Workplace violence and risk factors for PTSD among psychiatric nurses: Systematic review and directions for future research and practice

Hilton, N. Zoe; Addison, Sonja; Ham, Elke; Rodrigues, Nicole C.; Seto, Michael C.

doi:10.1111/jpm.12781

Cited by 47 publications

(30 citation statements)

References 61 publications

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“…In addition, due to the increasing demand of mental health services in China, psychiatrists are facing an inflow of patients suffering from mental illness, which would increase their workload. Hospitalizations in psychiatric settings maybe for days, weeks, or longer, and this ongoing care relationship may also increase the incidence of WPV ( 41 – 43 ). The prevalence of WPV vary across socio-economic groups.…”

Section: Discussionmentioning

confidence: 99%

Workplace Violence and Turnover Intention Among Psychiatrists in a National Sample in China: The Mediating Effects of Mental Health

et al. 2022

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BackgroundWorkplace violence (WPV) in healthcare has received much attention worldwide. However, scarce data are available on its impact on turnover intention among psychiatrists, and the possible mechanisms between WPV and turnover intention have not been explored in China.MethodsA cross-sectional survey was conducted among psychiatrists in 41 tertiary psychiatric hospitals from 29 provinces and autonomous regions in China. A stress-strain-outcome (SSO) model was adopted to examine the effects of WPV on mental health and turnover intention. The association and mediation by burnout and stress were examined by multivariate logistic regression (MLR) and generalized structure equation modeling (GSEM).ResultsWe invited 6,986 psychiatrists to participate, and 4,520 completed the survey (64.7% response rate). The prevalence of verbal and physical violence against psychiatrist in China was 78.0 and 30.7%, respectively. MLR analysis showed that psychiatrists who experienced verbal violence (OR = 1.15, 95% CI = 1.10–1.21) and physical violence (OR = 1.15, 95% CI = 1.07–1.24) were more likely to report turnover intention. GSEM analysis showed that burnout (β = 4.00, p < 0.001) and stress (β = 1.15, p < 0.001) mediated the association between verbal violence and turnover intention; similarly, burnout (β = 4.92, p < 0.001) and stress (β = 1.80, p < 0.001) also mediated the association between physical violence and turnover intention.ConclusionsExperience of WPV is a significant contributor to turnover intention among psychiatrists. Mental health status, such as burnout and stress level significantly mediated the association. Policy makers and hospital administrators need to be aware of this association. Action is needed to promote mental health among the psychiatrists to improve morale and workforce sustainability.

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Section: Discussionmentioning

confidence: 99%

Workplace Violence and Turnover Intention Among Psychiatrists in a National Sample in China: The Mediating Effects of Mental Health

et al. 2022

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“…burnout, workplace support). Hilton et al (2021) concluded that there is no strong evidence base for choosing risk factors to target for PTSD prevention in this occupational group. In order to address this complex aetiology, interventions which provide support across time (before, during and after the event) and which include both one‐on‐one support and systemic workplace policy changes may be most impactful.…”

Section: Discussionmentioning

confidence: 99%

“…A recent systematic review (Hilton et al, 2021) investigated evidence for risk factors for PTSD among nurses in psychiatric settings occurring before the traumatic event (e.g. nurses’ gender, training), during the event (e.g.…”

Section: Discussionmentioning

confidence: 99%

“…In the present review, one study(Morrison-Wylde et al, 2017) assessed a smartphone-delivered mindfulness application, which was most beneficial for participants without pre-existing PTSD symptoms. E-interventions are an increasingly popular mode of therapeutic delivery which should be further explored in terms of adherence, accessibility and the populations which gain the most benefit.A recent systematic review(Hilton et al, 2021) investigated evidence for risk factors for PTSD among nurses in psychiatric settings occurring before the traumatic event (e.g. nurses' gender, training), during the event (e.g.…”

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confidence: 99%

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Workplace interventions to prevent or reduce post‐traumatic stress disorder and symptoms among hospital nurses: A scoping review

Liyanage

Addison

Ham

et al. 2021

Journal of Clinical Nursing

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Objectives The aim of this study was to identify literature on evaluated workplace interventions to prevent or reduce the prevalence or impact of work‐related post‐traumatic stress disorder (PTSD) and PTSD symptoms among hospital nurses. A second objective was to summarise and compare the characteristics and effectiveness of these interventions. Background A substantial proportion of nurses report PTSD symptoms. Previous reviews have synthesised interventions to address PTSD in military and other high‐risk populations, but similar work focusing on nurses has yet to be conducted. Methods We conducted a scoping review with the question: What interventions have been studied to prevent or treat PTSD symptoms or PTSD among nurses working in hospitals? We followed the PRISMA Scoping Review Checklist using an unregistered protocol. We searched in twelve academic and grey literature databases (e.g. MedLine, CINAHL) with no language restrictions. We included publications reporting on interventions which were evaluated for measurable impacts on PTSD and PTSD symptoms among nursing staff working in inpatient settings from 1980 to 2019, and charted study characteristics in a spreadsheet. Results From 7746 results, 63 studies moved to full‐text screening, and six studies met inclusion criteria. Methodologies included three randomised controlled studies, one quasi‐experimental study, one pre‐post feasibility study and one descriptive correlational study. Four studies reported a significant reduction in PTSD scores in intervention groups compared with baseline or comparison, when using debriefing, guided imagery or mindfulness‐based exercises. Conclusions This review identified six studies evaluating hospital‐based interventions to reduce PTSD and PTSD symptoms among hospital nurses, with some positive effects reported, contributing to a preliminary evidence base on reducing workplace trauma. Larger studies can compare nurse subpopulations, and system‐level interventions should expand the focus from individuals to organisations. Relevance to clinical practice This review can inform nursing and hospital leaders developing evidence‐based interventions for PTSD among nurses.

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“…If burnout mediates the association between workplace exposures and PTSD, then workplace programmes to reduce burnout could be a helpful component of efforts to prevent workplace PTSD. If instead critical events have only a direct relation to PTSD symptoms, then more efforts could be placed on preventing workplace exposures, monitoring for posttraumatic symptoms, and providing PTSD-specific interventions when needed (Hilton et al 2021). The present study was conducted to address this gap by examining the role of burnout in the relationships among critical events, chronic stressors, worklife incongruence, and PTSD symptoms among psychiatric workers.…”

Section: The Role Of Burnout In Ptsd In Healthcare Workersmentioning

confidence: 99%

Workplace stressors and PTSD among psychiatric workers: The mediating role of burnout

Ham

Seto

Rodrigues

et al. 2022

Int J Mental Health Nurs

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Critical workplace events (e.g., assaults), chronic stressors, burnout, and work conditions all affect nurse well-being. The present study investigated associations among these sources of stress and posttraumatic stress disorder (PTSD) symptoms in psychiatric nurses, hypothesizing that burnout would mediate the paths between workplace stressors and PTSD. Surveys were completed by 611 psychiatric nurses or allied health staff working on inpatient units in three psychiatric hospitals. Participants reported on critical events and chronic stressors specific to providing psychiatric care and completed the Maslach Burnout Inventory (MBI), Areas of Worklife Survey (AWS) (work conditions), and PTSD Checklist for DSM-5. Data were analysed using structural equation modelling. Burnout had a direct relation to PTSD symptoms and partially mediated the effect of exposure to critical events, but not chronic stressors, on PTSD symptoms. Chronic stressors related to patients' disturbing behaviour (e.g., flooding room, eating non-food items) had a direct effect on PTSD symptoms, but those related to resisting care (e.g., screaming constantly, physically resisting care) had no significant association. Worklife conditions had a negative direct effect on Burnout and indirect effect on PTSD, whereby participants reporting poorer alignment of work conditions with their expectations had higher Burnout and PTSD symptom scores. Different sources of workplace stress have different relations to PTSD symptoms, and Burnout has both direct and mediation effects. Interventions aimed at reducing patients' aggressive and disturbing acts and improving healthcare providers' burnout and worklife factors in hospitals may all be needed to reduce PTSD among psychiatric staff.

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Workplace violence and risk factors for PTSD among psychiatric nurses: Systematic review and directions for future research and practice

Cited by 47 publications

References 61 publications

Workplace Violence and Turnover Intention Among Psychiatrists in a National Sample in China: The Mediating Effects of Mental Health

Workplace Violence and Turnover Intention Among Psychiatrists in a National Sample in China: The Mediating Effects of Mental Health

Workplace interventions to prevent or reduce post‐traumatic stress disorder and symptoms among hospital nurses: A scoping review

Workplace stressors and PTSD among psychiatric workers: The mediating role of burnout

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