Research On Recognizing High-risk Situational Elements Of Workplace Violence Among Nurses Based On Belk Situational Theory

Objective:The purpose of this study was to understand the current situation and influencing factors of workplace violence(WPV)among nurses,and to explore the high-risk situational elements of WPV among nurses,so as to help nurses recognize WPV early and quickly,and to provide basis for constructing coping strategies in the future,thereby reducing the incidence of WPV among nurses.Methods:This study is divided into two parts:1.Investigation about current status of nurses' WPV and analysis of influencing factors.A survey was conducted in this part.2566 in-service clinical nurses in Suzhou between October and December 2017 were selected by using full-randomized sampling,for describing the current status of nurses' WPV and analyzing its influencing factors.Analysised the high-risk departments of workplace violence based on the results of investigation,in order to provide the basis for the selection and confirmation of the interviewees in the next qualitative study.2.The Qualitative Study on high-risk situational elements in nurses' WPVAccording to Belk Situational Preventive Theory,a semi-structured interview outline was designed for different interviewees.In order to make the interviewees more representative,the method of targeted sampling was adopted based on the results of the first part of the survey.Thirty-six nurses from high-risk departments of workplace violence were interviewed,who were WPV experienced,witnesses of events and managers who dealt with the incident.Then,combined with the results of the first part of the quantitative survey,to identify the high-risk situational factors of nurses' WPV.Results:1.Current status of nurses' WPV(1)Incidence rate:The overall incidence of nurses' WPV was 68.4%,of which the incidence of psychological violence was 67.7%,and the incidence of physical violence was 13.1%;(2)Occurrence characteristics:?Environmental characteristics:66.6%of nurses'\WPV occurred in day shifts,66.6%of the nurses' WPV occurred in the day shift,and 86.2%of the violence occurred mainly in the ward,ward nurses' station and other areas where nurses worked.?Characteristics of the perpetrator:96.2%of the violent incidents were carried out by patients or their families,70.6%of the perpetrators were concentrated in men,of which 62.7%were middle-aged;(3)Reasons for occurrence:nurses' WPV caused by "low quality","rejection of unreasonable requirements","expensive medical expenses","long waiting time" and"dissatisfaction with doctors' work" accounted for 61.4%,49.0%,34.8%,33.6%and 23.4%of the total violent incidents respectively.2.Analysis of influencing factors of nurses' WPVMultivariate analyses showed that the cognition and attitude of the department and nurses to WPV,and the attitudes and coping measures of the hospital to WPV were the influencing factors of nurses' WPV.Further detailed analysis of departments revealed that emergency rooms,infusion rooms,outpatient clinics,psychiatry and pediatrics were the high-risk departments of WPV for nurses.3.Qualitative study on the high-risk situational elements of nurses' WPVThe high-risk situational elements of nurses' WPV(11):(1)Advanced status:When the patients were alcohol abused patients;when the patient's mental state was abnormal.(2)Environmental or institutional elements:When dissatisfied with the hospital's comprehensive environment;when dissatisfied with the hospital's treatment system or procedures(3)Objective elements:When the doctors or nurses were not found repeatedly;when the waiting time was long;when the unreasonable request was rejected.(4)Timing Elements:When refusing to accept the current condition;when questioning medical expenses;when dissatisfied with the attitude or communication of the nurse;accepting the first time the invasive operation is unsuccessful.Conclusions:1.The current status of nurses' WPV:(1)The phenomenon of workplace violence among in-service clinical nurses in Suzhou was quite common,and psychological violence is the main type of violence;(2)The time period for nurses5 workplace violence is mainly in the day shift,and its locations were mainly concentrated in wards and nurses' stations.The perpetrators were mainly composed of middle-aged male patients or their families;(3)"low quality","rejection of unreasonable requests","thinking that medical expenses are expensive","long waiting time" and "dissatisfied with doctor's work" are common triggering factors for nurses' WPV.2.The analysis of influencing factors about nurses' WPV:The influencing factors of nurses' WPV were respectively:the cognition and attitude of departments and nurses to workplace violence,and the attitude and coping measures of hospitals to WPV.3.Based on Belk Situational Preventive Theory,this study finally identified the high-risk situational elements in nurses' WPV through mixed research design,including two advance status:the patient was an alcoholic;or the patients had abnormal mental state;two environmental or institutional elements:when dissatisfied with the hospital's comprehensive environment;when dissatisfied with the hospital's treatment system or procedures;three objective elements;when repeatedly searched for doctors or nurses for failure;when waited for a long time;Or the unreasonable requests were rejected;four occasion elements:when refused to accept the current condition;when questioned medical expenses;when dissatisfied with the attitude or communication of the nurse;and when accepting invasive operation is unsuccessful for the first time.