Skip to main content
Download PDF

Prevalence of workplace violence in Chinese obstetric nurses under the new situation and its correlation with violence prevention knowledge-attitude-practice and climate perception: a cross-sectional study

BMC Nursing volume 22, Article number: 473 (2023) Cite this article

Abstract

Background

Workplace violence severely impacts individual nurses. With the three-child opening policy of China and the impact of the COVID-19 epidemic in the recently years, obstetric nurses face the double attack of heavy workload and staffing shortage. This study aimed to evaluate the current situation of workplace violence among Chinese obstetric nurses under the new situation, assess the level of violence prevention knowledge-attitude-practice and climate perception in Chinese obstetric nurses and explore the correlation between workplace violence and the level of violence prevention knowledge-attitude-practice and climate perception.

Methods

A cross-sectional survey on the workplace violence for Chinese obstetric nurses was conducted from August to February 2023. All the questionnaires came from 10 provinces and 3 autonomous regions in China. The basic characteristics of obstetric nurse’s workplace violence, workplace violence prevention knowledge-attitude-practice scale and workplace violence climate perception scale were collected.

Results

Totally, 522 Chinese obstetric nurses were included. 55.0% of obstetric nurses (287) had experienced workplace violence in the past 12 months, including verbal assault (40.4%), physical assault (34.1%), and sexual assault (31.0%). The overall level of obstetric nurses’ workplace violence prevention knowledge-attitude-practice and climate perception of workplace violence was low. Multiple linear regression analysis showed that the violence prevention knowledge dimension significantly influenced obstetric nurses’ workplace violence (B = -0.278, P < .001), attitude dimension (B = -0.241, P < .001), behavior dimension (B = -0.216, P < .001) and the violence climate perception’s organizational management (B = -0.177, P < .001), organizational training (B = -0.175, P < .001), organizational support (B = -0.143, p < .001) and the violence handling (B = -0.165, P < .001).

Conclusion

The incidence of workplace violence among obstetric nurses in the new situation is high. However, the overall violence prevention knowledge-attitude-practice and climate perception levels are low. Therefore, nursing managers should take targeted measures according to the relevant influencing factors and the characteristics of obstetrics to improve the level of obstetric nurses’ violence prevention knowledge-attitude-practice and climate perception to reduce workplace violence among obstetric nurses.

Peer Review reports

Introduction

The World Health Organization (WHO) defines workplace violence (WPV) as verbal abuse, threats, and attacks on health personnel in the workplace, resulting in explicit or implicit harm to their safety, well-being, and health [1]. According to its manifestations, WPV has three forms, including physical aggression, verbal aggression, and sexual harassment [2]. Furthermore, according to the source of violence, WPV has four types, the most common of which are vertical violence and horizontal violence [3]. Workplace violence is a global social problem, especially in the medical industry, where its incidence is high. In recent years, workplace violence has seriously affected the physical and mental health of medical staff and has received extensive global attention [4]. The incidence of workplace violence at home and abroad ranges from 68.4 to 87.0% [5, 6]. A recent survey of 28 member States of the European Federation of Nurses (EFN) found that health professionals have an 80% higher risk of workplace violence [7]. Verbal violence was the most frequent type, amounting to 71.9% [8].

Nurses play a crucial role in clinical diagnosis and treatment, as they have extensive patient contact. However, this also puts them at a higher risk of conflicts with patients, leading to workplace violence (WPV). WPV negatively impacts nurses’ work quality, job satisfaction, and overall nursing standards [9, 10]. It also contributes to job burnout and intentions to quit, resulting in staff shortages and economic losses [10,11,12,13,14]. It’s important to note that WPV can even discourage midwifery students, leading to a decline in the quantity and quality of future midwifery professionals [15]. The Ockenden report on adverse clinical events in UK obstetrics highlighted staff shortages and a culture of bullying as factors contributing to these events [16]. Despite increased awareness and support, WPV continues to rise among nurses [5]. A recent survey by international health organizations revealed an increase in violence against healthcare workers worldwide since the COVID-19 pandemic in 2020 [16]. In China, the implementation of the two-child policy in 2016 and the three-child policy in 2021 resulted in a significant rise in elderly and high-risk obstetric deliveries. After the complete implementation of the two-child policy, the incidence of high-risk pregnancies increased by up to 20% [17]. This not only adds to the workload of obstetric nurses but also presents new challenges. Additionally, since the outbreak of COVID-19 in 2020, hospitals have faced increased support demands. The combination of increased workload and staffing shortages has significantly contributed to job burnout among obstetric nurses [18], which is a contributing factor to WPV [19]. Similarly, research by Capper et al. [10] found that WPV leads to the loss of obstetric nurses and affects the quality of maternal and child care, perpetuating a cycle of WPV in obstetric settings.

The knowledge, attitudes, and practices of nurses regarding workplace violence prevention are crucial in addressing this issue. It has been found that having a good level of violence prevention knowledge and maintaining a correct and positive attitude can positively influence the behavior of violence prevention [20]. Furthermore, nurses’ perceptions of the workplace violence climate, which refers to their views on the organizational policies and practices implemented by hospital management to control and eliminate workplace violence, play a significant role. A reasonable perception of the violence climate can reduce the negative impact of violence on nurses and effectively decrease its incidence [21, 22].

While there have been numerous studies on workplace violence among nurses in emergency departments, psychiatry, and geriatrics, there is a lack of research focusing specifically on Chinese obstetric nurses. A previous study highlighted that although obstetric medical staff face a lower risk of physical attacks compared to emergency departments, they experience similar levels of verbal violence, which is associated with job burnout [23]. Therefore, the present study aims to investigate workplace violence among obstetric nurses in the current context, including their levels of violence prevention knowledge, beliefs, and behaviors, as well as their perceptions of the violence climate. The study also aims to explore the impact of these factors on workplace violence experienced by obstetric nurses.

Methods

Design, setting, and participants

A cross-sectional online questionnaire survey was conducted among Chinese obstetric nurses by convenience sampling from August to February 2023. First, generate a link to an online electronic questionnaire platform, then publish the questionnaire and create a QR code. The researchers then sent a QR code with the help of Guangdong Nurses Association notice, explaining the purpose of the survey and the requirements of the respondents and inviting eligible obstetric nurses to participate in the study. Respondents responded to questionnaires by scanning the QR code on their mobile phones, eligible nurses knew that the study was voluntary and anonymous, and all participants provided informed consent. Finally, A red envelopes were sent to group users to express their gratitude for improving the answer rate of the questionnaire. The Inclusion criteria were as follows: (1) those who had obtained the nurse practitioner qualification certification; (2) those who had worked in obstetrics for more than one year; and (3) those who voluntarily participated in research on this subject. In addition, the exclusion criteria were: (1) those who left their posts for various reasons such as vacations and advanced studies; and (2) the nurses with evident mental illness. All participants’ information was kept strictly confidential.

Sample size calculation

The calculation formula is N = z².p.(1-p)/d2. Among them, N is the required sample size, p is the probability of violence after a small-scale preliminary investigation, Researchers selected a 95% confidence interval for the z value, and the corresponding value is 1.96, d is the test level is 0.05 in this study. The study considered 10-20% as missing values. After pre-investigation, the incidence of WPV was 50%, and the sample size was at least 424.

Measurements

Questionnaire on essential characteristics of obstetric nurses

The study team adopted a self-designed questionnaire on the essential characteristics of obstetric nurses, which included gender, age, educational background, marital status, whether only child, whether local, and other demographic characteristics, as well as obstetric nursing working years, professional title, and position, employment form, and other job characteristics.

Questionnaire on workplace violence among obstetric nurses

The questionnaire consists of two parts: frequency of WPV (3 items) and event situation (13 items). If respondents have yet to experience WPV, they will skip the WPV incident situation section. The questionnaire refers to the “Hospital Site Violence Questionnaire” [23]. The researchers then consulted obstetric specialists (the professional title was associate chief of nursing or above). Opinions of the experts guided the revision of entries. The modified questionnaire was first pre-surveyed with a small sample (10) in a tertiary care hospital, and the questionnaire was calibrated again after the pre-survey. After the formal survey, the questionnaire was no longer modified.

Workplace violence prevention knowledge-attitude-practice scale (Cronbach’s alpha = 0.969)

The scale refers to the “Nurse Horizontal Violence Prevention Knowledge-Attitude-Practice Scale” [20]. The revised scale contains three dimensions and 15 items. Each item was constructed based on a 5-point Likert scale (1 = strongly disapprove, 5 = strongly agree), with a score ranging from 15 to 75. The higher the score, the higher the level of violence prevention knowledge-attitude-practice. Cronbach’s α of the scale was 0.969, and Cronbach’s α values of the three dimensions ranged from 0.953 to 0.985.

Workplace violence climate perception scale (Cronbach’s alpha = 0.984)

The scale refers to the “Workplace Violence Climate Perception Scale” [23] designed by Huang et al. The revised scale contains four dimensions and 24 items. On a 5-point Likert scale (1 = strongly disapprove, 5 = strongly agree), the score ranges from 24 to 120. The higher the score, the higher the Workplace Violence climate perception level. The Cronbach’s α of the scale was 0.984, and Cronbach’s α values of the four dimensions ranged from 0.846 to 0.995.

Statistical analysis

SPSS 26.0 was used to analyze the data. Descriptive statistical methods described the essential characteristics of obstetric nurses, workplace violence, violence prevention knowledge-attitude-practice, and climate perception. One-way ANOVA and Pearson correlation coefficients were used. Multiple linear regression was used as equations as control variables for significant variables identified in the one-way ANOVA. Significant variables identified in the Pearson correlation were used as independent variables to test the individual contribution of each potential independent variable to the dependent variable.

Results

Basic characteristics

Five hundred thirty-nine questionnaires were received, of which 522 were valid, with an effective rate of 96.85% (questionnaires with a completion time of fewer than 3 min or incomplete contents were invalid questionnaires). As shown in Table 1, most of the 522 obstetric nurses surveyed were in general public hospitals (62.8%) and tertiary hospitals (78.5%). Female participants accounted for 99.4%. 24.0% were unmarried, and approximately 74.3% were married. Most (76.2%) participants had a bachelor’s degree or above. Among the 522 obstetric nurses included, approximately 44.3% had junior titles, and 40.8% had intermediate titles. Most were in the 20–30 (32.2%) and 31–40 (51.2%) age groups. The working years were mainly concentrated in 6–10 years (28.7%) and 11–20 years (37.6%). Among the 522 obstetric nurses, 296 (56.7%) were midwives, 70.7% were general front-line nurses, and 310 (59.4%) were contract workers. Non-only child nurses accounted for a large proportion (90.4%), and nurses with prescription rights accounted for a small proportion (20.3%). There are significant differences of age, working years, professional title, and current marital status among obstetric nurses.

Table 1 Basic characteristics of obstetric nurses and univariate analysis of their relationship with workplace violence (N = 522)
Full size table

Workplace violence in obstetric nurses

Of the 522 obstetric nurses, approximately 55.0% (287) reported that they had experienced workplace violence in the past year. Verbal attacks were the most common type, accounting for 40.4%. More than half of all violent events (54.4%) occurred during the night shift. Of the 287 violent incidents, 58.2% occurred in the obstetrics ward, and 67.2% had other colleagues present at the time of the incident. The perpetrators of violence were mainly the family members of the patients (78.1%), and most of them were young men. Regarding to the violent incidents, half of the patients experienced obstetric violence during hospitalization (49.1%), and 48.2% of obstetric violence was directly related to the obstetric nurses who experienced WPV among the respondents. The top three characteristics of workplace violence perpetrators were low quality (65.5%), long waiting times (58.2%), and dissatisfaction with nurses’ work (53.7%). The coping styles of obstetric nurses were mainly tolerance and avoidance (77.0%), seeking help from colleagues or security guards (52.6%), and explaining patiently (52.3%). Violent incidents can lead to anger (54.0%), fear (56.1%), and reduced work quality (54.0%) among the obstetric nurses, shown in Table 2.

Table 2 Workplace violence (N = 287)
Full size table

The level of violence prevention knowledge-attitude-practice and climate perception among obstetric nurses

The mean total score of obstetric nurses’ WPV prevention knowledge-attitude-practice was 59.07 ± 15.17, and the mean score rate was 78.76% (Table 3). The average scoring rate of its subdimensions from high to low is 82.48% for the behavior dimension, 81.32% for the attitude dimension, and 72.44% for the knowledge dimension. According to the scoring rate, the overall level of obstetric nurses’ WPV prevention knowledge-attitude-practice is low (score rate < 80%), and the knowledge dimension is 72.44% with a lower score rate. The mean total score of WPV climate perception was 94.11 ± 24.69, and the average score rate was 78.43%. The average scoring rates of subdimensions from high to low are 80.26% in organizational support, 79.35% in the dimension of violence handling, 78.05% in organizational management, and 74.72% in the dimension of organizational training. According to the scoring rate, the overall level of obstetric nurses’ WPV climate perception was low (score rate < 80%), and the organizational training dimension is 74.72% with a low score rate.

Table 3 The level of violence prevention knowledge-attitude-practice and climate perception
Full size table

The correlation between workplace violence and the level of violence prevention knowledge-attitude-practice and climate perception among obstetric nurses

The workplace violence of obstetric nurses has a significant negative correlation with the WPV prevention knowledge dimension, attitude dimension, behavior dimension, and the total score of WPV prevention knowledge-attitude-practice (Table 4). At the same time, it also has a significantly negative correlation with organizational management, organizational training, organizational support, violence handling, and the total score of WPV climate perception.

Table 4 The correlation between workplace violence and violence prevention knowledge-attitude-practice and climate perception
Full size table

Multiple linear regression analysis of workplace violence

Regression analysis of the level of violence prevention knowledge-attitude-practice subdimensions on workplace violence

In the workplace violence model, the knowledge, attitude, and behavior dimensions of workplace violence impact workplace violence after considering them as independent variables, which explains the 43.7% change in WPV (adjusted R2 = 0.437, F = 58.860, P < .001) (Table 5). From the absolute value of the regression coefficient, the influence of the three dimensions from high to low is the knowledge dimension (0.278), the attitude dimension (0.241), and the behavior dimension (0.216).

Table 5 Regression analysis of the level of violence prevention knowledge-attitude-practice subdimensions on workplace violence
Full size table

Regression analysis of the level of violence climate perception sub-dimensions on workplace violence

The organizational management, organizational training, organizational support, and violence handling of workplace violence has an impact on workplace violence after considering them as independent variables, which can explain 38.1% of the changes in WPV (adjusted R2 = 0.381, F = 41.127, p < .001) (Table 6). From the absolute value of the regression coefficient, the influence of the four dimensions from high to low is organizational management (0.177), organizational training (0.175), violence handling (0.165), and organizational support (0.143).

Table 6 Regression analysis of the level of violence climate perception subdimensions on workplace violence
Full size table

Discussion

The incidence of workplace violence (WPV) among obstetric nurses in this study was found to be 55.0%, slightly lower than the rate reported in the study by Pich (58%) [24]. One possible reason for this difference is that the Pich study exclusively focused on midwives, whereas our study included both midwives and ward obstetric nurses. It is well-known that the delivery room is a fast-paced environment with frequent emergencies. Moreover, the patients in this setting experience significant mood swings and severe pain, which can contribute to increased pressure and higher risks for midwives. Consequently, the incidence of WPV may be higher for midwives compared to obstetric nurses working in the ward setting. However, the study by Zhu et al. [25] did not find a higher incidence of WPV among obstetric nurses, which could be attributed to variations in the number of obstetric nurses among the respondents and the timing of the study (conducted before the implementation of the new two-child policy). Verbal aggression (73.5%) was identified as the primary type of violence in this study, consistent with the findings of the Pich study (76.7%) [24]. The high incidence of verbal violence may be attributed to the perception of many perpetrators that verbal abuse and insults are merely minor disputes with nurses, not falling within the definition of violence.

Violence by perpetrators is mainly related to their low quality, long waiting time, and dissatisfaction with nursing work, which is consistent with a previous study [26]. While the time of occurrence in this study is mainly night shifts, contrary to the previous study, it may be related to the nature of obstetric work and China’s policies under the new situation. First, as a unique specialty, obstetrics has many emergency night shifts. Under the liberalization of the childbirth policy, the number of births has soared to some extent. Second, in terms of staffing, due to the impact of the COVID-19 epidemic, various clinical departments often dispatch human resources to support, resulting in a severe shortage of the working workforce. When nurses fail to attend to the needs of patients on time, it is easy to lead to conflicts between nurses and patients and leads to WPV. More than 3/4 of the nurses tolerated and avoided treatment after the incident. The results of this study are higher than those of the study of Hemati-Esmaeili et al. in Iran [27], which may be related to the specific background and policies of each country. The reason why nurses adopt a tolerant attitude is that the reporting process is too complicated, the reporting is invalid, or the matter is irrelevant, and some nurses even feel that they will be regarded as incompetent after reporting [27,28,29]. Therefore, managers should simplify the reporting process, encourage nurses to report, and even adopt an incentive mechanism to improve the reporting rate of WPV. A newer finding in this study is that nearly half of the patients with violent incidents experienced obstetric violence during hospitalization (49.13%), and 47.52% had a direct relationship with obstetric nurses who had experienced WPV among the respondents. Obstetric violence will not only cause psychological harm to mothers, such as heart dissatisfaction and postpartum depression, but also affect the expected delivery of mothers and babies, such as dystocia, hemorrhage, and neonatal hypoxia [30]. At the same time, satisfaction with obstetric nursing will decrease and stimulate contradiction between nurses and patients. When the tolerance level of the mother or her family exceeds the tolerance level, they often release their negative emotions on the nurses, such as loud reprimands and roars (particularly the nurses involved in obstetric violence), leading to the occurrence of WPV. Research shows that obstetric violence is associated with nurse burnout, bonuses, and a lack of educational opportunities [31]. Managers can take steps to reduce and prevent obstetric workplace violence.

Previous research findings support the notion that workplace violence is more likely to occur among unmarried young nurses with shorter working experience and lower professional titles [24, 32,33,34]. Varghese’s meta-analysis highlighted that young age and limited work experience are common risk factors for workplace violence [32]. Young nurses may face challenges in communication with patients, and effective communication plays a crucial role in reducing conflicts between nurses and patients [35]. It can also help predict potential signs of workplace violence, enhance vigilance, and enable the implementation of preventive measures [36]. Nurses with shorter professional working experience may have limited proficiency in their roles. The study discovered that patient dissatisfaction with nurses’ professional abilities is a major contributing factor to hospital violence. On the other hand, nurses with rich clinical experience and professional skills are more resilient to workplace violence [37, 38]. Obstetrics, as a unique specialty, demands a high level of professional competence from its nurses, particularly in emergency response. Nurses with strong professional abilities can promptly address changes in patients’ conditions and handle various emergencies effectively. Their ability to tackle complex issues can enhance patient and family satisfaction, ultimately reducing the incidence of workplace violence. Nurses with higher professional titles often possess advanced education and extensive work experience, enabling them to better handle high-risk patients who may be prone to workplace violence [39]. In comparison, unmarried nurses, when compared to their married counterparts, may exhibit relatively weaker sense of responsibility and lack humanistic nursing experience, making them more susceptible to workplace violence.

This study showed that the overall level of obstetric nurses’ workplace violence prevention knowledge-attitude-practice is low. Each subdimension negatively correlates with the incidence of WPV, of which the knowledge dimension has the most significant impact. Only by fully understanding what WPV is and how to prevent it can WPV be stifled in the cradle, or can quick and correct responses be made when WPV occurs to avoid or reduce the negative impact of WPV. First, on the management side, relevant training should be organized regularly. Studies have shown that planned training significantly impacts nurses’ attitudes toward workplace violence [40]. Managers can distribute WPV-related materials to nurses through electronic networks and brochures. At the same time, nurses should actively acquire WPV-related knowledge, regularly participate in training, be familiar with coping plans when violence occurs, participate in simulation training, and learn from violent incidents. A previous study found that a simulation training course intervention significantly improved nurses’ self-perception and confidence in workplace violence [41]. For violence prevention, we should maintain a positive attitude. When WPV occurs, we should not be overly pessimistic, let alone over-enhanced. Studies have shown [42] that passive coping is a risk factor for WPV. Nurses with a negative attitude toward WPV are more likely to experience WPV. Many countries have introduced zero-tolerance policies and believe a zero-tolerance attitude toward WPV should be adopted. However, the latest research has found that handling depends on different situations. A zero-tolerance attitude toward physical violence is a positive coping strategy. Appropriate strategies were adopted according to the nurses’ mental resilience [43]. The author believes that before or after violence occurs, one should maintain a good attitude and state of mind, continuously increase WPV-related knowledge and coping skills, improve one’s level of violence prevention knowledge-attitude-practice, and reduce the occurrence of WPV.

This study showed that the overall level of obstetric nurses’ workplace violence climate perception was relatively low. All subdimensions were negatively correlated with the incidence of WPV, of which organizational management had the most significant impact, followed by organizational training. A previous study found that a good perception of a violent climate was conducive to improving the job security of medical staff and promoting physical and mental health [44]. To effectively reduce the incidence of WPV, experienced managers and mature management programs are needed. First, managers need to know what causes WPV. Research by Wu et al. has demonstrated that patient dissatisfaction caused by high work demands is the main reason for WPV [45]. Therefore, managers’ interventions can be implemented strategically to protect nurses from WPV and its adverse effects in managing job demands and improving the environment. Regarding management strategies, managers can use the WPV risk assessment tool for patients or visitors with violent tendencies to assess suspicious persons to identify the risk of violence, such as the STAMPEDAR assessment tool developed by Chapman et al. [46]. Establishing a safe emergency drill program and a convenient reporting process may improve nurses’ WPV prevention and reporting abilities. Meanwhile, trainers should strengthen training programs because education and training are the best measures to improve nurses’ WPV prevention and response capabilities. Gillam’s research shows that non-violent crisis intervention can reduce the incidence of WPV by conducting intensive training every six months, and the training effect can be significantly enhanced [47]. Tian’s research also suggests that managers can incorporate violence prevention into the induction training and assessment of new nurses and adopt training methods such as scenario simulation to improve the perceptions of new nurses’ violent climate [44]. It has been shown that there is little or no violence-related education in university courses [48, 49]. Nursing students need more knowledge of WPV. Tee et al. [50] proposed that nursing students should do an excellent job of training before entering clinical practice to establish WPV risk awareness, correctly understand and face WPV, which can help them prevent the occurrence of WPV in future work.

Conclusions

Current study shows that workplace violence among Chinese obstetric nurses is relatively high in the new situation. However, violence prevention knowledge-attitude-practice and climate perception are relatively low. Workplace violence among obstetric nurses was influenced by age, years of obstetric work experience, professional title, and marital status. Nearly half of the maternal violence in hospitals is directly related to obstetric nurses who have experienced workplace violence in this study. Therefore, managers should pay attention, implement targeted interventions based on weak points, improve the perception level of obstetric nurses’ violent climate, enhance their confidence in preventing WPV, and reduce physical and mental harm. WPV-related knowledge, participating in various pieces of training, strengthening the professional skills, communication skills, and awareness of humanistic care to prevent obstetric violence will significantly improve obstetric nurses’ working atmosphere, reduce nurses’ turnover, and create an excellent occupational environment.

Limitations

There were some limitations in this study. First, this study used a cross-sectional design and further longitudinal studies were needed to explore its causal significance. Second, although the respondents in this study came from all provinces in the country, most were in Guangdong Province. Future studies should with multi centres design including obstetric nurses from other provinces were needed.

Implications of nursing management

This study investigated the current workplace violence among obstetric nurses in a new situation, the level of violence prevention knowledge-attitude-practice, and climate perception. It explored the correlation between violence prevention knowledge-attitude-practice and climate perception and the occurrence of WPV. The related factors fill the gap in the current literature on WPV in obstetric nurses. Our findings confirm that improving violence prevention knowledge-attitude-practice and climate perception effectively reduces workplace violence among obstetric nurses. Furthermore, WPV among obstetric nurses was strongly associated with the maternal experience of obstetric violence during hospitalization. Therefore, nursing managers can take targeted intervention measures to prevent and reduce the occurrence of WPV in obstetric nurses and promote their physical and mental health from a holistic perspective, aiming at the above-mentioned influencing factors and combining the characteristics of obstetrics.

Data availability

The datasets used or analyzed during the current study are available from the corresponding author upon reasonable request.

References

  1. Word Health Organization. Word report on violence and health[EB/OL].[2018-01-31].

  2. ILO ICN, WHO. et al. Framework guidelines for addressing workplace Violence in the health sector. Geneva: International Labour Office; 2002.

    Google Scholar 

  3. Injury Prevention Research. Ctr (IPRC), & United States of America. Workplace Violence: A Report to the Nation 2001.

  4. Cai J, Xi Y, Mao L, Yu W. Prevalence of workplace Violence encountered by clinical nurses in different level hospitals. J Nurs Sci. 2020;35(01):52–4. (in Chinese).

    Google Scholar 

  5. Cai J, Wang L, Yu L, et al. Comparative study of the incidence of workplace Violence among nurses in 2010 and 2018[J]. Chin Nurs Res. 2021;35(13):2280–4. (in Chinese).

    Google Scholar 

  6. Pich J, Kable A, Hazelton M. Antecedents and precipitants of patient-related Violence in the emergency department: results from the Australian VENT study (Violence in emergency nursing and triage) [J]. Australas Emerg Nurs J. 2017;20(3):107–13.

    Article  PubMed  Google Scholar 

  7. de Raeve P, Xyrichis A, Bolzonella F, Bergs J, Davidson PM. Workplace Violence against nurses: challenges and solutions for Europe. Policy Polit Nurs Pract. 2023;24(4):255–64. Epub 2023 Jul 20.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Sari H, Yildiz İ, Çağla B, Özel M, Tekalp R. The frequency of workplace Violence against healthcare workers and affecting factors. PLoS ONE. 2023;18(7):e0289363. https://doi.org/10.1371/journal.pone.0289363.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Li P, Jian X, Wang Y, Zhang M. The influence of workplace Violence on the quality of nursing work life in a class III hospital. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi. 2020;38(7):516–9. https://doi.org/10.3760/cma.j.cn121094-20190717-00297. [in Chinese].

    Article  CAS  PubMed  Google Scholar 

  10. Capper TS, Thorn M, Muurlink OT. Workplace Violence in the Australian and New Zealand midwifery workforce: a scoping review. J Nurs Manag. 2022;15. https://doi.org/10.1111/jonm.13766. Epub ahead of print.

  11. Yang Y, Wang P, Kelifa MO, Wang B, Liu M, Lu L, et al. How workplace Violence correlates turnover intention among Chinese health care workers in COVID-19: the mediating role of perceived social support and mental health. J Nurs Manag. 2022;30(6):1407–14. https://doi.org/10.1111/jonm.13325. Epub 2021 Apr 22.

    Article  PubMed  Google Scholar 

  12. Cakal H, Keshavarzi S, Ruhani A, Dakhil-Abbasi G. Workplace Violence and turnover intentions among nurses: the moderating roles of invulnerability and organizational support - A cross-sectional study. J Clin Nurs. 2021;12. https://doi.org/10.1111/jocn.15997. Epub ahead of print.

  13. Duan X, Ni X, Shi L, Zhang L, Ye Y, Mu H, et al. The impact of workplace Violence on job satisfaction, burnout, and turnover intention: the mediating role of social support. Health Qual Life Outcomes. 2019;30(1):93. https://doi.org/10.1186/s12955-019-1164-3.

    Article  Google Scholar 

  14. Kline R, Lewis D. The price of fear: estimating the financial cost of bullying and Harassment to the NHS in England. Public Money & Management. 2019;39(3):166–74. https://doi.org/10.1080/09540962.2018.1535044.

    Article  Google Scholar 

  15. Capper T, Muurlink O, Williamson M. Being bullied as a midwifery student: does age matter? Br J Midwifery. 2020;28(3):166–71. https://doi.org/10.12968/bjom.2020.28.3.166.

    Article  Google Scholar 

  16. Ockenden D. (Findings, Conclusions, and Essential Actions from the Independent Review of Maternity Services at the Shrewsbury and Telford Hospital NHS Trust. Retrieved from: 2022; https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1064302/Final-Ockenden-Report-webaccessible.pdf.

  17. Song Y, Feng G. Effect of prenatal care intervention on delivery outcomes of primiparas with a high-risk pregnancy. J Nurses Train. 2017;32(03):248–51. https://doi.org/10.16821/j.cnki.hsjx.2017.03.019.

    Article  Google Scholar 

  18. Khan Y, Bruyneel A, Smith P. Determinants of the risk of burnout among nurses during the first wave of the COVID-19 pandemic in Belgium: a cross-sectional study. J Nurs Manag. 2022;30(5):1125–35. https://doi.org/10.1111/jonm.13624. Epub 2022 Apr 28.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Jia L. Relationship between hospital workplace Violence and job satisfaction, burnout and organizational commitment in nurses. Shanxi Med Univ. 2014. (in Chinese).

  20. Zhang X. Investigation and analysis of nurse lateral Violence prevention knowledge-attitude-practice status. Yangtze Univ. 2020. https://doi.org/10.26981/d.cnki.gjhsc.2020.000616.

    Article  Google Scholar 

  21. Azar M, Badr LK, Samaha H, et al. Does administrative support negate the consequences of nurse abuse?[J]. J Nurs Adm Manag. 2016;24(1):E32–E43. https://doi.org/10.1111/jonm.12286. Epub 2015 Feb 27.

    Article  Google Scholar 

  22. Barling J, Dupré KE, Kelloway EK. Predicting workplace aggression and Violence [J]. Ann Rev Psychol. 2009;60:671–92. https://doi.org/10.1146/annurev.psych.60.110707.163629.

    Article  Google Scholar 

  23. Guglielmetti C, Gilardi S, Licata M, et al. The healthcare operators’ experience with aggressive patients and their visitors: a cross-sectional study in four clinical departments [J]. La Medicina Del Lavoro. 2016;107(3):223–34.

    PubMed  Google Scholar 

  24. Pich J, Roche M. Violence on the job: the experiences of nurses and midwives with Violence from patients and their friends and relatives. Healthc (Basel). 2020;30(4):522. https://doi.org/10.3390/healthcare8040522.

    Article  Google Scholar 

  25. Zhu Z, Shi X, Lin J, et al. Investigation of the status of workplace Violence of nurses in Hu Nan Province[J]. J Nurs Adm. 2017;17(11):801–3. (in Chinese).

    Google Scholar 

  26. Chen Y, Xu M, Zhang S. A Survey on the current status of the Workplace Violence against Nurses in General Hospitals[J]. Nurs J Chin PLA. 2018;35(10):15–9. (in Chinese).

    Google Scholar 

  27. Hemati-Esmaeili M, Heshmati-Nabavi F, Pouresmail Z, Mazlom S, Reihani H. Educational and Managerial Policy making to Reduce Workplace Violence against Nurses: an Action Research Study. Iran J Nurs Midwifery re. 2018;23(6):478–85. https://doi.org/10.4103/ijnmr.IJNMR_77_17.

    Article  Google Scholar 

  28. Babiarczyk B, Turbiarz A, Tomagová M, Zeleníková R, Önler E, Sancho-Cantus D. Reporting of workplace Violence towards nurses in 5 European countries - a cross-sectional study. Int J Occup Med Environ Health. 2020;30(3):325–38. https://doi.org/10.13075/ijomeh.1896.01475. Epub 2020 Mar 26.

    Article  Google Scholar 

  29. Sato K, Wakabayashi T, Kiyoshi-Teo H, Fukahori H. (factors associated with nurse’s reporting of patients aggressive behavior: a cross-sectional survey. Int J Nurs Stud. 2013;50(10):1368–76. Epub 2013 Jan 7.

    Article  PubMed  Google Scholar 

  30. Souza KJ, Rattner D, Gubert MB. (Institutional Violence and quality of service in obstetrics are associated with postpartum depression. Rev Saude Publica. 2017;51:69. https://doi.org/10.1590/S1518-8787.2017051006549.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Molla W, Wudneh A, Tilahun R. Obstetric Violence and associated factors among women during facility-based Childbirth at Gedeo Zone, South Ethiopia. BMC Pregnancy Childbirth. 2022;14(1):565. https://doi.org/10.1186/s12884-022-04895-6.

    Article  Google Scholar 

  32. Varghese A, Joseph J, Vijay VR, Khakha DC, Dhandapani M, Gigini G, et al. Prevalence and determinants of workplace Violence among nurses in the South-East Asian and Western Pacific regions: a systematic review and meta-analysis. J Clin Nurs. 2022;31(7–8):798–819. https://doi.org/10.1111/jocn.15987. Epub 2021 Aug 5.

    Article  PubMed  Google Scholar 

  33. Cheung T, Yip PS. Workplace Violence towards nurses in Hong Kong: prevalence and correlates. BMC Public Health. 2017;17:196. https://doi.org/10.1186/s12889-017-4112-3.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Nithimathachoke A, Wichiennopparat W. High Incidence of Workplace Violence in Metropolitan Emergency Departments of Thailand; a cross-sectional study. Arch Acad Emerg Med. 2021;9:e30. https://doi.org/10.22037/aaem.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Ridenour ML, Hendricks S, Hartley D, Blando JD. Workplace Violence and training required by New Legislation among NJ nurses. J Occup Environ Med. 2017;59(4):e35–e40. https://doi.org/10.1097/JOM.0000000000000973.

    Article  PubMed  Google Scholar 

  36. He J, Ye Z. Advances in research on workplace Violence coping resources for nurses[J]. Nurs Rehabilitation. 2022;21(05):81–3. (in Chinese).

    Google Scholar 

  37. Pan J, Yan F, LiuY, et al. Survey of occurrence and report status quo of pediatric nurses suffering workplace Violence in hospital[J]. Chin Nurs Res. 2018;32(01):84–9. (in Chinese).

    Google Scholar 

  38. Zhu W, Chen Y, Chen M. The current status and influencing factors of workplace Violence among outpatient nurses[J]. Chin Nurs Manage. 2014;14(12):1308–11. (in Chinese).

    Google Scholar 

  39. Zhu H, Liu X, Yao L, Zhou L, Qin J, Zhu C, et al. Workplace Violence in primary hospitals and associated risk factors: a cross-sectional study. Nurs Open. 2022;9(1):513–8. https://doi.org/10.1002/nop2.1090. Epub 2021 Oct 16.

    Article  PubMed  Google Scholar 

  40. Al-Ali NM, Al-Faouri I, Al-Niarat TF. The impact of a training program on nurses’ attitudes toward workplace Violence in Jordan. Appl Nurs Res. 2015;30:83–9. Epub 2015 Nov 14.

    Article  PubMed  Google Scholar 

  41. Ming JL, Huang HM, Hung SP, Chang CI, Hsu YS, Tzeng YM, et al. Using Simulation Training to Promote nurses’ effective handling of Workplace Violence: a quasi-experimental study. Int J Environ Res Public Health. 2019;28(19):3648. https://doi.org/10.3390/ijerph16193648.

    Article  Google Scholar 

  42. Li S, Yan H, Qiao S, Chang X. Prevalence, influencing factors and adverse consequences of workplace Violence against nurses in China: a cross-sectional study. J Nurs Manag. 2022;30(6):1801–10. https://doi.org/10.1111/jonm.13717. Epub 2022 Jul 3.

    Article  PubMed  Google Scholar 

  43. Fan S, An W, Zeng L, Liu J, Tang S, Chen J, et al. Rethinking zero tolerance: a moderated mediation model of mental resilience and coping strategies in workplace Violence and nurses’ mental health. J Nurs Scholarsh. 2022;54(4):501–12. https://doi.org/10.1111/jnu.12753. Epub 2021 Dec 5.

    Article  PubMed  Google Scholar 

  44. Tian X. Workplace Violence and perception of violent atmosphere among emergency department nurses survey[J]. Chin Gen Pract Nurs. 2022;20(05):706–9. (in Chinese).

    Google Scholar 

  45. Wu JC, Tung TH, Chen PY, Chen YL, Lin YW, Chen FL. Determinants of workplace Violence against clinical physicians in hospitals. J Occup Health. 2015;57:540–7. https://doi.org/10.1539/joh.15-0111-OA. Epub 2015 Sep 29.

    Article  PubMed  PubMed Central  Google Scholar 

  46. D’Ettorre G, Pellicani V, Mazzotta M, Vullo A. Preventing and managing workplace Violence against healthcare workers in Emergency Departments. Acta Biomed. 2018;89(4–S):28–36. https://doi.org/10.23750/abm.v89i4-S.7113.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Gillam SW. Non-violent crisis intervention training and the incidence of violent events in a large hospital emergency department: an observational quality improvement study. Adv Emerg Nurs J. 2014;36(2):177–88. https://doi.org/10.1097/TME.0000000000000019.

    Article  PubMed  Google Scholar 

  48. Ye Q, Li Y, Li J, et al. Survey of influence of incidents of Violence between nurses and patients on nursing students in school[J]. Chin Nurs Res. 2016;30(4):1224–7. (in Chinese).

    Google Scholar 

  49. Hopkins M, Fetherston CM, Morrison P. Prevalence and characteristics of aggression and Violence experienced by western Australian nursing students during clinical practice. Contemp Nurse. 2014;49(1):113–21. https://doi.org/10.5172/conu.2014.49.113.

    Article  PubMed  Google Scholar 

  50. Tee S, Özçetin YSÜ, Russell-Westhead M. Workplace Violence experienced by nursing students: a UK survey. Nurse Educ Today. 2016;4130–5. https://doi.org/10.1016/j.nedt.2016.03.014. Epub 2016 Mar 29.

Download references

Acknowledgements

Special thanks go to all the participants in this study, especially the nursing colleagues who helped distribute the questionnaires and sincerely thank every participant for their participation and attentive answers.

Funding

Dongguan Science and Technology Bureau, Guangdong Province, China (No. 20221800906102); 2022 Southern Medical University Teaching Quality and Teaching Reform Engineering Project (No. ZL2022007); Guangdong Provincial Education Science Planning Leading Group, 2021 Education Science Planning Project (Higher Education Project) (No. 2021GXJK163); Innovation program of graduate education in Guangdong Province (No. 2023ANLK_018).

Author information

Author notes

  1. Shan Huang and Xiaoqin Lu are the co-first author

Authors and Affiliations

  1. School of Nursing, Southern Medical University, Guangzhou, 510515, China

    Shan Huang, Jinguo Zhai & Hamza Saidi Lilenga

  2. Nursing Department, Guangzhou University of Traditional Chinese Medicine Dongguan Hospital, No. 3, Dongcheng section, Songshan Lake Avenue, Dongguan City, Guangdong Province, 523000, China

    Xiaoqin Lu & Yulian Liang

  3. Department of Obstetrics and Gynecology, Songshan Lake Central Hospital, No. 1, Xianglong Road, Dongguan City, Guangdong Province, 523000, China

    Qiumei Li

  4. School of Nursing, Southern Medical University, No.1023, South Shatai Road, Baiyun District, Guangzhou, Guangdong Province, 510515, China

    Jinguo Zhai

Authors
  1. Shan Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jinguo Zhai
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Xiaoqin Lu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yulian Liang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Qiumei Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hamza Saidi Lilenga
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Shan Huang is resposible for the study concepts & design, definition of intellectual content, clinical studies, manuscript preparation & editing; Jinguo Zhai is resposible for the study concepts, manuscript editing & review; Xiaoqin Lu is resposible for the study concepts & design, definition of intellectual content; Yulian Liang is resposible for the statistical analysis, manuscript review; Qiumei Li is resposible for the data acquisition & analysis; Hamza Saidi Lilenga is resposible for the literature research, data acquisition & analysis. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Jinguo Zhai.

Ethics declarations

Ethics approval and consent to participate

The Zhongshan People’s Hospital Ethics Committee issued ethical clearance to conduct this study (ethics number: 2022-32). Written informed consent was obtained from all individuals included in this study. All experiments were performed in accordance with relevant guidelines and regulations.

Consent for publication

Not applicable.

Competing interests

The authors declare no potential conflicts of interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary Material 1

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Huang, S., Zhai, J., Lu, X. et al. Prevalence of workplace violence in Chinese obstetric nurses under the new situation and its correlation with violence prevention knowledge-attitude-practice and climate perception: a cross-sectional study. BMC Nurs 22, 473 (2023). https://doi.org/10.1186/s12912-023-01637-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s12912-023-01637-7

Keywords

BMC Nursing

ISSN: 1472-6955

Contact us