HomePsychology and Education: A Multidisciplinary Journalvol. 44 no. 5 (2025)

Biphasic Methods in Developing an Anti-Workplace Violence Program for Healthcare Institutions

Jebb Renan Luna

Discipline: Education

 

Abstract:

Workplace violence, commonly known as WPV, was a prominent occurrence, particularly within the healthcare environment. The occurrence of workplace violence (WPV) targeting healthcare workers (HCWs) had witnessed a surge amidst the COVID-19 pandemic. The aim of the study was to develop triphasic methods by exploring the intended anti-workplace violence interventions among healthcare institutions, specifically hospitals in Batangas. This investigation utilized a three-phase research design that aimed to undertake an analysis of both qualitative and quantitative data to create a bespoke questionnaire pertaining to the efficacy of anti-violence measures in the healthcare workplace. An exploratory sequential design encompassed a research methodology that integrated both qualitative and quantitative methods. In this particular study design, the sequential steps involved the initial collection and analysis of qualitative data followed by the subsequent collection and analysis of quantitative data. Salvador et al. (2020) employed a three-stage exploratory sequential mixed-methods strategy. In phase one, the researchers conducted semi-structured qualitative interviews with 20 nurses. The Colaizzi approach was used to examine the data collected from these interviews. In phase two, the qualitative findings were converted into survey components, constructs, and items. The nursing process system concept was used to develop this new survey instrument. Finally, in phase three, validation was done to formally approach an extensive program tool that emphasized anti-violence. The aimed of the studied was to explore the workplace violence experienced by nurses in hospitals to provided a strategic intervention thus, this was implemented among hospitals in Batangas. Hospitals was classified according to functionality, known to acknowledged all kinds of illnesses, deformities, or diseases. The local context provided insights and statistics that was directly pertinent to the country's healthcare system and nursing staff. It assisted in addressing specific difficulties and needed faced by Filipino nurses and healthcare facilities. There had been incidents and reports of workplace violence, and knowing the precise elements that contributed to violence in this setting led to more targeted interventions and solutions. The variety of healthcare settings and the availability of resources was also factors in selecting Batangas province.



References:

  1. Abdelhafiz, Ziady HH, Maaly AM, Alorabi M, Sultan EA. Prevalence, associated factors, and consequences of burnout among Egyptian physicians during the COVID-19 pandemic. Front Public Health.2020;8:590190.doi:10.3389/fpubh.2020.590190 .
  2. Abor,P.(2023). Accountability and transparency: Is this possible in hospital governance?. https://www.tandfonline.com/doi/full/10.1080/23311975.2023.2266188  
  3. Al-Azzam., Al-Sagarat, Tawalbeh,(2018). . Mental health nurses’ perspective of workplace violence in Jordanian mental health hospitals. PerspectPsychiatr Care. 2018;54:477–487. doi: 10.1111/ppc.12250.
  4. Alves,(2022).Psychopathological symptoms and work status of Southeastern Brazilian nursing in the       context                        of COVID-19. Rev Lat Am Enfermagem. 2022;30:e3518. doi: 10.1590/1518-8345.5768.3518.
  5. Angwenyi, Kabue,Chongwo,(2021).Mental health during COVID - 19 pandemic among caregivers of young children      in Kenya’s urban informal settlements. A cross-sectional telephone survey. Int J       Environ Res Public Health      18. 10.3390/ijerph181910092
  6. Artificion, (2020).Shortage of Nurses: A Challenge to Health Care Setting. https://research.lpubatangas.edu.ph/wpcontent/uploads/2022/06/6-APJAHS-2020-01.pdf  
  7. Arnetz,(2019) Preventing Patient-to-worker Violence in Hospitals:Outcome of a Randomized Controlled Intervention. J Occup Environ Med. 59:18–27. https://pubmed.ncbi.nlm.nih.gov/28045793 
  8. Aspera,(2020). Violence against health personnel before and during the health contingency COVID-19. Rev Med Inst Mex Seguro Soc. 2020;58:S134–143. doi: 10.24875/rmimss.m20000125.
  9. Bandyopadhyay,(2020). Infection and mortality of healthcare workers worldwide from COVID-19: a systematic review. BMJ Glob Health. 2020;5:e003097. doi: 10.1136/bmjgh-2020-003097.
  10. Baskin,(2021) Healthcare worker resilience during the COVID-19 pandemic: an integrative review. J NursManag. 2021;29:2329–2342. doi: 10.1111/jonm.13395
  11. Beattie, (2019). Workplace violence perpetrated by clients of health care: A need for safety and trauma-informed care. Journal of Clinical Nursing, 28, 116-124
  12. Bellitto,(2018). Interrelationships between violent crime, demographic and socioeconomic factors: a preliminary analysis between Central-Northern European countries and Mediterranean countries. J Econ Soc Thought.        2018;5:230–246.
  13. Berlanda,(2019). Addressing risks of violence against healthcare staff in emergency departments: the effects of job         satisfaction and attachment style BioMed Res. Int., 2019 (2019), 10.1155/2019/5430870
  14. Brig, (2022). The impact of COVID-19 pandemic on temporal trends of workplace violence against healthcare workers in the emergency department. Health Policy. 2022;126:1110–1116. doi: 10.1016/j.healthpol.2022.09.010.
  15. Cabilan, McRae,&  Learmont, (2022). Validity and reliability of the novel three-item occupational violence patient risk assessment tool. Journal of Advanced Nursing, 78(4),1176–1185. https://doi.org/10.1111/jan.15166 
  16. Cao, Song, & Wu, (2023).What is nursing professionalism? A concept analysis.          BMC    Nurs.       2023;   22: 34. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9902819/
  17. CDC.(2023).Common Reasons   for        Workplace Violence. https://wwwn.cdc.gov/WPVHC/Nurses/Course/Slide/Unit3_6
  18. Chakraborty,(2022). Violence against Physicians and Nurses:A Systematic Literature Review. Z GesundhWiss.      2022;30:1837–55. https://pubmed.ncbi.nlm.nih.gov/35096514 
  19. Cheung, (2017). Workplace Violence toward Physicians and Nurses:Prevalence and Correlates in Macau. Int J Environ Res Public Health ;14:879. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5580583/
  20. Creswell, & Clark, (2017). Designing and conducting mixed methods research. Sage publications.
  21. Dafny, (2020). I do not even tell my partner: Nurses’ perceptions of verbal and physical violence against nurses working in a regional hospital. Journal of Clinical Nursing (John Wiley & Sons, Inc.), 29(17/18), 3336– 3348. https://doi-org.unh.idm.oclc.org/10.1111/jocn.15362 
  22. D’Ettorre,(2018). Preventing and Managing Workplace Violence against Healthcare Workers in Emergency Departments. Acta Biomed. 2018;89:28–36. https://pubmed.ncbi.nlm.nih.gov/2964498
  23. De Castro, Cabrera, & Gee, Fujishiro, Tagalog. Occupational Health and Safety Issues among Nurses in the Philippines. AAOHN Journal. 2009;57(4):149-157. doi:10.3928/08910162-20090401-04
  24. Do BN.(2020).Determinants of health literacy and its associations with health- related behaviors, depression among the older people with and without suspected COVID-19 symptoms: a multi-institutional study. Front Public Heal. (2020) 8:694. Doi: 10.3389/fpubh.2020.581746
  25. Dolan, (2020) Unmasking history: who was behind the anti-mask league protests during the 1918 influenza  epidemic in San Francisco? Perspect Med Humanit 5:19
  26. Edward,.(2019).Nursing andaggression in the workplace: a systematic review.Br J Nurs.23(12):653-4
  27. Escribano,(2019). Violence in the Workplace:Some Critical Issues Looking at the Health Sector. Heliyon 5:e01283. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6403074/ 
  28. Ferr,(2017). Workplace Violence in Different Settings and among Various Health Professionals in an Italian General Hospital:A Cross-sectional Study. Psychol         Res      BehavManag. 2016;9:263– 75. https://pubmed.ncbi.nlm.nih.gov/27729818 
  29. Fida,(2018). “First, do no harm”: the role of negative emotions and moral disengagement in understanding the relationship between workplace aggression and misbehavior Front. Psychol., 9 (2018), 10.3389/fpsyg.2018.00671
  30. García-Zamora, Pulido,& Miranda-Arboleda.(2022). Aggression, micro-aggression, and abuse against health care providers during the COVID-19 pandemic. A Latin American Survey. CurrProblCardiol. 2022;47:101296. doi:         10.1016/j.cpcardiol.2022.101296.
  31. Guindy, Ahmed, Ebrahim,(2022).Nursing Management Staff’ Talent and Creativity practices and its Relation with Organizational Development and Excellence. International Egyptian Journal of Nursing Sciences and Research(IEJNSR). https://ejnsr.journals.ekb.eg/article_247234_4968805ce7ff44422d4fb6503f2a53c6.pdf 
  32. Hadi,(2019). Bully And Harassment In Healthcare Industry: What Are Our Roles In Prevention, Powerpoint Slides, https://www.aoemm.org.my/wp-content/uploads/2019/07/Bully-Harassment-in-Healthcare-Industry-What-are-Our-Roles-in-Prevention-.pdf
  33. Hajizadeh,A.,Zamanzadeh, V., Kakemam, E et al.(2021).Factors influencing nurses participation in the health policy-making process: a systematic review.BMC Nursing volume 20, Article number: 128. https://bmcnurs.biomedcentral.com/articles/10.1186/s12912-021- 
  34. Hallett,(2017). De-escalation of aggressive behaviour in healthcare settings: Concept analysis. International          Journal of  Nursing Studies, 75, 10-20. doi: 10.1016/j.ijnurstu.2017.07.003
  35. He,(2024).Factors influencing the development of nursing professionalism: a descriptive qualitative study.BMC Nurs.2024; 23:283. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11055332/
  36. Hirsch,(2019). Measures to avoid coercion in psychiatry and their efficacy.DeutschesÄrzteblatt International, 116,             336-343
  37. Hoffman,(2019)Violence against healthcare workers Patient Saf., 1, pp. 12 13 https://patientsafetyj.com/index.php/patientsaf/article/view/reducing-violence , Accessed 15th Feb 2022
  38. Izadirad, & Zareban (2022). The relationship of health literacy with health status, preventive behaviors and health             services utilization in Baluchistan, Iran. J Educ Community Heal. (2022) 2:43–50. doi: 10.20286/jech-02036
  39. Jones (2023).Addressing  Workplace Violence and Creating a Safer Workplace. https://psnet.ahrq.gov/perspective/addressing-workplace-violence-and-creating-safer-workplace
  40. Jun (2023).Training Priority for Managerial Competence of Nurse Managers in Small and Medium-Sized       Hospitals: Focusing on the Management Level.SAGE Open  Nurs.  2023 Jan-Dec; 9:23779608231195660. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10454748/
  41. Kasper et al.(2023). The Work of Nurses in Primary Health Care: Crossings    of the New Public Management. Healthcare. 2023;11:1562. doi: 10.3390/healthcare11111562.
  42. Lai (2019). Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease. JAMA network open. 2020;3(3):e203976-e. doi: 10.1001/jamanetworkopen.2020.3976
  43. Liu (2019). Prevalence of Workplace Violence Against Healthcare Workers:A Systematic Review and Meta-analysis. Occup Environ Med. 2019;76:927–37. Liu J, Gan Y, Jiang H, Li L, Dwyer R, Lu K, et al. Prevalence of        Workplace Violence Against Healthcare Workers:A Systematic Review and Meta-analysis. Occup Environ Med. 2019;76:927–37.
  44. Liu  et al.(2020). The experiences of health-care providers during the COVID-19 crisis in China:        a qualitative study. Lancet Global Health. 2020;8:6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7190296/
  45. Lloyd (2023).Health service improvement using positive patient feedback: Systematic scoping review.PLoS One.             2023; 18(10): e0275045. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10553339/ 
  46. Logie  & Turan (2020). How do we balance tensions between COVID-19 public health responses and stigma mitigation? Learning from HIV research. AIDS and Behavior, 24(7), 2003-2006. 10.1007/s10461-020 02856 8
  47. Lu (2020).Prevalence of workplace violence against health-care professionals in China: a comprehensive meta-analysis of observational surveys Trauma Violence Abuse, 21, pp. 498-509, 10.1177/1524838018774429
  48. Lührmann (2020). Constraining governments: New indices of vertical, horizontal, and diagonal accountability.       The American Political Science Review, 114(3), 811–820. https://doi.org/10.1017/S0003055420000222
  49. Mavandadi (2018). Effective ingredients of verbal de-escalation: validating an English modified version of the             ‘De-Escalating Aggressive Behaviour Scale’. Journal of Psychiatric and Mental Health Nursing, 23, 357-  368. doi: 10.1111/jpm.12310
  50. Morphet (2019). The trouble with reporting and utilization of workplace violence data in health care. J Nurs Manag.;27(3):592-8. Epub 2018/09/18. doi: 10.1111/jonm.12717. PubMed PMID: 3022331
  51. Naveen (2020). Study on mitigation of workplace violence in hospitals. Medical Journal Armed Forces India,         76(3), 298–302. 10.1016/j.mjafi.2019.09.003
  52. Newman (2018). Effects of a staff training intervention on seclusion rates on an adult inpatient psychiatric unit.           Journal of Psychosocial Nursing, 56(6), 23-30. doi: 10.3928/02793695-20180212-02 OSHA.(2023).What is       workplace violence?. https://www.osha.gov/workplace-violence
  53. Nowrouzi-Kia, B., Isidro, R., Chai, E., Usuba, K., & Chen, A. (2019). Antecedent factors in different types of workplace violence against nurses: A systematic review. Aggression and Violent Behavior, 44, 1–7. https://doi.org/10.1016/j.avb.2018.11.005
  54. Ota (2023).Nurse leadership in promoting and supporting civility in health care settings: A scoping review.J Nurs        Manag. 2022 Nov; 30(8): 4221– 4233. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10098756/
  55. Patino (2018).Internal and external validity: can you apply research study results  toyourpatients?. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6188693/#:~:text=
  56. Patterson (2013). A mixed methods investigation of leadership and performance in practice-based research networks. Thesis and Dissertation. University of Iowa, Iowa Research Online.
  57. Phillips  (2018). Workplace violence against health care workers in the United States. The New England Journal      of Medicine, 374(17), 1661-1669
  58. Pompeii (2020).. Physical assault, physical threat, and verbal abuse perpetrated against hospital workers by patients or visitors in six US hospitals. Am J Ind Med. 2015 Nov; 58(11):1194-204
  59. Price (2018). The support-control continuum: An investigation of staff perspectives on factors influencing the success or failure of de-escalation techniques for the management of violence and aggression in mental health settings. International        Journal of Nursing Studies, 77, 197-206. doi: 10.1016/j.ijnurstu.2017.10.002
  60. Rock, Statistics You Should Know Workplace Violence In Healthcare(2019) https://www.campussafetymagazine.com/hospital/workplace-violence-in-healthcare-statistics
  61. Salvador  et al. Development of Student Survey on WritingNursing Care Plan: An exploratory sequential mixed-methodsstudy. J NursManag. 2020; 00:1–14. https://doi.org/10.1111/jonm.12996
  62. Salvador et.al (2021). Workplace violence among Registered Nurses in Saudi Arabia: A qualitative study. Nursing open, 8(2), 766–775. https://doi.org/10.1002/nop2.679
  63. Serrano et al.(2020). Comparative study of the assaults to professionals in Primary Care against Specialized Care, in the Aragón Health Service during the year 2018. Rev. Esp. Salud Pública. 2020;94:e202010125.
  64. Sevold et al.(2021).Prioritizing the Mental Health and Well-Being of Healthcare Workers: An Urgent Global Public Health Priority.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8137852/
  65. Shier et al.(2021). Supervisor–worker relationship dynamics for workplace violence prevention in public sector human service organizations. Human Service Organisations: Management, Leadership & Governance,45(2), 109–124. 10.1080/23303131.2021.1891169
  66. Spector (2018). Nurse exposure to physical and nonphysical violence, bullying, and sexual harassment: A quantitative review. Int J Nurs Stud. 2014 Jan; 51(1):72-84.
  67. Somani et.al (2021). A systematic review: Effectiveness of interventions to de-escalate workplace violence against nurses in healthcare settings. Safety and Health at Work, 12(3), 289–295. 10.1016/j.shaw.2021.04.004
  68. Stahl (2023). ASK ME!—Routine measurement of patient experience with patient safety in ambulatory care: A mixed-mode survey. PLOS ONE. 2021;16(12):e0259252. doi: 10.1371/journal.pone.0259252
  69. Timofeyev (2023).The impact of transparency constraints on the efficiency of the Russian healthcare system: systematic literature review. https://www.tandfonline.com/doi/pdf/10.1080/13696998.2022.2160 608
  70. West (2017). Evaluation of compassion and resilience in nursing from evidence- based projects to research findings. Nursing and Palliative Care. 2(4),1-7. doi: 10.15761/NPC.1000159
  71. Weston (2022).Stigma: A Barrier in Supporting Nurse Well-Being During the Pandemic.Nurse Lead. 2022      Apr;20(2):174–178. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8577880/
  72. Yang. Effects of health literacy competencies on patient-centered care among nurses. BMC Health Serv Res. (2022) 22:1–9. doi: 10.1186/s12913-022- 08550-w
  73. Zainal (2018). The risk factors of workplace violence among healthcare workers in public hospital Mal. J. Med. Health Sci., 14 (2018), pp. 120-127
  74. Zhang (2021). Nurses’ experiences and support needs following workplace violence: A qualitative systematic review. Journal of Clinical Nursing, 30(1- 2), 28–43. 10.1111/jocn.15492
  75. Zhang et al.(2023). Evaluating the impact of an information-based education and training platform on the incidence, severity, and coping resources status of workplace violence among nurses: a quasi-experimental study.BMC Nursing volume 22, Article number: 446. https://bmcnurs.biomedcentral.com/articles/10.1186/s12912-023- 01606-