The nature,extent and determinants of violence against psychiatric personnel

Violence against psychiatric staff seems to be on the increase. Such abuse can lead to mental health consequences for the staff and a reluctance to be closely involved with patients. Few Swedish investigations have examined violence against mental nurses and psychiatrists, or undertaken comparative studies between them. In this study we examined the extent, nature and determinants (i.e. risk factors) of violence against psychiatric nurses (n = 731) and psychiatrists (n = 320) working in the eight health care districts of Stockholm. These caregivers were assessed cross-sectionally by means of a questionnaire covering various areas (e.g. violence and work environment). The majority of the participants (85%) reported having been exposed to violence during their careers, with 57% being victimized in the past 12 months. Physical violence was common, and factors such as negative attitudes to work and diminished sense of autonomy were associated with an increased vulnerability to violence. Nurses and psychiatrists did not differ in violence variables. In spite of the weaknesses of the design (cross-sectional self-selecting sample), this study corroborates previous findings and identifies personal factors associated with violence that have received little attention in the literature (e.g. lack of respect for the organization of care).     

Violence towards psychiatric staff: a comparison of gender, job and environmental characteristics in England and Sweden

Workplace violence is receiving increasing attention world-wide, and studies suggest that, for example, nurses and women may be more abused at work than psychiatrists and men. However, there is a lack of cross-cultural data on the topic. Further, relatively few studies have addressed the influence of environmental factors in the occurrence of violence and within a cross-cultural context. The present study compares among other things the nature of violence encountered by female/male staff (nurses and psychiatrists) in Sweden and England. Psychiatric personnel from England (301 nurses; 74 psychiatrists) and Sweden (745 nurses; 306 psychiatrists) were assessed cross-sectionally by means of a questionnaire covering various areas (e.g. nature of violence). The univariate analyses showed an association between being abused and male gender, young age, being British and a nurse, physical and psychological strain. The multivariate logistic regression confirmed that British nurses and male nurses were the main risk group for exposure to violence. Further, the multivariate analysis indicated that the odds of being abused increased with increasing age, physical strain and dissatisfaction with quality of care. Interventions thus need to be sensitive to gender differences, societal context, professional roles and interactions between them. Further, clinical supervision and team functioning, organizational and environmentally friendly settings may help to reduce violence in mental health care.     

Violence towards psychiatric staff: a comparison of gender,job and environmental characteristics in England and Sweden

Workplace violence is receiving increasing attention world-wide, and studies suggest that, for example, nurses and women may be more abused at work than psychiatrists and men. However, there is a lack of cross-cultural data on the topic. Further, relatively few studies have addressed the influence of environmental factors in the occurrence of violence and within a cross-cultural context. The present study compares among other things the nature of violence encountered by female/male staff (nurses and psychiatrists) in Sweden and England. Psychiatric personnel from England (301 nurses; 74 psychiatrists) and Sweden (745 nurses; 306 psychiatrists) were assessed cross-sectionally by means of a questionnaire covering various areas (e.g. nature of violence). The univariate analyses showed an association between being abused and male gender, young age, being British and a nurse, physical and psychological strain. The multivariate logistic regression confirmed that British nurses and male nurses were the main risk group for exposure to violence. Further, the multivariate analysis indicated that the odds of being abused increased with increasing age, physical strain and dissatisfaction with quality of care. Interventions thus need to be sensitive to gender differences, societal context, professional roles and interactions between them. Further, clinical supervision and team functioning, organizational and environmentally friendly settings may help to reduce violence in mental health care.     

Violence in the nursing profession: Occupational and lifestyle risk factors in Swedish nurses

In a national study of the work environment, physical, and mental well-being of more than 2600 Swedish nurses, 30% reported having experienced violence at work. Possible association between violence and a range of occupational, demographic, and lifestyle characteristics were studied. Stepwise multiple linear and logistic regressions were used to further examine risk factors for violence. Occupational factors with significant correlations to workplace violence were nursing discipline (type of ward or facility), years of work experience, supervisory responsibilities, night work, work dissatisfaction, work-related musculoskeletal injury, and frequency of patient handling. Demographic/lifestyle factors related to violence were age, gender, smoking, coffee consumption at work, and use of alcohol to relax after work. The best fit linear regression model explained 17% of the variance in violence, 13%, of the variance in threat of violence. The logistic regression model confirmed an increased risk of violence and threats in psychiatric and geriatric settings. However, much remains unexplained about the aetiology of violencc in health carc settings. This report provides the basis for a pilot intervention study currently in progress.     

Violence in the nursing profession: Occupational and lifestyle risk factors in Swedish nurses

Abstract

In a national study of the work environment, physical, and mental well-being of more than 2600 Swedish nurses, 30% reported having experienced violence at work. Possible association between violence and a range of occupational, demographic, and lifestyle characteristics were studied. Stepwise multiple linear and logistic regressions were used to further examine risk factors for violence. Occupational factors with significant correlations to workplace violence were nursing discipline (type of ward or facility), years of work experience, supervisory responsibilities, night work, work dissatisfaction, work-related musculoskeletal injury, and frequency of patient handling. Demographic/lifestyle factors related to violence were age, gender, smoking, coffee consumption at work, and use of alcohol to relax after work. The best fit linear regression model explained 17% of the variance in violence, 13%, of the variance in threat of violence. The logistic regression model confirmed an increased risk of violence and threats in psychiatric and geriatric settings. However, much remains unexplained about the aetiology of violencc in health carc settings. This report provides the basis for a pilot intervention study currently in progress.     

Study-work satisfaction and psychological distress in older university students

In order to study the relationships between work satisfaction and mental health in a group known to be at risk for psychological distress, university students who were somewhat older than usual (n=568, average age 24 years) provided infomiation by questionnaire about their satisfactions from study and paid work, and their level of psychological distress. The measure of study satisfaction was a modified form of Warr et al.'s (1979) Job Satisfaction Scale, and had good reliability. Study satisfaction waslower for undergraduate than for postgraduate students, due to lack of clearly defined identity, less supportive relations with fellow-students and teaching staff, and financial hardship. For all subjects the availability of teacher support predicted study satisfaction, and study satisfaction had a major influence on the students' psychologcal well-being.     

Evaluation of an intervention programme based on empowerment for eldercare nursing staff

This study evaluated the impact of an intervention programme at individual, worksite, and organizational level, for eldercare nursing staff at 12 eldercare units. The project aimed at empowering auxiliary nurses and nursing assistants, thus promoting good working conditions, health and well-being of eldercare staff, and improving their evaluation of the quality of nursing care. Questionnaire responses from the nursing staff (n=200) before and after an 18-month intervention programme evaluated the effects using ANOVA, repeated measures for the statistical analyses. Although the improvements were limited, the intervention seemed to impact on work conditions and on the perceived quality of nursing rather than on the health and well-being of staff. Work at nursing homes or at home-care was shown to modify the outcome due to different needs and priorities for work unit improvements. Staff turnover and multiple reorganizations are discussed as inhibiting factors for performance as well as for the evaluation of workplace interventions. The sharing of power between occupational groups or organizational levels must be carefully considered. The study emphasizes the importance of involving the middle management in early project planning and decisions.     

Psychosocial safety climate,psychosocial and physical factors in the aetiology of musculoskeletal disorder symptoms and workplace injury compensation claims

Causal agents for workers' compensation claims and physical injury have largely been identified as physical demands. We proposed an integrated theory of physical injury (i.e. musculoskeletal disorder symptoms [MSDs]) and workers' compensation claims, which combined psychosocial and physical mechanisms. A random, population-based sample of 1095 Australian workers completed a telephone interview on two occasions 12 months apart. As expected, the physical mechanism was confirmed; physical demands were related to MSDs, which in turn predicted workers' compensation claims. Further, a novel psychosocial mechanism was confirmed. Psychosocial safety climate (PSC; perceptions about the organisation's climate for psychological health) was a precursor to psychosocial risks (e.g. harassment, violence, bullying and work pressure). In turn, these psychosocial risks were related to emotional exhaustion, MSDs and then workers' compensation claims. Evidence was therefore provided for psychosocial-physical processes in explaining MSDs and workers' compensation for claims for physical injury. Occupational health and safety legislators and policy makers should be aware that, beyond physical demands, factors usually associated with risk for mental stress claims (e.g. harassment, bullying, and violence) may additionally manifest in physical health problems and workers' compensation injury claims. Focusing on modifying the PSC in an organisation, “the cause of the causes”, may be an effective injury prevention and intervention strategy.     

The role of stress and social support in Sick Building Syndrome

Sick Building Syndrome (SBS) involves seemingly healthy individuals experiencing long-lasting symptoms of physical distress in their work settings and is estimated to exist in 20 to 30% of all work settings in the USA. We examined differences in stress, social support and both physical and psychological symptoms reported by hospital personnel working in known SBS sites in Halifax, Nova Scotia (n = 297) with control employees working in relatively SBS-free settings (n = 228). We found that employees reporting that their health had been affected by the building in which they worked and those complaining of poor air quality were more likely to be found in SBS locations. In addition, those people with higher levels of organizational support and marginally higher levels of union support were also more likely to be found in SBS locations. Further analyses revealed that employees with higher role overload and greater family support, but lower levels of organizational support were more likely to report that their own health had been adversely affected by their place of work. Perceptions of poor air quality were predicted by higher levels of role conflict, role overload, and organizational stress and lower levels of organizational support. These results suggest that SBS may not be solely dependent on environmental factors.     

The Violent Incident Form (VIF): A practical instrument for the registration of violent incidents in the health care workplace

The Violent Incident Form (VIF) is a practical instrument that has been developed for the registration of all types of threatening and violent behaviour directed toward staff in health care work environments. The instrument uses a broad definition of violence that encompasses verbal aggression and threats. A 1-page checklist, the VIF, summarizes key aspects of the violent incident, identifying the circumstances, perpetrator, event, and consequences. Results from a 15-week pilot study as well as a follow-up study of the instrument's test-retest reliability are presented. The VIF was then introduced at 47 health care workplaces and used for a period of 12 months. During this period, 684 incidents were recorded by 32 workplaces. Of these, only 147 incidents (21 %) were also filed as official work injury reports. The checklist is based on the principle that all kinds of violent events must be included if an accurate assessment of violence at the workplace is to be made. The VIF is not intended as a replacement for official work injury reports, but as a complement, focusing more specifically on the nature of the violent incident. It is presented here as a research tool for studying violence in today's health care environments. Further work is needed to assess the use of the VIF as a learning tool, and as a possible catalyst for the development of effective violence management programmes.     

A longitudinal study exploring the relationships between occupational stressors, non-work stressors, and work performance

There is a lack of intricate research into the relationships between work performance and other variables. This study examined the causal relationship between work, non-work stressors, and work performance. Using longitudinal multi-group data from three groups—university staff, trainee nurses, and part-time employees (overall N=244)—structural equation modelling was employed to explore one-way and reverse competing models. The results produced a good fitting model with one-way causal paths from work-related and non-work stressors (time 1) to job performance (time 2). Nested model comparison analysis provided further evidence to support this best fitting model, emphasizing the strong influence that non-work factors have within the workplace. This study has important implications for theory, methodology and statistical analysis, and practice in the field of work-related stressors and performance.     

Exploring the Michigan model: The relationship of personality, managerial support and organizational structure with health outcomes in entrants to the healthcare environment

Few studies have examined the role of managerial support in the adaptation of entrants to healthcare. The purpose of this study was to identify the job characteristic and role-related variables that mediate the effects of managerial support and personality on the mental and physical health and sickness absence in two independent groups of new recruits to a healthcare organization. Entrants to a healthcare environment (student nurses) were surveyed 25 weeks after entry. Latent variables represented neuroticism, demand, control, role clarity and affective outcome variables in a simplified version of the Michigan model of work stress (House, 1981). This study used a two-stage approach to structural equation modelling, exploring hypothesized structural models on an initial data set (N=195) prior to confirmation on an independent replication data set (N=239) using multi-sample methods. Finally the confirmed model of choice was evaluated using the combined data (N=434). Emotional distress reported at 6 months was found to be associated with dispositional characteristics of the entrant and indirectly, via job satisfaction, with managerial support from academic and clinical sources. Managerial support from academic and clinical sources had an indirect influence on job satisfaction, but by differing mechanisms involving role clarity and control. The demands perceived by the entrants arose from neuroticism and were independent of any other variable. Emotional distress had its deleterious association with sickness absence via somatic health. This study details a series of mechanisms that will subsequently be tested longitudinally.     

Work stress and attentional difficulties: An initial study on burnout and cognitive failures

Professional burnout is a stress-related disorder, having mental exhaustion due to work stress as its most important characteristic. Burned out individuals also often complain about attentional problems. However, it is currently not clear whether such complaints are based on true cognitive deficits or whether they merely reflect the way burned out individuals rate their own cognitive performance. To confirm the cognitive complaints we used a cognitive failure questionnaire (CFQ) to assess the level of self-reported attentional difficulties in daily life. We also measured performance on tasks of sustained attention and response inhibition (the SART and the Bourdon-Wiersma Test). We compared three groups: (1) a group of 'burned out' individuals (n=13) who stopped working due to their symptoms and sought professional treatment; (2) teachers at a vocational training institute (n=16) who reported high levels of burnout symptoms but continued to work; and (3) teachers from the same institute (n=14) who reported no burnout symptoms. The level of burnout symptoms was found to be significantly related to the number of cognitive failures in daily life, and to inhibition errors and performance variability in the attentional tasks. To our knowledge, explicit tests of objective cognitive deficits in burned out individuals have not been conducted before. Consequently, this is the first study to indicate that burnout is associated with difficulties in voluntary control over attention and that the level of such difficulties varies with the severity of burnout symptoms.     

Working mothers’ emotional exhaustion from work and care: The role of core self-evaluations,mental health,and control

This research examined the direct and indirect relationships between core self-evaluations (via mental health) and emotional exhaustion originating from both the work and caregiving domains. The extent to which these relationships were moderated by control over work and care also was examined. Data came from 142 employed mothers in Australia who completed surveys at three measurement points each separated by four weeks. Results showed that core self-evaluations related positively to mental health which, in turn, related negatively to emotional exhaustion originating from work, but only when work control was high. Moreover, core self-evaluations related negatively to emotional exhaustion originating from care through improvements in mental health, but care control did not moderate this relationship. Overall, these findings contribute to a better understanding of how working mothers’ personal and work resources mitigate emotional exhaustion.     

Work satisfaction, health, and stress: A study of Dutch nurses

A study was conducted to compare nurses' work satisfaction and feelings of health and stress in five different nursing departments: a cardiac care unit and a general surgical ward in a general hospital; and an admissions department, a short-stay department, and a long-stay department in a psychiatric hospital. One hundred nurses took part in the study: the instruments used were questionnaires and structured interviews. The main results showed that:

(1) nurses in the cardiac care unit had the most positive satisfaction scores

(2) nurses in the general surgical ward had the most positive scores on the health and stress variables

(3) feelings of dissatisfaction and stress were most prominent in the short-stay department and, to a lesser extent, in the long-stay department.

The findings are interpreted in terms of the different work situations and die implications for hospital management are discussed.

Dr J. A. Landeweerd graduated in industrial and organizational psychology in 1968 (PhD in 1978). He has worked at Eindhoven University of Technology (Department of Industrial Engineering) and now holds a position as senior lecturer at Limburg University (Department of Health Sciences), where he is project-leader for a number of research projects on the relationships between work and health.

Nicolle Boumans, MA, graduated in health sciences in 1985 (specialization: nursing science) and is now a research assistant. She is working on a PhD thesis concerned with the relationship between task characteristics of nurses and their reaction in terms of job satisfaction, health and stress.     

Does shift work lead to poorer health habits? A comparison between women who had always done shift work with those who had never done shift work

Shift work has been reported to predict health problems, and a possible explanation is that shift work may lead to poorer health habits, thereby increasing a person's vulnerability to illness. This study examined the association between shift work and health habits, as indicated by smoking, alcohol intake, physical activity and by being overweight. A questionnaire was sent to all 2795 female nurses working in the 10 hospitals of two Finnish health care districts. From the 2299 respondents, we selected those 506 shift workers who reported having always done shift work and those 183 day workers who had never done shift work. Shift workers were found to smoke more and to be overweight more often than day workers. These differences gradually increased in each successive age group, being 1.94 pack-years in smoking and 0.9 kg m^-2 in body mass index among nurses over 45 years of age. Shift work was not associated with alcohol intake or sedentary lifestyle. This evidence is compatible with the possibility that shift work in nurses increases smoking and being overweight to a degree that contributes to health problems, including coronary heart disease.     

Demanding work schedules and mental health in nursing assistants working in nursing homes

Nursing home assistants have physically and emotionally challenging jobs, and they often work demanding schedules in order to provide 24-h care. While the physical effects of demanding work schedules have been studied, little is known about the impact on mental health. This study explored the relationship between demanding scheduling variables and mental health indicators of depression, anxiety and somatization. A cross-section of 473 US female nursing assistants working in nursing homes was surveyed. Work schedule characteristics included shiftwork, hours per day and week, days per week, number of weekends per month, number of double shifts per month, breaks, and number of jobs worked. Working two or more double-shifts per month was associated with increased risk for all mental health indicators, and working 6-7 days per week was associated with depression and somatization. There was a trend for increasing odds of adverse mental health with increased numbers of demanding work schedule factors. The odds of depression was increased four-fold when working 50+ h/week, more than two weekends/month and more than two double shifts/month. Providing work schedules that are less unhealthy may have implications for both worker retention and the quality of care delivered to nursing home residents.     

Evaluation of an intervention programme based on empowerment for eldercare nursing staff

Abstract

This study evaluated the impact of an intervention programme at individual, worksite, and organizational level, for eldercare nursing staff at 12 eldercare units. The project aimed at empowering auxiliary nurses and nursing assistants, thus promoting good working conditions, health and well-being of eldercare staff, and improving their evaluation of the quality of nursing care. Questionnaire responses from the nursing staff (n=200) before and after an 18-month intervention programme evaluated the effects using ANOVA, repeated measures for the statistical analyses. Although the improvements were limited, the intervention seemed to impact on work conditions and on the perceived quality of nursing rather than on the health and well-being of staff. Work at nursing homes or at home-care was shown to modify the outcome due to different needs and priorities for work unit improvements. Staff turnover and multiple reorganizations are discussed as inhibiting factors for performance as well as for the evaluation of workplace interventions. The sharing of power between occupational groups or organizational levels must be carefully considered. The study emphasizes the importance of involving the middle management in early project planning and decisions.     

Demanding work schedules and mental health in nursing assistants working in nursing homes

Nursing home assistants have physically and emotionally challenging jobs, and they often work demanding schedules in order to provide 24-h care. While the physical effects of demanding work schedules have been studied, little is known about the impact on mental health. This study explored the relationship between demanding scheduling variables and mental health indicators of depression, anxiety and somatization. A cross-section of 473 US female nursing assistants working in nursing homes was surveyed. Work schedule characteristics included shiftwork, hours per day and week, days per week, number of weekends per month, number of double shifts per month, breaks, and number of jobs worked. Working two or more double-shifts per month was associated with increased risk for all mental health indicators, and working 6–7 days per week was associated with depression and somatization. There was a trend for increasing odds of adverse mental health with increased numbers of demanding work schedule factors. The odds of depression was increased four-fold when working 50+ h/week, more than two weekends/month and more than two double shifts/month. Providing work schedules that are less unhealthy may have implications for both worker retention and the quality of care delivered to nursing home residents.     

Work satisfaction,health, and stress: A study of Dutch nurses

Abstract

A study was conducted to compare nurses' work satisfaction and feelings of health and stress in five different nursing departments: a cardiac care unit and a general surgical ward in a general hospital; and an admissions department, a short-stay department, and a long-stay department in a psychiatric hospital. One hundred nurses took part in the study: the instruments used were questionnaires and structured interviews. The main results showed that:

(1) nurses in the cardiac care unit had the most positive satisfaction scores

(2) nurses in the general surgical ward had the most positive scores on the health and stress variables

(3) feelings of dissatisfaction and stress were most prominent in the short-stay department and, to a lesser extent, in the long-stay department.

The findings are interpreted in terms of the different work situations and die implications for hospital management are discussed.

Dr J. A. Landeweerd graduated in industrial and organizational psychology in 1968 (PhD in 1978). He has worked at Eindhoven University of Technology (Department of Industrial Engineering) and now holds a position as senior lecturer at Limburg University (Department of Health Sciences), where he is project-leader for a number of research projects on the relationships between work and health.

Nicolle Boumans, MA, graduated in health sciences in 1985 (specialization: nursing science) and is now a research assistant. She is working on a PhD thesis concerned with the relationship between task characteristics of nurses and their reaction in terms of job satisfaction, health and stress.