Workplace Violence and Mental Wellbeing Among Long-Term Care Nursing Assistants in Different Work Locations: A Cross-Sectional Study

Aims: This study aims to investigate the association between workplace violence and mental wellbeing of long-term care nursing assistants (LTC-NAs) based on work locations. Background: The increasing global elderly population is elevating the demand for LTC services. The LTC-NA population is expanding, highlighting the necessity to create a secure work environment. However, little is known about how workplace violence poses a threat to the mental wellbeing of LTC-NAs across different work locations. Methods: This observational cross-sectional study was conducted from October 2022 to July 2023, involving a survey of 937 certified LTC-NAs recruited through convenience sampling from various Taiwanese LTC units. Participants were evaluated for experiences of four types of workplace violence (physical, psychological, verbal, and sexual harassment) using a disseminated questionnaire. Mental health was assessed using the 5-item Brief Symptom Rating Scale, and client-related burnout was evaluated with the 6-item scale from the Chinese version of Copenhagen Burnout Inventory. Logistic regression identified the association between workplace violence and mental wellbeing. In addition, the relationship among participants working in residential facilities or home settings were examined. Results: The completion rate of the questionnaire was 86%. Psychological violence was associated with poor mental health (adjusted odds ratio [OR] = 2.38 and 95% CI = 1.40-4.05), while verbal violence and sexual harassment were associated with client-related burnout (adjusted OR = 2.03 and 1.75, respectively). All types of workplace violence were more prevalent in residential facilities than home settings; however, the associations of workplace violence with poor mental wellbeing were more prominent among those working in home settings. Among violence victims, a higher proportion of LTC-NAs working in home settings reported experiencing physical and psychological violence from patients' families compared to those working in residential facilities. Client-related burnout was found to mediate the relationship between violence from patients' families and poor mental health. Conclusion: Nonphysical workplace violence and sexual harassment were associated with poor mental wellbeing among LTC-NAs, especially in homecare settings. Violence from patients' families posed a notable risk to homecare LTC-NAs. Therefore, protective policies and organizational training programs should be tailored to address the unique challenges of each work setting.