sample thesis on workplace violence

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Muller, Doyle Sylvia M. "Workplace violence." Instructions for remote access. Click here to access this electronic resource. Access available to Kutztown University faculty, staff, and students only, 1999. http://www.kutztown.edu/library/services/remote_access.asp.

Frondigoun, Elizabeth Richmond. "Workplace violence : schools and hospitals." Thesis, University of Strathclyde, 2007. http://oleg.lib.strath.ac.uk:80/R/?func=dbin-jump-full&object_id=22177.

Huang, Jiajia, and L. Lee Glenn. "Measurement of Workplace Violence Reporting." Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/etsu-works/7458.

LeBlanc, Manon Mireille. "Predictors and outcomes of workplace violence." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2001. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp04/MQ56339.pdf.

DeClerck, Terri Lynne. "Violence Against Nurses." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/4134.

Savoie, Valerie. "Workplace violence : interpersonal tendencies, victimisation and disclosure." Thesis, University of Huddersfield, 2014. http://eprints.hud.ac.uk/id/eprint/20348/.

Diston, Richard Edward. "Workplace violence as a strategic organisational risk." Thesis, University of Portsmouth, 2018. https://researchportal.port.ac.uk/portal/en/theses/workplace-violence-as-a-strategic-organisational-risk(0b281dc5-59d0-451b-8310-267cdd06b822).html.

Ta, Myduc Linhchi Marshall Stephen William. "Contextual exploration of neighborhoods and workplace violence." Chapel Hill, N.C. : University of North Carolina at Chapel Hill, 2008. http://dc.lib.unc.edu/u?/etd,1958.

Boyce, Valerie Marie. "Workplace violence prevention model : an assessment of Travis County Department of Transportation and Natural Resources' workplace violence prevention program /." View online version, 2009. http://ecommons.txstate.edu/arp/299.

van, Wiltenburg Shannon Leigh. "Workplace violence against registered nurses: an interpretive description." Thesis, University of British Columbia, 2007. http://hdl.handle.net/2429/389.

劉芷欣 and Tsz-yan Lau. "Managing workplace violence: using a task force approach." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2008. http://hub.hku.hk/bib/B40720962.

Lau, Tsz-yan. "Managing workplace violence using a task force approach /." Click to view the E-thesis via HKUTO, 2008. http://sunzi.lib.hku.hk/hkuto/record/B40720962.

Coetzee, Annika. "Workplace violence toward educators in private and public secondary schools in Pretoria Gauteng : a comparative investigation." Diss., University of Pretoria, 2017. http://hdl.handle.net/2263/60351.

Smith, Carolyn R. "Exploring Adolescent Employees' Perceptions of Safety from Workplace Violence." University of Cincinnati / OhioLINK, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1353949993.

Watson, Jenkins Eleanor Lynn. "Active inaction--symbolic politics, agenda denial or incubation period twenty years of U.S. workplace violence research and prevention activity /." Morgantown, W. Va. : [West Virginia University Libraries], 2006. https://eidr.wvu.edu/etd/documentdata.eTD?documentid=4694.

Salter, Daniel C. "An investigation into healthcare staff exposed to workplace violence." Thesis, University of Sheffield, 2003. http://etheses.whiterose.ac.uk/3542/.

Hewett, Deirdre. "Workplace violence targeting student nurses in the clinical areas." Thesis, Stellenbosch : University of Stellenbosch, 2010. http://hdl.handle.net/10019.1/5183.

Adriansen, David J. "Workplace Violence Prevention Training: An Analysis of Employees' Attitudes." Thesis, University of North Texas, 2005. https://digital.library.unt.edu/ark:/67531/metadc4798/.

Ciping, Zhang, and Huang Enhui. "Nurses’ experience of workplace violence : A descriptive literature review." Thesis, Högskolan i Gävle, Avdelningen för vårdvetenskap, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:hig:diva-30328.

Norris, Tamala. "Workplace Violence Among Nurses and Nursing Assistants in Texas." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5510.

Beckett, Sharon Elizabeth. "Women and the violent workplace." Thesis, University of Plymouth, 2015. http://hdl.handle.net/10026.1/3475.

Schlebusch-Marie, Linda. "Workplace violence among professional nurses in a private healthcare facility." Thesis, Nelson Mandela Metropolitan University, 2016. http://hdl.handle.net/10948/12801.

金達人 and Tat-yan Deyoung Kam. "Workplace violence prevention programme targeting nursing staff in hospital setting." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2008. http://hub.hku.hk/bib/B40720792.

To, Mei-kuen Erica, and 杜美娟. "Workplace violence in Accident & Emergency Department of Hong Kong." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2004. http://hub.hku.hk/bib/B42577469.

Kam, Tat-yan Deyoung. "Workplace violence prevention programme targeting nursing staff in hospital setting." Click to view the E-thesis via HKUTO, 2008. http://sunzi.lib.hku.hk/hkuto/record/B40720792.

To, Mei-kuen Erica. "Workplace violence in Accident & Emergency Department of Hong Kong." Click to view the E-thesis via HKUTO, 2004. http://sunzi.lib.hku.hk/hkuto/record/B42577469.

Elliott, Joan Lincoln. "The age of rage : smoking guns that trigger workplace violence /." View abstract, 2001. http://library.ccsu.edu/ccsu%5Ftheses/showit.php3?id=1645.

Fleming, Anthony. "Strategies for Implementing Workplace Violence Prevention Policies in Small Businesses." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7848.

Bakker, Susette. "Covert violence in nursing: A Western Australian experience." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2012. https://ro.ecu.edu.au/theses/455.

Brown, April Hough. "Workplace Violence Prevention Program to Improve Nurses' Perception of Safety in the Emergency Department." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/1816.

Carlson, Greg P. "Hostile workplace violence directed toward rural emergency medical services (EMS) personnel /." Menomonie, WI : University of Wisconsin--Stout, 2007. http://www.uwstout.edu/lib/thesis/2007/2007carlsong.pdf.

Adedokun, Mosunmola. "Workplace Violence in the Healthcare Sector. A review of the Literature." Thesis, Malmö universitet, Fakulteten för hälsa och samhälle (HS), 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-26486.

He, Jiayi, and Yue Zhu. "Experience of Workplace Violence among Psychiatric Nurses : A descriptive literature review." Thesis, Högskolan i Gävle, Avdelningen för vårdvetenskap, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:hig:diva-36806.

Ellicott, Susan Gay. "Development of the Australian Government’s Workplace Domestic Violence Policy 2008–2018." Thesis, The University of Sydney, 2021. https://hdl.handle.net/2123/27212.

Jussab, Fardin. "Counselling and clinical psychologists' experience of client violence in the workplace." Thesis, University of East London, 2013. http://roar.uel.ac.uk/3043/.

Arroyo, Michelle Leigh. "Impact of a Healthcare Workplace Violence Prevention Module on Staff Knowledge." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7587.

Trott, Sandra. "Influence of Personal Experience on Workplace Bullying Behavior." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/3962.

Hutton, Scott. "A Longitudinal Study of Workplace Incivility in a Hospital." University of Cincinnati / OhioLINK, 2008. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1211989910.

Small, Tamara. "Workplace Violence Prevention Training: A Cross-sectional Study of Home Healthcare Workers." University of Cincinnati / OhioLINK, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1595850151324948.

Winsor-Dahlstrom, Josephine. "Aboriginal health workers: Role, recognition, racism and horizontal violence in the workplace." Thesis, Indigenous Heath Studies, 2000. http://hdl.handle.net/2123/5708.

Brown, Oliver Sabrina Renea. "Clinical Resource Practice Scenarios to Mitigate Bullying." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7859.

Varhama, Lasse. "Bullying and other dysfunctional behaviour at the workplace and at school /." Åbo : Åbo akademi university press, 2008. http://catalogue.bnf.fr/ark:/12148/cb414308871.

Potgieter, Lauren. "Bad office politics: victimisation and intimidation in the workplace." University of the Western Cape, 2013. http://hdl.handle.net/11394/4830.

Kennedy, Maureen Angeline. "Workplace violence: an exploratory study into nurses interpretations and responses to violence and abuse in trauma and emergency departments." Thesis, University of the Western Cape, 2004. http://etd.uwc.ac.za/index.php?module=etd&amp.

Miljak, Kristina. "Experiences of workplace violence among health care workers : A qualitative study of violence from the perspective of care professionals." Thesis, Malmö universitet, Malmö högskola, Institutionen för kriminologi (KR), 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-43562.

Kgosimore, David Leepile. "Educators as victims of workplace violence in selected secondary schools in the Capricorn District of the Limpopo Province, South Africa." Thesis, University of Limpopo, 2018. http://hdl.handle.net/10386/2330.

Schat, Aaron C. H. "The effects of perceived control on the outcomes of workplace aggression and violence." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape10/PQDD_0006/MQ43216.pdf.

羅淑兒 and Suk-yee Lo. "Vulnerability and resilience to workplace violence among health care workers in public hospitals." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2008. http://hub.hku.hk/bib/B41547822.

Swanson, Kim. "The Emergency Nurse as Crime Victim| Workplace Violence Contributors, Consequences, and Reporting Behavior." Thesis, Northcentral University, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=3579834.

Workplace violence committed against emergency nurses persistently continues with many factors contributing to this global phenomenon. As a result, victims experience a myriad of personal, professional, and organizational consequences. Unfortunately, underreporting remains a troubling problem that produces an obscured picture of the actual characteristics influencing this phenomenon. Interviews, a reflexive journal, and documents were used by the author of this qualitative collective case study to achieve the purpose of this study: to understand the lived experiences and reporting behavior of emergency department nurses as crime victims The author purposively sampled 10 emergency nurses who reported workplace violence while working at a Lee Memorial Health System hospital in Lee County, Florida. Thematic cross-case analysis demonstrated that emergency nurses work in a chaotic environment and violence is underreported due to the time it takes to report and confusion with violence definitions. Findings showed that law enforcement attitudes toward reporting negatively influenced nurses but that contact outside of work had no influence. Nurses were unaware of or rejected a crime victim identity and reported receiving support from supervisors but not hospital administration. Hospital security officers and crime preventive measures were seen as ineffective. Seasonal effects, unrestrained Baker patients, along with unmet patient expectations were contributing factors to workplace violence. Future reporting was influenced by unsatisfactory outcomes and law enforcement presence.

Recommendations for practice brings together law enforcement, hospital administration and nurses to evaluate existing policies, incorporate legal topics into existing training, implement a risk assessment instrument in triage, and conduct crime prevention surveys.

Future research should include other hospitals to see if similar results are found, also investigate peer-to-peer violence, compare hospitals that have full-time law enforcement officers in the emergency department with those who do not to see if it affects the number and severity of violent incidents, and evaluate the effectiveness of using a violence risk assessment instrument in triage.

Heming, Meike. "Workplace violence and its association with sleep disturbances in the Swedish working population." Thesis, Stockholms universitet, Institutionen för folkhälsovetenskap, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:su:diva-182514.

• Research article
• Open access
• Published: 23 March 2021

Workplace gender-based violence and associated factors among university women in Enugu, South-East Nigeria: an institutional-based cross-sectional study

• Olaoluwa Samson Agbaje 1 ,
• Chinenye Kalu Arua 1 ,
• Joshua Emeka Umeifekwem 1 ,
• Prince Christian Iheanachor Umoke   ORCID: orcid.org/0000-0002-0802-9073 1 ,
• Chima Charles Igbokwe 1 ,
• Tochi Emmanuel Iwuagwu 1 ,
• Cylia Nkechi Iweama 1 ,
• Eyuche Lawretta Ozoemena 1 &
• Edith N. Obande-Ogbuinya 2  

BMC Women's Health volume  21 , Article number:  124 ( 2021 ) Cite this article

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Exposure to workplace gender-based violence (GBV) can affect women's mental and physical health and work productivity in higher educational settings. Therefore, this study aimed to examine the prevalence of GBV (workplace incivility, bullying, sexual harassment), and associated factors among Nigerian university women.

The study was an institutional-based cross-sectional survey. The multi-stage sampling technique was used to select 339 female staff from public and private universities in Enugu, south-east Nigeria. Data was collected using the Workplace Incivility Scale (WIS), Modified Workplace Incivility Scale (MWIS), Negative Acts Questionnaire-Revised (NAQ-R), and Sexual Experiences Questionnaire (SEQ). Descriptive statistics, independent samples t -test, Pearson’s Chi-square test, univariate ANOVA, bivariate, and multivariable logistic regression analyses were conducted at 0.05 level of significance.

The prevalence of workplace incivility, bullying, and sexual harassment (SH) was 63.8%, 53.5%, and 40.5%. The 12-month experience of the supervisor, coworker, and instigated incivilities was 67.4%, 58.8%, and 52.8%, respectively. Also, 47.5% of the participants initiated personal bullying, 62.5% experienced work-related bullying, and 42.2% experienced physical bullying. The 12-month experience of gender harassment, unwanted sexual attention, and sexual coercion were 36.5%, 25.6%, and 26.6%, respectively. Being aged 35–49 years (AOR 0.15; 95% CI (0.06, 0.40), and ≥ 50 years (AOR 0.04; 95% CI (0.01, 0.14) were associated with workplace incivility among female staff. Having a temporary appointment (AOR 7.79, 95% CI (2.26, 26.91) and casual/contract employment status (AOR 29.93, 95% CI (4.57, 192.2) were reported to be associated with workplace bullying. Having a doctoral degree (AOR 3.57, 95% CI (1.24, 10.34), temporary appointment (AOR 91.26, 95% CI (14.27, 583.4) and casual/contract employment status (AOR 73.81, 95% CI (7.26, 750.78) were associated with workplace SH.

Conclusions

The prevalence of GBV was high. There is an urgent need for workplace interventions to eliminate different forms of GBV and address associated factors to reduce the adverse mental, physical, and social health outcomes among university women.

Peer Review reports

Gender-based violence (GBV), or violence against women in the workplace is a major public health problem globally. The World Bank’s Inter-Agency Standing Committee defines GBV as "an umbrella term for any harmful act that is perpetrated against a person's will, and that is based on socially ascribed (gender) differences between males and females” [ 1 ]. Furthermore, GBV has been conceptualized as violence towards minority groups, individuals, and/or communities solely based on their gender, which can directly or indirectly result in psychological, physical, and sexual traumas or injury and deprivation of their right as a human being [ 2 ]. GBV primarily involves violence against a person based on gender (i.e., both men and women) [ 1 , 2 , 3 ]; however, women bear the brunt of violence due to the prevailing gender inequalities [ 4 ]. For instance, epidemiological studies [ 4 , 5 , 6 , 7 ] reported that GBV undermines the daily life activities of women.

In Nigeria, the prevalence of GBV is high. Previous studies reported that GBV is an important public health problem in Nigeria [ 4 , 8 , 9 , 10 ]. For instance, a study [ 8 ] reported that about 52.1% of the women indicated that domestic violence incidence is high, while 63.3% had experienced domestic violence at one time or the other. Sexual abuse was the most frequently reported form of abuse experienced [ 10 ]. The high prevalence of GBV in Nigeria has been attributed to a culture of silence, cultural values, and practices [ 4 , 8 ].

Also, research evidence suggests that GBV has deleterious effects on women’s health. Such adverse health outcomes include physical injuries, mental health problems, sexual and reproductive health problems, sexually transmitted infections (STIs), gynecological disorders, poor pregnancy outcomes, poor health outcomes in children of affected women [ 3 , 11 ].

Previous studies have indicated that GBV is a predominant phenomenon in higher educational institutions [ 9 , 12 ]. However, this problem is still under-studied in educational institutions in developing nations [ 13 ]. Thus, there may be a paucity of data available on the prevalence of GBV among university women in Nigeria. In the present study, we use the concept of GBV to encompass the most common and potential forms of workplace violence against women in higher education systems, such as the university environment. A previous study [ 14 ] adopted this approach. However, the present study focused on incivility, bullying, and sexual harassment among female university staff.

Workplace incivility refers to a subtle form of negative interpersonal behavior characterized by rudeness and disrespect [ 15 , 16 ]. Incivility also implies rude speech or behavior, impoliteness, bad manners, and inappropriateness [ 17 ]. From the victim's view, workplace incivility is caused by individuals such as coworkers/colleagues, clients or supervisors who exhibit rude behaviors towards him or her. Similarly, incivility exemplifies uncivil behavior that has low-intensity and that the intention to harm is not apparent [ 16 ]. Leiter [ 18 ] posited the uncivil workplace behaviors could be an integral part of an organization's climate or culture rather than as an individual phenomenon. Regardless of its subtleness, incivility has been considered as a risk factor for more severe aggressive behavior and adverse health outcomes [ 19 ]. In numerous work settings, women are more likely than men to experience uncivil behaviors such as rude and discourteous comments, and men are the primary perpetrators of workplace incivility [ 16 , 20 , 21 ]. Examples of uncivil behaviors in the workplace include receiving a commendation for others' endeavors, peddling unverified reports about coworkers, nonchalant attitude towards collective tasks, sending unwanted emails to colleagues [ 19 , 22 ].

Previous studies affirm that incivility can precipitate many adverse outcomes in the workplace, including university setting. Workplace incivility can result in academic stress, poor motivation, and low productivity, and absenteeism [ 23 ], mental health problems [ 16 , 19 ], low self-efficacy [ 24 ], poor self-control [ 25 ], diminished task performance [ 26 ], and burnout [ 27 ].

Moreover, incivility has been identified to be closely linked with other forms of workplace GBV such as bullying, abuse, harassment, antisocial behavior, and social undermining [ 27 , 28 ]. Workplace bullying (WPB) is a prevalent public health problem in many regions of the world [ 29 ]. Einarsen et al. [ 30 ] conceptualized workplace bullying as an act of harassing, offending, socially excluding someone, or negatively affecting someone's work tasks. Similarly, for an activity to be termed bullying, it has to be perpetrated repeatedly and regularly and over some time (e.g., about six months). Additionally, workplace bullying refers to repeated hurtful detrimental acts or acts (physical, verbal, or psychological intimidation) involving criticism and humiliation to cause fear, distress, or harm to the individual [ 31 ].

The two major linked forms of WPB identified in extant literature include work-related bullying (i.e., unfair deadlines, insurmountable workloads, excessive monitoring, and a feeling of denial of access to relevant information), and personal bullying. Personal bullying includes the persistent experience of gossip, discourteous/rude comments, unwarranted teasing, and persistent criticism [ 32 ]. Also, many factors besides individual factors (i.e., inadequate social competencies and psychosomatic symptoms) have been identified to promote and trigger WPB's perpetuation in diverse organizational and cultural climes. Such factors include power distance, uncertainty avoidance, fear of employee to express disagreement, patriarchalism, the overall decision-making process [ 33 ], organizational culture and climate [ 34 ], working conditions and job design [ 35 ], leadership [ 36 ], role conflict and role ambiguity [ 37 ]. Akella [ 31 ] further asserted that communities characterized by high power distance and low in uncertainty avoidance support the occurrence of workplace bullying.

A plethora of studies have identified the adverse outcomes of WPB [ 30 , 38 , 39 ]. For instance, WPB creates a toxic environment [ 40 ] with adverse outcomes such as diminished corporate/organizational productivity, decreased work motivation, a lack of concentration, errors, and absenteeism [ 41 , 42 ], sleep disorders, anxiety, chronic fatigue, anger, depression, and several somatic disorders and decreased performance [ 30 , 43 ]. Women in academia may be more prone to WPB than other work contexts due to high-stress levels [ 44 ]. Thus, identifying the prevalence of WPB among female university staff could offer profound insights that may further inform appropriate interventions.

Furthermore, exposure to workplace incivility and bullying could also lead to workplace sexual harassment (WSH). Workplace SH has been identified as a severe public health problem in extant literature. Sexual harassment is any form of unwanted verbal, non-verbal or physical conduct of a sexual nature that occurs with the purpose or effect of violating a person's dignity, particularly when creating an intimidating, hostile, degrading, humiliating or offensive environment [ 45 ]. Also, WSH is a form of workplace harassment typically characterized by gender or sex lines [ 46 ]. Besides, the literature suggests that women are more likely than men to experience sexual harassment in a lifetime [ 47 , 48 , 49 ]. Fitzgerald identified three dimensions of SH. These include gender harassment (GH), unwanted sexual attention (UwSA), and sexual attention (SA). Gender harassment entails verbal and nonverbal behaviors that portray abusive, unfriendly, or undignified attitudes towards women. GH's primary purpose is not sexual intercourse; however, it accentuates the dispersion of attitudes that foster hatred of women.

In contrast, UwSA encompasses forms of sexual advances perceived by the victim as offensive, unwanted, and unrequited. Such can include requests for dates, letters, phone calls, touching, grabbing, and other sexual assaults forms. Sexual coercion highlights the request for sexual favors as compensation for job rewards or prospects.

Previous studies [ 9 , 50 , 51 , 52 ] have reported a high prevalence of SH in higher educational settings. Also, prior studies [ 50 , 52 ] had reported that women in most cases are the victims of SH in higher educational settings. Women exposed to SH in the workplace experience adverse health outcomes such as decreased job satisfaction, long-term sickness absence, depression, and anxiety [ 53 , 54 , 55 , 56 ]. The literature further shows that SH negatively impacts the victims' mental health [ 53 , 56 ]. Since SH is a preventable occupational health problem, concerted efforts are needed to identify its magnitude and predictors in the Nigerian university context. Thus, the present study is birthed as part of the efforts to ascertain the prevalence of SH and associated factors among university women in south-east Nigeria.

Research evidence has shown that an interplay of different factors influences GBV perpetration and victimization. For instance, past studies [ 57 , 58 , 59 ] identified age, rural residence, parity, childhood exposure or experience of violence, educational status, marital conflict, partner, and personal substance use as the predictors of GBV. GBV, as a complex and multidimensional concept, is influenced by an interplay of several factors, such as personal, situational, and sociocultural factors [ 60 ]. This understanding supports the underlying assumptions of the social ecological model (SEM). Therefore, we employed the socio-ecological model to investigate associated factors of GBV among university women, such as individual and institutional. The SEM posits that multiple factors interact to influence health behaviors and efforts designed to motivate an individual to change their behavior should embrace all the factors or web of influence that support such behaviors to be effective. The SEM identifies the individual as the core of an ecosystem and offers a valuable and integrative framework to enhance an in-depth understanding of the numerous factors that sustain systemic perpetuation of GBV in higher education systems and those that hinder its eradication [ 61 , 62 ]. The socio-ecological models [ 61 , 62 ] provide a wide-ranging framework of systems and interactive levels such as intrapersonal, interpersonal, institutional, community, and policy that helped explain the associated factors of GBV perpetration, victimization and further informs interventions that can be implemented at each level to address GBV.

This study aimed to determine whether the prevalence of incivility, bullying and sexual harassment (i.e., forms of GBV) is high among university women and examines if women's GBV experiences are associated with their personal factors and contextual variables (staff category, employment status). Next, we hypothesized that there are interrelationships among the outcomes-workplace bullying, incivility, and sexual harassment. Hopefully, the findings may substantiate and add to the existing data on the prevalence of GBV and associated factors among university women. This study may further increase an understanding of factors that influence GBV perpetration and contribute to prevention programs. The findings can also help identify evidence-based prevention interventions and those for mitigating the effects of GBV exposure among university women.

Study design and setting

This study was an institutional-based cross-sectional design. It was conducted in Enugu, south-east Nigeria. The study period covered five months from May 25 to October 30, 2019. The Igbo communities mainly inhabit Enugu state. People from other tribes also reside in the states. Examples of such tribes include Yoruba, Hausas/Fulani, Itsekiri people, Ibibio and Efik people, Idoma people, Igala people, etc. Enugu state has a population of 3,267,837 people, according to the 2006 population census [ 63 ]. The University of Nigeria Enugu Campus (UNEC) is a federal tertiary institution in Enugu city. Also, the Enugu State University of Science and Technology (ESUT) is a state university located in Enugu and Agbani, respectively. Private/mission universities such as Renaissance University with its main campus in Ugbawka, Enugu; Godfrey Okoye University, Enugu; Caritas University, Amorji-Nike, Enugu. The universities serve as academic hubs for the south-east, south-south, south-west, and the northern states. The population for the study comprises 4995 female staff in the sampled universities during the 2018/2019 academic session. Female employees constitute the bulk of manpower in these universities.

Sample size determination and procedure

We used the Leslie Kish single population proportion formula to calculate the study sample size. We assumed the prevalence of workplace incivility, bullying, and sexual harassment to be 30% among female university staff with a 95% confidence level and 5% margin of error. Also, a 5% non-response rate was added to the initial sample size. Thus, 339 women constituted the study sample size.

The calculated sample size for the study was 323. Afterwards, the sample size was multiplied by 5% non-response rate (323 * 0.05 = 16) and was added to 323 (i.e., 323 + 16). Finally, the study sample was determined to be 339. The sample size is an approximation. Thus, three hundred and thirty-nine female staff were recruited from the universities in Enugu, Enugu State. Multi-stage random sampling was used to select participants for the study. At the first stage, we stratified the universities to private and public institutions, and subsequently, we randomly selected four out of six universities in Enugu City. Two public and two private universities were selected. In the second stage, a systematic sampling technique was employed to select the faculties using the list of faculties in the respective universities as a sampling frame. The principal investigators and well-trained research assistants approached the eligible participants individually, invited them to participate, and the study’s aims were explained to them. The participants were informed that participation is voluntary and that they can withdraw from participation at any time they deem fit without any reason. When necessary, we provided clarification, and participants were assured that their responses would be treated confidentially and without identity disclosure. We obtained informed verbal consent from the participants. The approval of the University of Nigeria's institutional review board (IRB), Nsukka, was obtained (Reference number: NHREC/05/01/2008B-FWA00002458-IRB00002323). The inclusion criteria include working for at least 12 months as university staff, absence of ill health, and issuance of voluntary informed consent. Exclusion criteria include a work experience of fewer than 12 months, and refusal to participate in the study, and ill-health. Interviews were conducted face-to-face, and each interview lasted, on average, 30–45 min.

After obtaining informed verbal consent from the participants, the investigators and trained data collectors administered the demographic information sheet, 7-item workplace incivility Scale (WIS), the 7-item modified workplace incivility Scale (MWIS) by Blau and Andersson, the Negative Acts Questionnaire-Revised (NAQ-R), and the Sexual Experiences Questionnaire (SEQ). The WIS, MWIS, NAQ-R and SEQ are not under license. They are available in the public domain. Thus, licenses were required for their use.

Sociodemographic characteristics

Information on demographic characteristics of the participants was collected using an information sheet developed by the researchers. The information sheet collected data on the participant’s age, academic qualification, marital status (having a partner or spouse, divorced, single, widowed), employment status, work experience (i.e., years of experience working as an academic or non-academic staff) salary grade, and staff category/position. Moreover, we coded the participants' age in years, both as a continuous and discrete variable. Participants’ age was categorized as follows: 18–34 years coded as 1; 35–49 years coded as 2; and ≥ 50 years coded as 3 (older female staff). Academic qualification was categorized into five groups such as Senior Secondary School Certificate of Examination-SSCE (coded as 1), Ordinary National Diploma/National Certificate of Examination-OND/NCE (coded as 2), first degree-B.Sc., B.Ed., B.A, etc. (coded as 3), having master’s degree-M.Sc., M.A., M.Ed. (coded as 4). Furthermore, possession of a doctoral degree/Ph.D. (coded as 5). Marital status was coded 1 for single, 2 for married, 3 for divorced/separated, and 4 for widowed. We created three categories for employment status, which include permanent appointment (coded as 1), temporary appointment (coded as 2), and casual/contract (coded as 3). Work experience (i.e., length of years of teaching/working as a staff in the university) was categorized into < 5 years (coded as 1), 5–9 years (coded as 2), and ≥ 10 years (coded as 3). Other variables were categorized as follows: salary grade (CONTISS II grade 01–05, CONTISS II grade 06–10, CONTISS II grade 11–15, CONAUSS II Grade 01–04, and CONAUSS II Grade 05–07) [ 64 , 65 ]; staff category/position was grouped into academic staff, and non-academic/clerical staff (coded as 1 and 2, respectively), and the institutional type was categorized into private university (coded as 1) and public university (coded as 2).

Workplace incivility

We used the 7-item Workplace Incivility Scale (WIS) developed by Cortina et al. [ 15 ] to measure experienced incivility from the supervisors and co-workers. The scale assesses the frequency of perceived incivility in the past five years. However, to minimize recall bias or ambiguity, the study participants were asked to describe their workplace incivility experience in the last 12 months or academic session . This is a shorter period than the five-year period recommended by Cortina et al. [ 15 ]. The scale comprised items that measure both direct and indirect forms of workplace aggression. Examples of items in the 7-item WIS include 'My co-workers address me in unprofessional terms, either publicly or privately,' 'My co-workers put me down or are condescending to me,' and 'My co-workers make demeaning or derogatory remarks about me.' The response format ranges from 0 (never) to 5 (daily). Next, we calculated the total WIS score for all the participants. The WIS score ranges from 0 to 35. Higher scores indicate a high level of workplace incivility experience. To assess women's supervisor and co-worker incivility experience, we dichotomized the response option into "Yes" or "No." Women answered "Yes," when their responses showed rarely to daily to at least one item on the WIS in the past 12 months while a never response was regarded "No." The WIS has been used in a previous study [ 66 ]. The WIS has good internal consistency reliability that ranged from 0.85 to 0.89 [ 67 , 68 , 69 ]. The Cronbach’s alpha reliability for the entire 7-item WIS was 0.65. The alpha coefficients for the supervisor incivility and co-worker incivility subscales were 0.50 and 0.73, respectively.

Additionally, we used the seven-item modified Workplace Incivility Scale (MWIS) developed by Blau and Andersson [ 70 ] to measure person-initiated or instigated incivility. sample questions from the MWIS include “How often have you exhibited the following behaviors in the past year to someone at work (e.g., co-worker, other employees, supervisor)? “During the past year, while employed in the current organization, have often have you made demeaning or derogatory remarks about others?” The MWIS used a 4-point Likert response format 1 = hardly ever (once every few months or less, 2 = rarely (about once a month), 3 = sometimes (at least once a week), and 4 = frequently (at least once a day). The scores range from 1 to 28, with higher scores implies much involvement in person-initiated incivility in the workplace. However, to assess women’s perpetration/involvement in instigated incivility, responses that indicated rarely (about once a month) to frequently (at least once a day) to at least one item on the MWIS were categorized as “Yes” while responses that indicated hardly ever to all the items on the MWIS were considered “No”. Thus, we dichotomized participants’ instigated incivility into Yes (coded as 1) and No (coded as 0). The internal consistency reliability coefficient via Cronbach’s alpha for Blau and Andersson MWIS scale was 0.81 (Additional File 1 ). The alpha coefficient for the combined 7-item Cortina et al. WIS and Blau and Andersson MWIS scale was 0.84 (Additional File 2 ).

• Workplace bullying

The Negative Acts Questionnaire-Revised (NAQ-R) is the most used scale to evaluate workplace bullying [ 71 , 72 , 73 , 74 ]. The NAQ-R is a 22-item questionnaire designed to measure workplace bullying in diverse workplace settings [ 75 , 76 ]. The 22 items in the NAQ-R are structured to measure bullying behaviors. The NAQ-R is a free 22-item questionnaire for use in non-commercial research projects. The NAQ-R is available in the public domain for surveys. The NAQ-R involves three different categories of negative behaviors, such as person-oriented bullying, workplace-related bullying, and physically intimidating bullying. Additionally, 12 items measure person-oriented bullying; 7 items measure work-related bullying, and 3 items measure physically intimidating bullying [ 75 , 76 ]. Examples of such items include “been excluded from the social fellowship” and “exposed to exaggerated teasing and joking.” The NAQ-R has a five-point Likert scale response format to evaluate workplace bullying exposure in the past 6 months (i.e., 1 = never, 2 = occasionally, 3 = monthly, 4 = weekly, 5 = daily). We used a cut-off point of 33 on the NAQ-R to categorize the participants into two exclusive groups of bullied vs. not bullied, based on their workplace bullying exposure. Thus, participants with a score lower than 33 (< 33) are not bullied, while participants with a score greater than 33 (≥ 33) are bullied. The cut-off point has been used in a previous study [ 77 ]. The NAQ-R has good psychometric properties. [ 71 , 72 , 73 , 74 , 75 ]. The Cronbach’s alpha of 0.91 was obtained for the NAQ-R in this study (Additional File 3 ).

Sexual harassment (SH)

The 20-item version of the Sexual Experiences Questionnaire (SEQ) [ 78 ] was used to measure SH experiences. The SEQ is a non-proprietary instrument that is available for non-commercial research purpose. The SEQ measures three dimensions of SH, such as gender harassment, unwanted sexual attention, and sexual coercion. Participants were asked to rate the frequency of each experience on a 5-point scale that ranged from 0 (never) through 4 (many times); SEQ total scores indicate the frequency with which the participants reported experiencing SH in the university environment in the past 12 months [ 78 , 79 ]. However, we dichotomized the SH experience of the participants for the prevalence analyses. We coded one or more experiences of SH as 1 (Yes) , while no experience/never experienced SH was coded as 0 (No). Otherwise, we used the composite score. This procedure was used by Rospenda et al. [ 80 ]. Fitzgerald et al. reported that the internal consistency coefficient for the SEQ ranged between 0.86 and 0.92, and a test–retest coefficient of 0.86 for 1 week [ 80 ]. The Cronbach's alpha coefficient for the SEQ was 0.73. The subscales' alpha coefficients were as follows: 0.77 for gender harassment; 0.72 for unwanted sexual attention; and 0.93 for sexual coercion (Additional File 4 ).

Data processing and analyses

We conducted data entry, data cleaning, and coding using SPSS version 25 software (IBM Corp., Armonk, NY, USA) and analyzed with the same software. First, we conducted test of normality on the data to inform the selection of statistics used for data analyses. The normality of the continuous data was examined using the Kolmogorov–Smirnov test, and data distribution fulfilled the criteria for normality. The skewness and kurtosis were also performed. We also conducted descriptive statistics such as frequencies, means, and standard deviations (SD), and bivariate correlation analysis using Pearson’s r to present the information. The skewness and kurtosis values were considered appropriate for any item values if they fall within the range of + 2 or − 2 [ 81 ]. We used the Chi-squared test to examine the association between the groups (experienced/yes vs. never experienced/no) and the categorical variables. In contrast, independent samples t -test and one-way analysis of variance (ANOVA) were used to test mean differences in the WIS, NAQ-R, and SEQ index scores using the participants' sociodemographic variables.

Furthermore, each independent variable was fitted separately into the bivariate logistic analysis to evaluate for the degree of association with the forms of workplace GBV (incivility, bullying, and sexual harassment). We conducted bivariate logistic regression to check the crude association between the outcome variables and predictors using the forced entry method. Before the use of bivariate logistic regression, we examined multi-collinearity for all the models through the variance inflation factor (VIF) [ 82 ], and none was detected (VIF values < 5). We selected the variables with P  < 0.05 for further exploration in the multivariable logistic regression analysis (MLR). We used the MLR analysis to identify the independently associated predictors of GBV. The staggered entry method was used for the MLR by entering first the demographic variables (age, academic qualification, and marital status), second, the work-related variables (employment status and work experience) and third, staff category was entered. We checked the goodness of fit of the final model using Hosmer and Lemeshow [ 83 ] and was found fit. The results were summarized using crude odds ratio (COR), adjusted odds ratio (AOR), and 95% confidence interval (CI). A P -value of 0.05 was considered as the threshold for statistical significance. Also, the study adhered to the STROBE guideline (Additional File 5 ).

Descriptive statistics

A total of 301 out of 339 participants completed the survey with full information, representing an 88.8% response rate. Among the 301 that completed the questionnaires, 113 (37.5%) were academic staff, and 188 (62.5%) were non-academic staff (administrative/clerical staff). One hundred and sixty-two (53.8%) were from public universities, and 139 participants (46.2%) were from private universities. Also, 89.4% had permanent job status, 6.6% had a temporary appointment/employment status, and 4.0% had casual or contract employment status. Furthermore, 16.3% of the participants had a doctorate, 22.6% had a master's degree or its equivalent, 29.6% had a first degree, 16.6% possessed OND/NCE certificate, and 15.0% had SSCE. The mean age for participants was 40.1 years (SD = 12.9), ranging from 22 to 66 years (Table 1 ). Table 2 shows the means, standard deviations, and intercorrelations for all the study variables. The mean WIS score was 24.7 (SD = 7.39), and the mean NAQ-R score was 36.1 (SD = 12.9). Besides, the mean score for the SEQ was 8.30 (SD = 11.0). There was a positive moderate relationship between workplace incivility and sexual harassment ( r  = 0.36, p  < 0.000) and workplace bullying ( r  = 0.43, p  < 0.000). Moreover, there was a strong relationship between workplace bullying and sexual harassment ( r  = 0.76, p  < 0.000) (Table 2 ).

Prevalence of workplace incivility, bullying, and sexual harassment

A total of 63.8% of respondents had experienced at least one form of workplace incivility during the previous session (i.e., past 12 months). In detail, 67.4% experienced supervisor incivility, 58.8% experienced coworker incivility and 52.8% experienced instigated incivility. Also, a total of 53.5% of participants had experienced at least one form of WPB. Concerning types of WPB, 47.5% of the participants initiated personal bullying, 62.5% experienced work-related bullying and 42.2% experienced physical bullying. Also, 40.5% of the women experienced sexual harassment (SH). Regarding other of forms of SH, 36.5% experienced gender harassment, 25.6% experienced unwanted sexual attention and 26.6% experienced sexual coercion (Table 3 ). There was a significant difference in the NAQ-R scores [ F (2, 298)  = 7.663, η 2  = 0.05, p  = 0.001] among the participants of different age groups. Besides, there was a significant difference in the bullying status-bullied vs. not bullied, [χ 2 (2) = 11.362, p  = 0.003] among participants of different age groups. In addition, participants of diverse age groups differed significantly in their SH experience-harassed vs. never harassed [χ 2 (2) = 7.118, p  = 0.028]. There were significant differences in the WIS scores [ F (4, 296)  = 7.593, η 2  = 0.10, p  < 0.0001], NAQ-R scores [ F (4, 296)  = 3.160, η 2  = 0.04, p  = 0.014], and SEQ scores [ F (4, 296)  = 3.781, η 2  = 0.05, p  = 0.005] among the participants in terms of academic qualification groups. Also, there were significant differences in the WIS scores [ F (2, 298)  = 4.880, η 2  = 0.03, p  = 0.008] among women in terms of employment status. Furthermore, there were significant differences in the WIS scores [ F (2, 298)  = 30.835, η 2  = 0.17, p  < 0.0001], NAQ-R scores [ F (2, 298)  = 21.971, η 2  = 0.13, p  < 0.0001], and SEQ scores [ F (2, 298)  = 11.423, η 2  = 0.07, p  < 0.0001] among the participants in terms of work experience. Women differed significantly in their WIS scores [ F (4, 296)  = 5.560, η 2  = 0.07, p  < 0.0001], NAQ-R scores [ F (4, 296)  = 3.214, η 2  = 0.04, p  = 0.013], and SEQ scores [ F (4, 296)  = 3.214, η 2  = 0.04, p  = 0.031]. Moreover, there was a significant difference in WIS scores of female academic and non-academic staff [ t (299) = -2.874, η 2  = 0.03, p  = 0.004]. In addition, female academic and non-academic staff differed significantly in their workplace incivility experience-yes vs. no [χ 2 (1) = 6.036, p  = 0.014], and SH experience-harassed vs. never harassed [χ 2 (1) = 6.115, p  = 0.013] (Tables 4 , 5 ).

Workplace incivility, bullying, sexual harassment, and associated factors

Table 6 presents the results of the analyses to examine workplace incivility, bullying, sexual harassment among female university staff, and associated factors. In both the bivariate and multivariable logistic regressions, we entered workplace incivility, bullying, and sexual harassment into the models as dependent variables, being aged ≥ 50 years, having a doctoral degree (Ph.D.), having temporal and contract appointments, having a work experience of ≥ 10 years, being on CONUASSII Grade 01–04, and being an academic staff were associated with workplace incivility experience among female staff. Furthermore, being aged 35–49 years and ≥ 50 years, having OND/NCE and first degree, being separated/divorced, having temporal and contract appointments, having work experience of 5–9 years, and ≥ 10 years were associated with workplace bullying among female staff. Also, having a doctoral degree (Ph.D.), having temporal and contract appointments, having a work experience of ≥ 10 years, and being an academic staff were associated with sexual harassment of female university staff.

In the multivariable logistic regression model, being aged 35–49 years (AOR 0.15; 95% CI (0.06, 0.40) and ≥ 50 years (AOR 0.04; 95% CI (0.01, 0.14) were associated with workplace incivility among female staff. Female staff with doctoral degree had higher odds to experience workplace incivility compared to female staff with SSCE (AOR 8.32, 95% CI (2.01, 34.38). Women on temporal and casual/contract appointments were 7 times (AOR 6.99, 95% CI (1.48, 32.94) and 20 times (AOR 19.9, 95% CI (3.10, 128.4), respectively more likely than women with a permanent appointment to experience uncivil behaviors. Also, women with a work experience of ≥ 10 years had higher odds to experience incivility from supervisors, and co-workers compared to women with less than 5 years’ experience (AOR 23.36, 95% CI (8.19, 66.7) (Table 7 ). Next, women having a CONTISS II Grade 06–10 (AOR 2.73, 95% CI (1.03, 7.22) and CONUASS II Grade 01–04 (AOR 9.14, 95% CI (3.08, 27.08) had higher odds to experience workplace incivility compared to women on CONTISS II Grade 01–05.

Additionally, women aged 35–49 years had higher odds to be bullied compared to those aged 18–34 years (AOR 2.50, 95% (1.16, 5.40). However, being ≥ 50 years (AOR 0.39, 95% (0.16, 0.94) reduced the odds of being bullied in the workplace compared to being aged 18–34 years.

Having OND/NCE (AOR 0.32, 95% CI (0.12, 0.89) and a first degree (AOR 0.32 95% CI (0.13, 0.80) reduced the odds of workplace bullying compared to female staff with SSCE. Similarly, being single (AOR 0.36, 95% CI (0.14, 0.88) and separated/divorced (AOR 0.27 95% CI (0.08, 0.88) reduced the odds of workplace bullying compared to the married female staff.

Women with temporary appointment (AOR 7.79, 95% CI (2.26, 26.91) and casual/contract appointment (AOR 29.93, 95% CI (4.57, 196.2) had higher odds to report workplace bullying compared to women with a permanent appointment/employment status. Women with 5–9 years’ work experience had lesser odds to experience workplace bullying compared to women with < 5 years’ work experience in the university (AOR 0.33; 95% CI (0.12, 0.89). Also, women with ≥ 10 years had higher odds to be bullied in the university compared to women with 5 years’ work experience (AOR 3.71; 95% CI (1.75, 7.86) (Table 7 ).

Furthermore, having a doctoral degree, (AOR 3.57, 95% CI (1.24, 10.34), and being single (AOR 0.19, 95% CI (0.06, 0.58) were significantly associated with sexual harassment of female staff. Women with temporary appointment (AOR 91.26, 95% CI (14.27, 583.4) and casual/contract appointment (AOR 73.81, 95% CI (7.26, 750.78), respectively had higher odds to experience sexual harassment from a supervisor, head of the department/unit, senior colleagues, or other colleagues in the workplace compared to women with SSCE. The odds of being sexually harassed were higher among female staff with ≥ 10 years’ work experience (AOR 3.94, 95% CI (1.85, 8.42) compared to those with less than 5 years' work experience. Female staff on CONUASS II Grade 01–04 had higher odds to experience sexual harassment from a supervisor, head of department/unit, senior male colleagues, or other male colleagues compared to female on CONTISS II Grade 01–05 (AOR 2.92, 95% CI (1.25, 6.84).

Main findings

The study aimed to examine the prevalence of workplace GBV and associated factors among female university staff. Workplace GBV is a prevalent problem in higher educational institutions and manifested as workplace incivility, bullying, and sexual harassment. In this study, the prevalence of workplace incivility, bullying, and sexual harassment was 63.8%, 53.5%, and 40.5%, respectively. The prevalence of workplace incivility, bullying, and sexual harassment in our study is higher than the reported prevalence in a Nigerian study [ 9 ]. The high prevalence of GBV in our study could be due to many factors, including women’s reluctance to report incidents of GBV, fear of social stigma, fear of consequence such as job loss, and retribution [ 49 , 84 ]. This finding is consistent with the reported prevalence of GBV in previous studies [ 9 , 14 , 15 , 44 , 47 , 85 ].

Also, there was a high prevalence of sub-types of workplace incivility-supervisor, coworker, and instigated incivility in our sample. A plausible explanation for our finding could be that the university women experience persistent uncivil or discourteous behaviors while performing their duties due to high job strain and demands that characterize the university environments. Also, a poor working environment characterized by lower support from co-workers, lower levels of job insecurity, reduced job satisfaction, aggression, and low incentives for workers has been linked to a higher level of incivility from coworkers [ 84 , 86 , 87 , 88 ]. Such workplace settings foster organizational pressures that support uncivil behaviors from supervisors, colleagues, and subordinates. The findings are consistent with prior studies [ 15 , 19 , 22 , 23 , 24 , 27 , 28 ] which reported that coworkers perpetrate diverse forms of incivility as a retributory or retaliatory response to recent exposure to perceived or actual uncivil or rude behaviors such as low social support from supervisors and co-workers and high job demands. Future research should focus on evidence-based preventive interventions that consider the organizational aspects implicated in the persistent occurrence of workplace incivility in Nigerian university contexts. Such intervention could reduce workplace incivility in educational environments.

This study reported a high prevalence of personal, work-related, and physical bullying among our sample. The finding could suggest a persistent and prolonged problem and dysfunctional system suggestive of an organizational culture that tolerates harmful behaviors or negative acts. Consistent with the view of Cortina et al. [ 15 ], bullying variants could be attributed to the spiraling effects of negative acts in the working environment. Our findings are consistent with previous studies [ 15 , 16 , 44 , 52 , 88 ]. The findings also imply that university management needs to create a workplace climate that mitigates the negative acts since WPB is associated with poor health outcomes [ 39 ]. Interventions that identify bullying subcultures and incorporate preventive and mitigating measures, are vital for promoting health among university employees, especially women [ 88 ].

The high prevalence of SH observed in our study could be due to a poor working environment or organizational climate that permits SH's forms by supervisors, colleagues, or subordinates. For instance, studies have suggested power imbalance (i.e., power imbalance predisposes female staff to sexual coercion) in the workplace context, the offer of bonuses and promotion in return for sexual attention are prevalent in many workplaces including the academia [ 47 ]. Our findings corroborate prior research showing that sexual harassment of women is prevalent in diverse workplaces, including academia [ 48 , 49 , 52 , 79 , 84 ]. The finding is an urgent call for well-functioning support structures for SH's victims, and active organizational structures are also essential for preventing SH in higher education. Also, creating an inclusive, structurally egalitarian workplaces that ensure power balance and equality between women and men prevents sexual harassment since women in male-dominated workplaces are at higher risk of sexual harassment [ 84 , 86 , 87 ]. Furthermore, from a theoretical point of view, the socioecological model offers a theoretical understanding of the diversity of SH's risk factors in higher education. Thus, future intervention studies should leverage the SEM to design appropriate interventions to address the risk factors at the individual and organizational levels.

. Our results further showed that being aged 35–49 years and ≥ 50 years and having a doctoral degree were associated with workplace incivility. The finding that having a doctoral degree is associated with workplace incivility contradicts available evidence. that shows that education serves as a buffer against rude or uncivil behaviors among women in the workplace, including academia [ 86 , 89 , 90 ]. The finding could suggest that possession of a higher degree does not protect women from workplace uncivil behaviours. The finding is inconsistent with previous studies [ 9 , 86 , 90 ].

In our study, having temporary and casual/contract employment status, and work experience of ≥ 10 years increased the odds of workplace incivility among women. Additionally, the finding could suggest that marital status does not protect against exposure to rude and discourteous acts in the workplace. This finding is inconsistent with a previous study [ 9 ] that reported being married as a protective factor against GBV. Similarly, women with temporary and casual/contract employment status may be insensitive to covert or overt uncivil behaviors towards them because of their status. In many circumstances in Nigerian workplace environments, the status and privileges that come with permanent or full-time appointments are not usually accorded temporal and casual workers. To prevent job loss, women with temporal and casual/contract appointments "endure" these behaviors possibly to secure a permanent appointment or at least secure a decent means of livelihood. The limited research on the association between GBV and employment status among women in Nigeria's tertiary education community hinders finding comparison. Nevertheless, higher education institutions can provide viable mechanisms for women regardless of their educational qualification, employment status, and work experience to identify, report, and avoid rude behaviors. Similarly, incivility victims should be provided with emotional or psychological support structures that can help them build resilience against rude behaviors [ 91 ].

Furthermore, our findings showed that older age reduced the odds of bullying among university women. A reasonable explanation for the finding may be that people’s respect for old age in many Nigerian cultures inhibits the display of aggression towards older women. Future research may further explore the protective or mediating role of advanced or older age in women’s experience of GBV in higher educational environments.

Concerning the association between having a temporary and casual/contract employment (TCCE) status and WPB, female staff with TCCE status experience WPB due to non-existence or ineffective mechanisms to deal with WPB and fear of retribution. Many victims of WPB may not have sought help because they perceive the university-oriented policy and support structures as dysfunctional. Thus, higher education institutions should provide emotional or psychological support structures that can help them build resilience against rude behaviors [ 91 ]. In general, university administrations should explore measures that support gender-related expectations about how people should be treated, which permeate countries, industries, professions, and work domains [ 89 ].

Furthermore, our findings showed that having a doctoral degree, being single and having a TCCE status, work experience of ≥ 10 years, and having a low income (CONUASS II Grade 01–04, i.e., #1, 478,046-#3,125, 980) [ 64 , 65 ] were significantly associated with sexual harassment among university women. A plausible explanation for the findings could be unsafe working conditions, inactive or passive leadership, inequalities between men and women in terms of accessibility to research funding, a societal normalization of GBV, toxic academic masculine cultures, and poor economic condition [ 86 , 92 ]. The findings agree with previous studies [ 2 , 9 , 13 , 14 , 80 , 92 ]. Further, university administrators could adopt standard guidelines and policies that provide employees with criteria for acceptable and non-acceptable behavior regarding sexual harassment in the workplace [ 47 ]. Social support from colleagues and supervisors for a victim could help in ameliorating adverse health outcomes following SH [ 79 ]. Also, there is a need for restructuring working conditions in higher education, especially for women, challenging toxic academic masculine cultures, and implementing viable measures to eradicate men's violence against women [ 86 ]. Although women’s financial or economic condition improves overtime as they advance through the ranks in academia, women who currently earn an annual income between #1, 478,046 (i.e., equivalent of USD 3,213 at the current exchange rate of #460 per 1 USD) and #3,125, 980 (USD 6795.60) could be exposed to SH due persistent economic problems. however, research evidence on the association between women’s income and SH is mixed. Studies suggested that higher income is a protective factor and low income is a risk factor [ 92 , 93 ]. Another study reported that higher income does not immune women from sexual assault or harassment [ 94 ,  95 ]. Nevertheless, interventions to increase university women’s access to economic opportunities such as research grants, scholarships and other financial incentives may help mitigate the incidence of SH.

Study strengths and weaknesses

The present study offers new insights and valuable evidence on the prevalence of GBV forms and associated factors among university women, an under-studied group in health surveys in Nigerian academia. The cross-sectional nature of the present study limits the ability to draw any conclusions concerning the associated factors of GBV, and thus, causality cannot be established. Future studies that employ more robust designs such as experimental or longitudinal research methodologies may help establish causality. Another limitation of this study is the small sample size. Future research would benefit from a larger sample size. The use cut-off points on the NAQ-R for dichotomization of university women’s GBV experience may lead to overestimation or underestimation of WPB prevalence in our study. However, since the tool's psychometric properties have been established in many populations or subgroups, our findings are comparable with previous studies. This situation could potentially be addressed in future studies by adopting objective measures of WPB so that findings do not only reflect the individual’s subjective responses. The study data were also collected subjectively and retrospectively, although this method is more convenient and beneficial for surveys. However, there is the possibility of recall bias and response biases since research evidence suggests that women tend not to report SH experience for fear of stigma or retribution. Nevertheless, we used standardized anonymous scales which have potential to significantly reduce response bias due to social desirability and sensitive items. Besides, the study participants were drawn from the high educational setting (university environments). Thus, the generalizability of findings to other higher education settings such as colleges of education, monotechnics, polytechnics, and sectors may be limited. Despite these limitations, the survey reflects the current situation of GBV in many Nigerian university environments.

There was a high prevalence of GBV (incivility, bullying, and sexual harassment) among university women. Interrelationship was found between women’s experience of incivility, bullying, and sexual harassment in the university environment. Women's experience of forms of GBV in the workplace was significantly associated with their age, higher academic qualification, marital status, having temporal and contract/casual appointment, and work experience of ≥ 10 years. This study's findings could inform the development of evidence-based interventions in university environments to prevent workplace GBV and its detrimental effects on women’s health. Also, such interventions should be aimed at eliminating different forms of GBV and addressing associated factors to reduce the adverse mental, physical, and social health outcomes among women. In addition, human resource policies that focus on addressing GBV in academia are imperative.

Availability of data and materials

All data generated or analysed during this study are included in this published article [and its supplementary information files].

Abbreviations

• Gender-based violence

Bachelor of Science

Bachelor of Education

Bachelor of Arts

National Certificate of Examination

National Population Commission

Master of Science

Master of Education

Master of Arts

Multivariable logistic regression

Ordinary National Diploma

Socio-ecological model

Sexual Experiences Questionnaire

Negative Acts Questionnaire-Revised

• Sexual harassment

Workplace incivility scale

Workplace sexual harassment

Temporal and casual/contract employment status

Local Government Area

Unwanted sexual attention

Adjusted odds ratio

Crude odds ratio

Confidence interval

Institutional Review Board

Variance inflation factor

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Acknowledgements

We would like to acknowledge the technical support provided by the staff of personnel departments and human resource units of the selected universities that assisted in providing data on the female staff population. We sincerely appreciate the university women who participated in this study.

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Olaoluwa Samson Agbaje, Chinenye Kalu Arua, Joshua Emeka Umeifekwem, Prince Christian Iheanachor Umoke, Chima Charles Igbokwe, Tochi Emmanuel Iwuagwu, Cylia Nkechi Iweama & Eyuche Lawretta Ozoemena

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OSA, CKA, PCIU, CCI, ELO and EOO conceptualized and designed the study. OSA and CKA, TEI performed the statistical analyses. OSA, CKA, JEU, ENI, and CNO drafted the manuscript, and all authors were involved in the interpretation of data, critically revising the manuscript, and approving the final version. All authors read and approved the final manuscript.

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Additional file 1:.

Reliability test results for MWIS.

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Reliability test results for WIS.

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Reliability test results for NAQ-R.

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Reliability test results for SEQ.

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STROBE Checklist.

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Agbaje, O.S., Arua, C.K., Umeifekwem, J.E. et al. Workplace gender-based violence and associated factors among university women in Enugu, South-East Nigeria: an institutional-based cross-sectional study. BMC Women's Health 21 , 124 (2021). https://doi.org/10.1186/s12905-021-01273-w

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Nursing students’ experiences of workplace violence based on the perspective of gender differences: a phenomenological study

• Jun Cao 1 ,
• Hongbo Sun 1 ,
• Ying Zhou 1 ,
• Anqi Yang 1 ,
• Xiaoshu Zhuang 1 &
• Jiaxian Liu 1 , 2  

BMC Nursing volume  22 , Article number:  387 ( 2023 ) Cite this article

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Workplace violence is a worldwide concern, and particularly affects nursing students. It has a seriously negative impact on nursing students’ clinical learning experience and their physical and mental health. This study explored whether there are differences in psychological responses and coping styles among different gender nursing students after exposure to workplace violence, and investigated the causes for these differences.

We enrolled 22 nursing undergraduates from Guangzhou Medical University and Zunyi Medical University, China. Phenomenological qualitative research and online semi-structured interviews were conducted. The data were analyzed by the Colaizzi seven-step content analysis method.

Two categories were collated: psychological experience and coping styles. Three themes of the former were extracted: negative emotional experience, low level of professional identity, and negative effect on self-efficacy. Two themes of the latter: responses to violence and adjustment after violence. In addition, fourteen subthemes were extracted.

Conclusions

Different gender nursing students have different psychological experience and coping styles in the face of workplace violence. The causes of the differences are likely related to sociocultural factors and psychological gender status.

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Introduction

Workplace violence refers to insult, threat, or attack by staff in a work environment, and it brings explicit or implicit challenges to personal safety, happiness, and health [ 1 ]. Violence can be classified as horizontal and vertical according to the source [ 1 ]. Horizontal violence refers to hostile behavior that occurs toward members of the same group. Horizontal violence among nursing students refers to bullying behaviors that involve physical, verbal, and emotional assault among them [ 2 ]. Vertical violence refers to violence among colleagues in different positions hierarchically or violence committed by superiors against subordinates. Vertical violence experienced by nursing students refers to the hostile behavior of instructors, other clinical staff members, and patients or their families [ 3 ]. In addition, violence is classified as physical or psychological [ 1 ]. Physical violence is a physical injury caused by physical attacks, such as beating and pushing. Psychological violence refers to intentional verbal abuse and sexual harassment by words that lead to damage to spirit and social development [ 4 ].

Nursing students frequently experience workplace violence, a phenomenon that has become a concern worldwide [ 5 ]. Incidence of workplace violence among nursing students ranges from 42.8 to 98.3%, and the forms involve verbal or physical assaults, racial discrimination, and sexual harassment [ 3 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 ]. Nursing students experience negative emotions, loss of confidence, and decreased self-esteem after violence. These reactions can lead to a poor sense of professional identity [ 7 , 8 , 9 ]. Currently, there are several qualitative studies on nursing students’ experiences of violence in clinical settings, but most mainly focus on females, and less focused on males [ 5 , 7 , 11 , 15 , 16 , 17 ]. The theory of gender differences points out that men and women have different specific behaviors, basic attitudes, and feelings in the same environment [ 18 , 19 ]. However, little is known whether nursing students of different genders have different feelings, attitudes, and coping styles after workplace violence in clinical settings.

Therefore, we adopted the phenomenological qualitative research to explore the inner experience and coping styles of different gender nursing students after workplace violence, exploring the intrinsic meaning of their behavior. The causes and internal mechanisms were also discussed based on hermeneutic philosophy. That all is the originality of the current study. We expect that the findings will provide a reference basis for nursing managers and educators to develop targeted violence countermeasures.

This study was based on the theory of gender differences [ 18 , 19 , 20 , 21 , 22 ]. It originated from the personality gender difference theory in personality psychology. Gender difference theory began in the late 19th century. It examines male and female personalities by correlating gender with behavior. Gender distinguishes male and female individuals based on sociocultural and psychological perspectives. Different cultures have diverse norms and standards for gender. Psychological gender is a specific behavior pattern that individuals can perceive, which is suitable for social cultures, and identifies persons with the mental state of being male or female. In this way, individuals can form a behavioral system, basic attitudes, and feelings that are suitable for social cultures and psychological gender, that is, gender roles. Different gender roles have different specific behaviors, basic attitudes, and feelings that form in a specific sociocultural background and that change with the change of sociocultural factors and psychological gender status [ 23 , 24 , 25 ]. The theory of gender differences is used widely in the fields of adolescent violence, mental health, and violence criminal psychology [ 18 , 19 ]. Figure  1 shows the theoretical framework of gender differences. Figure  2 shows the research framework of this study.

Theory gender differences-----Theoretical framework

Theory of gender differences-----The research framework

Using the hermeneutic phenomenological method, we observed the individual’s current experiences and fairly described their experiences, and investigated the underlying causes as much as possible [ 26 ]. Then a semi-structured, one-to-one, in-depth interview was carried out among the participants. The interview outline was formulated concerning relevant literature [ 15 , 17 ] and the results of the initial part of this study about workplace violence among nursing students. It mainly found that nursing students’ experiences of violence are mainly related to factors such as personality, gender, internship time, and other factors. The main interview outlines were the following questions:

Do you know about workplace violence? Could you please talk about your understanding?

What aspects of violence have you experienced during your internship? Could you talk about your experiences?

What were your feelings when the violence occurred? Could you further describe a little bit?

How did you handle the occurrence? Why?

How did the violence affect you? How long did the effect of the violence last?

The researchers of this study included one Associate Professor (LJX), one Professor (ZY), two postgraduate nursing students (CJ and SHB), and two undergraduate students (YAQ and ZXS). All of them are females. CJ was the main interviewer and she conducted interviews and primary data analysis. She had 25 months of clinical internship experience and once experienced slight verbal violence from patients four years ago, which had a little negative effect on her. She and the participants work in different hospitals. This enabled her to approach the subject with an open attitude, aiming to bracket other influences-excluding them through self-reflexivity. Associate Professor LJX who had published several qualitative research articles guided the study during the process. SHB, ZY, YAQ, and ZXS were involved in the study design and review of the analysis. All the researchers (including the main interviewer) had learned the qualitative research methods systematically and comprehensively.

This study aims at exploring whether there are differences in psychological responses and coping styles among different gender nursing students after workplace violence and providing an in-depth analysis of the causes for the differences.

Participants

A purpose sampling method (a non-probability sample selected based on the overall characteristics and study objectives) was used to select participants. From September 2020 to December 2021, nursing students were chosen from Guangzhou Medical University and Zunyi Medical University, in China.

Inclusion criteria: ① Undergraduate nursing students who were in internships (  ≧  4 months)and the same academic year; ② Students must have experienced workplace violence and have described it clearly and in detail; ③ Students must have provided informed consent and participated voluntarily. Exclusion criteria: ① Students who were on personal leave, sick leave, or studying and training elsewhere; ② Students who were unable to self-report their gender.

Twenty-two participants were included, 11 males and 11 females, aged 20 to 23 (mean age: 21.5 years). No one declined participation in the study. This study determined whether a nursing student is a male or female nursing student based on their self-gender report. The internship time was from 4 to 11 months. The participants were numbered in turn according to the order of the interviews. Table  1 shows the participants’ general data.

Local ethics institutions approved this study. Ethics information was publicly released and explained to the participants. All participants signed written informed consent.

Data collection

Phenomenological methods of qualitative research were used to collect data in semi-structured in-depth interviews. Interviews were conducted via WeChat phone calls (including four researchers and one participant each time with one researcher responsible for interviewing, and the others for supplementing and recording). Appointments with the participant were scheduled in advance and the interviews were carried out in a quiet and private environment. Researchers explained the purpose and methods of the study before the interviews and pledged to protect participant privacy. The interviews were recorded by a whole process of synchronous recording, notes, and timely reminiscence during the interview, and participants’ views were clarified and confirmed to ensure accuracy. The interview times ranged from 30 to 40 min. The sample size was saturated when the information appeared repeatedly and there was no new content or topic. The study did not repeat the interviews.

Data analysis

After the interview, a systematically written transcript of the interview was completed within 24 h by comparing the recording, notes, and reminiscence methods, and transcribing the interviewees’ narratives verbatim. The data were summarized, sorted, and analyzed according to the steps of Colaizzi of the qualitative content analysis [ 26 ]: ① Listen to the recording or take notes to find the feelings; ② Find out the meaningful statements; ③ Translate meaningful parts into general statements and encode the recurring views; ④ Derive implications from the meaningful and restatement sections, then gather together the encoded views; ⑤ Organize the exported meanings as themes, subject groups, and categories; ⑥ Connect themes to a complete narrative of research phenomena; ⑦ State the essential structure; ⑧ Return to the participants for verification and finally form the themes. Ultimately, 2 categories, 5 themes, and 14 subthemes were derived.

To ensure the rigor of this study, qualitative research was conducted in strict accordance with the standard when guaranteeing the participation of researchers in the whole process. All researchers were asked to systematically learn the qualitative research, avoiding subjective thinking. The research topic and results were determined under the guidance of an associate professor who has published many qualitative researches.

Basic conditions of workplace violence experiences among nursing students

Twenty-two nursing interns (11 males and 11 females)were interviewed. Fifty-seven incidents of violence were reported. The main types of violence were verbal (50 cases), physical (3 cases), intentional ignoring (2 cases), psychological violence (1 case), and sexual harassment (1 case). Verbal violence, physical violence, intentional ignoring, and psychological violence were experienced by all the participants. One case of sexual harassment was witnessed by a female nursing student. All eleven males experienced verbal violence, and one of them was subjected to intentional ignoring, too. All eleven females experienced verbal violence, and three of them also were subjected to physical violence, one experienced intentional ignoring and one experienced psychological violence.

The abusers included mainly patients or their families (34 cases), clinical instructors (10 cases), doctors (11 cases), nursing workers (1 case), and a cleaner (1 case). The causes of experiencing violence mainly were associated with the operational ability and the theoretical knowledge of the nursing students were questioned and there was no timely communication. Besides, perpetrator factors were included as well. Table  2 shows the basic conditions of workplace violence among nursing students.

From the interview data, 2 categories, 5 themes, and 14 subthemes were extracted. Three themes are regarding psychological experience: negative emotional experience, low level of professional identity, and negative effect on self-efficacy. Two themes are about coping styles: responses to violence and adjustment after violence. Table  3 summarizes the themes.

Category 1: psychological experience–negative emotions, thoughts and feelings of nursing students experience violence

Theme 1: negative emotional experience–all kinds of bad emotions of nursing students due to violence, subtheme 1: anger–situations in which different gender nursing students tend to feel angry.

Nine male and six female nursing students expressed anger when they were faced with violence from doctors and patients. And the males were easier to feel angry when they were crudely ordered out to do something by doctors, because they thought that they were not being treated fairly, and they felt that their profession was not being respected. Male X6: “I once received a patient who needed to do a bedside electrocardiogram, and that should register first. However, a doctor directly asked me to ‘Do an electrocardiogram for him.’ I explained to him that he needed to register first, but the doctor roared, ‘Didn’t you hear what I said? Why go against me?’ I felt very angry and speechless at that moment. What power he was entitled to command me?” Female nursing students were more likely to be indignated when the work that they were able to complete was questioned by the patient in comparison to males. Because females thought that patients should not arbitrarily question anybody when they completely do not understand others’ professional ability, which was uncivilized behavior. Female X19: “One time I observed that a patient’s nose feed pump seemed to be motionless, I was ready to inspect it. The patient directly pushed me away and said, ‘You may be unskilled for this, ask your instructor to do it.’ I was very speechless, why didn’t allow me to explain? How did he know that I wouldn’t? I was just very angry so much.”

Subtheme 2: Fear–situations in which different gender nursing students tend to feel fear

Two male and one female student said they felt afraid after experiencing verbal violence from patients. Two males expressed that they feared the patients’ uncivilized behavior would aggravate and put them in more danger or be criticized by an instructor. Male X7: “I failed to puncture, the patient verbally attacked me, I was afraid that he would escalate, and the instructors’ condemnations.” However, the female said that the patient’s malice would make her afraid to work for fear of making mistakes. Female X14: “The patient found that my name tag shows that I am an intern, and refused me to do any operations, I was afraid that I would cause the patient’s dissatisfaction if I made a mistake.”

Subtheme 3: Grievance–situations in which different gender nursing students tend to feel wronged

Two males and eight females felt wrong when they experienced verbal or physical violence from doctors or patients. Just two males felt wronged when they were despised by the doctors because of their questioned operational ability. Male X11: “One day I was assigned to cooperate with a small operation, but I was not very familiar with the medical apparatuses and the cooperation with doctors was not so satisfactory. The doctor said, ‘Do you joke with me?’ The attitude was so scornful. I was so wrong that I didn’t understand why he had such an attitude.” Nevertheless, the females were more likely to feel wronged when experienced verbal and physical violence from patients. Female X22: “There was an autistic child. I was particularly careful and very kind to him. But when I injected him, he kicked and cursed me. I felt some grievance at that time.”

Subtheme 4: Sorrow–situations in which different gender nursing students tend to feel sad

Three males and three females said they would feel sad after experiencing verbal violence from doctors, instructors, and patients. Males were more likely to be sad when they were disgusted by their instructors for they were less familiar with the environment and operations. Male X3: “I just changed the department, so there were some operations that I was not very skilled in. However, the instructor did not train something to me patiently. I just felt a little lost and sad.” And the females were more likely to be sad when they were blamed by patients for unsuccessful punctures. Female X20: “I failed to puncture, the patient scolded me that I was not professional. He was so impatient, so I had to apologize, and felt lost and depressed.”

Subtheme 5: Helplessness– situations in which different gender nursing students tend to feel helpless

Three male and one female student expressed that they felt helpless when they knew that the instructors slandered them without any reason. They were confused by the occurrence of this bad situation. On this issue, male nursing students have the same view as females. Male X4: “I think if I did not good enough, the instructor should point out to me face to face and guide me to correct, rather than slandering me. I felt very helpless.” Female X16: “Some instructors didn’t respect students, they liked to gossip about the students, I didn’t like this behavior and felt very speechless.”

Theme 2: Low level of professional identity–nursing students experiencing workload violence feel that the nursing profession is not highly respected and has low status in society

Six males and five females stated that they would feel a low social status and disrespected after several exposures to workplace violence, and it led to a reduced level of professional identity assessment. This view is no tremendous difference between males and females. Male X5: “There is a big gap between nursing and clinical medicine, the patient’s attitudes toward doctors and nurses were different. Nursing was not only looked down upon by the outside world but also by doctors…” Female X13: “I felt so inferior, even though nursing is so unimportant. It has very little social status and is always in a passive position. If you were not satisfied, you could only endure it, otherwise, you would have complained, I felt bad and wanted to change careers later.”

Theme 3: Negative effect on self-efficacy–the workload violence leaves nursing students low self-esteem and skeptical about their professional competence

Subtheme 6: impaired self-esteem–situations in which different gender nursing students tend to have low self-esteem.

One male nursing student thought that his self-esteem was affected after being belittled by doctors, and he thought that he should not be disdained. Male X2: “I was just an intern, a newcomer in this department, and was not very familiar with many aspects, Why the doctor was so impatient with me? I felt very inferior and ashamed.” There were no female students who felt that their self-esteem was impaired in our interviews. It may be related to the difference in the forms of violence and the perpetrators.

Subtheme 7: Self-doubt–situations in which different gender nursing students tend to feel self-doubt

Two male nursing students expressed self-doubt and a lack of self-confidence after their operational ability was questioned several times, and the views were the same as one female student. Male X8: “After experiencing violence, I became less and less confident, sometimes even doubting my ability. I was hesitant about some operations because of tension and I was feared to make mistakes.” Female X15: “In fact, I could do many operations skillfully, but when I experienced verbal abuse from patients, I started getting doubts myself. Moreover, my work state was affected, I seemed to make more mistakes such as forgetting to check the patient’s name, etc.”

Category 2: Coping styles–nursing student response during and after violence

Theme 4: responses to violence–situations in which different gender nursing students tend to take the coping styles in case of violence, subtheme 8: explicate face-to-face–situations in which different gender nursing students chose face-to-face confrontation of violence.

Seven male and three female nursing students explicated face to face with patients when they were able to complete some operations or they did not make mistakes. The males would bravely expound on the brutal patients. Male X1: “A drunk patient scolded us without any reason, and I responded directly ‘We would send you to the police station if you continued.” And the females would communicate with patients to explain and prove their operational ability when they were questioned by patients. Female X17: “When the patient refused me to do any operation on him. I did explain to him that I had been practicing for a long time and could do many aspects.”

Subtheme 9: Tolerance and avoidance–situations in which different gender nursing students tend to tolerate and avoid violence

Four males and six females chose to tolerate it to avoid the greater negative impact of the escalation of violence. One male student pointed out that he reported the situation to his superiors after experiencing verbal violence, but the feedback effect was not ideal, so he did not do that again. Male X9: “He was a doctor, but I was just an intern. Can I report the situation to my instructor? No one would care about these things, except myself.” Nevertheless, females chose to endure it for fear of being further hurt by the patient. Female X12: “When I went to give treatment to the patients and did nothing wrong, they said that I was very unprofessional. I chose to ignore him, just do not want to be pestered by him and avoid more serious problems.”

Subtheme 10: Ask for help–situations in which different gender nursing students tend to ask for assistance

Three male nursing students asked for help from their instructors when they were questioned by patients, but this method was more inclined to be chosen by six females to avoid the aggravation of the violence. Male X10: “The patient didn’t think I could do it well just because I was an intern, so if I didn’t get it right, he resented me with his words. I directly asked for help from my instructor to deal with it.” Female X18: “When I was resisted by patients, to prevent being complained, I directly found an instructor to deal with it.”

Theme 5: Adjustment after violence–situations in which different gender nursing students tend to take the coping styles after violence

Subtheme 11: self-adjustment–situations in which different gender nursing students tend to self-adjust.

More male nursing students released negative emotions by self-regulation after violence because they thought that their adjustment ability was excellent, although three females also chose this way. Male X4: “My adjustment ability was great, maybe it would affect my emotions at first, but it won’t last long. And I usually listened to music and went out for drinks with my friends.” The female students realized the goal of self-regulation by understanding the patients’ pessimism. FemaleX19: “I consoled myself that he was a cancer patient and was so sensitive to pain, therefore, it was normal for patients to lose emotional control.”

Subtheme 12: Talk to others–situations in which different gender nursing students tend to talk to others

Six male and five female students chose to share their violent experiences with classmates or friends. Because they expressed that they could share experiences. Male X11: “After that, I would talk to classmates and exchange experiences with each other, felt that the mood would be a little suddenly enlightened.” Female X21: “I shared my experiences with the members of the same group to avoid similar violence, and I could feel better.”

Subtheme 13: Introspection and promotion–situations in which different gender nursing students tend to introspect themselves and improve their capacity

Six males and three females did introspection after the violence, actively consolidated their theoretical knowledge, and strengthened the training of various operations. There was no great difference between males and females at this point. Male X5: “I introspected myself. I would review the theoretical knowledge when I was free and actively ask the instructors for some operational knowledge for strengthening my professional ability.” Female X13: “In fact, I did make the mistakes, the operation should be a little decisive, I should not hesitate. In addition, the operation of venipuncture was indeed not standardized enough, and the relevant knowledge needed to be consolidated in time.”

Subtheme 14: Understanding and acceptance–situations in which different gender nursing students tend to understand perpetrators’ behaviors

Two male nursing students could adjust themselves promptly and understand perpetrators’ behaviors with empathy because of good psychological endurance. And one female student stated she could understand patient violence due to the disease. Male X8: “In hindsight, the doctor was on the operating table for a day, so it was inevitable that he was very tired and the mood would be impatient, so the attitude was bad to me could be understandable.” Female X22: “Because this patient was an autistic child, I could understand his impatience. Well, although he kicked me, it was not serious, and his parents apologized to me, I thought it was nothing.”

In addition to the above findings, we found that some nursing students’ operational ability was questioned and they were unable to communicate and explain with the perpetrators, which increased the risk of experiencing violence. Although nursing students take courses on humanistic care and communication methods in school, these courses are not necessarily suitable for the clinical environment, after all, each department is different. On this issue, we suggest that hospitals or departments where nursing students conduct their practice can independently set up a course to help nursing students better adapt and respond to violence. This is also a new finding and worthy reference of the study. However, all of the above results of this study need to be further validated by researchers in other countries and regions. This also gave the researchers a revelation that the research methods in the implementation process also needed a process of continuous adjustment and improvement.

Basic conditions analysis of violence among diverse gender nursing students

This study found that nursing students were subjected to frequent violence in the workplace. The main forms included verbal, physical, intentional ignoring, psychological, and sexual harassment. Males mainly experienced verbal violence and intentional ignoring, whereas females incurred the same experience but also physical violence, psychological violence, and sexual harassment. The reasons were related to the students’ operational ability and the theoretical knowledge was questioned, beside, it also included perpetrator factors. It was similar to the study which surveyed 129 nurse interns who experienced workplace violence [ 9 ]. Furthermore, it did not find differences in the sources and causes of violence. This observation was the same as the research which surveyed 150 nurse trainees [ 27 ]. However, we found that male nursing students more frequently experienced violence compared with female students. This finding differed from the study which conducted a cross-sectional survey of the frequency, sources, and forms of violence among 14 male and 93 female nurse interns [ 22 ]. Its results showed that patients or their families, instructors, and other clinical staff reported significantly more violence against female nursing students than against males. One explanation for the different results is that the two studies had different ratios of males and females. Another reason is that women are closely linked to nursing and have become a socially solidified stereotype in most Asian countries. Men who enter the nursing profession are vulnerable to patients and their families because their skills may be questioned [ 28 ]. Therefore, male nurses are more likely to experience workplace violence.

Analysis of the psychological experience of different gender nursing students after workplace violence

Our findings found that nursing students were prone to negative emotions of anger, fear, grievance, sorrow, and helplessness after experiencing violence. These findings were similar to qualitative research conducted on the experiences of seven male and nine female nursing students [ 16 ]. From in-depth interviews, we found that male and female nursing students showed fear when they experienced verbal violence due to their operational ability being questioned and without timely communication. In addition, the students feared escalation of violence or a second violent act from their instructors. Male nursing students were more likely to show anger when faced with violence caused by perpetrator factors, whereas female students were more likely to feel grievance. These differences may be related to male traits. Aggressive traits of men make them prone to radical basic attitudes and emotions in the face of violence [ 21 , 23 , 29 ]. Women’s sentimental, weak, and humble qualities could lead to more negative basic psychological states in the face of violence [ 21 , 23 , 29 ]. In addition, Asian women tend to meekness, consideration, and obedience may also aggravate the grievance mood [ 30 ]. Males were more likely to develop low self-esteem and self-doubt after experiencing verbal violence from doctors and patients. Besides, one male nursing student had developed a month-long feeling of poor self-efficacy due to intentional ignoring by instructors. However, female nursing students were less frequent with this in the study. This may be related to male dominance and successful orientation traits. Men tend to show themselves in public to gain social approval. Thus, an experience of verbal violence and the implicit negative self-esteem effect will aggravate the impaired gender psychological status and lower self-efficacy of men [ 21 , 23 , 29 ]. And impaired self-esteem may remain for a long time if it is difficult to adjust quickly. Nursing students’ helplessness after experiencing instructors’ slander, and lower professional identity assessment after several exposures to violence had no great difference in the interviews.

Analysis of coping styles after violence among different gender nursing students

This study showed that there were gender differences in student coping styles during and after violence. At the time of violence, students of different genders usually had different responses (endurance, avoidance, and seeking help) because of different gender characteristics and differences in abusers. We found that more male nursing students tended to communicate face to face when exposed to verbal violence from patients or their families, they usually tried to explain and communicate with the abusers, and they would use positive words to respond to the unreasonable patients. This response may be related to the masculine and tenacious qualities of the men, and the traditional Chinese cultural influences cause them to be more proactive and inclined to solve problems by themselves [ 21 , 23 , 25 , 30 ]. Female nursing students were more inclined to seek help. This is the same as the research which reported that female nursing students usually asked for help to avoid more serious conflicts in the event of violence [ 31 ]. This behavior may be related to the subsidiary and effeminacy characteristics of women that cause them to be passive [ 21 , 23 , 24 , 25 , 30 ]. In addition, some nursing students chose to tolerate verbal violence from doctors and patients due to poor feedback after they had reported violence and they feared being further hurt.

We found that nursing students would choose ways such as talking with others and adopt self-regulation, introspection, self-improvement, understanding, and acceptance after experiencing violence. The male nursing students tended to self-regulate after the violence, such as listening to music and participating in sports. This strategy may be related to male self-control and a tough mental state, which cause them to be resilient to bad emotions [ 21 , 23 , 24 , 25 , 30 ]. However, half of the male nursing students in this study also talked with others. They explained that sharing experiences was conducive to the disappearance of negative emotions. This outcome may be related to the successful orientation characteristics of men and the “masculinity” endowed with inclusive, generous, and eclectic qualities in Orientalism [ 29 ]. Men actively open their minds to enrich their experience after violence. In addition, some males said that they could understand the verbal violence from doctors and patients when the violence was not excessive. Tenacity makes male nursing students rational when faced with violence [21,23,25,]. Thus, men can judge correctly the cause of the violence by analyzing the state and situation of the perpetrator, and they can explain and regulate to understand the behaviors of perpetrators. In addition, we found that the male nursing students were more active in introspection and improvement after violence compared with female nursing students. They strengthened professional knowledge and skills, which were mainly influenced by male dominance, conquering, and successful orientation traits. To obtain approval from doctors and patients, male nursing students actively analyzed the reasons for violence, found solutions, and improved their operation skills and theoretical knowledge [ 23 ].

Recommendations

To reduce the adverse effects of violence, we recommend strengthening violent training to respond to violence. Nursing managers and educators need to avoid male students’ escalating violence when they are experiencing that and strengthen the psychological comfort and active guidance of female students. Besides, psychological assessments should be made on time to limit the negative effects of violence. Clinical instructors (nurses) should help nursing students (especially male nursing students) to better identify the aggressive patients and prevent violence. In addition, the instructors can teach more coping experiences to nursing students, help them (especially female nursing students) to better adjust their status, and pay more attention to their physical and mental health and learning status.

Limitations

The sample size of this study was small and did not represent the psychological experience and coping styles of all nursing students who experience violent events. Only one interview for each participant could be insufficient for the richness of the data, chronological interviews or data triangulation can further exploration of the student’s feelings and reflections. In the process of data collation and analysis, the researchers might have transferred their subjective judgments and speculations. Besides, we did not include those who cannot actualize self-report gender.

Nursing students were prone to bad emotional experiences from workplace violence, which affected their professional identity and self-efficacy. Male nursing students were more likely to become angry when exposed to violence, whereas female students were more likely to feel wronged. Male nursing students usually explicated face to face at the time of violence, whereas females tended to seek help. Male nursing students often took a self-regulation way to eliminate bad emotions and were more active in introspection and improvement after experiencing violence compared with female students. We suggest that managers need to take gender-specific, targeted measures to strengthen the psychological counseling and guidance of female nursing students and prevent male nursing students from taking radical steps to deal with perpetrators.

Relevance to clinical practice

This study showed that nursing students mainly encounter vertical violence, which is a big obstacle to their study, life, and professional identity. In order to prevent bullying and violence during the practice of nursing students, training on prevention and response to violence should be provided according to the characteristics of nursing students of different genders. In addition, leaders should create a positive work atmosphere, boost team spirit of clinical staff, and show patience, love and empathy to nursing students. In addition, the leaders should build bridges between patients, families and students to help the patients better understand and support nursing students’ learning and work.

Data Availability

The datasets produced during the current study are available from the corresponding author upon reasonable request.

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Jun Cao, Hongbo Sun, Ying Zhou, Anqi Yang, Xiaoshu Zhuang & Jiaxian Liu

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Jun Cao: Study design, data analysis, interpretation of the results and manuscript drafting, writing–original draft, conceptualization, methodology, writing–review & editing, Visualization, Project administration. Hongbo Sun: Participated in the interview and data analysis.Ying Zhou: Conceptualization, Methodology. Anqi Yang: Participated in the interview and data analysis. Xiaoshu Zhuang: Participated in the interview and data analysis. Jiaxian Liu: Study design, Writing original draft, Writing review & editing, Visualization, Project administration.

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Cao, J., Sun, H., Zhou, Y. et al. Nursing students’ experiences of workplace violence based on the perspective of gender differences: a phenomenological study. BMC Nurs 22 , 387 (2023). https://doi.org/10.1186/s12912-023-01551-y

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DOI : https://doi.org/10.1186/s12912-023-01551-y

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1 Fayetteville State University School of Nursing, Fayetteville, NC, 28301, USA

Swosti Paudel

2 Kalgoorlie Health Campus, Kalgoorlie, WA, 6430, Australia

Anisha Thapaliya

3 Royal Perth Hospital, Perth WA 6000, Australia

Roshan Acharya

4 Carilion Roanoke Memorial Hospital, Roanoke, VA, 24014, USA

Background and Aim:

Any harmful act Physical, sexual, or psychological committed against the nurses in the workplace by a patient or visitor is called workplace violence (WPV) against nurses. WPV is directly related to decreasing job satisfaction, burnout, humiliation, guilt, emotional stress, intention to quit a job, and increased staff turnover. The purpose of this narrative review is to explore the concept of WPV, its prevalence, consequences, influence on nursing, and strategies developed to prevent such incidences. WPV is not acceptable and, regardless of the culprit’s physical or psychological status, should be held responsible for such a heinous crime. WPV can have a vastly negative impact on nurses. Unfortunately, violence in the workplace has become so common that it is now considered an unpleasant part of the job and ignored instead of being reported. Nurses should be educated appropriately on hospital policies against WPV and be encouraged to report any incidence.

Relevance for Patients:

WPV is detrimental to nurse and patient’s relationship which negatively affects patient care.

1. Background

Violence against nurses has been a pandemic. According to the World Health Organization (WHO), “between 8 and 38% of nurses suffer from health-care violence at some point of their career” [ 1 ]. Compared to other workplaces, health care workers have a higher risk of getting physically, sexually, or psychologically injured. Incidents where staff is abused, threatened, or assaulted in the circumstances related to their work, including commuting to and from work, involving an explicit or implicit challenge to their safety, well-being, or health are Workplace Violence (WPV) [ 2 ]. The WPV is divided into two main groups: Physical and psychological, including racial abuse, bullying, verbal abuse, and mobbing, which may overlap in both groups [ 3 ]. WPV can be directly related to increased job stress, decreased job satisfaction, absenteeism, burnout, sleep disorder, fatigue, post-traumatic stress disorder, fear, and suicide. Overall, WPV negatively affects a nurse’s working life, resulting in decreased productivity and quality of care. There is a paucity of information regarding WPV against nurses in the literature. A few publications available discuss WPV aggregately in the health-care profession [4–6]. A recent systematic literature review on WPV against nurses discussed the antecedent factors surrounding WPV [ 7 ]. However, articles written from the perspective of a nurse discussing exclusively WPV against nurses and the mental and professional implications of such WPV incidents are very rare to none. In this narrative review, we intend to exclusively discuss WPV against nurses and its implications.

The purpose of this paper is to explore the concept and prevalence of WPV, its trend, consequences, influence on nursing, and strategies developed to prevent such incidences.

3. Discussion

The prevalence of WPV is very high. Different research suggests variable prevalence but undoubtedly remains high. According to Cheung et al. , in 2017, among 25,630 incidences of WPV occurred in the United States, of which 74% occurred in healthcare settings. Similarly, the same study shows that medical occupation group represents 10.2% of all WPV [ 2 ]. Health-care professionals, and in particular, nurses, are most exposed to WPV [ 3 ]. Similarly, Liu et al . in their study reported that 62% of participants reported exposure to any form of WPV, 43% reported exposure to non-physical violence, and 24% reported experiencing physical violence in the past year [ 5 ]. Nurses are the frontline workers, and patients spend more time with nurses in care facilities than other health-care providers, automatically increasing the risk of violence. Other factors that increase the risk of violence in health-care settings include increased workplace stress, novice nurses, shift jobs, and understaffing. These situations can lead to delayed care for patients and they might take these situations as negligence of nurses causing the violence [ 3 ]. Similarly, other important components of violence are a patient’s viewpoint regarding the nurse and their role. They have a specific role for a nurse and violence occurs when those roles are not played out as the patient wishes. Similarly, WPV depends on the workplace environment because nurses are abused by patients and visitors and by coworkers, supervisors, or administrators.

Being a female dominant profession also puts nurses at risk of WPV. We live in a patriarchal society and nurses have been subject to violence since the beginning of time [ 3 ]. According to one study conducted in Iran, 90% of nurses who reported being victims of violence at the workplace were female [ 8 ]. Furthermore, according to Cheung et al. , engaging in direct patient care seems to correlate significantly with WPV. The incidence of WPV is very high in elderly units (63.8%), pediatrics (22.1%), maternity units (15.3%), psychiatric units (14.7%), and emergency rooms (<10%) [ 2 ]. The patients in these departments need high-level and direct care from nurses. Patients may feel powerless and lose control over their life and simultaneously may be in pain and under the influence of drugs or alcohol with no proper way to vent. The accumulation of anger, frustration, and powerlessness is often directed toward the nurses in verbal abuse or physical violence, which ultimately causes psychological problems. Ironically, the professional who helps the injured and abused toward better health is at the highest risk of getting abused and forgotten.

3.2. Current trends

WPV is increasing at an alarming rate. According to Arnetz et al . [ 9 ], hospital WPV-related injuries are four times greater than in other sectors. Similarly, according to the same study, one out of every five nurses had to experience WPV at some point in their career. Among the health care workers, nurses have been affected mainly by violence and nothing much has changed since the pioneering research of Marilyn Lanza in 1985 [ 3 ]. The rate of violence against nurses seems to be increasing rather than decreasing. In the health-care setting, nurses follow orders from doctors, which is perceived by many as a low hierarchy job, which is another reason for the incivility of the patient toward the nurses. Nurses are the backbone of the health-care system but often go unnoticed. Despite the disturbingly increasing rate of violence, very few things to none have been done to prevent it. Violence is taken as one of the ugly parts of the job and it is being ignored by the administrators and supervisors. Similarly, nothing much has been done by the federal or state governments to protect nurses. According to the American Nursing Association, only 36 states have established penalties for assault of nurses. Among those 36 states, seven states apply if the assaults have occurred in an emergency or mental institute only. In general, in a WPV case, the law only helps if severe bodily injuries are inflicted on nurses. There are no laws for emotional abuse or any other form of non-physical abuse [ 10 ].

3.3. Significance of issue

WPV creates constant fears in the mind of the nurses. WPV not only affects the health care worker like nurses and doctors but also the organization like hospitals or mental health institutions. Nurses and the health-care setting have an intimate and interdependent relationship; the deterioration of one leads to the ultimate deterioration of the other. More than 70% of nurses are constantly worried about being a victim of WPV. These stresses decrease job satisfaction and increase the constant psychological stress, which negatively affects nurses’ work and personal life. All forms of violence result in psychological distress. According to Li et al. , among all types of violence, nurses face verbal abuse and physical abuse the most [ 4 ]. In another study, verbal abuse (57.6%) was the most common form of non-physical violence reported, followed by threats (33.2%) and sexual harassment (12.4%) [ 5 ]. Physical abuse includes but is not limited to kicking, shooting, biting, beating, slapping, pinching, stabbing, and pushing. Constant physical and verbal abuse emotionally scares nurses.

WPV has a significant negative impact on nurses and has been categorized into four subgroups: Biophysiological, cognitive, emotional, and social [ 3 ]. Fear, anxiety, headache, and irritability fall under the biophysiological category, which physically interferes with the quality of care provided by a nurse. Similarly, disbelief, a threat to personal integrity, and transformed perception fall under the cognitive category, which causes decreased job satisfaction, increased staff turnover, burnout, and absenteeism. Anger, guilt, apathy, and helplessness fall under the emotional category, which causes sleeplessness. Likewise, insecurity and antisocial fall under the social category, which hampers coworkers’ relations and creates a toxic working environment [ 3 ]. All these humiliations and violence, in the long run, can cause severe emotional distress such as post-traumatic stress disorder, depression, and suicide [ 8 ]. Hence, it is vital to address these issues as fast as possible. WPV is constantly pushing the nursing profession backward.

3.4. Influence on nursing practice

WPV significantly hampers nursing professionals. Constant fear and anxiety dramatically decrease the quality of care provided by a nurse. WPV negatively affects the therapeutic relationship between nurse and patient. Violence results in humiliation and guilt, which negatively affects the psyche of a nurse. In the long run, this phenomenon causes burnout, decreased job satisfaction, and reduced attraction to the nursing profession. Living in constant fear of unavoidable violence causes physical exhaustion, increased stress, insomnia, and post-traumatic stress disorder. According to Escribano et al. , 1.4% of total homicide in the United States is related to WPV in the health-care system. It is a great irony that the group of people responsible for the well-being of others is being abused [ 3 ].

WPV creates a toxic working environment for nurses. Trust toward the administration, supervisor, and coworker diminishes, creating a hostile working environment. Furthermore, it creates significant consequences for victims, coworkers, and organizations.

3.5. Controversies

There are not sufficient pieces of consistent literature on WPV toward nurses. Inconsistent literature regarding the concepts of WPV makes these situations more complex. It could be true that some violent acts such as verbal abuse are simply considered an unpleasant part of the job. In a setting such as psychiatric, maternity, and pediatrics, this violence is regarded as an unavoidable or average risk of the job. Similarly, some psychiatric nurses can have a positive view of aggression [ 3 ]. However, this point of view does not protect nurses’ integrity and dignity. Despite the unit nurses are working, they will feel fear, humiliation, and stress in response to WPV.

3.6. Strategies

WPV has become so prevalent globally that the International Labor Office, International Council of Nurses, World Health Organization, and Public Services International in 2002 jointly issued guidelines to address WPV in the health-care sector. In 2003, the American Association of Occupational Health Nurses, Inc. signed an alliance with the Occupational Safety and Health Administration regarding WPV [ 11 ]. The health institutions have their specific strategies and workforce against WPV. Despite all the efforts, the WPV remains high, and the success data of such strategies remain elusive. Patients with dementia, schizophrenia, under the influence of alcohol or drugs, and anxiety are some of the major delinquents of WPV against the nurses [ 12 ]. However, the culprits of WPV are not limited to the above medical conditions but also patients in a lucid and normal state of consciousness. Hence, it is vital to perform a quick assessment of risk behavior. For example, according to D’Ettorre et al. , this assessment can be done by following the STAMPEDAR (staring, tone, and volume of voice, assertiveness, mumbling, pacing, emotions, disease process, anxiety, and resources) technique. However, this technique does not protect against the violence itself. This risk assessment helps predict whether the patient will be violent or not down the line and gives nurses some insight to prepare for what might come next [ 12 ].

In general, the common causes of WPV are understaffing, increased stress among nurses, the demanding nature of the job, and prolonged waiting period. These causes eventually end with dissatisfied patients and visitors, causing WPV [ 12 ]. In a study, 63% of emergency department violence was reported to have occurred in the waiting room, which can be attributed to the aforementioned causes [ 13 ]. To prevent WPV, the primary interventions should be carried out at the administrative level managing the high demanding job and improving the working environment. Frequent training should be conducted on improving patient-nurse relationships, stress management, communication skills, anger-control management, and de-escalation skills [ 12 ].

Health care workers, including nurses, should be appropriately educated on the hospital/organization’s policy on reporting violence. According to Escribano et al. , in a study conducted in Switzerland general hospital, only 7.6% of the participants knew about their hospital policy against WPV. Similarly, as per the same article, in a study conducted in Australia, among the 37.7% of official complaints against the WPV, only 1% got a response from the administration [ 3 ]. These two studies show that WPV is most likely not being reported due to a lack of knowledge on policies, and administration/supervisors utterly ignore those reported. Hence, it creates an untrusty working climate. WPV against nurses is getting worse day by day. Hence, it is imperative to have a zero-tolerance policy against WPV.

3.7. A nurse’s position

WPV is an occupational hazard that is getting uglier by the day. It is never acceptable, and no matter the culprit’s physical or psychological status, they should be held responsible for such a heinous crime. Among all health care workers, nurses, especially female nurses, are more at risk of being abused at the workplace. Despite being the most ethical and caring profession, the nursing profession is still a victim in today’s patriarchal society. It is disheartening to see that despite the increased violence against the nurses, nothing tangible has been done to protect them. The constant fear of being a victim of WPV makes nurses self-conscious around the patient, which hampers the nurse-patient relationship. This situation dramatically decreases the quality of care and willingness to care for a patient.

Nursing is not an easy profession. It is demanding and requires a lot of patience as the nurses work with people from different locations and cultural backgrounds. However, WPV is turning an already difficult job into an unbearable one. The nursing profession is already facing shortages due to increased life expectancy of patients and inequitable workforce distribution. Furthermore, if this WPV against nurses cannot be managed in time, we cannot say that the day will not come when we have a severe shortage of nurses which will eventually cause the collapse of the health-care services.

4. Conclusion

Any act that causes physical, psychological, or sexual harm to the nurses at the place of work is WPV against the nurses. Unfortunately, violence in the workplace has become so common that it is now considered an unpleasant part of the job and ignored instead of being reported. Nurses should be educated appropriately on hospital policies against WPV and be encouraged to report any incidence.

Acknowledgments

Conflicts of interest.

The authors have no conflicts of interest to declare.