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.     

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).     

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).     

A longitudinal investigation of the role of violence prevention climate in exposure to workplace physical violence and verbal abuse

The temporal direction of the relationships between violence prevention climate and both physical violence and verbal abuse was investigated in a longitudinal study of newly graduated registered nurses. A sample of 126 nurses, recruited into the study while students, completed similar surveys at approximately 6 and 12 months after graduation that assessed violence prevention climate, physical violence, verbal abuse exposure, and strains of anger, anxiety, depression, and physical symptoms. Results showed that high values of Time 1 climate were associated with less likelihood of violence and abuse at Time 2 when prior exposure to violence and abuse was controlled. Furthermore, repeated measures multivariate analyses of variance (MANOVA) results suggested that being exposed to violence or abuse did not affect perceptions of climate. Both climate and violence exposure were correlated with some strains both cross-sectionally and longitudinally, but repeated measures MANOVAs failed to find evidence that exposure to violence or abuse would result in an increase in strain over time. It is concluded that the direction of effects is from climate to violence/abuse but not the reverse, and that climate should be a target for interventions designed to keep employees safe from both forms of mistreatment.     

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.     

Perceived violence climate: A new construct and its relationship to workplace physical violence and verbal aggression, and their potential consequences

Workplace accidents and violence are both potential sources of employee injuries that have been dealt with in entirely separate literatures. In this study we adapted the concept of safety climate from the accident/injury literature to violence in developing the concept of perceived violence climate. A scale was developed to assess perceived violence climate, including items about management attention, concern, and policies designed to keep employees safe from violence. Data were collected from a sample of 198 nurses from a US Hospital. Perceived violence climate was found to correlate significantly with both physical violence and verbal aggression experienced by the nurses, injury from violence, and perceptions of workplace danger. Furthermore, regression analyses showed that climate explained additional variance in psychological strain and perceptions of danger over experienced violence. These results have implications for interventions aimed at producing a good perceived violence climate in order to reduce the incidence of violence and aggression within an organization.     

Perceived violence climate: A new construct and its relationship to workplace physical violence and verbal aggression,and their potential consequences

Abstract

Workplace accidents and violence are both potential sources of employee injuries that have been dealt with in entirely separate literatures. In this study we adapted the concept of safety climate from the accident/injury literature to violence in developing the concept of perceived violence climate. A scale was developed to assess perceived violence climate, including items about management attention, concern, and policies designed to keep employees safe from violence. Data were collected from a sample of 198 nurses from a US Hospital. Perceived violence climate was found to correlate significantly with both physical violence and verbal aggression experienced by the nurses, injury from violence, and perceptions of workplace danger. Furthermore, regression analyses showed that climate explained additional variance in psychological strain and perceptions of danger over experienced violence. These results have implications for interventions aimed at producing a good perceived violence climate in order to reduce the incidence of violence and aggression within an organization.     

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.     

Arbeitskampf mit Nadel und Faden

The film “Made in Dagenham”, produced by the British director Nigel Cole, focuses on the turbulent times of the first labor dispute led by women in British history. The sewing machinists strike at the Ford Dagenham plant in 1969 was a major step towards gender equality in the workplace and initiated the “Equal Pay Law” which was passed in 1970 in England. The film is a cinematic monument to women and at the same time an adorable comedy characterized by a typical British sense of humor. This contribution addresses the continuing discrimination of women in employment as well as the male chauvinist culture of trade unions.     

Impact of shift work and department type upon strain and attitudinal measures of hospital nurses

The effects of shift work (fixed versus rotating), type of hospital department (intensive care unit versus non-ICU), and job scope on stress and attitudes have been reported previously. The goal of the present study was to examine the interactive, as well as individual, impact of these variables on measures of perceived work stress, strain, work satisfaction and withdrawal intentions. Respondents in the study were nurses in a large general hospital in Israel. None of the two- or three-way interactions received empirical support. However, significant multivariate main effects for each of the three independent measures were found. The negative influence of rotating work shift compared to fixed work shift was supported. Nurses who thought that their job was more enriching were more satisfied and perceived their workload as being lower. Department type affected only burnout level; nurses in non-ICUs were lower in burnout. Several theoretical and practical possible interpretations and possible implications are presented.     

Editorial statement: Stress and work compensation

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.     

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.     

Distinguishing traumatic, vicarious and routine operational stressor exposure and attendant adverse consequences in a sample of police officers

Problems in studying occupational stress within the police service are identified and the paucity of work on operational duties as potential stressors are discussed. The present study reports the results of a factor analysis of operational stressors (N = 601 serving British police officers) that revealed three factors: exposure to death and disaster; violence and injury; sexual crime. These were demonstrated to be reliable scales and were included in logistic regression models together with a range of demographic and psychological variables. Models were applied to men and women separately, which showed there to be different predictors of the likelihood of suffering distress (measured by the General Health Questionnaire, GHQ) in terms of the officer's gender and operational role. Overall the model for women officers was better at predicting psychological distress than that for men. These findings are related to aspects of the police occupational culture. Further discussion is offered that conceptualizes police operational stressors as traumatic, routine and vicarious. Finally, some implications are drawn for the provision of stress intervention in the light of this differentiation.     

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.     

Childcare involvement, job characteristics, gender and work attitudes as predictors of emotional exhaustion and sickness absence

Reports in the literature vary regarding the existence of gender differences in relation to burnout and sickness absence. To investigate this, the present study was aimed at investigating the role of several gender-relevant variables, particularly childcare obligations, job characteristics, and work attitudes in emotional exhaustion and sickness absence in 404 male and female nurses in an institution for people with learning difficulties. Questionnaires were administered reflecting demographic and job characteristics, work and non-work attitudes, and emotional exhaustion (as measured by the Emotional Exhaustion Scale of the Maslach Burnout Inventory). Female nurses were expected to report higher levels of emotional exhaustion and to be absent through sickness more often than men. Also, childcare investment, job characteristics, and (non) work attitudes were expected—via emotional exhaustion—to predict gender differences in sickness absence. It was found that women did not have higher sickness absence rates, and although a gender difference appeared in emotional exhaustion it was in the opposite direction from that predicted. For both genders, emotional exhaustion had a significant positive effect on sickness absence, and especially childcare investment and number of work hours appeared to contribute to both outcomes. These results are of interest because, despite current stereotypes, sickness absence was not higher in women, and neither were women more at risk for emotional exhaustion. In particular, load—workload as well as care load—appeared to predict emotional exhaustion and thus sickness absence.     

Effects of age and domestic commitment on the sleep and alertness of female shiftworkers

Abstract

In this study, the combined effects of age and domestic commitment on sleep duration, sleep difficulties and alertness in a sample of female shiftworkers were studied. A total of 572 nurses working in general hospitals in England completed a questionnaire. Two main shift systems were worked by the nurses: permanent nights or rotating shifts. Initial analysis revealed significant differences between these two groups of nurses, resulting in separate analysis of each group. Regression analysis showed that although older nurses had shorter sleep duration they did not report more sleep difficulties, in addition, their overall on-shift alertness was higher compared to younger nurses. Domestic commitment, defined as the number of dependants in the household and the level of perceived work-home conflict, not only reduced sleep duration, but also resulted in more sleep difficulties and lower on-shift alertness for most of the shifts. Two implications with regards to the relationship between age and sleep are discussed. First, the study points to the relevance of considering both biological and social factors when looking at age and sleep. Secondly, the study shows that the effects of age on sleep duration and sleep difficulties are not similar. This finding requires further research, especially in the light of the higher levels of alertness reported by older nurses.     

The moderating role of personality characteristics on the relationship between job insecurity and strain

The experience of job insecurity has been linked to several different outcomes, such as negative attitudes towards work and the organization, turnover intention, as well as health complaints. However, since the strength of these effects have been found to vary across studies, it is vital to identify factors that could influence the relationships. The present study examines the moderating role of three personality characteristics (negative affectivity, positive affectivity, and external locus of control) on the relation between job insecurity and outcomes (mental health complaints, job dissatisfaction, and job-induced tension). Data from 400 nurses at a Swedish acute care hospital (response rate 71%; 91% women, aged 20-68 years) showed that both job insecurity and personality were related to strain. Also, the data indicated some buffering effect of personality. Despite the gender bias of the sample, the study provides additional support for the notion that job insecurity affects strain even after controlling for individual characteristics. The study also expands the literature on job insecurity by pointing out the influence of personality characteristics on the relationship between stressors and strain.     

Gender,pain, and doctor involvement: high school student attitudes toward doctor-assisted suicide

The present study concentrates on the attitudes of high school students toward active doctor-assisted suicide as described in hypothetical doctor-patient scenarios, orthogonally manipulating doctor's reaction to patient's wishes to end his/her life (whether discussed, accepted or encouraged), presence of patient's physical pain, presence of patient's emotional pain, and the gender of the hypothetical patient. Doctor-assisted suicides thoroughly discussed with the patient are judged to be more moral, acceptable, and "legal" than assisted suicides that are simply accepted by the doctor or actively encouraged by him. Significantly, this is not a distinction that is relevant in the eyes of the law. Further, the presence of both physical and emotional pain on the part of the patient make the patient death more acceptable in the eyes of high school students. This latter effect is striking, given the result of the Wooddell and Kaplan (1999-2000) study showing that patient depression tends to weaken acceptability of death. Finally, respondents, both male and female, tend to view deaths of patients of the opposite gender as more acceptable than patients of the same gender.     

Employee absence, age and tenure: a study of nonlinear effects and trivariate models

Multiple regression techniques were used to explore the nature of the relationships between age, tenure and absence in 2417 British local government workers drawn from three work groups. The data were collected from organizational records and included measures of both non-certified absence and medically certified absence. Linear and curvilinear associations among age, tenure and absence were examined. The possible moderating or mediating role of tenure in the relationship between age and absence was subsequently analysed. The data revealed linear relationships between age and absence that were negative for non-certified absence and positive for certified absence. In contrast, curvilinear relationships were found between tenure and absence that were U-shaped for noncertified absence and inverse U-shaped for certified absence. Tenure was found to moderate but not to mediate the relationship between age and absence. The implications of the results are discussed in the context of the changing age and career paths of the workforce, and of methodological issues in absence research.     

The heritability of emergent leadership: Age and gender as moderating factors

In this study, we examined the moderating influences of gender and age with respect to testing the heritability of leadership emergence. A large data base of 12,112 twins from Sweden was used in the current study to decompose the variance of emergent leadership into an unobservable genetic component and environmental components that are either common or unshared among twin pairs. Consistent with prior leadership research on genetics, we found that a genetic factor is able to explain a significant proportion of the variation across individuals in predicting how twins perceive their emergent leadership behavior (about 44% for women and 37% for men). Furthermore, we also found that the magnitude of genetic influence on emergent leadership varied with age, but only for women with the heritability estimate being highest for the mid-age women versus lowest for the older women. Implications for advancing research on the genetic and environmental influences on leadership emergence are discussed.