Analysis of workplace violence suffered by nurses in general hospitals in southwest China

doi:10.21203/rs.3.rs-3222493/v1

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Analysis of workplace violence suffered by nurses in general hospitals in southwest China

https://doi.org/10.21203/rs.3.rs-3222493/v1

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This study aimed to examine the prevalence of workplace violence among nurses in general hospitals in Southwest China and provide a basis for developing relevant policies. A total of 254 nurses from a tertiary general hospital in Southwest China were surveyed using a revised questionnaire on workplace violence. Results showed that the incidence rate of hospital violence among nurses was 46.46% within one year, with verbal abuse being the most common type of violence. Nurses with only children were found to have a higher incidence of workplace violence, while nurses with different educational backgrounds and attitudes towards patients also had significant differences in incidents of workplace violence in hospitals. The overall awareness rate of nurses on workplace violence was 66.1%. The study also found that training on workplace violence, encouraging reporting of workplace violence, and adopting a fair attitude towards dealing with violence can lower the incidence of workplace violence in hospitals. Therefore, effective comprehensive intervention measures should be taken by hospital management departments and nursing managers to reduce the occurrence of hospital violence and create a harmonious medical environment for nurses.

Nurse

hospital

violence

Workplace violence

Current situation

influencing factor

Occupational protection

The safety and well-being of medical workers are being threatened by hospital workplace violence. According to the World Health Organization (WHO), workplace violence is defined as the abuse, threat, or attack of an individual or group in their workplace, which can cause physical or psychological harm. This type of violence can be categorized into four types: abuse, threat, sexual harassment, and assault. Nurses are particularly vulnerable to workplace violence, and it is a common issue worldwide^[1]. Workplace violence is a complex and hazardous occupational hazard in the healthcare industry^[2].Previous studies have reported that more than half of nurses in Asia have experienced workplace violence, which not only causes physical pain but also significant mental stress^[3]. Studies indicate that this can lead to high levels of anxiety among healthcare workers^[4]. Due to their specific professional and service characteristics, nurses have become a common group that suffers from hospital violence, which contributes to the high turnover rates of nursing staff and hinders the development of nursing teams. This study aims to investigate and analyze the current situation and influencing factors of workplace violence among nurses.

1.1 Study design

The revised version of the hospital workplace violence questionnaire was administered to 254 nurses at a Grade A general hospital in southwest China, which is a tertiary healthcare facility.

Inclusion criteria for exclusion:The inclusion criteria for this study were current nurses who have direct patient contact in clinical departments, have at least one year of experience in clinical nursing, and voluntarily chose to participate. The exclusion criteria were nurses who have not worked in nursing for at least one year, those who have taken maternity leave, sick leave, or other extended leave for more than one month, and those who declined to participate in the study.

1.2 Methods

1.2.1 Survey tools

The questionnaire used in this study is the Revised Questionnaire on Violence in Hospital Workplaces developed by Yang Xiaoduo et al ^[5]. It consists of 40 items and is divided into five main parts:① In the past 1 year, The incidence of workplace violence among the survey respondents; ② Description of the workplace violence, Including the time and place of violence, the characteristics of the perpetrator, the response of the nurse (such as tolerance avoidance, calling the police, etc.); ③ Perceptions and attitudes of medical staff towards violence and response in the workplace (e. g. receiving training, supporting zero tolerance policy, etc.); ④ Attitude and measures to prevent violence in the workplace (such as the hospital's attitude to handling violence in the workplace, whether to install camera equipment, etc.); ⑤ General data of nurses, Including demographic sociology information and work background.

1.2.2 Methods of data collection

The questionnaire was created by the researcher using the Wenjuanxing APP and distributed through WeChat as a two-dimensional code. A total of 280 questionnaires were distributed, and 254 valid questionnaires were collected, resulting in an effective recovery rate of 90.71%.

The study included 254 nurses, out of which 81 were males (31.89%) and 173 were females (68.11%). The age of the participants ranged from 18 to 50 years, with an average age of 28.57 ± 6.2 years. The participants were from different departments, including 29 from the emergency department (11.42%), 42 from the outpatient department (16.64%), 174 from the inpatient department (68.50%), and 9 from the social health center (3.54%). Furthermore, 104 participants were only children (40.94%), while 150 were non-only children (59.06%). In terms of education, 15 candidates had a technical secondary school degree (5.91%), 51 had a junior college degree (20.08%), 175 had a bachelor's degree (68.90%), and 13 had a master's degree or above (5.12%). Additionally, 15 participants held senior professional titles (5.91%), 59 held intermediate professional titles (23.23%), 145 held junior professional titles (57.09%), and 35 were unemployed professionals (13.78%). All participants were informed about the research purpose and voluntarily participated in the study.

1.2.3 Statistical analysis

In this study, we used SPSS 26 statistical software to perform statistical processing. The count data were expressed as frequency and percentage, and descriptive statistics and x2Inspection were conducted. The test level was set at α = 0.05. Statistical significance was expressed as p < 0.05 or P < 0.01.

2.1 Investigation results of the current situation of violence in nurses' workplace

2.1.1 Incidence of workplace violence and characteristics of workplace violence among nurses in Southwest China 2.1.1.1 Incidence of workplace violence among nurses in Southwest

This section presents the results of a survey conducted in Southwest China on workplace violence against nurses. The survey found that the overall incidence rate of violence was 46.46%, with verbal abuse being the most common (44.49%), followed by verbal threats (35.83%), physical violence (23.23%), and sexual harassment (18.77%). Table 1 provides a detailed breakdown of the current status of workplace violence among hospital nurses, with a total of 254 nurses surveyed.

Table 1

Current situation of violence in the workplace of hospital nurses [N = 254 n (%)]
Title/ Options	not have	One time	2–3 Times	> 3 Times
1. Scolding, name-calling, insulting, belittling or other words that damage personal dignity (in person, on the phone, in letters or leaflets, etc.), but without physical contact.	141(55.51%)	41(16.14%)	49(19.29%)	23(9.06%)
2. Threats (by words, spitting, punching, slapping the table, stamping feet, holding things at you, including phone calls, texts, third-person transmissions, etc.), but without physical contact, and the content of the threats involves personal and property safety, etc.	163(64.17%)	60(23.62%)	22(8.66%)	9(3.54%)
3. Physical aggression (by physical contact or attacking with objects), including beating, kicking, slapping, stabbing, pushing, biting, throwing objects, twisting arms, pulling hair, etc.	195(76.77%)	31(12.20%)	22(8.66%)	6(2.36%)
4. Sexual harassment: Harassing language or sexual assault, such as being pulled, hugged, kissed or touched by the opposite sex.	207(81.50%)	30(11.81%)	17(6.69%)	0(0)

2.1.1.2 Characteristics of hospital workplace violence among nurses in general hospitals in Southwest China

The study findings indicate that workplace violence is prevalent among nurses, with significant differences observed in the incidence of violence based on the department and the attitude of the nurses towards patients in hospitals (P < 0.05), as shown in Table 2.

Table 2

Comparison of hospital: workplace violence [n (%)]
project	No workplace violence has occurred n = 136	Event of workplace violence n = 118	X²	P
Whether it is an only child
yes	46(33.82%)	58(49.15%)	6.140	0.013
deny	90(66.18%)	60(50.85%)
Different departments
emergency call	10(7.35%)	19(16.10%)	5.398	0.145
section for outpatients	23(16.18%)	20(16.95%)
in-patient department	98(72.06%)	76(64.41%)
Social health center	6(4.41%)	3(2.54%)
Different academic qualifications
special school	4(2.94%)	11(9.32%)	8.016	0.046
junior college	23(16.91%)	28(23.73%)
undergraduate course	100(73.53%)	75(63.56%)
Master's degree or above	9(6.62%)	4(3.39%)
Different titles
senior	4(2.94%)	11(9.32%)	12.344	0.006
middle rank	25(18.38%)	34(28.81%)
elementary	82(60.29%)	63(53.39%)
uncertain	25(18.38%)	10(8.47%)

According to the study, workplace violence incidents suffered by nurses were mainly caused by men (63.56%) who were mostly middle-aged (57.63%). The perpetrators were mostly patients (38.14%) and patients' family members (35.60%). The incidents were most frequent in inpatient wards (43.22%) and day shifts (35.59%). The top four causes of workplace violence were patient quality and emotional factors (51.69%), patients' unreasonable demands or high expectations (32.20%), long waiting time (30.51%), and dissatisfaction with nurses' work (28.81%). Nurses' coping methods included patient explanation (66.95%), forbearance and avoidance (50.85%), and reasoning first and then fighting back (33.90%). The impact on nurses' psychological and behavioral well-being after the incident included feeling angry (51.69%), feeling wronged (50%), and declining work enthusiasm (41.53%). Please refer to Table 3 for more details.

Table 3

Characteristics of nurse workplace violence [n (%)]
project	project	Overall situation, n = 118
Violators	patient	45(38.14%)
	family members	42(35.60%)
	visiting personnel	20(16.95%)
	Staff of the hospital	11(9.32%)
Sex of the abuser	men	75(63.56%)
	women	43(36.44%)
Age of the abuser	early youth	10(8.47%)
	youth	14(11.86%)
	mid-life	68(57.63%)
	old age	26(22.03%)
occurrence time	day shift	42(35.59%)
	Front night shift	38(32.20%)
	After the night shift	33(27.97%)
	after work	5(4.24%)
scene	ward	51(43.22%)
	Doctor's office	10(8.47%)
	Nurse's office	25(21.19%)
	corridor	17(14.41%)
	treatment room	5(4.24%)
	commuting	3(2.54%)
	others	7(5.93%)
Causes of violence	Death	8(6.78%)
	mental disorder	16(13.56%)
	low quality	61(51.69%)
	long waiting time	36(30.51%)
	drinking alcohol	22(18.64%)
	wanting to seek financial compensation	15(12.71%)
	taking drugs	4(3.39%)
	being rejected for unreasonable medical expenses	38(32.20%)
	The medical costs are expensive	27(22.88%)
	dissatisfied with the work of doctors,	23(19.49%)
	dissatisfied with the work of nurses	34(28.81%)
	dissatisfied with the treatment effect	20(16.95%)
	others	5(4.24%)
coping style	avoidance	60(50.85%)
	patient explanation	79(66.95%)
	tit-for-tat	21(17.80%)
	reason first and then fight back	40(33.90%)
	seek help from colleagues	37(31.36%)
	seek help from security guards	29(24.58%)
	seek help from other patients/family members	10(8.47%)
	seek help from leaders	15(12.71%)
	report to the police	9(7.63%)
	others	2(1.69%)
psychological and behavioral influences	have no effect	15(12.71%)
psychological and behavioral influences	can't concentrate	28(23.73%)
	feel aggrieved	59(50.00%)
	Feel angry	61(51.69%)
	feel fear	24(20.34%)
	insomnia	16(13.56%)
	work enthusiasm decreases	49(41.53%)
	work quality decreases	23(19.49%)
	the patient hates	17(14.41%)
	not wanting to this line of work	35(29.66%)
	suicidal thoughts	3(2.54%)
	others	4(3.39%)

2.1.1.3 Cognition and coping attitudes towards workplace violence

The study found that 87.9% of nurses are aware of workplace violence, while 83.5% believe it is inevitable. Interestingly, 31.1% of nurses believe that it is not worth making a fuss about. The top three measures suggested by nurses to prevent violence are carrying out publicity and education on hospital violence prevention (84.5%), improving service attitude (84.0%), and improving professional level (81.6%). Additionally, 81.6% of nurses reported that hospitals have security days and 74.8% of wards have installed cameras. Furthermore, 73.8% of wards have security guards on duty, as indicated in Table 4.

Table 4

Cognition and coping attitudes towards violence in the workplace [n (%)]
project		Number of people, n = 118
Awareness	Heard of workplace violence	179(70.47%)
	Think it is inevitable	172(67.72%)
	Think it is not worth making a fuss	80(31.50%)
	Think pre-employment training should include violence prevention content	209(82.28%)
	Think violence training is beneficial	206(81.10%)
	Think there is a need for a dedicated agency to deal with violence	219(86.22%)
	Think there should be a zero-tolerance policy to respond to violence	206(81.10%)
Response	Believes that the following measures can effectively prevent or reduce violence
	Conduct targeted training on legislation on workplace violence	170(66.93%)
	Conduct targeted training	199(78.35%)
	Carry out publicity and education	172(67.72%)
	Improve service attitude	160(62.99%)
	Improve business level	128(50.39%)
	Increase the correct orientation of the media	154(60.63%)
	Increase security personnel and on-duty posts	129(50.79%)
	Public security personnel are stationed in the hospital	84(33.07%)
	Medical personnel are equipped with protective equipment	78(30.71%)
	Cameras are installed in wards	138(54.33%)
	Night work areas are kept brightly lit	91(35.83%)
	others	6(2.36%)
	Preventive measures taken by the hospital
	Security patrols on a daily basis	135(53.15%)
	Install cameras in wards	202(79.53%)
	Emergency personnel are equipped with protective equipment	122(48.03%)
	Security guards are on duty in wards	125(49.21%)
	Increase security personnel and on-duty positions	92(36.22%)
	Keep lights bright in night work areas	115(45.28%)
	others	5(1,97)

2.1.1.4 Nursing staff's hospital's attitude towards workplace violence

The study's findings indicate that effective handling of workplace violence, encouragement of reporting incidents, and fair attitudes towards violence in hospitals lead to a lower incidence of workplace violence (P < 0.05), as shown in Table 5.

Table 5

Response attitudes to workplace violence in the nurses' hospitals [n (%)]
project	No workplace violence has occurred n = 136	Event of workplace violence n = 118	X²	P
Whether the event is handled
yes	99(72.79%)	49(41.53%)	25.404	< 0.001
deny	37(27.21%)	69(58.47%)
Encourage reporting
yes	114(83.82%)	79(66.95%)	9.859	0.002
deny	22(16.18%)	39(33.05%)
Set up a special processing agency
yes	89(65.44%)	79(66.95%)	0.064	0.800
deny	47(34.56%)	39(33.05%)
Attitude after experiencing violence
To protect the interests of employees	51(37.5%)	28(23.73%)	10.543	0.014
to deal with them fairly	70(51.47%)	62(52.54%)
ignore it	6(4.41%)	15(12.71%)
punish the employees	9(6.62%)	13(11.02%)
The degree of importance attached to violence
the importance attached to doctors	51(37.5%)	54(45.76%)	28.347	< 0.001
the importance attached to nurses	8(5.88%)	30(25.42%)
the equal importance attached to nurses	77(56.62%)	34(28.81%)

3.1 Incidence of workplace violence among nurses in general hospitals in Southwest China

This study found that 46.46% of nurses in tertiary general hospitals experienced workplace violence within one year. This highlights the significant issue of workplace violence faced by medical staff, particularly nurses. The incidence rate varies across regions and may be influenced by factors such as economic resources, population quality, and access to health resources^[10]. While the incidence rate in this study was lower than in some previous research^[6–9], it was consistent with findings from Taiwan^[10] and Hong Kong^[11]. Verbal scolding and threats were the most common forms of workplace violence experienced by nurses, with sexual harassment being relatively rare. However, the low reporting rate of sexual harassment suggests a need for further research into this issue and its potential consequences.

3.2 Characteristics of workplace violence among nurses in general hospitals in Southwest China

3.2.1 Place of the violence and the identity of the perpetrator

According to this study, workplace violence is most likely to occur in general wards, which is consistent with previous research by Yang Xiaoduo et al^[5]. The study suggests that nurses should be aware of preventing violence in the workplace and take precautions such as keeping the route clear and avoiding standing by the door or in corners. The study also found that perpetrators of workplace violence are mostly middle-aged, male patients. Therefore, nurses should avoid conflicts with individuals who fit this description and take steps to minimize the occurrence of workplace violence.

3.2.2 Common causes for violent incidents

This study confirms that workplace violence is often caused by the perpetrator's quality and emotional factors, as well as the patient's unreasonable demands or high expectations. This aligns with previous research ^{[6, 7]}, which also ranked the perpetrator's quality and emotional factors as the primary cause. The survey also revealed that nurses are often victims of workplace violence, but the main reason for perpetrators' violence against nurses is not dissatisfaction with their work, but rather unreasonable demands or high expectations from patients. Therefore, nurses should focus on improving their communication skills and addressing problems strategically when faced with such situations.

3.2.3 Cognition and attitude of nurses on workplace violence and response in southwest China General Hospital

This research suggests that hospitals should establish dedicated departments or personnel to manage workplace violence. This includes coordinating training courses related to workplace violence and improving the reporting and intervention system for violence incidents. Nurses are more likely to use changes in external social factors of the hospital to prevent violence in the workplace. This includes advocating for the media to maintain the principles of objectivity and integrity in their coverage. Workplace violence is both an individual experience and an organizational consequence, and social forces should be utilized to resolve it.

3.3.4 Specific measures and attitudes of the workplace violence prevention in hospitals

The survey reveals that hospitals in China have limited violence-related training among employees and there is a lack of specialized research on preventive measures for medical violence. To address this issue, the hospital management department has proposed a series of administrative countermeasures to reduce the occurrence of violence. They have established an inter professional working group to design and implement a prevention plan applicable to hospital violence, including crisis assessment and consultation with professional institutions. The hospital staff is provided with a three-tiered training program through specialized personnel, including prevention and management of violence and attacks, get rid of skills, control and restrain violent patients, etc^[12]. Additionally, hospitals are advised to strengthen risk management by improving monitoring methods, conducting risk assessments for individual cases of violence, and providing personal protective equipment for high-risk staff. The hospital management department hopes to learn from Hong Kong's experience and formulate a domestic administrative response strategy for preventing violence as soon as possible while considering local characteristics.

3.3.5 Factors affecting the occurrence of violence in the hospital workplace

Workplace violence is influenced by several factors, including job position, education level, hospital's attitude towards employees after suffering from the workplace, and whether one is an only child. Among the different work departments, nurses in the emergency department are the most vulnerable to violence due to the urgent and critical nature of their work. Patients, relatives, and accompanying staff can become anxious, affecting the patients' cognition and judgment, which may lead to violent incidents. Additionally, being an only child is also a factor that may contribute to workplace violence, possibly due to the willful personality traits associated with being an only child.

The study demonstrates that workplace violence against nurses is prevalent in general hospitals in Southwest China. It is imperative to take immediate and effective measures to reduce such incidents. One possible solution is to establish an anti-riot curriculum system specifically designed for nurses, which would enhance their capability to deal with workplace violence. Additionally, hospitals and society should collaborate to create a peaceful and harmonious medical environment.

5.1 Ethical Approval

The studies involving human participants were reviewed and approved by Xinqiao Hospital (the Second Affiliated Hospital of Army Medical University) Academic Ethics Committee.

5.2 Competing interests

The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest .

5.3 Authors' contributions

Conceptualization, M.Y. and S.L.; Data collection and analysis, M.Y. and X.W.; writing-original draft preparation, M.Y. and C.L.; writing—review and editing, S.L. supervision, S.L. All authors have read and agreed to the published version of the manuscript.

5.4 Funding

This study was supported by Army Medical University .(Grant NO.2021B24)

5.5 Availability of data and materials

The original contributions presented in the study are included in the article , further inquiries can be directed to the corresponding author .

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No competing interests reported.

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Analysis of workplace violence suffered by nurses in general hospitals in southwest China

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