A qualitative system dynamics model for effects of workplace violence and clinician burnout on agitation management in the emergency department

Background Over 1.7 million episodes of agitation occur annually across the United States in emergency departments (EDs), some of which lead to workplace assaults on clinicians and require invasive methods like physical restraints to maintain staff and patient safety. Recent studies demonstrated that experiences of workplace violence contribute to symptoms of burnout, which may impact future decisions regarding use of physical restraints on agitated patients. To capture the dynamic interactions between clinicians and agitated patients under their care, we applied qualitative system dynamics methods to develop a model that describes feedback mechanisms of clinician burnout and the use of physical restraints to manage agitation. Methods We convened an interprofessional panel of clinician stakeholders and agitation experts for a series of model building sessions to develop the current model. The panel derived the final version of our model over ten sessions of iterative refinement and modification, each lasting approximately three to four hours. We incorporated findings from prior studies on agitation and burnout related to workplace violence, identifying interpersonal and psychological factors likely to influence our outcomes of interest to form the basis of our model. Results The final model resulted in five main sets of feedback loops that describe key narratives regarding the relationship between clinician burnout and agitated patients becoming physically restrained: (1) use of restraints decreases agitation and risk of assault, leading to increased perceptions of safety and decreasing use of restraints in a balancing feedback loop which stabilizes the system; (2) clinician stress leads to a perception of decreased safety and lower threshold to restrain, causing more stress in a negatively reinforcing loop; (3) clinician burnout leads to a decreased perception of colleague support which leads to more burnout in a negatively reinforcing loop; (4) clinician burnout leads to negative perceptions of patient intent during agitation, thus lowering threshold to restrain and leading to higher task load, more likelihood of workplace assaults, and higher burnout in a negatively reinforcing loop; and (5) mutual trust between clinicians causes increased perceptions of safety and improved team control, leading to decreased clinician stress and further increased mutual trust in a positively reinforcing loop. Conclusions Our system dynamics approach led to the development of a robust qualitative model that illustrates a number of important feedback cycles that underly the relationships between clinician experiences of workplace violence, stress and burnout, and impact on decisions to physically restrain agitated patients. This work identifies potential opportunities at multiple targets to break negatively reinforcing cycles and support positive influences on safety for both clinicians and patients in the face of physical danger.

Examination of Quality of Life in Workplace Environments

Healthcare organizations are commonly known to be high-stress environments due to the life-or-death nature of the work. Thus, examining the quality of life in healthcare professionals is of significance to the field. Quality of life is a common measurement in healthcare, typically in determining the effectiveness of treatment on patients. But, quality of life in healthcare workers is often overlooked. A review of the literature was conducted regarding factors that impact quality of life of workers in healthcare environments. The areas of occupational stress, burnout, and workplace violence were explored in depth in order to understand the potential negative consequences of each on quality of life in healthcare professionals. In comparison to other industries, healthcare professionals are at an increased risk for occupational stress, burnout, and workplace violence. Effectively managing these areas could have a positive impact on quality of life in healthcare workers.

Victimizations and surviving of workplace violence against waitresses in southern Ethiopia

Women are obliged to take on vulnerable forms of employment that fail to protect their basic labor rights. Exposure to workplace violence is especially high for those women who work within the agriculture, the hotels, restaurants and catering, the transport as well as the manufacturing sectors. In this context, we explored workplace violence against women working as waitresses in various hotels, restaurants, cafeterias and grocery stores of Wolaita Sodo town, southern Ethiopia. Cross-sectional study was undertaken with descriptive and exploratory study designs. Qualitative data were collected by using in-depth interview method in which 16 waitresses were interviewed. Data were voice recorded, transcribed, and analyzed searching themes and patterns in the data. While we found that waitresses are highly exposed to workplace violence, the level of exposure to the violence varies across various circumstances, including working in large and small towns, the situation of the owners/supervisors, public’s insight of the position, waitresses’ ability to speak the local language, the role of the waitresses, customers’ behavior and the specific context in which waitresses work. Waitresses were generally exposed to all forms of violence including spitting, throwing objects, simple physical assault, touching on private parts, and intimidation, among which verbal abuse and emotional exploitations are found to be the most common. Furthermore, the results revealed that though waitresses rarely experienced violence from female customers, the most common perpetrators involved in the practice were males. Amid widespread exposure of waitresses to all forms of workplace violence, ignorance, mostly motivated by fear of losing one’s job, has been the common way waitresses respond to the violence. The study implies the vulnerability state of waitresses partly due to lack of adequate awareness regarding the rights and obligations expected of an employee when working in such organizations. This is again exacerbated by the lack of formal employment procedures in such organizations. Therefore, awareness creation and supervisory activities are expected from the media, workers’ and social security office of the government, police and other concerned bodies.

Workplace Violence Among Health Care Professionals in Public and Private Health Facilities in Bangladesh

Objectives: The main objectives of this study were to examine the prevalence of workplace violence (WPV), its associated factors and explore the experiences of healthcare workers.Methods: A hospital-based cross-sectional study design used a nationally representative sample of 1,081 healthcare workers covering eight administrative divisions of Bangladesh. Logistic regression analysis was employed to estimate the adjusted effect of independent factors on WPV among healthcare workers.Results: Of the participants, 43% (468) experienced some form of WPV. Of those, 84% reported experiencing nonphysical violence, and 16% experienced physical violence in the past year. About 65% of victims claimed no action was taken to investigate the incident, and 44% reported no consequence for perpetrators. Four factors: being married (AOR = 1.63; CI: 1.12–2.39); public sector healthcare worker (AOR = 2.74; CI:1.99–3.76); working in an emergency department (AOR = 2.30; CI:1.03–5.12); and undertaking shift work (AOR = 1.52; CI: 1.10–2.11) were found to be significantly associated with WPV. One-third of the participants were worried about violence in their workplace.Conclusion: WPV is highly prevalent among healthcare workers in Bangladesh. Formal guidelines for reporting and managing WPV are urgently needed at the individual, hospital, and national levels.

Workplace Violence Against Police Officers and The Effect of Workplace Violence on Mental Health

Aim: The aim of the research is to reveal the prevalence of violence against police officers and to examine the effect of being subjected to violence on their mental health. Methods: The sample of the research consists of 339 police officers working in different duty areas. Questionnaire technique was used to collect data in the study. The questionnaire form consists of two parts. In the first part of the questionnaire, there are questions to determine the demographic characteristics of the participants (age, gender, marital status, education level, working year, etc.). In the second part of the questionnaire, there are questions to measure workplace violence and the Depression-Anxiety-Stress Scale. SPSS 23.0 package program was used in the analysis of the research data. Frequency distribution, descriptive statistics and t-test were used in the analysis of the data. Results: In the current study, it has been determined that 39.2% of police officers have been exposed to at least one type of workplace violence in the last 1 year. It was observed that the most common type of violence was verbal violence (28.9%). The results show that exposure to workplace violence negatively affects the stress and depression levels of police officers. Conclusion: Research results show that workplace violence is an important risk factor for police officers. Being exposed to violence also negatively affects the mental health of police officers. These results show the importance of implementing policies to prevent violence against police officers. Keywords: Police Officers, Workplace Violence, Stress, Depression And Anxiety

Prevalence of Violation Among Nurses Working in Public Health Facilities in Saudi Arabia

Workplace violence (WPV) is more likely to affect those who work in community services, notably nurses. WPV is generally recognized as a workplace health hazard and has been a significant concern in a number of countries. Limited studies have been conducted in the global countries and this study was designed as a cross-sectional study from Saudi Arabia to document the WPV among the nurses. The aim of this study was to enroll the consequences obtain during the WPV among the nurses in Saudi Arabia. In this cross-sectional study, we have enrolled 550 nurses based on the signed of informed consent form and filled questionnaire. The study results indicated that 77.6% of nurses were violated at work. The 90.4% of the majority violations were classified as verbal abuse. The relatives of the patients violated 66.7% of the nurses, and the occurrence occurred during the evening shifts of the working hours between 2.30-10.30pm. The most violations occurred in the patient room, accounting for 46.8% of all violations, with the severe workload accounting for 89.2% of all violations. However, among the violations, 21.4% of the nurses were reported to senior management. In conclusion, this study confirms the nurses who have participated in this were mentally strong in handling the WPV during their job. Further studies are required for looking at the factors that increase the chance of a repeat event and those that decrease it, as well as development of an intervention program for the emotional load that accompanies WPV. To prevent workplace violence in healthcare settings, it is equally vital to implement policies that supplement the existing call to action.

Compassion Satisfaction, Burnout, and Secondary Traumatic Stress Among Nursing Staff at an Academic Medical Center: A Cross-Sectional Analysis

Background: Although several studies have recently described compassion satisfaction (CS), burnout (BO), and secondary traumatic stress (STS) in nurses, few to date have examined these issues across nursing specialties. Such examination is needed to inform future nursing-subspecialty tailored interventions. Aims: To examine (1) differences in CS, BO, and STS across nursing specialties and (2) differences associated with demographic, work-related, and behavioral factors among nurses. Method: A secondary analysis of survey responses from nurses ( N = 350) at an academic medical center. Demographic, behavioral, work-related, and professional quality of life variables were analyzed using hierarchical regression analyses. Results: CS, BO, and STS scores significantly varied across specialties with emergency nurses experiencing significantly elevated rates of BO and STS, and lowest rates of CS; scores were also differentially associated with demographic, work-related, behavioral, and workplace violence variables. Conclusions: Key differences in CS, BO, and STS by nursing specialty suggests the importance of tailoring BO and STS mitigative interventions. BO and STS risk factors should be assessed in nurses (e.g., behavioral health problems and poor sleep quality) and specialty-specific interventions (e.g., reducing workplace violence exposure in emergency settings) may be considered to improve CS while reducing BO and STS among nurses.

Does Exposure to High Job Demands, Low Decision Authority, or Workplace Violence Mediate the Association between Employment in the Health and Social Care Industry and Register-Based Sickness Absence? A Longitudinal Study of a Swedish Cohort

Background: The aim of this paper was to investigate if job demands, decision authority, and workplace violence mediate the association between employment in the health and social care industry and register-based sickness absence. Methods: Participants from the Swedish Longitudinal Occupational Survey of Health who responded to questionnaires in 2006–2016 (n = 3951) were included. Multilevel autoregressive cross-lagged mediation models were fitted to the data. Employment in the health and social care industry at one time point was used as the predictor variable and register-based sickness absence >14 days as the outcome variable. Self-reported levels of job demands, decision authority, and exposure to workplace violence from the first time point were used as mediating variables. Results: The direct path between employment in the health and social care industry and sickness absence >14 days was, while adjusting for the reverse path, 0.032, p = 0.002. The indirect effect mediated by low decision authority was 0.002, p = 0.006 and the one mediated by exposure to workplace violence was 0.008, p = 0.002. High job demands were not found to mediate the association. Conclusion: Workplace violence and low decision authority may, to a small extent, mediate the association between employment in the health and social care industry and sickness absence.