Nurse exposure to physical and nonphysical violence, bullying, and sexual harassment: A quantitative review

The aftermath of workplace violence among healthcare workers: A systematic literature review of the consequences

Title. Aggressive behaviour on acute psychiatric wards: prevalence, severity and management

Aim.  This paper reports a study to investigate the nature and prevalence of inpatient aggressive behaviour directed at staff and other patients and, in the case of patient self-harm, the methods used by nursing staff to manage this.

Background.  Aggressive behaviour poses a threat to the physical and psychological health of psychiatric nursing staff. The fear that results from working in a climate of potential danger can also have a damaging impact on patient care.

Methods.  Nursing staff on five acute inpatient wards in one hospital in the United Kingdom collected data on aggressive incidents using the Staff Observation Aggression Scale – Revised during a 10 month period from June 2001 to April 2002.

Results.  There were 254 incidents of aggression recorded. Staff were most commonly targeted and were involved in 57·1% of incidents. The most frequent provocation of the aggression was the patient being denied something such as leave from the ward (29·5% of incidents). The most frequent means used by patients was verbal aggression (60% of incidents), the most frequent outcome for the victim was feeling threatened (59% of incidents), and verbal interventions were used most frequently to manage the aggressive behaviour (43·7%). Despite many incidents involving verbal aggression in both staff- and patient-targeted aggression, 35·9% of incidents involving staff and 25% of incidents involving other patients resulted in seclusion.

Conclusion.  It is estimated that in a 12 month period at the hospital in this study a nurse would have a one in 10 chance per year of receiving any kind of injury as a result of patient aggression. Despite the predominance of verbal over physical aggression, the fear generated from working in such an environment and a difficulty in understanding the causes of patient aggression may motivate staff to manage aggressive incidents with physical methods such as seclusion and restraint on a frequent basis.

Aggressive behaviour on acute psychiatric wards: prevalence, severity and management

Although international scientific research on health issues has been dealing with the problem of aggression and violence towards those employed in health care, research activities in Germany are still at an early stage. In view of this, the aim of this study was to examine the frequency and consequences of aggressive behaviour towards nurses and health care workers in different health sectors in Germany and to assess the need for preventive measures. We conducted a cross-sectional retrospective survey. Nurses and health care workers from two nursing homes, a psychiatric clinic and a workshop for people with disabilities were interviewed using a standardised questionnaire. The sample covered 123 individuals (response rate 38.8%). The survey assessed the frequency, the type and the consequences of aggressive behaviour, and social support in connection with coping with aggression in the workplace. Odds ratios (OR) and 95% confidence intervals (CI) for putative risk factors which may influence the stress induced by aggression at the workplace were calculated using conditional logistic regression. During the previous twelve months 70.7% of the respondents experienced physical and 89.4% verbal aggression. Physical aggression more frequently occurred in nursing homes (83.9% of the employees) and verbal aggression was more common in the psychiatric clinic (96.7% of the employees). The proportion of the individuals affected in the workshop for people with disabilities was lower (41.9% and 77.4% respectively). The incidents impaired the physical (55%) and emotional well-being (77.2%) of the employees. The frequency of incidents (weekly: OR 2.7; 95% CI 1.1-6.4) combined with the lack of social support (OR 2.8; 95% CI 1.2-6.6) increased the probability of higher stress due to aggression. This study corroborates previous reports of frequent physical and verbal aggression towards care workers in the various areas of health care. The present study highlights differences between various areas of health care in Germany and the aggravating effect of prevention neglect such as missing social support at the workplace. Therefore our data suggest the need for improved target group specific prevention of aggressive incidents towards care workers and the need for effective aftercare in Germany.

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Aggression and violence against health care workers in Germany - a cross sectional retrospective survey

This study was designed to examine the job-related, psychological, and physical outcomes of sexual harassment in the workplace. Using a meta-analytic approach, we analyzed findings from 49 primary studies, with a total sample size of 89,382, to obtain estimates of the population mean effect size of the association between sexual harassment and job-related outcomes (e.g., job satisfaction and organizational commitment), psychological outcomes (e.g., well-being and distress), and physical outcomes (e.g., health satisfaction and physical symptoms). Moderator analyses were also conducted to examine whether gender, age (below 40 years vs. greater than or equal to 40 years), and type of measure (a “direct question” approach vs. “behavioral list” approach) moderate the strength of these associations. Meta-analytic results confirm that sexual harassment experiences are negatively associated with job-related outcomes, psychological health, and physical health conditions. In addition, our moderator analyses reveal that the strength of these associations was moderated by the mean age of the samples and the type of measure used in the primary studies. Conceptual and applied implications of these findings are discussed.

Examining the job‐related, psychological, and physical outcomes of workplace sexual harassment: a meta‐analytic review

Using a survey instrument, the experiences of psychiatric nurses with inpatienaggression were investigated in East London, U.K. On this Perceptions of Prevalence Of Aggression Scale (POPAS), annual experiences with 15 types of disruptive and aggressive behavior were rated anonymously. Staff members were also asked to disclose the number of days missed from work due to inpatient violence. On the basis of these POPAS forms, internal consistency of the instrument, mean reported aggression frequencies, and days missed from work due to violence were calculated. Internal consistency of the POPAS appeared to be reasonable. Verbal abuse and threats were experienced by most of the psychiatric nurses during a one-year period (i.e., by about 80-90 percent of nurses). Sexual harassment or intimidation was also experienced relatively often on an annual basis (68 percent), particularly by female and young staff members. A minority of staff members (i.e., 16 percent) had experienced severe physical violence. Although not prevalent, this type of behavior was most strongly connected with reporting sick. In particular, staff members working with involuntarily admitted patients experienced much (severe) violence during their work. Although the validity of estimates of aggression prevalence with the POPAS instrument needs to be investigated further, such a survey may be helpful in gaining insight rather quickly into the level of day-to-day contact with aggressive behavior. Also, since information on verbal, physical, and sexual violence, and on days missed from work, can be provided anonymously, this rather delicate, but essential management information, may be accessed relatively easily with the POPAS.

/pdf/psychiatric-nurses-experiences-with-inpatient-aggression-24gmy79k70.pdf

Psychiatric nurses' experiences with inpatient aggression

A European perspective on psychiatric nursing and violent incidents: management, education and service organisation

While an emerging research programme has begun to chart and examine occupational and workplace violence in the health sector much of this work has focused upon identifying prevalence rates, capturing experiences of violence and developing an evidence base for implementing strategies of prevention and response. In complement to such important investigations and in line with multi-method, multi-disciplinary enquiry, social science can help provide significant insights regarding the cultural and social contexts of health sector violence and responses/strategies to such violence. Drawing upon an extensive programme of research examining occupational violence in general practice/ family medicine in Australia, this talk outlines a selection of key social science insights gained from recent fieldwork experiences and data collection. In particular, the talk explores the significance of adopting and promoting a wider sociological research gaze as part of an applied health services research agenda. A number of examples are outlined including identification of a geographical schema for framing occupational violence in primary health care, examining the experiences and perspectives of a range of stakeholders, and exploration of wider professional culture in understanding reactions and responses to violence and subsequent strategies.

Nico Oud

Papers

Psychiatric nurses' experiences with inpatient aggression

A European perspective on psychiatric nursing and violent incidents: management, education and service organisation

Violence in the Health Sector From Awareness to Sustainable Action

Nurses’ contribution to prevent seclusion in acute mental health care