Associations of neighborhood-level workplace violence with workers' mental distress problems: a multilevel analysis of Taiwanese employees.

OBJECTIVE: Workplace violence is known to pose mental health risks. However, whether or not workplace violence in a surrounding area might further increase the risk of mental distress in workers has rarely been examined. METHODS: The study subjects were 9,393 male and 7,716 female employees who participated in a nationwide survey in 2010. Their personal experiences of workplace violence over the past 1 year were ascertained by a standardized questionnaire. Also assessed were their psychosocial work characteristics and mental distress problems. Neighborhood-level workplace violence was computed based on aggregated data at the county level and was categorized into low-, medium-, and high-level categories. Multilevel logistic regression models were constructed to examine the associations between neighborhood-level workplace violence and individual-level mental distress problems, with adjustment of individual-level experience of workplace violence. FINDINGS: The neighborhood-level prevalence of workplace violence ranged from 4.7 to 14.7% in men and from 6.4 to 14.8% in women across 22 counties. As compared with those who live in counties of the lowest tertile of workplace violence, female workers who lived in counties of the highest tertile of workplace violence had a 1.72-fold increased risk for mental distress problems after controlling for individual experience of workplace violence and other psychosocial work characteristics. CONCLUSION: Neighborhood-level workplace violence was associated with poor mental health in female workers. Preventative strategies targeting workplace violence should pay attention to neighborhood factors and gender-specific effects that might influence societal tolerance of abusive work practices and workers' vulnerability to mental health impacts of workplace violence.

Analysis of manpower and career characteristics of nurse anesthetists in Taiwan: results of a cross-sectional survey of 113 institutes.

BACKGROUND: Manpower and the quality of nurse anesthetists (NA) have become critical concerns in Taiwan over the past few decades because of increasing clinical demand and the supervision of NAs by anesthesiologists. To understand manpower distribution, clinical load, job description and limitations, and job satisfaction of NAs, we conducted a cross-sectional survey in Taiwan in 2005. METHODS: The structure of the questionnaire was initially developed by a drafting group that included members of the Taiwan Society of Anesthesiologists and the Taiwan Association of Nurse Anesthetists. The validity and reliability of the questionnaire was evaluated by specialists. The survey contained questions regarding the demographic characteristics of manpower (anesthesiologist/NA ratio), clinical work load, present job roles, professional expectations, job satisfaction, and reasons for career transfer. The questionnaires were mailed to the superintendents or matrons of NAs, and the administrators of anesthesiology departments across 228 institutions with different accreditation levels and 1953 NA staff between February 1 and December 31, 2005. RESULTS: The validity and reliability of the questionnaire for the department chief and anesthesiology nursing staff was 0.8 and 0.7, respectively. Questionnaires were returned by 113 executives (39 anesthesiology department directors, 74 NA superintendents or matrons) with a response rate of 49.6%, and from 1452 NAs with a response rate of 74.3%. The average clinical load (2002-2004) for the anesthesiologists was 1500-1700 cases/year and 350-380 cases/year for the NAs. The manpower ratio of attending anesthesiologists to NAs was 1:4.3, while the medical centers held the highest ratio. The job stipulation for NAs in Taiwan was compatible with that in the United States and there was a high consistency of opinions between the directors and NA superintendents or matrons. The average rate of career transfer was relatively low (5.5%). From the executives' view, the concerns regarding management of NAs included limited staff capacity, recruiting difficulty, shortage of staff and undefined roles for NAs. On the other hand, NAs showed relatively high job satisfaction and work acceptance and a lower turnover rate in comparison with the general nursing staff. CONCLUSION: This study represents the first large-scale assessment of the distribution, clinical load, and job satisfaction for NAs in Taiwan. The roles of NAs, which include preoperative preliminary preparation and postoperative intensive care, need to be more well-defined. To improve the quality of NAs and anesthetic care in Taiwan, it is vital to establish an official accreditation system and formal education programs, to institute well-defined and standardized job descriptions, and to improve resource allocation for NAs.