Understanding the Workplace-Violence-Related Perceptions and Coping Strategies of Nurses in Emergency Rooms

10.1097/jnr.0000000000000581

Hsiu-Fen HSIEH；Yao-Mei CHEN；Shu-Lin CHEN；Hsiu-Hung WANG

workplace violence ； emergency nurses ； perceptions ； coping strategies ； qualitative research

The Journal of Nursing Research

31卷6期（2023 / 12 / 01）

1 - 10

英文

Background: Workplace violence (WPV) is a well-known and serious issue in most countries, and WPV against healthcare providers is of particular concern, especially among nurses working in emergency rooms (ERs). Purpose: We aimed to develop a deeper understanding of nurses' perceptions and coping strategies related to WPV that took place over a 1-year period from the perspective of nursing victims still working in ERs in southern Taiwan. Methods: This is a qualitative study with in-depth and semi-structured interviews. Nineteen ER nurse victims were recruited from six hospitals in southern Taiwan from June 2015 to April 2016. All of the interview recordings were analyzed using content analysis. Results: The content analysis identified two themes of perceptions and two themes of coping strategies toward WPV. The two themes of perceptions were "adversity" and "dilemma," with the former covering the three subthemes of "misunderstanding of health policy," "unsafe environment," and "nursing shortage" and the latter covering the two subthemes of "burnout" and "keeping or quitting the job." The two themes of coping strategies were "adjustment" and "resilience," with the former covering the three subthemes of "acceptance of the reality of WPV," "self-regulation," and "culture and belief" and the latter covering the two subthemes of "living with WPV" and "problem solving." Conclusions/Implications for Practice: The findings revealed that ER nurse victims of WPV experienced a complicated journey after encountering WPV. Their coping strategies may be referenced by other ER nurses to better prevent and manage violent events in ERs. To prevent and manage violence in ERs, hospital managers should create a safe working environment through, for example, assigning sufficient security personnel and staff; provide relevant training to ER nurses in communications and other skills; and implement support systems to strengthen nurse resilience.

1. Tsai, J. T.(2014).A experience of Taiwanese belief: An example of local temple in Taichung.Taiwan Studies in Literature and History,8,113-139.
   連結：
2. Yee, D. H.,Liu, M. Y.(2004).The inspiration of conventional wisdom for the ethical/spiritual well-being in Taiwanese folk belief system.New Century Religious Study,2(4),71-117.
   連結：
3. Abraham, L. J.,Thom, O.,Greenslade, J. H.,Wallis, M.,Johnston, A. N.,Carlström, E.,Mills, D.,Crilly, J.(2018).Morale, stress and coping strategies of staff working in the emergency department: A comparison of two different-sized departments.Emergency Medicine Australasia,30(3),375-381.
4. Aiken, L. H.,Sloane, D. M.,Bruyneel, L.,Van den Heede, K.,Griffiths, P.,Busse, R.,Diomidous, M.,Kinnunen, J.,Kózka, M.,Lesaffre, E.,McHugh, M. D.,Moreno-Casbas, M. T.,Rafferty, A. M.,Schwendimann, R.,Scott, P. A.,Tishelman, C.,van Achterberg, T.,Sermeus, W.,RN4CAST Consortium.(2014).Nurse staffing and education and hospital mortality in nine European countries: A retrospective observational study.The Lancet,383(9931),1824-1830.
5. Aivazi, A. A.,Menati, W.,Tavan, H.,Navkhasi, S.,Mehrdadi, A.(2017).Patients' bill of rights and effective factors of workplace violence against female nurses on duty at Ilam teaching hospitals.Journal of Injury & Violence Research,9(1),1-6.
6. Alkorashy, H. A.,Al Moalad, F. B.(2016).Workplace violence against nursing staff in a Saudi university hospital.International Nursing Review,63(2),226-232.
7. Alyaemni, A.,Alhudaithi, H.(2016).Workplace violence against nurses in the emergency departments of three hospitals in Riyadh, Saudi Arabia: A cross-sectional survey.NursingPlus Open,2,35-41.
8. Chang, C. L.(2009)。Religious therapy and its faith base of Taiwan's folk belief: "Ritual of asking to god" performed at Tsu De Tsu Huei Temple in Taichung。Taiwan Journal of Religious Studies，8(2)，27-56。
9. Chapman, R.,Styles, I.,Perry, L.,Combs, S.(2010).Nurses' experience of adjusting to workplace violence: A theory of adaptation.International Journal of Mental Health Nursing,19(3),186-194.
10. Chen, S.,Lin, S.,Ruan, Q.,Li, H.,Wu, S.(2016).Workplace violence and its effect on burnout and turnover attempt among Chinese medical staff.Archives of Environmental & Occupational Health,71(6),330-337.
11. Copeland, D.,Henry, M.(2017).Workplace violence and perceptions of safety among emergency department staff members: Experiences, expectations, tolerance, reporting, and recommendations.Journal of Trauma Nursing,24(2),65-77.
12. DiCicco-Bloom, B.,Crabtree, B. F.(2006).The qualitative research interview.Medical Education,40(4),314-321.
13. DiCorcia, J. A.,Tronick, E.(2011).Quotidian resilience: Exploring mechanisms that drive resilience from a perspective of everyday stress and coping.Neuroscience & Biobehavioral Reviews,35(7),1593-1602.
14. Duan, X.,Ni, X.,Shi, L.,Zhang, L.,Ye, Y.,Mu, H.,Li, Z.,Liu, X.,Fan, L.,Wang, Y.(2019).The impact of workplace violence on jobsatisfaction, job burnout, and turnover intention: The mediating role of social support.Health Quality of Life Outcomes,17(1),93.
15. Edward, K. L.,Ousey, K.,Warelow, P.,Lui, S.(2014).Nursing and aggression in the workplace: A systematic review.British Journal of Nursing,23(12),653-659.
16. Emergency Nurses Association. (2014). Position statement: Violence in the emergency care setting. https://www.ena.org/quality-and-safety/workplace-violence
17. Ferns, T.(2007).Considering theories of aggression in an emergency department context.Accident and Emergency Nursing,15(4),193-200.
18. Firmin, R. L.,Mao, S.,Bellamy, C. D.,Davidson, L.(2019).Peer support specialists' experiences of microaggressions.Psychological Services,16(3),456-462.
19. Freeland, R.,Goldenberg, T.,Stephenson, R.(2018).Perceptions of informal and formal coping strategies for intimate partner violence among gay and bisexual men.American Journal of Men's Health,12(2),302-312.
20. Gerberich, S. G.,Church, T. R.,McGovern, P. M.,Hansen, H.,Nachreiner, N. M.,Geisser, M. S.,Ryan, A. D.,Mongin, S. J.,Watt, G. D.,Jurek, A.(2005).Risk factors for work-related assaults on nurses.Epidemiology,16(5),704-709.
21. Gong, Y.,Han, T.,Yin, X.,Yang, G.,Zhuang, R.,Chen, Y.,Lu, Z.(2014).Prevalence of depressive symptoms and work-related risk factors among nurses in public hospitals in southern China: A cross-sectional study.Scientific Reports,4,7109.
22. Hamdan, M.,Hamra, A. A.(2017).Burnout among workers in emergency departments in Palestinian hospitals: Prevalence and associated factors.BMC Health Services Research,17,407.
23. Hammad, K. S.,Arbon, P.,Gebbie, K.,Hutton, A.(2018).Why a disaster is not just normal business ramped up: Disaster response among ED nurses.Australasian Emergency Care,21(1),36-41.
24. Hsieh, H.-F.,Chen, Y.-M.,Wang, H.-H.,Chang, S.-C.,Ma, S.-C.(2016).Association among components of resilience and workplace violence-related depression among emergency department nurses in Taiwan: A cross-sectional study.Journal of Clinical Nursing,25(17-18),2639-2647.
25. International Council of Nurses. (2009). Prevention and management of workplace violence. https://www.icn.ch/sites/default/files/inline-files/PS_C_Prevention_mgmt_workplace_violence.pdf
26. Isaak, V.,Vashdi, D.,Bar-Noy, D.(2017).Enhancing the safety climate and reducing violence against staff in closed hospital wards.Workplace Health & Safety,65(9),409-416.
27. Jones, A. L.(2017).Experience of protagonists in workplace bullying: An integrated literature review.International Journal of Nursing & Clinical Practices,4,246.
28. Krippendorff, K.(2004).Content analysis: An introduction to its methodology.Sage.
29. Lee, S.,Pai, H.-C.,Yen, W.-J.(2010)。Nurse violence in the workplace: A study of experiences and related factors in Taiwan。The Journal of Nursing，57(2)，61-69。
30. Lin, F.-Y.,Huang, L.-H.(2016).The incidence of workplace violence and its related factors among nurses in a medical center.Show Chwan Medical Journal,15(3-4),79-91.
31. Lin, Y. H.,Liu, H. E.(2005).The impact of workplace violence on nurses in South Taiwan.International Journal of Nursing Studies,42(7),773-778.
32. Lincoln, Y. S.,Guba, E.(1985).Naturalistic inquiry.Sage.
33. Magnavita, N.(2014).Workplace violence and occupational stress in healthcare workers: A chicken-and-egg situation-results of a 6-year follow-up study.Journal of Nursing Scholarship,46(5),366-376.
34. Minichiello, V.,Aroni, R.,Timewell, E.,Alexander, L.(1995).In-depth interviewing.Longman.
35. Ministry of Health and Welfare, Taiwan, ROC. (2018). Nurse-patient ratio in Taiwan. https://www.mohw.gov.tw/cp-2644-20596-1.html
36. Nantsupawat, A.,Kunaviktikul,W,Nantsupawat, R.,Wichaikhum, O. A.,Thienthong, H.,Poghosyan, L.(2017).Effects of nurse work environment on job dissatisfaction, burnout, intention to leave.International Nursing Review,64(1),91-98.
37. National Health Insurance Administration. (1995). National health insurance premium. https://eng.nhi.gov.tw/en/mp-2.html
38. Occupational Safety and Health Administration, Ministry of Labor, Taiwan, ROC. (2016). Occupational disease and injury prevention service center and diagnosis and treatment network project. https://www.osha.gov.tw/ (Original work published in Chinese)
39. Sandelowski, M.,Barroso, J.(2003).Classifying the findings in qualitative studies.Qualitative Health Research,13(7),905-923.
40. Schneider, D.,Signorelli, M. C.,Pereira, P. P. G.(2017).Public security female workers at the coast of Paraná, Brazil: Intersections of gender, work, violence(s), and health.Ciência & Saúde Coletiva,22(9),3003-3011.
41. Taiwan Radical Nurses Union. (2014). Free yourself revolution. https://powerfulnurses.wordpress.com/ (Original work published in Chinese)
42. Vezyridis, P.,Samoutis, A.,Mavrikiou, P. M.(2015).Workplace violence against clinicians in Cypriot emergency departments: A national questionnaire survey.Journal of Clinical Nursing,24(9-10),1210-1222.
43. Wei, C. Y.,Chiou, S. T.,Chien, L. Y.,Huang, N.(2016).Workplace violence against nurses—Prevalence and association with hospital organizational characteristics and health-promotion efforts: Cross-sectional study.International Journal of Nursing Studies,56,63-70.
44. World Health Organization(2003).,未出版
45. World Health Organization. (2012). Workplace violence in the health sector. https://www.who.int/publications/m/item/workplace-violence-in-the-health-sector-country-case-study-research-instruments-survey-questionnaire
46. Yang, C.-K.,Yang, C.-H.,Lin, L.-F.,Lin, K.-Y.(2015).Violence in the workplace: Experiences of emergency department nurses.Cheng Ching Medical Journal,11(3),22-31.
47. Zhou, H.,Peng, J.,Wang, D.,Kou, L.,Chen, F.,Ye, M.,Deng, Y.,Yan, J.,Liao, S.(2017).Mediating effect of coping styles on the association between psychological capital and psychological distress among Chinese nurses: A cross-sectional study.Journal of Psychiatric and Mental Health Nursing,24(2-3),114-122.