Occupational Medicine Advance Access originally published online on August 3, 2006
Occupational Medicine 2006 56(7):501-503; doi:10.1093/occmed/kql073
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SHORT REPORT |
Violence exposure and burn-out among Turkish nursing home staff
1 Department of Public Health, Faculty of Medicine, Ege University, Izmir, Turkey
2 Department of Nursing Psychiatry, Nursing School, Ege University, Izmir, Turkey
Correspondence to: Aliye Mandiracioglu, Ege universitesi tip fakultesi halk sagligi, Bornova, Izmir, Turkey. e-mail: aliye.mandiracioglu{at}ege.edu.tr
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Abstract |
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Aim The aim of this study was to describe the frequency of violence against personnel from residents and to identify the prevalence of burn-out among staff working in nursing homes.
Methods The study was performed in two cities in the west of Turkey. A semi-structured questionnaire on violence and Pines' Burnout scale were distributed among all the staff working in six nursing homes, and 214 of them responded.
Results Of the total number of respondents, 56% stated that they had been exposed to violence during the preceding year. More than 20% stated that they had reported violence to their supervisor. Less than 10% had received medical or psychological support following the event. Violent incidents were reported significantly more frequently among staff who reported problems working with elderly residents. There was no relationship between violence towards staff and burn-out.
Conclusions Violence is commonly experienced by care workers in nursing homes for the elderly. Strategies to improve occupational conditions in nursing homes are required.
Keywords Burn-out; caregivers; elderly people; violence
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Introduction |
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Violence is a common problem especially in caring occupations. Certain environmental factors appear to affect the risk of violence and these factors are important variables for burn-out [1,2,3]. Arnetz et al. [2] noted that longer length of stay (e.g. nursing care) was a risk for violence behaviour. Arnetz and Arnetz [4] found that there was an association between burn-out and violence towards staff. It has also been reported that violence or threats experienced by health care staff, as well as burn-out, have a negative effect on the quality of health care services offered [4,5].
Staff working in nursing homes experience frequent harassment, assaults, and violence by nursing home residents. However, in Turkey at present, there are no accurate statistics available on violence towards staff except in the hospital care setting, although there have been some Turkish studies on this topic.
Our aims were to investigate the frequency of violence against staff working in nursing homes, and to identify burn-out among these personnel.
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Methods |
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All the nursing homes in Izmir and Manisa in the west of Turkey (three private and three public) were included. Written consent was obtained from the administrators of the nursing homes. Care workers were asked to complete a questionnaire which included basic demographics and respondents were asked to recall experiences of violence directed at them during the course of work over the previous year—type of violence, emotional reactions, consequences and management of the violent incident, and the characteristics of the perpetrators. Responses to the question on violence were dichotomized (yes/no).
The 21-item Pines–Aronson Burnout Questionnaire was used for measurement of experienced burn-out [6]. The factor structure of the scale was examined using principal component analysis with Varimax rotation. The analysis produced three factors with an eigenvalue >1. Cumulatively, 51% of the variance was accounted for by three factors. Cronbach's alpha for the 21-items burn-out measure was 0.75.
SPSS for Windows software (version 11.5) was used for statistical analyses. Chi-square tests were employed to assess sociodemographical and occupational differences in the rates of prevalence between those who were and were not exposed to violence. One-way variance analysis, Kruskal–Wallis H, and Mann Whitney U-test were used for analysing statistical differences between some personnel characteristics and burn-out scores.
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Results |
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After having delivered the questionnaires, 214 forms were collected 1 week later. The response rate was 86%. Reported frequency of violence to caregivers by the elderly was 56%; 75% of the respondents had been verbally abused, 24% had been exposed to physical threats and actions, and 7% had been sexually abused. Selected staff characteristics can be seen in Table 1. Neither the age nor the gender of the caregivers was associated with experience of violence and there was no significant relationship between exposure to violence and job title, working years, working pattern, professional education, and status.
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The reasons of the elderly violent behaviour were observed to be alcohol abuse in 1% of cases, dementia in 11%, psychiatric diseases in 25%, physical disability in 4%, and no problem in the remained. Approximately one-third of the elderly were formally consulted and warned about their violent behaviour.
Only 6% of the participants consulted a doctor due to consequences of the violent incident, and only 1% changed their department. The most frequently reported consequences of a violent incident were sadness (35%), disappointment (32%), fear (9%), anger (3%), powerlessness (2%), and loneliness (1%).
When the staff's perception of the problems related to the work environment and social climate was questioned, most of them complained about characteristics of the elderly (39%), the increase in the expectations of the elderly clients and the decrease in their appreciation (30%), and lack of communication with them, the elderly (24%). Reported problems with working conditions were lack of equipment and personnel (28%), low salaries (14%), workload (13%), and administrative mechanisms and bureaucracy (13%).
The mean burn-out score was 2.43 ± 0.83 (range 1.0–5.24). Women had significantly higher scores than men (P < 0.001). No significant differences were observed in the burn-out scores across age, job, or income. Results of the study revealed no associations between reported violence and burn-out. Burn-out levels were found to be highest in those with complaints related to the elderly and organizational problems in the nursing homes.
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Discussion |
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The main finding of this study was that no relationship between violence and burn-out scores was observed. The staff might have thought that assaults were to be tolerated and accepted. There is no legislation concerning on-the-job violence in Turkey. Gates et al. [7] reported that many nursing home administrators, supervisors, and caregivers believed that violence from residents was a normal and expected part of the job.
The second important finding in our study was that staff who had complaints about the elderly and work conditions had more exposure to violent behaviour and higher burn-out scores. Some authors have stated that violence occurring in nursing homes has complex causation and includes characteristics of the caregiver, environment, and resident [3,7,8]. In a Turkish study, it was found that low wages, inadequacy of equipment and materials, excessive working hours, and excessive number of patients had a negative effect on working conditions and physical/psychological health of the nurses [9].
Our response rate was 86% and this was high enough to assume that the sample was unbiased. The current study has some weaknesses. As it is a cross-sectional study, it is not possible to draw causal links. Results may not be generalized for the rest of Turkey. Another limitation of this study is collecting data by retrospective self-report in a questionnaire. This inevitably relies on participants' memory of events, which might sometimes be inaccurate and unreliable. In addition, we could not evaluate all the violence-related health outcomes due to retrospective data.
Violence is sometimes a taboo subject for care workers. A supportive workplace is an important issue in nursing homes, and support from managers and co-workers can prevent violence and burn-out [4,5,7].
In summary, this study showed that violence is common is nursing homes in Turkey but more commonly experienced by care workers who were less satisfied about their work. Improving the working environment and the relationship between care workers and the elderly, as well as improving support in the workplace, may reduce the level of violence experienced.
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Conflicts of interest |
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None declared.
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Acknowledgements |
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The authors would like to thank the staff in the nursing homes for participating in this study. Special thanks also to Sture Astrom for his initial advice.
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References |
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