Implementing Effective Interventions Against Workplace Violence.

Workplace violence (WPV) is widespread and increasing in health care organizations. The purpose of this performance improvement (PI) project was to understand what measures could effectively be implemented to decrease the incidence of WPV events in an acute inpatient health care facility. The A3 problem-solving methodology was utilized. The current state and countermeasures to decrease gaps in the current processes were examined. The methodology engaged all stakeholders in problem-solving and continuous improvement. PI members implemented the house-wide interventions in January 2019 and in financial year 2019 assault with injuries decreased to 39. Further research is needed to support effective interventions against WPV.

Caring Knowledge as a Strategy to Mitigate Violence against Nurses: A Discussion Paper.

Violence against nurses is a disturbing trend in healthcare that has reached epidemic proportions globally. These violent incidents can result in physical and psychological injury, exacerbating already elevated levels of stress and burnout among nurses, further contributing to absenteeism, turnover, and intent to leave the profession. To ensure the physical and mental well-being of nurses and patients, attention to the development of strategies to reduce violence against nurses must be a priority. Caring knowledge-rooted in the philosophy of care-is a potential strategy for mitigating violence against nurses in healthcare settings. We present what caring knowledge is, analyze its barriers to implementation at the health system and education levels and explore potential solutions to navigate those barriers. We conclude how the application of models of caring knowledge to the nurse-patient relationship has the potential to generate improved patient safety and increased satisfaction for both nurses and patients.

Workplace Bullying and Violence on Burnout Among Bangladeshi Registered Nurses: A Survey Following a Year of the COVID-19 Pandemic.

Objectives: To investigate burnout among Bangladeshi nurses and the factors that influence it, particularly the association of workplace bullying (WPB) and workplace violence (WPV) with burnout. Methods: This cross-sectional study collected data from 1,264 Bangladeshi nurses. Mixed-effects Poisson regression models were fitted to find the adjusted association between WPB, WPV, and burnout. Results: Burnout was found to be prevalent in 54.19% of 1,264 nurses. 61.79% of nurses reported that they had been bullied, and 16.3% of nurses reported experience of "intermediate and high" levels of workplace violence in the previous year. Nurses who were exposed to "high risk bullying" (RR = 2.29, CI: 1.53-3.41) and "targeted bullying" (RR = 4.86, CI: 3.32-7.11) had a higher risk of burnout than those who were not. Similarly, WPV exposed groups at "intermediate and high" levels had a higher risk of burnout (RR = 3.65, CI: 2.40-5.56) than WPV non-exposed groups. Conclusion: Nurses' burnout could be decreased if issues like violence and bullying were addressed in the workplace. Hospital administrators, policymakers, and the government must all promote and implement an acceptable working environment.

Workplace violence against healthcare workers during the COVID-19 pandemic: a systematic review and meta-analysis.

Workplace violence (WPV) is a prevalent phenomenon, especially in the healthcare setting. WPV against healthcare workers (HCWs) has increased during the COVID-19 epidemic. This meta-analysis determined the prevalence and risk factors of WPV. A database search was conducted across six databases in May 2022, which was updated in October 2022. WPV prevalence among HCWs was the main outcome. Data were stratified by WPV/HCW type, pandemic period (early, mid, late), and medical specialty. WPV risk factors were the secondary outcome. All analyses were conducted through STATA. Newcastle Ottawa Scale evaluated the quality. Sensitivity analysis identified effect estimate changes. A total of 38 studies (63,672 HCWs) were analyzed. The prevalence of WPV of any kind (43%), physical (9%), verbal (48%), and emotional (26%) was high. From mid-pandemic to late-pandemic, WPV (40-47%), physical violence (12-23%), and verbal violence (45-58%) increased. Nurses had more than double the rate of physical violence (13% vs. 5%) than physicians, while WPV and verbal violence were equal. Gender, profession, and COVID-19 timing did not affect WPV, physical, or verbal violence risk. COVID-19 HCWs were more likely to be physically assaulted (logOR = 0.54; 95% CI: 0.10: 0.97). Most healthcare employees suffer verbal violence, followed by emotional, bullying, sexual harassment, and physical assault. Pandemic-related workplace violence increased. Nurses were twice as violent as doctors. COVID-19 healthcare employees had a higher risk of physical and workplace violence.

Workplace Violence in the Hospital: Strategies for Meaningful Change.

BACKGROUND: Workplace violence is not a unique problem to organizations. Evidence-based toolkits and strategies are available to help provide a guiding framework for the reduction of workplace violence events. As times and stressors (both personal and environmental) change, hospitals must keep constant attention on how to address and implement initiatives to keep staff safe. This manuscript addresses steps taken at 1 hospital to meet this challenge. PROCESS: Although a workplace violence committee had been in place for some time, it was identified that not all of the key players were included. Membership was evaluated, and executive-level support was provided. A review of literature was conducted and identified top priorities upon which to focus efforts. Subcommittees were formed to be responsible for these categories of work and to report back to the committee. EVALUATION: Data points and a dashboard were created to monitor trends and effectiveness, especially regarding combating the culture of underreporting. Processes and resources were formalized and made easily accessible to staff. Case studies and direct feedback from staff have been impactful and helped identify additional barriers. Evaluation will continue to occur using process-improvement methodology along with technological assistance. CONCLUSIONS: Workplace violence is not part of the job. Ongoing work is needed to continue to move the needle and make hospitals a safer place to work. Engagement from all levels of the organization is necessary to have a successful program.

Violence Risk Assessment in the Emergency Department.

INTRODUCTION: Workplace violence is a prevalent problem in health care, with mental health and emergency departments being the most at-risk settings. The aim of this evidence-based practice project was to pilot use of a violence risk assessment tool, the Broset Violence Checklist, to assess for risk of type II violence and record the interventions that nurses chose to implement to mitigate the situation. Additionally, reports made to the hospital reporting system were tracked and compared to previous reporting frequency. METHODS: Following staff education, nurses were instructed to complete checklists for all patients who have a score of 1 or higher, which indicates the presence of at least 1 high-risk behavior, and continue hourly scoring until the score returned to 0 or the patient was dispositioned. The number of incidents recorded, time of day, scores, interventions applied to mitigate violence, and change in scores after interventions were evaluated. The number of Broset Violence Checklist scoring sheets submitted and reports made via the hospital reporting system were compared. RESULTS: Incidents were most frequent from 11 am until 3 am. The highest scores occurred in the late evening and early morning hours. There were significantly more incidents captured with the use of the Broset Violence Checklist as compared to the hospital reporting system. Incidents significantly associated with higher scores included providing comfort measures, addressing concerns, and applying restraints. DISCUSSION: The Broset Violence Checklist was used successfully in the emergency department setting to identify behaviors associated with violence. Under-reporting to the hospital report system was identified in this project, consistent with reports in the literature. Specific interventions were not associated with a decrease in Broset Violence Checklist scores.

Aggression and burnout in nurses during COVID-19: A cross-sectional study.

Workplace violence against nurses, an ever-present problem in the healthcare workplace, has been increasing with COVID-19 and affects occupational health. This study analyzed the consequences of COVID-19 on violence against nurses, identifying its association with burnout, emphasizing the importance of work-related variables. A total of 1013 actively employed nurses in Spain with a mean age of 34.71 years filled out a computer-assisted web interviewing survey. Aggression as a consequence of their work was reported by 73.44% of the nurses. Those most affected were in primary care, and verbal aggression by patients and their families was the most frequent. Nurses who were attacked scored significantly higher in emotional exhaustion and depersonalization. Furthermore, 83.22% said that COVID-19 was an important factor in the increase in violence toward healthcare workers. Analysis showed that a perceived secure environment was a mediator between the belief that COVID-19 was an influential factor in the increase of violence and the depersonalization dimension of burnout. Increasing perceived security in the work environment among nurses can be effective in promoting well-being, work performance, and commitment to the profession.

To End Workplace Violence, Integrate High-Tech With High-Touch.

A leader should create an environment in which everyone feels safe. Yet, there is a rising, deadly epidemic in healthcare on the heels of the COVID-19 pandemic: workplace violence. Healthcare workers, particularly nurses, are at a far higher risk of violence on the job compared with most other professions. Leaders have the power to reverse this trend by sounding the alarm, doubling down on their commitment to workplace safety organization-wide, and taking a comprehensive approach that integrates high-tech with high-touch strategies.

The effect of COVID-19 on workplace violence in California's hospitals: An interrupted time series analysis.

AIM: This study used California's unique Workplace Violent Incident Reporting System (WVIRS) to describe changes in workplace violence (WV) exposure for hospital-based healthcare workers during the pandemic. DESIGN: Interrupted time series analysis. METHODS: We compared the linear trends in weekly WV incidents reported during the period before the COVID-19 pandemic (7/1/2017-3/20/2020) to the period following California's shutdown (3/21/2020-6/30/2021). We created mixed effects models for incidents reported in emergency departments (EDs) and in other hospital units. We used hospital volume data from the California Department of Health Care Access and Information. RESULTS: A total of 418 hospitals reported 37,561 incidents during the study period. For EDs, the number of reported incidents remained essentially constant, despite a 26% drop in outpatient visits between the first and second quarters of 2020. For other hospital units, weekly incidents initially dropped-parallel to a 13% decrease in inpatient days between the first and second quarters of 2020-but then continued parallel to the trend seen in the pre-COVID period. CONCLUSION: WV persists steadily in California's hospitals. Despite major reductions in patient volume due to COVID-19, weekly reported ED incidents remained essentially unchanged. IMPACT: Surveys and media reported that WV increased during the pandemic, but it has been difficult to measure these changes using a large-scale database. The absolute number of WV incidents did not increase during the pandemic; however, the trend in reported incidents remained constant in the context of dramatic decreases in patient volume. New federal WV prevention legislation is being considered in the U.S. California's experience of implementation should be considered to improve WV reporting and prevention. PUBLIC CONTRIBUTION: There was no public contribution to this study. The goal of this analysis was to summarize findings from administrative data. The findings presented can inform future discussion of public policy and action.

Violence in the pain clinic: the hidden pandemic.

Workplace violence is any physical assault, threatening behavior or other verbal abuse directed toward persons at work or in the workplace. The incidence of workplace violence in healthcare settings in general and more specifically the pain clinic is thought to be underestimated due to hesitancy to report, lack of support from management and healthcare systems, and lack of institutional policies as it relates to violence from patients against healthcare workers. In the following article, we explore risk factors that place clinicians at risk of workplace violence, the cost and impact of workplace violence, how to build a violence prevention program and lastly how to recover from violence in the practice setting.

Workplace violence against health care workers during the COVID-19 Pandemic: A systematic review and meta-analysis.

INTRODUCTION: During the COVID-19 pandemic, Health Care Workers (HCWs) have been at the frontline against the disease and have direct contact with patients and their companions, so they are exposed to all sorts of Workplace Violence (WPV). The aim of this study was to investigate the prevalence of WPV against HCWs during the COVID-19 pandemic. METHOD: This study was conducted according to the PRISMA guideline, and its protocol was registered at the PROSPERO under the code of CRD42021285558. Articles were obtained from data resources such as Scopus, PubMed, Web of Science, Science Direct, Google Scholar, and Embase. A literature search was conducted from the beginning of 2020 to the end of December 2021. Meta-analysis was conducted using the Random effects model, and the I2 index was used to check the heterogeneity. RESULTS: In this study, 1,054 articles were initially obtained during the primary search, of which 13 were finally entered in the meta-analysis. According to the results of the meta-analysis, the prevalence of physical and verbal WPV were 10.75% (95% CI: 8.20-13.30, I2 = 97.8%, P = 0 < 001) and 45.87% (95% CI: 36.8-54.93, I2 = 99.6%, P = 0 < 001), respectively. The overall prevalence of WPV was obtained, 45.80% (95% CI: 34.65-56.94, I2 = 99.8%, P = 0 < 001) were reported. CONCLUSION: The results of the present study showed that the prevalence of WPV against HCWs was relatively high during the COVID-19 pandemic; nevertheless, it was lower compared to the area prior to the pandemic. Therefore, HCWs need essential training to reduce stress and increase resilience. Also, considering organizational interventions (including policies to ensure that HCWs report WPV to their supervisors, increasing staffing per patient, and installing systems for HCWs to call for immediate assistance) can increase the resilience HCWs.

Association between interrupted access to sex work community services during the COVID-19 pandemic and changes in sex workers' occupational conditions: findings from a community-based cohort study in Vancouver, Canada.

OBJECTIVES: Globally, criminalisation has shaped sex workers' structural exclusion from occupational protections, and this exclusion has been exacerbated during the COVID-19 pandemic. While community organisations aim to bridge this gap through providing health and safety resources for sex workers, many were forced to scale back services when Canadian provinces declared a state of emergency at the pandemic onset. As little empirical research has examined the impacts of sex work community services interruptions amid COVID-19, our objectives were to (1) examine the correlates of interrupted access to community services and (2) model the independent association between interrupted access to community services and changes in working conditions (ie, self-reported increases in workplace violence or fear of violence), among sex workers during the COVID-19 pandemic. DESIGN, SETTING AND PARTICIPANTS: As part of an ongoing community-based cohort of sex workers in Vancouver, Canada (An Evaluation of Sex Workers Health Access, 2010-present), 183 participants completed COVID-19 questionnaires between April 2020 and April 2021. ANALYSIS: Cross-sectional analysis used bivariate and multivariable logistic regression with explanatory and confounder modelling approaches. RESULTS: 18.6% of participants (n=34) reported interrupted access to community services (closure/reduction in drop-in hours, reduced access to spaces offering sex worker supports and/or reduced access/contact with outreach services). In multivariable analysis, sex workers who had difficulty maintaining social supports during COVID-19 (adjusted OR, AOR 2.29, 95% CI 0.95 to 5.56) and who experienced recent non-fatal overdose (AOR 2.71, 95% CI 0.82 to 8.98) faced marginally increased odds of service interruptions. In multivariable confounder analysis, interrupted access to community services during COVID-19 was independently associated with changes in working conditions (ie, self-reported increases in workplace violence or fear of violence; AOR 4.00, 95% CI 1.01 to 15.90). CONCLUSIONS: Findings highlight concerning implications of community service interruptions for sex workers' labour conditions. Sustainable funding to community organisations is urgently needed to uphold sex workers' occupational safety amid COVID-19 and beyond.

The Management of Workplace Violence against Healthcare Workers: A Multidisciplinary Team for Total Worker Health® Approach in a Hospital.

The risk of aggression against healthcare workers (HCWs) is a globally well-known topic. However, workplace violence (WV) is often considered as part of HCW's job, leading to a general underreporting. This cross-sectional study aims at providing a descriptive analysis of aggressive acts against HCWs registered in a 34-month period in a pediatric hospital. According to a specific protocol, each aggressive act was analyzed by a multidisciplinary team using the "Modified Overt Aggression Scale" (MOAS), the "General Health Questionnaire-12" (GHQ-12), and the "Short Form-36 Health Survey" (SF-36) to build a report addressing improvement measures. A three-domain model of WV was also developed considering: (1) assaulted HCWs, (2) attacker-related issues, and (3) environmental context. Contributing factors to overt aggression were outlined and tested using univariate analyses. Statistically significant factors were then included in a multiple linear regression model. A total of 82 aggressive acts were registered in the period. MOAS scores registered a mean value of 3.71 (SD: 4.09). Verbal abuse was the most common form of WV. HCWs professional category, minor psychiatric disorder, emotional role limitation, type of containment used, and emotion intensity were significantly associated with overt aggression (p < 0.05), as well as the attacker's role in the hospital (p < 0.05). The multiple regression analysis confirmed these findings (p < 0.001). Raising awareness on the aggression risk and contributing factors may lead to a relevant improvement of workplace environment, individual workers' health, and organizational well-being.

Occurrences of Workplace Violence Related to the COVID-19 Pandemic, United States, March 2020 to August 2021.

As businesses dealt with an increasingly anxious public during the COVID-19 pandemic and were frequently tasked with enforcing various COVID-19 prevention policies such as mask mandates, workplace violence and harassment (WPV) emerged as an increasing important issue affecting worker safety and health. Publicly available media reports were searched for WPV events related to the COVID-19 pandemic that occurred during 1 March 2020, and 31 August 2021, using Google News aggregator services scans with data abstraction and verification. The search found 408 unique WPV events related to COVID-19. Almost two-thirds involved mask disputes. Over half (57%) of the 408 events occurred in retail (38%) and food service (19%). We also conducted a comparison of events identified in this search to a similar study of media reports between March 2020 to October 2020 that used multiple search engines to identify WPV events. Despite similar conclusions, a one-to-one comparison of relevant data from these studies found only modest overlap in the incidents identified, suggesting the need to make improvements to future efforts to extract data from media reports. Prevention resources such as training and education for workers may help industries de-escalate or prevent similar WPV events in the future.

The impact of COVID-19 pandemic on temporal trends of workplace violence against healthcare workers in the emergency department.

BACKGROUND: It is known that there has been an increase over the years in attacks by patients admitted to the emergency department (ED) on healthcare workers; it is unclear what effect the COVID-19 pandemic has on these attacks. AIM: to verify through a long-term time analysis the effect of COVID-19 on ED attacks on healthcare workers. MOTHODS: a quasi-experimental interrupted time-series analysis on attacks on healthcare workers was performed from January 2017 to August 2021. The main outcome was the monthly rate of attacks on healthcare workers per 1000 general accesses. The pandemic outbreak was used as an intervention point. RESULTS: 1002 attacks on healthcare workers in the ED were recorded. The rate of monthly attacks on total accesses increased from an average of 13.5 (SD 6.6) in the pre-COVID-19 era to 27.2 (SD 9.8) in the pandemic months, p < 0.001. The pandemic outbreak led to a significant increase in attacks on healthcare workers from 0.05/1000 attacks per month (p = 0.018), to 4.3/1000 attacks per month (p = 0.005). CONCLUSIONS: The COVID-19 pandemic has led to a significant increase in attacks on healthcare workers in the ED. Trends compared to pre-pandemic months do not seem to indicate a return to normality. Health institutions and policymakers should develop strategies to improve the safety of the working environment in hospitals and EDs.

Workplace violence, bullying, burnout, job satisfaction and their correlation with depression among Bangladeshi nurses: A cross-sectional survey during the COVID-19 pandemic.

BACKGROUND: Depression is one of the most serious yet understudied issues among Bangladeshi nurses, bringing health dangers to this workforce. This study aimed to investigate how workplace violence (WPV), bullying, burnout, and job satisfaction are correlated with depression and identify the factors associated with depression among Bangladeshi nurses. METHODS: For this cross-sectional study, data were collected between February 26, 2021, and July 10, 2021 from the Bangladeshi registered nurses. The Workplace Violence Scale (WPVS), the Short Negative Acts Questionnaire [S-NAQ], the Burnout Measure-Short version (BMS), the Short Index of Job Satisfaction (SIJS-5), and the Patient Health Questionnaire (PHQ-9) were used to measure WPV, bullying, burnout, job satisfaction, and depression, respectively. Inferential statistics include Pearson's correlation test, t-test, one-way ANOVA test, multiple linear regression, and multiple hierarchal regression analyses were performed. RESULTS: The study investigated 1,264 nurses (70.02% female) with an average age of 28.41 years (SD = 5.54). Depression was positively correlated with WPV, bullying, and burnout and negatively correlated with job satisfaction (p <0.001). According to the multiple linear regression model, depression was significantly lower among nurses with diploma degrees (ß = -1.323, 95% CI = -2.149 to -0.497) and bachelor's degrees (ß = -1.327, 95% CI = -2.131 to- 0.523) compared to the nurses with master's degree. The nurses who worked extended hours (>48 hours) had a significantly higher depression score (ß = 1.490, 95% CI = 0.511 to 2.470) than those who worked ≤ 36 hours. Depression was found to be significantly higher among those who did not receive a timely salary (ß = 2.136, 95% CI = 1.138 to 3.134), rewards for good works (ß = 1.862, 95% CI = 1.117 to 2.607), and who had no training on WPV (ß = 0.895, 95% CI = 0.092 to 1.698). CONCLUSIONS: Controlling burnout, bullying, and workplace violence, as well as improving the work environment for nurses and increasing job satisfaction, are the essential indicators of reducing depression. This can be accomplished with integrative support from hospital executives, policymakers, and government officials.

The impact of the COVID-19 pandemic on the prevalence and risk factors of workplace violence among healthcare workers in China.

Background: The pandemic of COVID-19 has significantly increased the burden on healthcare workers and potentially affect their risk of workplace violence (WPV). This study aimed to explore the prevalence and risk factors of WPV among healthcare workers during the peaking and the remission of the COVID-19 pandemic in China. Methods: Using the snowball method, a repeated online questionnaire survey was conducted among Chinese healthcare workers from March 27th to April 26th in 2020 and 2021, respectively. Data included healthcare workers' socio-demographic and occupational characteristics, psychological status, and workplace violence. Results: A total of 3006 samples in 2020 and 3465 samples in 2021 were analyzed. In 2020, the prevalence of WPV and witnessing colleagues suffering from WPV among healthcare workers were 64.2% and 79.7% respectively. Compared with 2020, the prevalence decreased by 11.0% and 14.4% in 2021, respectively. Logistic regression showed that WPV in 2020 was influenced by males, long working experience, working in the psychiatric department, direct contact with COVID-19 patients, self-discovery of medical errors, moral injury, depression, and anxiety (minimum OR = 1.22, maximum OR = 2.82). While risk factors of WPV in 2021 included males, working in psychiatric departments, self-discovery of medical errors, moral injury, depression, and anxiety (minimum OR = 1.33, maximum OR = 3.32); and protective factors were holding a master's degree (OR = 0.78) and working in other departments (OR = 0.54). Conclusion: This study retains the common effects of WPV among healthcare workers, though after the baptism of the COVID-19 pandemic, the prevalence of WPV among healthcare workers decreased; however, part of the influencing factors changed. In addition, COVID-19 has seriously affected the mental health of healthcare workers, and the effect of mental health problems on WPV should also attract more attention.