of Turkish workers from different sectors and to investigate the impact of the exposed violence on their psychological well-being. Data were collected anonymously with printed questionnaires from the volunteer participants and depended on self-reporting. The response rate was 79.0% (1708/2161). The prevalence of workplace violence was found to be 44.8%. The most common type was verbal violence together with mobbing (bullying). Victims of physical violence were mostly males, whereas females were found to be victims of verbal, psychological and sexual violence. Most cases did not result in legal action and the victims remained silent. Psychological well-being of exposed workers in terms of depression, anxiety and stress seemed to deteriorate. Workplace violence remains a silent epidemic in Turkey. Preventive measures against workplace violence and social support for violated workers do not exist.