There is a lack of high-quality evidence to support the recommendation of an instrument to screen emergency department patients for their risk for violence.

To demonstrate the content and predictive validity and reliability of the novel Risk for Violence Screening Tool to identify patients at risk for violence.

This retrospective risk screening study was conducted at a 100-bed emergency department in an urban, academic, safety net trauma center in Southern California.

Nine subject matter expert employees and 22,583 non-critical adult emergency patients.

Subject matter experts rated the relevance of 30 risk items and 10 domains comprising the Risk for Violence Screening Tool. Content Validity Index/Average Content Validity and Universal Agreement analyses determined the tool's content validity. Predictive validity, analyzed with logistic regression, used data from a patient incidence of violence registry (an incident occurred or did not occur), compared with the Risk for Violence Screening Tool screening result (positive or negative). Response agreement among three nurses who independently utilized the Risk for Violence Screening Tool to assess the same patients upon their arrival at the emergency department determined inter-rater reliability.

The overall Content Validity Index was 0.84, and the item-level Content Validity Index and the universal agreement scores were 1.00, indicating perfect agreement on item relevance and a unanimous consensus among experts. Patients who screened positive on the Risk of Violence Screening Tool, indicating a high probability of violence, were 27.55 times more likely to commit an act of violence compared to those who screened negative (95 % CI = 24.73 to 30.70). The logistic regression model was statistically significant, (χ2 (1) = 1140.29, p < 0.0001), explaining a range from 4.9 % (Cox & Snell R2 ) to 37.3 % (Nagelkerke R2 ) of the variance and indicating that the Risk for Violence Screening Tool successfully predicted violent incidents. The calculated area under the curve of 0.843 (95 % confidence interval, 0.812-0.873, p < 0.001) affirmed the Risk for Violence Screening Tool's discriminatory ability to distinguish between individuals with and without a risk for violent behavior. Cohen's Kappa statistic yielded a value of 0.86 (p < 0.001).

The Risk for Violence Screening Tool is valid and reliable. This standardized tool can be used in emergency departments as part of a robust violence prevention program, creating a safer workplace for both staff and patients.

The Risk for Violence Screening Tool (RVST) is a valid and reliable brief screener to identify emergency department patients at risk for violence. @dhs.lacounty @ijn2024.

Violence in healthcare settings, especially in emergency departments (ED), remains an important public health issue worldwide. Thus, additional insight into the effect of these incidents into nurses' professional attitudes, their work life and related implications to patient safety issues may be valuable. We investigated ED nurses' living experience of exposure to workplace violence by healthcare service users, with focus on the impact on them.

Following a qualitative study design, data were collected (January-June 2024) through semi-structured interviews with open-ended questions and were analyzed according to an inductive, content analysis approach. Participants provided informed consent, and data collection continued until theoretical saturation was reached.

The sample included six nurses. Various forms of workplace violence and its psychological, social, and professional consequences were identified. Violence was more frequently perpetrated by patients' relatives, with verbal aggression being the most common form. A fundamental divergence in needs and expectation between patients and their family members/caregivers, on one side, and participants, on the other, revealed a pronounced empathy gap. Each group remained focused on its own priorities while struggling to recognize or accommodate others' perspectives. This lack of mutual understanding contributed to tension that, in some cases, escalated even into physically violent incidents against the participants. A similar gap was identified between the participants' needs and administrators' attitudes and related policies. The failure of administrative measures to bridge this gap was described as a crucial factor in further escalating conflicts and tension in the ED.

Further research on quality improvement projects, including all stakeholders, aiming to enhance empathy in all parties involved is proposed.

Although the phenomenon of crowding in emergency departments (EDs) is not new, it remains a significant problem for patients, ED staff and the wider healthcare system. Crowding in EDs, which is also called overcrowding, has been widely explored in the literature, but there are relatively few studies of the subject from an emergency nurse perspective. This article reports the findings of a literature review that aimed to explore the effects of crowding on nurses working in EDs. Four key themes were identified from a synthesis of 16 articles included in the review: staffing and skill mix; inadequate care and the effect on nurses' well-being and stress levels; violence in the ED; and hospital metrics and patient flow. Further research is required to explore in more depth the effects of ED crowding on emergency nurses and to address the multiple factors that perpetuate the phenomenon.

Violence is a common hazard for those working in emergency departments (EDs), yet it remains understudied. We describe a prospectively derived estimate of the prevalence of violence against health care workers among agitated patients in an ED.

This was a secondary analysis of two prospective, observational studies of patients receiving care in a dedicated portion of the ED meant primarily to observe patients with intoxication. We collected detailed data for patients with agitation, defined as a score of +1 or higher using the altered mental status scale, an ordinal agitation scale from -4 (coma) to 0 (normal) to +4 (most agitated). Trained observers present in the ED 24/7 recorded whether each encounter involved verbal abuse, threat of violence, or a violent act against a health care worker. The primary outcome was the occurrence of assault as defined by state statute (threat of violence or violent act). We compare observed events to those formally reported to the hospital.

From 17,873 encounters screened there were 4609 (25.8%) in which the patient had agitation. Alcohol or drug intoxication was present in 4108 (89.1%) encounters. The number of encounters with assault was 937 (20.3%, 95% confidence interval [CI] 19.1%-21.5%), which included 802 encounters (17.4%, 95% CI 16.3%-18.5%) with a threat of violence and 362 encounters (7.9%, 95% CI 7.1%-8.7%) with a violent act. Verbal abuse occurred in 1786 encounters (38.8%, 95% CI 37.3%-40.2%). Events were formally reported to the hospital in 9/1786 (0.5%) instances of verbal abuse and in 224/362 (61.9%) instances of a violent act.

Verbal abuse, threats of assault, and violent acts occurred frequently in ED patients with agitation and were underreported.

Violence against health workers in hospital emergency departments is a global concern. The aim of this comparative study is to assess the differences in the patterns, magnitude, effects and underlying reasons for violence against health workers in the emergency departments of Palestine and Türkiye.

A cross-sectional study was conducted in 14 emergency departments in the West Bank and 3 in Isparta Province in Türkiye. A convenience sample of 377 health workers (227 in Palestine and 150 in Türkiye), consisting of 97 physicians, 198 nurses, and 82 other workers, including administrative and support health personnel, participated in the study. A self-administered survey was used to collect data between June and November 2024. Data was analyzed using SPSS with a significance level set at < 0.05. Statistical methods included, frequencies and percentages of the study variables, as well as Chi-square tests (χ2) and Fisher's exact tests used to assess the differences between the two countries in relation to violence prevalence and related factors.

A total of 68.7% of the participants reported exposure to workplace violence during the past year, which was significantly greater among Palestinian participants (84.6%) than among Türkiye participants. The prevalence rates of physical violence were 28.1%, 35.7% and 16.7% in Palestine and Türkiye, respectively; the prevalence rates of nonphysical violence were 65.3%, 81.1% and 41.1%, respectively (p < 0.05). Among the participants, physicians were the most affected by violence. The perpetrators were mainly (79.0%) patient families/companions and the patients themselves. A long waiting time to receive services, unmet expectations of patients and families and a lack of violence prevention measures were the top reported reasons. Approximately 80.0% of the events were not reported (62.1% in Türkiye, 86.3% in Palestine, p < 0.05), mainly because of a lack of follow-up and actions taken against aggressors or because the events were considered trivial/part of the job or feared consequences of reporting. The impacts of violence include significant negative psychological effects, such as hopelessness, disappointment, fear, and anxiety, in addition to effects on the delivery of care, e.g., minimizing communication and time spent with patients and companions. Violence was also associated with the intention of health care workers to leave their job in emergency services (p < 0.05).

Contextual differences are evident in the patterns and levels of violence in the countries studied; however, concerns are clearly common regarding and underlying reasons and impacts. The findings show that both settings suffer from considerable levels of workplace violence and negative consequences for healthcare workers and health care services with insufficient measures to combat them, which would require immediate attention. A collaborative approach among key stakeholders for developing and implementing evidence-based policies and strategies to mitigate the risks of this arduous public health problem is crucial.

Workplace violence (WPV) is a pervasive issue in health care that has shown rising incidence in recent years. There are several risk factors related to the worker, occupational environment, and patient that predispose to WPV events and should be considered in risk mitigation strategies. WPV has been associated with negative effects on worker health and professional efficacy. Past work has shown that multifactorial intervention models are more effective at improving WPV prevention and response in health care. This review summarizes the statistical trends, risk factors, and negative effects of WPV in health care, as well as interventions to improve prevention and response.

Verbal aggression toward healthcare professionals, primarily from patients and visitors, is widespread and negatively affects employee well-being and patient care quality. This study, comprising two samples, investigates the relationship between user-initiated verbal aggression and job satisfaction, with a focus on psychological processes (i.e., cynicism and mental distance) and personal boundary conditions (i.e., self-efficacy). Study 1 (pandemic period) explored cynicism and work-related self-efficacy, while Study 2 (post-pandemic) replicated and expanded these findings, incorporating mental distance, self-efficacy in managing negative emotions, and workload. Participants included 201 (Study 1) and 1442 (Study 2) healthcare professionals from one and eight Italian healthcare facilities, respectively, who completed online questionnaires. In both cross-sectional studies, verbal aggression was positively associated with psychological withdrawal responses, which, in turn, was negatively related to job satisfaction. However, high self-efficacy in managing negative emotions (rather than work-related self-efficacy) buffered these effects. In Study 2, the negative impact of verbal aggression on job satisfaction, mediated by mental distance, was most pronounced among those with low self-efficacy in managing negative emotions and a high workload. Conversely, individuals with high self-efficacy maintained their job satisfaction and did not exhibit psychological withdrawal, even under high workload conditions.

Workplace bullying among nurses working in emergency departments is a serious issue that can significantly impact their job stress levels. One of the most important sources of stress in every person's life is their job. This study aimed to determine the relationship between workplace bullying and job stress among nurses in emergency departments.

This cross-sectional study was conducted in the emergency departments of hospitals affiliated with Kurdistan University of Medical Sciences in 2023 in Iran. A total of 211 nurses were selected based on inclusion criteria using a census method. Data collection tools included a demographic information form, the Negative Acts Questionnaire for workplace bullying, and the Nursing Job Stress Questionnaire. Data were analyzed using descriptive and inferential statistics (P < 0.05).

The findings showed that the mean scores for job stress and workplace bullying in nurses were 127.87 ± 34.30 and 56.47 ± 21.58, respectively, both at moderate levels. Furthermore, the results indicated a significant relationship between nurses' job stress in all dimensions and workplace bullying (P < 0.05).

Considering the average levels of bullying in the work environment and occupational stress of nurses and the existence of a significant statistical relationship between these two variables, the results of this research can help nursing managers to plan effectively to reduce bullying in the workplace and occupational stress of nurses.

Not applicable.

Globally, the nursing workforce is facing significant shortages, exacerbated by the COVID-19 pandemic. Emergency departments (ED) are dynamic environments that expose nurses to high levels of stress. Retention of existing nurses is vital, however the efficacy of interventions to improve the retention of ED nurses is limited. This review aimed to explore the evidence surrounding interventions focussed on addressing the retention of ED nurses.

A scoping review of the literature was undertaken, guided by the Joanna Briggs Institute framework. A search of five electronic databases was conducted. Original research published between 2012 and 2023 regarding the population of nurses, the concept of interventions to decrease turnover/improve retention and the context of the emergency department were considered for inclusion.

Five articles met the criteria for inclusion; three evaluated educational programs to ease the transition to becoming ED nurses, two assessed locally developed 'ad hoc' interventions. All the transitional education programs reported an increase in retention rates, while the ad hoc interventions produced minimal to no improvement in retention or reduction of turnover intent. All studies were conducted in high-income countries.

There is a dearth of evidence for organisations to draw upon to increase the retention of ED nurses. Additional research is warranted, especially regarding the long-term effects of interventions aimed at improving ED nurse retention, as well as evaluating interventions implemented in a wider variety of contexts.

Improving nursing interns' behavioral patterns toward the constructive conflict management style is critical for promoting effective nurse-patient conflict resolution. However, there is a dearth of research on the factors that influence constructive conflict management styles guided by theoretical principles.

To explore the relationships among nursing interns' constructive conflict management style, career-related social support, emotional intelligence, and communication ability with angry patients using self-determination theory.

We conducted a cross-sectional study following STROBE guidelines and recruited 375 nursing interns from 31 universities at a comprehensive teaching hospital in Hunan Province. Data on general information, career-related social support, emotional intelligence, communication ability with angry patients, and constructive conflict management style was collected from nursing interns using a general information questionnaire and reliable scales. Structural equation modeling was used to model and test the hypothesis.

The nursing interns' career-related social support had a significant immediate impact on constructive conflict management style (β = 0.320, CI: 0.099-0.213). Career-related social support and constructive conflict management style were mediated by emotional intelligence (β = 0.088, CI: 0.010-0.081) and communication ability with angry patients (β = 0.098, CI: 0.023-0.078), respectively. While multiple mediating effects (β = 0.067, CI: 0.014-0.057) were found.

High levels of professional social support, emotional intelligence, and communication ability with angry patients positively influence constructive conflict management style, especially social support. In order to promote the constructive conflict management style of nursing interns, nursing educators and managers should emphasize the establishment and maintenance of career support systems, and use experiential teaching methods such as role playing, virtual reality scenario simulation, and peer mentoring.

Workplace violence (WPV) is a harmful phenomenon happening in psychiatric wards. Despite preventive efforts, mental health services cannot eliminate WPV. If mental health services can increase the coping and resilience of frontline mental healthcare professionals (FMHPs) towards WPV, it could contribute to their mental health and well-being. To perform a systematic review of comparative studies on interventions to improve coping and resilience towards WPV aimed at FMHPs working in psychiatric wards. Systematic review on comparative intervention studies, with electronic searches in MEDLINE, Embase, Cochrane CENTRAL, PsycINFO and CINAHL. We registered our protocol in PROSPERO (CRD42022373757). Performing a meta-analysis seemed not to be feasible, so we provided a narrative summary of the included studies, methodological quality and results. We included nine studies, with interventions focused on positive behavioural support, resilience enhancement and aggression management training. Most studies reported positive effects, though with a moderate to high risk of bias. Positive behavioural support, biofeedback and aggression management training are promising interventions in our review. Biofeedback interventions and positive behavioural support could be valuable additions to existing training programmes to improve coping and resilience. Future studies should focus on demonstrating the robustness of effects, the mechanism of increasing coping and resilience regarding WPV and the development and implementation of effective interventions.

To synthesise how ED crowding contributes to patient-initiated violence against emergency nurses.

Framework synthesis.

A systematic literature search was conducted in the PubMed, PsycINFO, CINAHL and Scopus databases, covering articles up to 21 March 2024.

A total of 25 articles were reviewed, evaluating study quality using the Crowe Critical Appraisal Tool and employing a framework synthesis approach to chart and synthesise data.

The review identifies key factors linking emergency department crowding to patient-initiated violence, focusing on crowding conditions, vulnerable populations and adverse outcomes. It emphasises the importance of multidimensional assessments, including input, throughput, output stages and staffing characteristics. Special attention is needed for patients with severe symptoms who are triaged into lower priority categories, as their perceptions of injustice and dissatisfaction may increase the risk of aggressive behaviour. However, limited information is available regarding the perspectives of patients' family members.

Accurate assessments of emergency department crowding and a thorough understanding of cognitive and emotional changes in high-risk patients are essential to develop strategies to manage patient-initiated violence effectively.

This review improves emergency nurses' understanding of the dynamics of patient-initiated violence in crowded emergency departments, equipping them with knowledge to better anticipate and respond to such incidents. It also offers insights that are crucial for enhancing nursing practices and ensuring workplace safety, thereby supporting the development of future emergency safety strategies.

As this is a systematic review and framework synthesis, there was no direct patient or public involvement.

To assess the job satisfaction (JS) of physiotherapists in Spain and their relationship with occupational violence, as with other socio-demographic, health, and occupational factors.

A cross-sectional study was conducted. Setting Primary, community, and hospital attention level at public and private care in Spain.

Physiotherapists in Spain who have been working for at least 3months during the last year, and with complete answer to the required variables (n=2,590).

Information was collected through a questionnaire distributed online. A descriptive quantitative analysis and 3 logistic regression models were performed. In the first model, sociodemographic and violence variables were included as independent variables, in the second, health-related variables, and in the third, occupational variables.

The average JS of physiotherapists is 7.26 points, being 8 or more in 46.8% of the cases, with a higher percentage in men". Referring not having suffered psychological violence was related to a higher probability of having JS, even controlling for the rest of the variables studied (OR1=0.485; OR2=0.611; OR3=0.697, respectively for each model). Variables related to health (state of health, symptoms, consumption of tobacco/alcohol/other substances) and to the work environment (working day, work area, autonomy, relationship with superiors/colleagues) were statistically significantly related to JS.

Almost 47% of the respondents had very high JS values. Certain areas of work as well as positive health factors have been linked to very high JS. Psychological violence is the form of violence that, independently of the other factors analysed, leads to lower JS.

Psychological issues and work-related violence are the main challenges faced by medical staff. The situation has become even more prevalent during the COVID-19 pandemic.

This research aimed to analyze the relationships among work-related violence, occupational stress and psychological distress and to further identify the direct or indirect effects of violence on psychological distress.

A total of 1,765 medical staff members were surveyed using the Kessler Psychological Distress Scale and Revised Occupational Stress Inventory. Work-related violence was assessed using a self-made 5-question questionnaire. STATA 14.0 and Amos 21.0 software were used for correlation analysis, variance analysis, and structural equation modeling analysis.

A total of 66.1% of the medical staff suffered workplace violence, and 61.2% witnessed workplace violence. The psychological distress score (Kessler 10 Scale) of the medical staff was 22.7±7.67. The psychological strain score and physical strain score were 26.8±7.14 and 24.2±6.51, respectively. Work-related violence (suffered: β= 0.467; witnessed: β= 0.258) and occupational stress (psychological strain: β= 0.269; physical strain: β= 0.317) were predictors of psychological distress, and social support (β= -0.265) was a protective factor. Work-related violence and social support had both direct and indirect effects on psychological distress, and the intermediate factor was occupational stress. The total effects of suffered workplace violence and witnessed workplace violence were 0.181 and 0.092, respectively, and the total effect of social support was -0.262.

Work-related violence may exacerbate symptoms of occupational stress and psychological distress. Reducing workplace violence and protecting medical staff from work-related violence are extremely important aspects of mental health prevention.

Workplace violence (WV) is a ubiquitous, yet under-reported and under-studied phenomenon. Prevention measures may be ineffective because risk assessment is often based on unvalidated algorithms. After monitoring the risk of WV in a healthcare company for over 20 years, this paper presents the results collected in 2023 and details of the methodology used. Monitoring WV in health surveillance can involve three actions: (1) asking all the workers who attend periodic medical examinations in the workplace whether they have suffered physical aggression, threats, or harassment in the previous year; (2) investigating WV at the end of workplace inspections by setting up participatory ergonomics groups (PEGs) to suggest solutions; (3) investigating the characteristics and consequences of WV through anonymous online questionnaires. In 2023, 6.9% of the healthcare workers (HCWs) reported having experienced one or more physical attacks during the previous year; 12.7% reported having been threatened, and 12.9% reported other types of violent, harassing behavior. The HCWs observed an increase in violence after the pandemic years and, in the PEGs, suggested using different preventive measures in different health departments. The online survey provided further information on the characteristics of WV and its consequences. The risk of WV can be effectively characterized and measured through health surveillance.

Medical staff are regularly confronted with workplace violence (WPV), which poses a threat to the safety of both staff and patients. Structured de-escalation training (DET) for Emergency Department (ED) staff has been shown to positively affect the reporting of WPV incidents and possibly reduce its impact. This study aimed to describe the development of incidence rates, causes, means, targets, locations, responses, and the time of WPV events. Additionally, it explored the effect of the staff trained in DET on the objective and subjective severity of the respective WPV events.

In a retrospective, single-center cohort study, we analyzed ten years of WPV events using the data of Staff Observation Aggression Scale-Revised (SOAS-R) score (ranging from 0 to 22) in a tertiary ED from 2014 to 2023. The events were documented by ED staff and stored in the electronic health record (EHR).

Between 2014 and 2023, 160 staff members recorded 859 incidents, noting an average perceived severity of 5.78 (SD = 2.65) and SOAS-R score of 11.18 (SD = 4.21). Trends showed a non-significant rise in incident rates per 10,000 patients over time. The WPV events were most frequently reported by nursing staff, and the cause of the aggression was most often not discernible (n = 353, 54.56%). In total, n = 273 (31.78%) of the WPV events were categorized as severe, and the most frequent target of the aggressive behavior was the staff. WPV events occurred most frequently in the traumatology section and the detoxification rooms. While the majority of events could be addressed with verbal interventions, more forceful interventions were performed significantly more often for higher severity WPV events. More WPV events occurred during off-hours and were of a significantly higher objective and subjective severity. Overall, the presence of staff with completed DET led to significantly higher SOAS-R scores and higher perceived severity.

The findings underline the relevance of WPV events in the high-risk environment of an ED. The analyzed data suggest that DET significantly fostered the awareness of WPV. While most events can be addressed with verbal interventions, WPV remains a concern that needs to be addressed through organizational measures and further research.

To explore the prevalence of turnover intentions among emergency nurses across the globe, decision-makers should be offered evidence-based assistance.

Compared with those of general nurses, the unique work environment and pressure significantly impact emergency nurses' turnover intention. High personnel turnover intention often hinders the provision of high-quality emergency services.

This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Published and unpublished papers were identified through electronic searches of PubMed, Web of Science, EMBASE, CINAHL, and the Cochrane Library from their establishment until February 1, 2023. The literature included in this study may encompass cross-sectional studies and longitudinal studies. Two researchers independently screened the literature, extracted data, and assessed the quality of the included studies while using the tool developed by Hoy and colleagues in 2012. Stata 17.0 was used for all the statistical analyses.

This study included 12 articles by screening 744 articles, which included a total of 4400 nurses. All studies included in the analysis were cross-sectional. The overall prevalence of turnover intention among emergency nurses was 45%. Further analysis revealed that the turnover intention prevalence among emergency nurses in Asia was 54%, whereas in other regions, it was 38%. The turnover intention among younger nurses (61%) was significantly greater than that among older nurses (30%). Compared with the published scale, the self-developed scale resulted in a higher turnover intention rate of 52%, which was 41%.

The prevalence of emergency nurses' turnover intention is relatively high and shows an increasing trend, with noticeable variations across different regions and age groups. Notably, Asian nurses and those younger than 35.6 years exhibit a greater intention to turnover.

There is no patient or public involvement, as this article is a meta-analysis.

Nursing managers, administrators, and policymakers must recognize the seriousness of high turnover intentions among emergency nurses and develop effective prevention strategies to address this issue globally.

The objective of this study is to provide a comprehensive analysis and synthesis of pertinent research on the subject of nursing professionalism.

The number of studies documenting nursing professionalism has been consistently increasing over the years; however, a comprehensive synthesis and analysis of the evidence presented in these reports is currently lacking. Evaluation. The scope reviews were conducted using electronic databases including PubMed, Web of Science, Cochrane Library, Embase, Chinese National Knowledge Infrastructure (CNKI), Chinese Science and Technology Periodical Database (VIP), and Wanfang database. Key Issues. This review included 15 studies and identified 4 significant pertinent issues: (1) the need for further investigation into the implementation level of nursing professionalism; (2) the development of culturally sensitive instruments to assess nursing professionalism; (3) an in-depth exploration of the associated factors influencing nursing professionalism; and (4) the critical implementation of diverse intervention strategies to enhance nursing professionalism.

This review presents a comprehensive overview of the implementation level, assessment tools, influential factors, and intervention strategies in nursing professionalism research. In addition, it emphasizes the future research direction in this field. Implications for Nursing Management. Nursing administrators need to understand the significance of improving the professional education and training of nurses, fostering a conducive work environment, and providing support for their active development of professional skills and nursing professionalism. These factors collectively contribute to the long-term professional development of nurses and enhance the quality of patient care.

Patient and family violent outbursts toward staff, caregivers, or through self-harm, have increased during the ongoing behavioral health crisis. These health care-associated violence (HAV) episodes are likely under-reported. We sought to assess the feasibility of using nursing notes to identify under-reported HAV episodes.

We extracted nursing notes across inpatient units at 2 hospitals for 2019: a pediatric tertiary care center and a community-based hospital. We used a workflow for narrative data processing using a natural language processing (NLP) assisted manual review process performed by domain experts (a nurse and a physician). We trained the NLP models on the tertiary care center data and validated it on the community hospital data. Finally, we applied these surveillance methods to real-time data for 2022 to assess reporting completeness of new cases.

We used 70 981 notes from the tertiary care center for model building and internal validation and 19 332 notes from the community hospital for external validation. The final community hospital model sensitivity was 96.8% (95% CI 90.6% to 100%) and a specificity of 47.1% (39.6% to 54.6%) compared with manual review. We identified 31 HAV episodes in July to December 2022, of which 26 were reportable in accordance with the hospital internal criteria. Only 7 of 26 cases were reported by employees using the self-reporting system, all of which were identified by our surveillance process.

NLP-assisted review is a feasible method for surveillance of under-reported HAV episodes, with implementation and usability that can be achieved even at a low information technology-resourced hospital setting.

This study aims to reveal the violent experiences of nurses working in the emergency department and the meanings they attribute to them.

This research was conducted as narrative inquiry and interpretive phenomenology and recruited 15 nurses. Interviews with nurses actively working in the emergency department and who had been exposed to violence by patients or their relatives were conducted with a semi-structured interview form. The consolidated criteria for reporting qualitative research (COREQ) checklist was used.

In the study, three themes were determined (1) Unpredictable event, (2) Interminable effects of violence, and (3) Like a bottomless pit. With seven sub-themes.

This study underlined that violence applied to nurses by patients or relatives of patients in the emergency department is an unexpected situation that causes negative emotions. Violence affects all aspects of life and limits communication with the patient. Coping with a violent situation is challenging for nurses, and they demand support from the management.

Conflicts with patients and relatives occur frequently in intensive care units (ICUs), driven by factors that are intensified by critical illness and its treatments. A majority of ICU healthcare professionals have experienced verbal and/or physical violence. There is a need to understand how healthcare professionals in ICUs experience and manage this workplace violence.

A qualitative descriptive analysis of four hospitals in Sweden was conducted using semi-structured focus-group interviews with ICU healthcare professionals.

A total of 34 participants (14 nurses, 6 physicians and 14 other staff) were interviewed across the four hospitals. The overarching theme: "The paradox of violence in healthcare" illustrated a normalisation of violence in ICU care and indicated a complex association between healthcare professionals regarding violence as an integral aspect of caregiving, while simultaneously identifying themselves as victims of this violence. The healthcare professionals described being poorly prepared and lacking appropriate tools to manage violent situations. The management of violence was therefore mostly based on self-taught skills.

This study contributes to understanding the normalisation of violence in ICU care and gives a possible explanation for its origins. The paradox involves a multifaceted approach that acknowledges and confronts the structural and cultural dimensions of violence in healthcare. Such an approach will lay the foundations for a more sustainable healthcare system.

The emerging field of implementation science (IS) facilitates the sustainment of evidence-based practice in clinical care. This article, the second in a series on applying IS, describes how a nurse-led IS team at a multisite health system implemented the Brøset Violence Checklist-a validated, evidence-based tool to predict a patient's potential to become violent-in the system's adult EDs, with the aim of decreasing the rate of violence against staff. The authors discuss how they leveraged IS concepts, methods, and tools to achieve this goal.

This study investigates the incidence of violence escalation among psychiatric emergency patients admitted to general emergency departments in hospitals in central Thailand. In addition, patient and service delivery system factors associated with the survival time of violence escalation in 16 emergency departments in the central region of Thailand are determined. This is a prospective observational study, and the study sample includes 507 psychiatric emergency patients who are ≥ 18 years old. The patients are selected through stratified random and purposive sampling.

Patient data-including demographic data, emergency services used, and clinical characteristics-are analyzed using descriptive statistics. The Kaplan-Meier method estimates the violence escalation curve, and the log-rank test compares the violence escalation-free time between the levels of the violent behavior group. In addition, univariable and multivariable Cox proportional hazard analyses are performed to investigate the factors affecting violence escalation.

The incidence of violence escalation in psychiatric emergency patients in the emergency department is 7.3%, whereas the incidence rate of violence escalation is 3 per 100 psychiatric emergency patient visit hours. Factors affecting violence escalation include the violent behavior score at triage (aHR = 2.004; 95% CI: 1.051-3.823) and the nurse competency score (aHR = 0.147; 95% CI: 0.032-0.680).

Assessing the violent behavior of psychiatric emergency patients at triage may assist emergency providers in monitoring patient behavior and providing early intervention to prevent the escalation of violent behavior. Furthermore, training emergency nurses in psychiatric emergency care is necessary.

Workplace bullying affects workers' lives, causing several mental and physical health problems and job-related issues. Therefore, a summary of the evidence on the consequences of workplace bullying on workers' lives is essential to improve working conditions. The literature lacks systematic reviews and meta-analyses on the association between workplace bullying and job stress and the professional quality of life of nurses. Thus, we aimed to quantitatively summarize the data on the association between workplace bullying, job stress, and professional quality of life. We performed our study in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The review protocol was registered with PROSPERO (CRD42024495948). We searched PubMed, Medline, Scopus, Cinahl, and Web of Science up to 4 January 2024. We calculated pooled correlation coefficients and 95% confidence intervals [CI]. We identified nine studies with a total of 3730 nurses. We found a moderate positive correlation between workplace bullying and job stress (pooled correlation coefficient = 0.34, 95% CI = 0.29 to 0.39). Moreover, a small negative correlation between workplace bullying and compassion satisfaction (pooled correlation coefficient = -0.28, 95% CI = -0.41 to -0.15) was identified. Additionally, our findings suggested a moderate positive correlation between workplace bullying and job burnout (pooled correlation coefficient = 0.43, 95% CI = 0.32 to 0.53) and secondary traumatic stress (pooled correlation coefficient = 0.36, 95% CI = 0.11 to 0.57). Our findings can help nursing managers and policy-makers to draw attention to workplace bullying by implementing effective interventions, so as to reduce the bullying of nurses.

Workplace violence (WPV) exposure has been particularly prevalent in emergency nurses, coupled with negative mental health outcomes. Few explored resilience after WPV exposure using the perspective of positive mental health. We aimed to identify latent profiles of resilience and examine associations with flourishing in emergency nurses with WPV exposure. A total of 1241 Chinese emergency nurses were surveyed on the frequency of WPV exposure, resilience, and flourishing. Eight hundred and twenty five participants (90.1% female, 86.6% aged 20-39) reported WPV exposure at least once in the past 3 months. Latent profile analysis identified profiles of resilience as low resilience (15.0%), moderate decision respond and interpersonal link with low rational thought and flexible adaption (18.0%), moderate resilience (31.0%), high decision respond, interpersonal link, and rational thought with moderate flexible adaption (16.0%), and high resilience (20.0%). Higher flourishing was observed in profiles of moderate resilience, high decision respond, interpersonal link, and rational thought with moderate flexible adaption, and high resilience. We differentiated profiles of resilience and the associations with flourishing in emergency nurses with WPV exposure, which informed targeted interventions for promoting positive mental health.

NHS job vacancies remain at record levels and an increasing number of staff are leaving the NHS. Work-related violence is an aspect that has received little attention as a possible driving force in dropout rates among NHS workforce. Recent figures indicate that approximately 15% of NHS staff had experienced physical violence while at work (NHS Staff Survey, 2022). Given the prevalence of abuse and the consequences it may have on staff wellbeing, we examine the impact of workplace violence on intention to quit the organisation. We employ data from the NHS Staff Survey, a rich dataset that records the experience and views of staff working in the NHS. We use data from 2018 to 2022 of NHS employees surveyed in all NHS acute hospitals, with a sample size of 1,814,120 observations. We study the impact of experiencing physical or verbal violence in the workplace on the intention to quit the organization, examining differences according to perpetrator type. Our analysis also sheds light on any aggravated effect the pandemic had on intention to leave for those exposed to violence. The results suggest that experiencing physical violence increases the intention to leave by 10 percentage points. The effect of verbal violence is quantitatively greater in magnitude, increasing intention to leave by 21 percentage points. Violence from managers has the largest detrimental effect, followed by exposure to violence from multiple perpetrators and violence from colleagues. Heterogeneous effects exist according to occupational group, gender, age and ethnicity. The pandemic only had a marginal contribution to these effects. Staff health, trust in management and quality of patient care are some of the possible mechanisms through which violence influences the intention to quit. Overall, the results suggest that targeted interventions are needed to improve retention after exposure to violence.

Medical professionals' low level of apprehension and insights may result in the undervaluing of emergency medicine (EM) as a speciality to pursue in the future, which is a vital component in the everyday management of hundreds of patients.

The aim of this study is to assess medical professionals' perception of the barriers in opting for EM as a career option in Pakistan.

This was an online survey study that examined doctors'/medical students' perception of hurdles in EM in Pakistan between November and December 2023. This study was conducted at Rawalpindi Medical University, Rawalpindi, Pakistan. Social media platforms were used to recruit the participants to carry out this survey. The questionnaire proforma comprised three sections: a demographic characteristics section (six questions), a perception section (11 questions), and the last section, where participants were asked to give their opinion to improve EM for a future speciality.

An online Google survey form was used for the acquisition of data. Percentage and frequency distribution analysis was used. A total of 144 individuals (N = 144) participated in this study. Around 33.3% (N = 48) of the participants expressed that they had not considered a career in EM. Around 43% (N = 62) of them reported not having done a clinical placement in this speciality. A majority of the participants said that either they or their close friends/family members had faced a medical emergency. Leading barriers that proved a hindrance in pursuing this field were high levels of burnout, poor work-life balance, loss of patient follow-up, inability to work independently, more hostile environment, increased mortalities, and lack of exposure. Interestingly, family pressure had been reported by some participants as a limiting factor in pursuing EM.

In Pakistan, many doctors and medical students are not willing to pursue their careers in EM. Nationwide educational seminars should be conducted to increase awareness and interest among doctors in this field. Moreover, more and more clinical placement opportunities should be made available for junior doctors in EM. In the future, further research should be carried out to identify effective educational interventions to increase doctors'/medical students' awareness in this field of medicine.

Most of the recent research on nightmare distress and depressive symptoms has focused on adolescents and students, with less research on the nurse population. Emergency department nurses are at high risk for nightmare distress and depressive symptoms, but no studies have been conducted to explore the relationship between the two; thus, further investigation is needed.

To understand the relationship between nightmare distress and depressive symptoms among emergency department nurses in China.

A convenience sampling method was used to select 280 emergency department nurses from nine provinces, including Jiangxi, Sichuan, Jiangsu, and Shanxi Provinces. The Chinese version of the Nightmare Distress Questionnaire and the Center for Epidemiological Studies Depression Scale (CES-D) were administered.

Emergency department nurses' nightmare distress scores were positively associated with depressive symptom scores (r = 0.732), depressed affect (r = 0.727), somatic symptoms (r = 0.737), and interpersonal difficulty (r = 0.647). Further multiple linear regression analyses showed that education level, work pressure, self-reported health, and CES-D scores were factors that influenced nightmare distress among Chinese emergency department nurses (P < 0.05).

Nightmare distress is closely associated with depressive symptoms in Chinese emergency department nurses, and early intervention is recommended for professionals with this type of sleep disorder to reduce the occurrence of depressive symptoms.

This study aimed to explore the role of the doctor-patient relationship (DPR) perception from the perspective of medical professionals in the association between workplace violence (WPV), job satisfaction and turnover intention in the early stages of the COVID-19 pandemic based on the affective events theory (AET).

A cross-sectional study.

Nine medical institutions in Beijing were enrolled in this study.

In total, 792 medical professionals participated in the study, excluding administrators and logisticians.

The structural equation model was well adapted (comparative fit index (CFI) = 0.933; root mean square error of approximation (RMSEA) = 0.060). DPR mediated the association between WPV and job satisfaction, with an indirect effect of 0.247 (p<0.001). DPR perception mediated the effect of WPV on turnover intention, with an indirect effect of 0.090 (p<0.001). It also played a chain-mediating role in job satisfaction between WPV and turnover intention, with a mediation value of 0.117 (p<0.001), accounting for 53.42% of the total effect.

This study developed a stable model using AET. DPR perception plays an important role in the relationship between WPV and job satisfaction and turnover intention, suggesting the key impact of emotional factors. This has strong practical implications for maintaining the stability of medical teams. Therefore, medical institutions should improve the level of DPR perception from the perspective of medical professionals to effectively prevent mental health problems following WPV.

Violence directed at healthcare workers (HCWs) is common and may be more frequent in the emergency department (ED). In addition to physical injury, other consequences of workplace violence in the ED include an increased risk of burnout, post-traumatic stress disorder, reduced job satisfaction, and feelings of avoidance and futility. Understanding behaviors underlying workplace violence is the first step to employing mitigation strategies. The objective of this descriptive study was to assess the prevalence and types of violence against HCWs in a large, urban ED.

This study took place in the ED of an urban hospital with an annual ED census of approximately 100,000. A previously existing general patient safety incident "dropbox" for HCWs was utilized to capture workplace violence reports. At the completion of the study period, all data was collated into the electronic database and each report was categorized based on the nature and severity of the abuse. Further, all events were also coded as either involving or not involving specifically racist, sexist, or homophobic content. The primary outcomes were the number of reported events over the study period, and the percentage of total events that fell into each category. The secondary outcomes were the overall prevalence and ratio of events that included racist, sexist, or homophobic language or provocation.

Over the 5-month survey period, 130 reports of workplace violence were recorded, on average 0.85 per day. Perpetrators were mostly male, and most victims were nurses. Hospital security was involved in 26% of cases. At least 37% of incidents involved patients that were intoxicated and/or had history of psychiatric illness. Type I events (swearing provocatively, shouting, and legal threats) were the most common at 44% of encounters while 22% involved physical violence. Racist, sexist, and homophobic comments were involved in 8 (6%), 18 (14%), and 3 (2%) incidents respectively.

We found that workplace violence against HCWs was common in this study, and sometimes involved a component of racist, sexist, or homophobic bias. Consistent with previous ED literature, we found that abusive events occurred almost daily and that approximately 20% of events involved physical violence. Future efforts toward policy change to address workplace violence in health care is needed at local, state, and national levels.

Workplace violence (WPV) against medical staff has been an important public health and societal problem worldwide. Although numerous studies have implied the differences between physical violence (PV) and verbal violence (VV) against medical staff, few studies were conducted to analyze the different associations between work-related variables, PV, and VV, especially in China.

A cross-sectional study was conducted among Chinese medical staff in public hospitals, and 3,426 medical staff were interviewed and analyzed. WPV, including PV and VV, were evaluated by the self-report of the medical staff. Work-related variables, physical disease, depression, and social-demographic variables were also measured. The work-related variables included types of medical staff, professional titles, hospital levels, managers, working years, job changing, working hours/week, night duty times/week, monthly income, self-reported working environment, and social position. Logistic regressions were conducted to examine the factors associated with PV and VV.

A total of 489 medical staff (23.0%) reported the experience of PV and 1,744 (50.9%) reported the experience of VV. Several work-related variables were associated with PV and VV, including nurse (OR = 0.56 for PV, p < 0.01; OR = 0.76 for VV, p < 0.05), manager (OR = 1.86 for PV, p < 0.01; OR = 1.56 for VV, p < 0.001), night duty frequency/week (OR = 1.06 for PV, p < 0.01; OR = 1.03 for VV, p < 0.01), bad working environment (OR = 2.73 for PV, p < 0.001; OR = 3.52 for VV, p < 0.001), averaged working environment (OR = 1.51 for PV, p < 0.05; OR = 1.55 for VV, p < 0.001), and bad social position (OR = 4.21 for PV, p < 0.001; OR = 3.32 for VV, p < 0.001). Working years (OR = 1.02, p < 0.05), job changing (OR = 1.33, p < 0.05), and L2 income level (OR = 1.33, p < 0.01) were positively associated with VV, but the associations were not supported for PV (all p>0.05). The other associated factors were male gender (OR = 1.97 for PV, p < 0.001; OR = 1.28 for VV, p < 0.05) and depression (OR = 1.05 for PV, p < 0.001; OR = 1.04 for VV, p < 0.001).

Both PV and VV were positively associated with work-related variables, such as doctor, manager, more night duty frequency, perceived bad working environment, or social position. Some variables were only associated with VV, such as working years, job changing, and monthly income. Some special strategies for the work-related variables should be applied for controlling PV and VV.