Review
Nurse exposure to physical and nonphysical violence, bullying, and sexual harassment: A quantitative review

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Abstract

Objectives

This paper provides a quantitative review that estimates exposure rates by type of violence, setting, source, and world region.

Design

A quantitative review of the nursing violence literature was summarized.

Data sources

A literature search was conducted using the CINAHL, Medline and PsycInfo data bases. Studies included had to report empirical results using a nursing sample, and include data on bullying, sexual harassment, and/or violence exposure rates. A total of 136 articles provided data on 151,347 nurses from 160 samples.

Procedure

Articles were identified through a database search and by consulting reference lists of review articles that were located. Relevant data were coded by the three authors. Categories depended on the availability of at least five studies. Exposure rates were coded as percentages of nurses in the sample who reported a given type of violence. Five types of violence were physical, nonphysical, bullying, sexual harassment, and combined (type of violence was not indicated). Setting, timeframe, country, and source of violence were coded.

Results

Overall violence exposure rates were 36.4% for physical violence, 66.9% for nonphysical violence, 39.7% for bullying, and 25% for sexual harassment, with 32.7% of nurses reporting having been physically injured in an assault. Rates of exposure varied by world region (Anglo, Asia, Europe and Middle East), with the highest rates for physical violence and sexual harassment in the Anglo region, and the highest rates of nonphysical violence and bullying in the Middle East. Regions also varied in the source of violence, with patients accounting for most of it in Anglo and European regions, whereas patents’ families/friends were the most common source in the Middle East.

Conclusions

About a third of nurses worldwide indicated exposure to physical violence and bullying, about a third reported injury, about a quarter experienced sexual harassment, and about two-thirds indicated nonphysical violence. Physical violence was most prevalent in emergency departments, geriatric, and psychiatric facilities. Physical violence and sexual harassment were most prevalent in Anglo countries, and nonphysical violence and bullying were most prevalent in the Middle East. Patients accounted for most physical violence in the Anglo region and Europe, and patient family and friends accounted for the most in the Middle East.

Section snippets

Background

It has been well documented that nurses and other direct care health professionals are at significant risk for violence exposure (e.g., Happell, 2008, Nachreiner et al., 2005). A national Canadian study, for example, found that the rate of violence-related worker compensation claims was second highest of all occupations for nurses’ aides, and sixth highest for nurses (Boyd, 1995). Many qualitative reviews can be found in the nursing literature (the literature search for this project located 17)

Methodology

The methodology of this quantitative review followed accepted practices for conducting meta-analysis (e.g., Hunter and Schmidt, 1990, Rosenthal, 1991, Stroup et al., 2000). This included the following steps: (1) define the domain of interest, (2) conduct a search of relevant databases to identify potential articles for the analysis, (3) set inclusion criteria by which to screen potential articles, (4) retrieve statistics from the articles, and (5) conduct analyses.

Results

Analyses began by computing the mean percentage of nurses exposed for all studies broken down by type of violence. As shown in Table 1, 36.4% of nurses reported being physically assaulted, with 67.2% reporting nonphysical assault, 37.1% reporting being bullied, 27.9% reporting sexual harassment, and 50.5% reporting general violence not broken down by type (i.e., nurses were merely asked if they were subject to some type of violence at work). Almost a third of nurses indicated they had been

Discussion

Nurses’ exposure to different types of violence has been a topic of considerable research attention. The literature review for this paper located 136 published articles in the literature that provided incidence rates, and more than 100 additional papers on the topic that did not meet inclusion criteria. What analysis of these studies provides are estimates of the prevalence of different types of violence worldwide, as well as breakdowns by study timeframe, setting, source, and world region.

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