Abstract
Aims
The purpose of this study was to investigate the prevalence of sexual harassment among operating room nurses, and to analyze the influencing factors.
Background
Sexual harassment in the healthcare field has a high incidence and nurses are the main victims; sexual harassment not only leads to physical and mental problems, but also undermines nurses’ performance and affects the quality of medical care.
Methods
A multi-center cross-sectional study was conducted using an online survey to investigate the sexual harassment experiences of 483 operating room nurses. The survey included demographic information, personality traits (Ten-Item Personality Inventory), sexual harassment experiences (Workplace Sexual Harassment Questionnaire), negative consequences, coping strategies, and social support status.
Results
63% of operating room nurses experienced sexual harassment in the past 12 months, with gender harassment predominating (56.7%), followed by unwanted sexual attention (28.6%) and sexual coercion (13.6%). Surgeons (81.20%) and married ones (66.7%) were the most common perpetrators. Most victims possess limited knowledge regarding sexual harassment laws and exhibit weak awareness of their rights protection. 47.8% remained silent after being sexually harassed; most of nurse employed passive coping strategies. Sexual harassment had the most prominent impact on the work of operating room nurses, mainly in the form of decreased work quality and efficiency (87.3%), as well as decreased work engagement (77.0%) and negative workplace pressure experience (72.2%); emotional disturbances, such as anxiety (76.6%), stigma (71.8%), and fear (71.5%); and was accompanied by sleep disorders (74.9%), headaches (56.0%) and nausea and vomiting (54.3%); as well as reduced trust in the opposite sex (83.8%) and disruption of family life (82.1%).Only 39.2% of the hospitals had sexual harassment reporting channels or methods, 30.7% had departments to deal with sexual harassment in the workplace, and 46.8% had communication discussions about psychological safety after sexual harassment. Personality traits, drinking behaviour, age, marriage, and social support were associated with sexual harassment behavior in the operating room.
Conclusion
The high incidence of sexual harassment in the operating room affects nurses’ productivity and physical and mental health. Operating room nurses had insufficient legal knowledge about sexual harassment and lacked hospital organizational support. agreeableness and openness personality traits, alcohol consumption, age, being married, and lack of social support were influential factors of sexual harassment in the operating room.
Implications for nursing management
Healthcare organizations should encourage reporting, care for victims, and join with the police department, judiciary, and women’s federation to develop reporting procedures and training programs on sexual harassment knowledge to create a safe and comfortable professional environment.
Keywords: Workplace, Operating room, Sexual harassment, nurses
Introduction
Sexual harassment refers to any unwelcome behavior of comments, jokes, innuendos, and lewd expressions or physical contact, such as touching and caressing related to sexual [1]. Depending on the severity and its negative consequences, it is categorized as gender harassment, unwanted sexual attention, and sexual coercion [2].
The field of healthcare has a high prevalence of sexual harassment due to its predominantly female workforce, the hierarchical structure of the clinical environment, and intimate contact with patients [1, 3]. Studies have shown that the incidence of sexual harassment among clinical nurses is 12.6% within 12 months and 53.4% during their careers [1], which is 16 times higher than in other professions [4].
Sexual harassment can lead to a range of physical and psychological problems such as headaches, sleep disorders, anxiety, depression, stress, and affect their family life [5]. In addition, sexual harassment is significantly associated with the risk of suicide and suicide attempts [6]. Although men rarely experience emotional distress or physical-psychological problems as a result of sexual harassment, they can be overwhelmed in the face of sexual harassment [7]. Sexual harassment also triggers intra-team conflict, decreases job satisfaction, productivity and performance, increases stress, turnover and burnout [8–10], and even 36% of the victims gave up surgical work due to sexual harassment [11].This shows that sexual harassment not only affects the physical and mental health of operating room nurses, but also their job performance.
The operating room (OR*) is an independent medical unit with distinct work content and pattern compared to clinical departments, and due to the close proximity of healthcare professionals during surgical operations and occasional physical touch; coupled with the confined nature of the work environment, surgical staff may be more susceptible to sexual harassment [12, 13]. It can also be attributed to the cultural connotations of the operating room such as surgical male culture, physician rights dominance, and inclusiveness [12–14]. A descriptive study in Canada showed that closed environments, strict hierarchies are a major cause of violence in the operating room, where the surgeon has absolute power over the procedure [13]. Less than 10% of respondents who experienced harassment reported it, and less than 1% reported every incident they experienced, with common reasons for underreporting being the belief that the behaviors were harmless and that reporting was considered a waste of time [15]. Moreover, the vast majority of victims remain silent after sexual harassment for fear of damaging relationships with colleagues and fear of power, which means that similar incidents of sexual harassment may be repeated [16, 17].A mixed study at a general hospital in southern Thailand found that the 12-month incidence of verbal abuse by nurses was 38.9%, physical abuse 3.1%, and sexual harassment 0.7%, with coworkers being the main perpetrators of sexual harassment, and that there was an 80% increase in the incidence of violence in the operating room relative to other departments [18]. Data from a multicenter study in Turkey showed that the probability of sexual harassment of operating room nurses was 32.6% and most of the abusers were doctors [19]. Another study showed a 19.7% incidence of sexual harassment by clinical nurses in the past 12 months, with the highest rate in the operating room [20]. In vascular surgery training, the operating room is considered to be the worst department for harassment [21], with surgeons experiencing intraoperative sexual harassment at rates ranging from 31.3–74% [12, 22, 23].
Previous studies of group sexual harassment of nurses have focused on clinical departments such as emergency medicine and psychiatry, and less on operating room nurses [16, 20]. Relevant research often focuses on violence in the workplace, including verbal and physical violence, sexual harassment.The subjects of previous investigations of sexual harassment in the OR* are mostly physicians [11, 18, 19, 24], and there is a relative lack of research on sexual harassment of nurses in the operating room.
Most nurses remain silent after experiencing sexual harassment, perhaps related to the persistence of sexual harassment incidents [26]. In addition, studies have shown that appropriate work requirements and a work environment of trust and fairness can reduce violence against nurses [20]. Healthcare organizations with systems for handling sexual harassment and incentives for reporting have lower rates of sexual harassment [26]. Indicates that the occurrence of sexual harassment may be related to the victim’s attitude, the status of the organization’s policy support, and that sexual harassment may be facilitated by the individual’s acquiescence and the organization’s inaction. Different personalities were associated with sexual orientation and sexual attitudes; neuroticism was positively associated with lower sexual satisfaction, self-acceptance, and more negative sexual attitudes; sexual extroverts had higher levels of sexual desire, frequency of sexual intercourse, variety, and sexual satisfaction [25]。In addition, personality traits were significantly correlated with sexual fantasies as well as aggression, especially neuroticism and extroversion [26]. In the Big Five personality model, neurotic personalities are more likely to commit sexual assault on others [27]. However, there is no study that analyzes the personality traits of the victims, and people with different personality traits who are subjected to sexual harassment may present different attitudes and ways of dealing with it, such as acquiescence or resistance, which may affect the occurrence of sexual harassment. Few studies have focused on the subjective factors of the victim (e.g., sexual harassment coping styles) and the impact of factors such as support on sexual harassment in the operating room.
A good work environment has a significant impact on improving nurses’ work quality [28]. Surgical safety and postoperative recovery depend on close communication and cooperation of the surgical team [29]. Operating room work requires nurses to be highly concentrated, the slightest error will affect the safety of the operation, the nurse’s working condition is related to the patient’s life and health, it is very important to provide a safe and comfortable professional environment for nurses in the operating room. Therefore, this study explored the experiences of sexual harassment and its negative impacts among operating room nursing staff through a multicenter cross-sectional survey, and analyzed the relationship between different personality traits and sexual harassment, coping styles and causes of sexual harassment, and social support status. Aims to provide valuable insights for hospital administrators to develop effective coping strategies against sexual harassment.
Methods
Design
This study was a multi-center cross-sectional study conducted at 20 medical centers from September 2023 to December 2023, and convenience sampling was used in consideration of the sensitivity of the research topic. The questionnaire was released to the operating room nursing staff of each hospital in a form of online survey (we chat two-dimensional code/link of mini program) to investigate the sexual harassment of operating room nurses in the past 12 months. In order to avoid duplication, the questionnaire was released with the setting that users could only fill in the questionnaire once. A total of 533 questionnaires were distributed in this study and 462 questionnaires were recovered with a recovery rate of 86.6%.
Participants
Inclusion criteria: ① Age ≥ 18 years old; ② Hospital operating room nursing workers; ③ Work or study in the operating room for at least one year. Exclusion criteria: ① Medical staff on leave; ② Have participated in similar researchers; ③Have taken maternity leave or sick leave in the past 12 months. Informed consent to participate was obtained from all of the participants in the study.
Data collection tools
Questionnaire
The questionnaire was developed with the participation of the Department of Nursing, Operating Room and Department of Anesthesia of the Affiliated Hospital of Southwest Medical University. Five experts were invited to conduct two rounds of expert consultation on the formulated items, and a pilot study (20 OR* nurses) was conducted to make the questionnaire.
The questionnaire consisted of seven parts. The homepage was informed consent, and agreeing to this option was required to further fill out the questionnaire. The first part was demographic information, including gender, age, education, title, position, years of working experience, and hospital level et al., totaling 17 entries. The second part was the Chinese version of the Ten-item Big Five Personality Inventory (TIPI) with 10 entries. The third part is the knowledge of sexual harassment, totaling 8 entries, with 5 options for each entry(5:know very well, 4:Understanding, 3:generally, 2:not really, 1:do not know), and the scores of each entry were added together to calculate the total score. The fourth part was the prevalence of sexual harassment, including the Sexual Harassment Questionnaire (Chinese version) and the sexual harassment situation, totaling 21 entries. The fifth part was coping strategies, which was categorized into 5 dimensions of denial, avoidance, negotiation, social coping, and assertion seeking with reference to the studies of Cortina et al. [30], totaling 14 entries. The sixth part is the impact of sexual harassment in the operating room, which consists of 5 entries and is multiple choice. The seventh part was social support for sexual harassment in the operating room, with 10 entries each set with 3 options(3:yes, 2:unsure,1:no); The scores for each entry were summed to calculate the total social support score.
Ten-item personality inventory
The Big Five is an important model for analyzing personality traits, including agreeableness (soft-hearted and trusting), conscientiousness(organized and reliable), emotional stability(calm and relaxed, we uses neuroticism as its opposite in place of this factor), extraversion(sociable and active), and openness (curious and creative). Ten-Item Personality Inventory was compiled by Gosling et al. and has been translated into various versions [31]. Li Jinde et al. [32] translated it into Chinese, Ten-Item Personality Inventory in China (TIPI - C) has 10 items, of which 1, 3, 5, 7 and 9 are positively items and 2, 4, 6, 8 and 10 are negatively items. Items 1 and 6 are extraversion factors, items 2 and 7 are agreeableness factors, items 3 and 8 are conscientiousness factors, items 4 and 9 are neuroticism factors, and items 5 and 10 are openness factors. The scale is a 7-point Likert scale(1:absolutely disagree, 2:strongly disagree, 3: mostly disagree, 4:uncertainty, 5:basically agree, 6:strongly agree, 7: definitely agree). The Cronbach’s alpha coefficient value of the scale ranged from 0.41 to 0.77, and the validity correlation coefficient value ranged from 0.44 to 0.65, indicating good reliability and validity.
Workplace Sexual Experiences Questionnaire (WSEQ)
The Sexual Experiences Questionnaire(SEQ) was developed by Fitzgerald et al., and Yichian Y [33] translated it into Chinese, in On this basis, the Workplace Sexual Experiences Questionnaire (WSEQ) was developed, totaling17 items, including three dimensions of “gender harassment”, “unwelcome sexual attention”, and “sexual coercion”. The scale has a Cronbach’s alpha coefficient value of 0.92, and is scored on a 6-Point Likert scale (1: never, 2: occasionally, 3:sometimes, 4:very often, 5: often, 6:always), from which respondents are asked to select the frequency with which they encounter the behaviors described in the questionnaire. The frequency of each sexual harassment behavior was obtained by subtracting the frequency of not experiencing the behavior [34].
Statistic analysis
Statistical analysis was performed using SPSS 23. Descriptive statistics were performed to describe the sample demographics and the variables related to sexual harassment behaviors.continuous variables were expressed as mean ± standard deviation (X ± SD), and comparisons between groups were analyzed using the independent samples t-test. Categorical variables were expressed as frequencies and percentages, and comparisons between groups were analyzed using the chi-square test. Variables that were statistically significant in the one-way analysis of variance were included, and factors influencing sexual harassment behavior were analyzed using binary logistic regression. The associations between the measured predictor variables and their results were expressed as the Odds Ratio (OR) with 95% confidence intervals (CI), and differences were considered statistically significant at P < 0.05.
Results
Demographic data
The respondents were 41 (8.9%) males and 421 (91.1%) females, aged 20–59 years with a mean age of 32.59 ± 7.00, 68.8% (318) were married, 14.3% (66) were single, 11.1% (52) were in a love, 5.6% (26) were divorced, and 85.5% (395) of the nurses had bachelor’s degree or higher. (See Table 1)
Table 1.
Demographic data of operating room nurses (n = 462)
| Variable | Yes n(%) | No n(%) | Total | t/X2value | P value |
|---|---|---|---|---|---|
| Personality trait | 63.351 | 0.000 | |||
| Neuroticism | 22(35.5) | 40(64.5) | 62 | ||
| Conscientiousness | 29(36.7) | 50(63.3) | 79 | ||
| Agreeableness | 69(78.4) | 19(21.6) | 88 | ||
| Openness | 80(74.1) | 28(25.9) | 108 | ||
| Extraversion | 91(72.8) | 34(27.2) | 125 | ||
| Drink | 101.107 | 0.000 | |||
| Yes | 255(77.3) | 75(22.7) | 330 | ||
| No | 36(27.3) | 96(72.7) | 132 | ||
| Gender | |||||
| Male | 33(80.5) | 8(19.5) | 41 | 5.911 | 0.017 |
| Female | 296(63.0) | 171(37.0) | 462 | ||
| Age(year) | |||||
| 18–25 | 10(17.9) | 46(82.1) | 56 | 60.133 | 0.000 |
| 26–35 | 208(70.7) | 86(29.3) | 294 | ||
| 36–45 | 57(70.4) | 24(29.6) | 81 | ||
| >45 | 16(51.6) | 15(48.4) | 31 | ||
| Working experience(year) | 33.917 | 0.000 | |||
| <5 | 23(7.9) | 48(28.1) | 71 | ||
| 5∽10 | 149(51.2) | 65(38.0) | 214 | ||
| >10 | 119(40.9) | 58(33.9) | 177 | ||
| Marital status | |||||
| Single | 15(22.7) | 51(77.3) | 66 | 81.928 | 0.000 |
| Love | 43(82.7) | 9(17.3) | 52 | ||
| Married | 227(71.4) | 91(28.6) | 318 | ||
| Divorced | 6(23.1) | 20(76.9) | 26 | ||
| Education | 4.862 | 0.153 | |||
| Junior College | 38(56.7) | 29(43.3) | 67 | ||
| Undergraduate | 243(63.3) | 141(36.7) | 384 | ||
| Master | 9(90) | 1(10) | 10 | ||
| Doctor | 1(100) | 0 | 1 | ||
| Professional Title | 3.824 | 0.153 | |||
| Primary | 182(59.9) | 122(40.1) | 304 | ||
| Intermediate | 91(68.4) | 42(31.6) | 133 | ||
| Advanced | 18(72.0) | 7(28.0) | 25 | ||
| Position | 5.892 | 0.116 | |||
| None | 225(60.5) | 147(39.5) | 372 | ||
| Department Manager | 50(71.4) | 20(28.6) | 70 | ||
| Charge Nurse | 14(82.4) | 3(17.6) | 17 | ||
| Chief Head Nurse | 2(66.7) | 1(33.3) | 3 | ||
| Hospital | |||||
| Public | 250(61.0) | 160(39.0) | 410 | 6.321 | 0.014 |
| Private | 41(78.8) | 11(21.2) | 52 | ||
| Hospital level | |||||
| Grade 3 A | 143(56.3) | 111(43.7) | 254 | 13.565 | 0.016 |
| Grade 3 B | 97(68.3) | 45(31.7) | 142 | ||
| Grade 3 C | 13(86.7) | 2(13.3) | 15 | ||
| Grade 2 A | 20(71.4) | 8(28.6) | 28 | ||
| Grade 2 B | 13(81.3) | 3(18.8) | 16 | ||
| Grade 2 C | 5(71.4) | 2(28.6) | 7 | ||
| Operation period | |||||
| Preanesthesia | 35(74.5) | 12(25.5) | 47 | 9.068 | 0.025 |
| Before enters the body cavity | 8(88.9) | 1(11.1) | 9 | ||
| After into the body cavity | 11(84.6) | 2(15.4) | 13 | ||
| After close the body cavity | 237(60.3) | 156(39.7) | 393 | ||
| Disturbance time | 1.918 | 0.381 | |||
| Day shift | 223(61.9) | 137(38.1) | 360 | ||
| Night shift | 58(69.0) | 26(31.0) | 84 | ||
| Off-hours | 10(55.6) | 8(44.4) | 18 | ||
| Social support | 24.75 ± 5.03 | 21.38 ± 4.77 | 462 | 7.177 | 0.000 |
Prevalence of sexual harassment in operating room
We collected 462 questionnaires, and 291 people reported sexual harassment, the prevalence of sexual harassment in the operating room was 63%. Dominated by gender harassment, especially telling of dirty jokes (56.7%) and vulgar and indecent remarks (51.9%); followed by unwanted sexual attention (28.6%) and sexual coercion (13.6%). The vast majority of harassment came from surgeons (81.20%), followed by patients (33.8%), anesthesiologists (31.6%), workers (27.5%), and nurses (17.7%). 66.7% of sexual harassment perpetrators were married, 20.8% single, 9.5% divorced, and 3.0% in love. The main time periods of harassment were after surgical closure of the body cavity (85.1%), before anesthesia (10.2%), after entering the body cavity (2.8%), and before entering the body cavity (1.9%). The highest occurrence was during day shift (77.9%), followed by night shift (18.2%) and non-working hours (3.91%). (See Table 2)
Table 2.
Prevalence of sexual harassment of nurses in the operating room(n = 462)
| Variable | Never | Occasionally | Sometimes | Very Often | Often | Always | Frequency |
|---|---|---|---|---|---|---|---|
| Gender harassment | |||||||
| Tells flirty stories | 200(43.3) | 174(37.7) | 67(14.5) | 13(2.8%) | 7(1.5) | 1(0.20) | 56.7 |
| Says something vulgar and obscene | 222(48.1) | 161(34.8) | 58(12.6) | 13(2.8) | 7(1.5) | 1(0.20) | 51.9 |
| Made offensive sexist remarks | 246(53.2) | 144(31.2) | 58(12.6) | 9(1.9) | 4(0.9) | 1(0.20) | 46.8 |
| Displayed, used, or distributed sexist or suggestive materials | 361(78.1) | 68(14.7) | 26(5.6) | 3(0.6) | 3(0.6) | 1(0.2) | 21.9 |
| Makes sexist or discriminatory comments about you | 320(69.3) | 87(18.8) | 47(10.2) | 3(0.6) | 4(0.9) | 1(0.2) | 30.7 |
| Unwanted sexual attention | |||||||
| Tries to discuss sexual matters with you | 330(71.4) | 90(19.5) | 33(7.1) | 6(1.3) | 2(0.4) | 1(0.2) | 28.6 |
| Makes unwanted sexual advances towards you | 351(76.0) | 77(16.7) | 29(6.3) | 3(0.6) | 1(0.2) | 1(0.2) | 24 |
| Stare at you with unblinking, seductive eyes | 360(77.9) | 73(15.8) | 24(5.2) | 2(0.4) | 2(0.4) | 1(0.2) | 22.1 |
| Tries to have sex with you | 412(89.2) | 31(6.7) | 17(3.0) | 1(0.2) | 1(0.2) | 0 | 10.8 |
| Repeatedly asks you for a drink or a meal, even though they’ve been turned down | 386(83.5) | 53(11.5) | 21(4.5) | 1(0.2) | 1(0.2) | 0 | 16.5 |
| Touches you in a way that makes you uncomfortable | 346(74.9) | 87(18.8) | 21(4.5) | 4(0.9) | 2(0.40) | 2(0.40) | 25.1 |
| Tries to touch or rub you | 374(81.0) | 63(13.6) | 17(3.7) | 5(1.1) | 1(0.2) | 2(0.4) | 19 |
| sexual coercion | |||||||
| Bribed you without even thinking about it | 426(92.2) | 25(5.4) | 9(1.9) | 2(0.4) | 0 | 0 | 7.8 |
| Makes a veiled threat | 425(92.6) | 26(5.6) | 8(1.7) | 3(0.6) | 0 | 0 | 7.4 |
| Makes you feel compelled to cooperate in order to be treated well | 399(86.4) | 44(9.5) | 10(2.2) | 6(1.3) | 1(0.2) | 2(0.4) | 13.6 |
| Makes you fear that you’ll be treated badly if you don’t cooperate | 414(89.6) | 28(6.1) | 15(3.2) | 4(0.9) | 0 | 1(0.2) | 10.4 |
| You’ve experienced bad consequences at work for saying no | 418(90.5) | 29(6.3) | 14(3.0) | 0 | 0 | 1(0.20) | 9.5 |
Knowledge of sexual harassment
OR* nurses had the lowest level of knowledge about environmental sexual harassment (71%), and lacked knowledge of sexual harassment laws and awareness of their rights. 24.5% did not know how to safeguard their legal rights and interests, and 30.5% did not know that institutions, enterprises, schools and other units should take reasonable measures of prevention, acceptance of complaints, and investigations and disposition, in order to prevent and stop the use of their authority and subordination to commit sexual harassment. 34.2% did not know that sexual harassment of women is prohibited and that victimized women have the right to file complaints with their units and the relevant authorities. 36.4% did not know that a perpetrator who sexually harasses another person constitutes the crime of forced indecent assault or insult, and shall be sentenced to fixed-term imprisonment of not more than five years or criminal detention. (See Table 3.)
Table 3.
The knowledge about sexual harassment of nurses in operating room (n = 462)
| Variable | Know Very Well | Understanding | Generally | Not really | Do Not Know |
|---|---|---|---|---|---|
| Do you know what sexual harassment is? | 70(15.2) | 260(56.3) | 90(19.5) | 40(8.7) | 2(0.4) |
| Do you know what environmental sexual harassment is? | 50(10.8) | 169(36.6) | 109(23.6) | 125(27.1) | 9(1.9) |
| Do you know what physical sexual harassment is? | 102(22.1) | 254(55.0) | 67(14.5) | 36(7.8) | 3(0.6) |
| If you suffer from workplace sexual harassment, do you know how to properly defend your rights and interests? | 59(12.8) | 177(38.3) | 113(24.5) | 109(23.6) | 4(0.9) |
| Do you know that organs, enterprises, schools and other units should take reasonable measures to prevent, accept complaints, investigate and deal with, to prevent and stop the use of power, affiliation and other sexual harassment? | 52(11.3) | 152(32.9) | 117(25.3) | 128(27.7) | 13(2.8) |
| You know that “sexual harassment of women is prohibited, and women victims have the right to complain to the work unit and relevant authorities.” Did you? | 47(10.2) | 150(32.5) | 107(23.2) | 135(29.2) | 23(5.0) |
| Do you know that “if the perpetrator sexually harass another person, which constitutes the crime of compulsory indecency or insult, he shall be sentenced to fixed-term imprisonment of not more than five years or criminal detention”? | 37(8.0) | 143(31.0) | 114(24.7) | 147(31.8) | 21(4.5) |
Coping strategy of sexual harassment.
Our study find that 52.2% of those who suffered sexual harassment would report it to superiors, while 47.8% kept silent. A few chose to deny it; Act like nothing happened, ignore, forget, tolerate(45.4%), treat harassment as a joke and tell yourself it doesn’t matter(31.6%). The vast majority employed passive coping strategies: avoid; step away from the harasser, switch posts with other co-workers(65.6%); rejecting it implicitly, changing the topic(90.4%); smile, or use humor to defuse an awkward situation(86.3%). Or negotiate; make it clear that don’t like the harassing behavior and ask the harasser to stop(60.8%); make it clear to the other person that this behavior is wrong(63.6%). Someone choose to seek social support, e.g. confiding in colleagues or friends for emotional support (79.4%); seek medical counseling or advice(55.6%). Claim seeking; consult relevant books and Internet information to find solutions(66.7%); seek help from managers and organize discussions to solve problems(74.2%); gather evidence, seek legal support(73.9%); Exposure through the media(27.1%).
Reasons for keeping silent included fear of negative consequences of reporting, e.g. bullying by power and obstruction of future (31.65%); belief that the harasser might not be subject to substantial punishment (37.41%); letting the matter rest for the sake of sentiment and human relations with colleagues (40.29%); feeling that it did not matter and there was no harm done (25.18%); “the family’s shame should not be spread to the public “, fearing damage to reputation and being criticized (27.33%); others (7.19%).(See Table 4).
Table 4.
coping strategy of nurses in the operating room to sexual harassment(n = 291)
| Coping strategy | Frequency | Percentage(%) |
|---|---|---|
| Deny | ||
| Act like nothing happened, ignore, forget, tolerate. | 132 | 45.4 |
| Treat harassment as a joke and tell yourself it doesn’t matter. | 92 | 31.6 |
| Avoid | ||
| Step away from the harasser, switch posts with other co-workers. | 191 | 65.6 |
| Implicitly decline, and change the subject. | 263 | 90.4 |
| Smile, or use humor to defuse an awkward situation. | 251 | 86.3 |
| Negotiate | ||
| Make it clear that you don’t like the harassing behavior and ask the harasser to stop. | 177 | 60.8 |
| Make it clear to the other person that this behavior is wrong. | 185 | 63.6 |
| Social coping | ||
| Talk to a colleague or friend for emotional support | 231 | 79.4 |
| Seek medical counseling or advice. | 162 | 55.7 |
| Claim seeking | ||
| Consult relevant books and Internet information to find solutions. | 194 | 66.7 |
| Seek help from managers and organize discussions to solve problems. | 216 | 74.2 |
| Gather evidence, seek legal support. | 215 | 73.9 |
| Exposure through the media. | 79 | 27.1 |
Negative consequences of sexual harassment
Studies have shown that sexual harassment has negative physical, psychological, work, and family effects on operating room nurses. The work aspect was the most prominent, mainly decreased quality and efficiency (87.3%), decreased work engagement (77.0%), and negative stressful experiences in the workplace (72.2%). Psychological aspects were mainly anxiety (76.6%), stigma (71.8%), and fear (71.5%); physical aspects were manifested as sleep disorders (74.9%), headache (56.0%), and nausea and vomiting (54.3%); as well as reduced trust in the opposite sex (83.8%), and affected family life (82.1%). (See Table 5)
Table 5.
Negative consequences of sexual harassment(n = 291)
| Variable | Frequency | Percentage(%) |
|---|---|---|
| Physical | ||
| Headaches | 163 | 56.0 |
| Sleep disorders | 218 | 74.9 |
| Appetite decreased | 154 | 52.9 |
| Weight loss | 102 | 35.1 |
| Fatigue | 142 | 48.8 |
| Nausea vomiting | 158 | 54.3 |
| Menstrual disorders | 84 | 28.9 |
| Other | 55 | 18.9 |
| Immunity decreased | 4 | - |
| Breast and thyroid nodules | 2 | - |
| Endocrine disorder | 3 | - |
| Aggravated dysmenorrhea | 3 | - |
| Hypomnesia | 2 | - |
| None | 41 | - |
| Psychology | ||
| Anxiety | 223 | 76.6 |
| Depressed | 194 | 66.7 |
| Fear | 208 | 71.5 |
| Shame | 209 | 71.8 |
| Disappointment and sadness | 152 | 52.2 |
| Pressure increase | 166 | 57.0 |
| Decreased happiness | 145 | 49.8 |
| Autistic or unwilling to associate with men, refusing to fall in love and marry | 150 | 51.5 |
| Post-traumatic stress disorder | 126 | 43.3 |
| None | 28 | 9.6 |
| Work | ||
| The decrease of work efficiency and quality: such as inattention, errors and accidents | 254 | 87.3 |
| Decreased job engagement | 224 | 77.0 |
| Increased working pressure | 206 | 70.8 |
| Negative pressure experience in the workplace | 210 | 72.2 |
| Hidden absenteeism (also known as impaired health productivity, health-related work inefficiency) | 166 | 57.0 |
| Relieve a guard | 137 | 47.1 |
| Dimission | 137 | 47.1 |
| Job burnout | 159 | 54.6 |
| None | 23 | 7.9 |
| Social and family life | ||
| Family life is affected | 239 | 82.1 |
| Distrust of the opposite sex | 244 | 83.8 |
| Deterioration of social relations | 215 | 73.9 |
| Other | 47 | 16.2 |
| Autism and unwillingness to interact with other | 4 | - |
| Tend to lead people to the worst | 2 | - |
| Reduced empathy or indifference to others | 1 | - |
| None | 40 | - |
Social support
At the family level, 64.7% of operating room nurses would tell their family members after experiencing sexual harassment; but 23.6% of the respondent are not sure about this; 64.1% of respondents indicated that family or friends show understanding and concern when know they had been sexually harassed, but 28.4% of the respondent are not sure about this. At the hospital level, only 39.2% of the hospitals have a way or method to report sexual harassment, 37.0% of the respondent are not sure if there were; 30.7% of the hospitals have a department to deal with sexual harassment in the workplace, 44.9% of the respondent are not sure if there is; 46.8% of the hospitals have a communication and discussion about psychological safety after sexual harassment, 36.1% of the respondent are not sure if there is. 49.4% of the leaders encourage the nurses to report sexual harassment, and 35.7% of the respondent are not sure if the leaders encourage the nurses to report; When sexual harassment occurs, 55.8% of the leaders are very concerned about whether nurses are harmed, 30.7% of the respondent are not sure if the leaders are concerned; After the sexual harassment incident, 56.3% of the management will take care of the victim nurses, 32.0% of the respondent are not sure if management will did so; After nurses suffer sexual harassment, 51.7% of the leaders will analyze and discuss, and take countermeasures, 34.6% of the respondent are not sure if there is; 48.5% of leaders has listened to Victims’ suggestions on the prevention and treatment of sexual harassment in the operating room; 41.1% of the respondent are not sure.(see Table 6).
Table 6.
Social support for sexual harassment of nurses in the operating room (n = 462)
| Variable | Yes | No | Not sure |
|---|---|---|---|
| Tell your partner or family when you experience sexual harassment | 299(64.7%) | 54(11.7%) | 109(23.6%) |
| Your family or friends show understanding and concern when know you’ve been sexually harassed | 296(64.1%) | 35(7.6%) | 131(28.4%) |
| Hospitals have ways or means to report sexual harassment | 181(39.2%) | 110(23.8%) | 171(37.0%) |
| The hospital has a special department to deal with sexual harassment in the workplace | 142(30.7%) | 124(42.4%) | 196(44.9%) |
| Management encourages nurses to report sexual harassment | 228(49.4%) | 69(14.9%) | 165(35.7%) |
| When sexual harassment occurs, management is very concerned about whether nurses are harmed | 258(55.8%) | 62(13.4%) | 142(30.7%) |
| After nurses suffer sexual harassment, the management will analyze and discuss, and take countermeasures | 239(51.7%) | 63(13.6%) | 160(34.6%) |
| After the sexual harassment incident, the management will take care of the victim nurses. | 260(56.3%) | 54(11.7%) | 148(32.0%) |
| The hospital has an exchange on psychological safety issues after sexual harassment. | 216(46.8%) | 79(17.1%) | 167(36.1%) |
| The management has listened to my suggestions on the prevention and treatment of sexual harassment in the operating room | 224(48.5%) | 48(10.4%) | 190(41.1%) |
Influencing factors of sexual harassment
Whether to experience sexual harassment as the dependent variable (1:yes, 2:no), the variables that were statistically significant in the univariate analysis (personality traits, alcohol consumption, gender, age, years of experience, marriage, nature of the hospital, level of the hospital, duration of the operation, social support, see Table 1) were set as the independent variables to establish a Lojistic regression model for the multifactorial analysis.The results showed that personality traits, dink, age, marriage, and social support were statistically significant(see Table 7). Agreeable personality and open personality were 6.865 (P = 0.001) and 4.431 (P = 0.003) times more likely to experience sexual harassment than emotional stability personality, respectively. Drinkers were 20.334 (P = 0.000) times more likely to experience sexual harassment than non-drinkers.Nurses aged 18–25 years (OR = 0.071, P = 0.003) were more likely to experience sexual harassment than nurses older than 45 years. Those who were in love and married were 13.341 (P = 0.000) and 7.603 (P = 0.000) times more likely to experience sexual harassment than those who were unmarried, respectively. The probability of sexual harassment was lower for those with high social support scores (OR = 0.918, P = 0.007).
Table 7.
Influencing factors of sexual harassment (n = 462)
| Variable | B | Standard error | P-Value | OR | 95% CI for OR | |
|---|---|---|---|---|---|---|
| Lower | Upper | |||||
| Personality Trait | 0.000 | |||||
| Neuroticism* | ||||||
| Conscientiousness | -0.196 | 0.538 | 0.715 | 0.822 | 0.286 | 2.360 |
| Agreeableness | 1.926 | 0.558 | 0.001 | 6.865 | 2.299 | 20.500 |
| Openness | 1.489 | 0.501 | 0.003 | 4.431 | 1.659 | 11.834 |
| Extraversion | 0.798 | 0.551 | 0.148 | 2.220 | 0.753 | 6.541 |
| Drunk | 3.012 | 0.356 | 0.000 | 20.334 | 10.118 | 40.867 |
| Female | -1.290 | 0.662 | 0.051 | 0.275 | 0.075 | 1.008 |
| Age(year) | 0.000 | |||||
| >45* | ||||||
| 36∽45 | 0.741 | 0.611 | 0.225 | 2.099 | 0.634 | 6.946 |
| 26∽35 | 0.053 | 0.624 | 0.932 | 1.055 | 0.311 | 3.584 |
| 18∽25 | -2.641 | 0.876 | 0.003 | 0.071 | 0.013 | 0.397 |
| Work experience(year) | 0.595 | |||||
| <5* | ||||||
| 5–10 | 0.086 | 0.599 | 0.885 | 1.090 | 0.337 | 3.529 |
| >10 | -0.376 | 0.694 | 0.588 | 0.687 | 0.176 | 2.675 |
| Marital status | 0.000 | |||||
| Single* | ||||||
| Love | 2.591 | 0.656 | 0.000 | 13.341 | 3.685 | 48.298 |
| Married | 2.028 | 0.519 | 0.000 | 7.603 | 2.749 | 21.023 |
| Divorced | -1.189 | 0.765 | 0.120 | 0.304 | 0.068 | 1.364 |
| Private hospital | 1.019 | 0.645 | 0.114 | 2.772 | 0.783 | 9.806 |
| Hospital level | 0.349 | |||||
| Grade 3 A * | ||||||
| Grade 3 B | 0.556 | 0.394 | 0.157 | 1.745 | 0.807 | 3.774 |
| Grade 3 C | 2.060 | 1.096 | 0.060 | 7.844 | 0.916 | 67.196 |
| Grade 2 A | 0.934 | 0.725 | 0.198 | 2.544 | 0.615 | 10.524 |
| Grade 2 B | 0.066 | 1.045 | 0.950 | 1.068 | 0.138 | 8.289 |
| Grade 2 C | 1.151 | 1.276 | 0.367 | 3.161 | 0.259 | 38.557 |
| Operation period | 0.293 | |||||
| Preanesthesia * | ||||||
| Before enters the body cavity | 2.196 | 1.654 | 0.184 | 8.985 | 0.351 | 230.004 |
| After into the body cavity | 1.103 | 1.129 | 0.329 | 3.012 | 0.329 | 27.543 |
| After close the body cavity | -0.165 | 0.510 | 0.747 | 0.848 | 0.312 | 2.306 |
| Social support | -0.086 | 0.032 | 0.007 | 0.918 | 0.862 | 0.977 |
| Constant | -3.468 | 1.320 | 0.009 | 0.031 | ||
Note * is a comparison item
Discuss
Prevelance of sexual harassment in operating room
This study showed that the incidence of sexual harassment among operating room nurses was 63%, which was higher than that of other clinical nurses [1]. Forms of sexual harassment were dominated by gender harassment, mainly verbal harassment, including telling provocative stories, vulgar and obscene words, and offensive and rude words; followed by unwanted sexual attention and sexual coercion; in which male nurses suffered from sexual harassment more frequently than female nurses, which is in line with previous studies [35, 36]. Surgeons were the main harassers, especially married ones. This can be attributed to the close and prolonged interaction between nurses and doctors in surgical settings. Married individuals may more knowledgeable about sexuality due to their life experiences, hence they may not consider sexual jokes or physical contact as embarrassing or ashamed for others. Surgery after the closure of the body cavity is the main time of sexual harassment occurs. Following a tense operation, doctors subconsciously need a short psychological relaxation and often resort to verbal harassment like teasing or sharing lewd jokes with nurses as a way to get rid of the tension. So, hospital administrators should train their staff on knowledge related to sexual harassment so that perpetrators are aware of their wrongdoings and its consequences, victims’ awareness of anti-harassment is enhanced, and a professional environment with zero tolerance for sexual harassment is created. Sexual harassment can affect the working performance of operating room nurses, and causing distractions and errors [8–10]. Enhance the professionalism and self-discipline of the surgical team. Even if the body cavity is closed during surgery, there are still many risk points in the surgery, such as bleeding, foreign body left behind, and anesthesia accidents, etc. Surgical participants should keep surgery with rigorous attitude to ensure the safety of the patients. The management and supervision of doctors should be strengthened and sexual harassment should be included in the outcome of doctors’ career assessment.
Disturbingly enough, these behaviors have gradually become normalized [12], and nurses become accustomed to sexual harassment with continued and repeated exposure to it; sexual harassment is integrated into the working environment of the operating room, forming an inclusive operating room culture.
Coping strategy of sexual harassment
The vast majority of victims employed passive coping strategies, similar to previous studies by [16, 30]. 90.4% of the victims in this study implicitly refused and changed the topic; 86.3% of the victims smiled, or used humor to diffuse the awkward situation. Especially when the abuser is a coworker, victims may respond negatively for fear of damage to their reputation and its potential aspect consequences [16]. Repeated exposure to sexual harassment can desensitize medical staff members and normalize such behavior in their daily work routines [37]; this may also explain the negative response. Only 31.6% regarded the harassing behavior as a joke and told themselves that it was not important; 45.4% of the victims behaved as if nothing happened, ignoring, forgetting, and tolerating it. It shows that sexual harassment is a problem for victims that cannot be ignored, and long-term exposure may evolve into a chronic stressor.
This study shows that 52.2% of the victims who will report to superior, while 47.8% kept silent, a higher reporting rate than in previous studies in China [38]. This may be due to the fact that this survey was conducted in Sichuan Province, China, where the husbands show a high degree of obedience and respect to their wives in family life, which is a symbol of men’s sense of responsibility and love of the family virtues. Since ancient times, traditional agriculture in Sichuan has not relied on men to provide a large amount of labor, and women’s labor has also produced considerable output; the economic value created by women in the family is equally substantial to that of men. As a result, women in Sichuan enjoy a higher social status in work and life than in other places, and are more vocal.
Further study of the reasons for maintaining silence revealed that it is primarily driven by concerns regarding friendship and interpersonal relationships with colleagues, as individuals aim to avoid causing conflicts; secondly, they thought that the harasser might not be subject to substantive punishment; thirdly, they were afraid of the negative consequences of reporting, such as oppression by authority and hindrance to their future; they were afraid that their reputation might be damaged and they would be criticized for “keeping a family shame in the public domain”; They feel that it does not matter and that it is harmless. These reasons are similar to previous study, in which the perpetrators of sexual harassment were primarily physicians [19]. Doctors are higher than nurses in terms of social status, education, and salary, or hold high positions [37], creating power pressure on nurses. At the same time, they are also afraid of destroying the friendly relationship with colleagues, causing unnecessary trouble and affecting their work and future [16]. Others believe that these behaviors are irrelevant or a waste of time to report, and that the perpetrator may not be punished accordingly [2, 15, 16]. Perhaps keeping silent for them is an expression of self-protection and avoidance of conflict, but acquiescence and tolerance can contribute to the harasser’s bad behavior.
In our study, the main reason to keep silence is they were concerns regarding friendship and interpersonal relationships with colleagues, as individuals aim to avoid causing conflicts. it may influenced by confucianism, traditional chinese culture emphasizes the value of harmony, and “harmony” is not only a means of dealing with conflicts and maintaining good interpersonal relationships, but also a motivating factor of collectivist culture, used to protect group cohesion [33]. Another reason is they were afraid that their reputation might be damaged and they would be criticized for “keeping a family shame in the public domain”. women concern for their reputation, and often choose to endure when they are humiliated by sexual harassment. Whether any harmony related to nobility or morality was essentially maintained remains to be examined. In some countries or regions where sexuality is conservative and women’s rights are not well developed, the same reason may exist [16], or it may be related to the lack of knowledge of sexual harassment among the group of nurses in the operating room, who do not know how to deal with sexual harassment, and therefore take passive measures to deal with it. Therefore, the improvement of the female protection system and the training of medical staff on sexual harassment are indispensable.
Management of sexual harassment in the organization
We found that there is a lack of management and proper handling of sexual harassment in healthcare organizations, only 39.2% of the hospitals in this study have a way or method to report sexual harassment, 30.7% of the hospitals have a department to deal with sexual harassment in the workplace, and 46.8% of the hospitals have a communication and discussion about psychological safety after sexual harassment. 49.4% of the leaders encourage nurses to report sexual harassment, 55.8% of the leaders will show concern for the victims, 56.3% of leaders take appropriate caring measures, and 48.5% of leaders listen to nurses about sexual harassment. Healthcare organization support and managerial attitudes are important influences on the occurrence of and response to sexual harassment [16].Song et al. [38] found that the main reasons for silence after experiencing sexual harassment were a lack of knowledge about the reporting pathway and related events, low priority given to healthcare workers, and lack of managerial response to the report.
Meanwhile, the operating room nurses in this study had insufficient legal knowledge about sexual harassment and weak awareness of their rights. 24.5% did not know how to protect their legal rights and interests, and 30.5 − 36.4% did not know that the perpetrators of sexual harassment would be dealt with by the law, and that the business unit should be punished and held responsible for the behavior. This, to some extent, encourages the bad behavior of harassers. Perhaps, improving the institutional setup and policy support, as well as training staff on sexual harassment can reduce the occurrence of sexual harassment in the operating room and its negative consequences.
Negative effects of sexual harassment
Sexual harassment in this study had the most prominent impact on operating room nurses at work in the form of decreased quality and efficiency of work, decreased work engagement, and negative workplace stress experience. In addition, sexual harassment was associated with absenteeism and turnover [37], leading to poorer job performance and affecting the quality of healthcare services, patient life safety, and disease recovery [39]. This is followed by psychological anxiety, stigma, and fear; sleep disturbances, headaches, and nausea and vomiting; as well as reduced trust in the opposite sex and affected family life, consistent with previous studies [36, 40–42]. Meanwhile, sexual harassment can deteriorate their relationship with their spouses, breed mistrust, and even lead to family breakup [39]. Thus, it can be seen that sexual harassment not only jeopardizes the physical and mental health of nurses, but also affects their family and social life.
According to American psychologist Herzberg’s two-factor theory of motivation, there are two factors of work motivation: Hygiene Factors and Incentive Factors. Among them, Hygiene Factors are related to the working environment and conditions of the employees, which can reduce their dissatisfaction and discomfort with their jobs. For example, providing good working conditions, safe environment and reasonable work load and maintaining good employee relations [43]. Work and physical and mental health interact with each other, and a healthy body and mind make a person present a good working condition, and vice versa. Negative physical and psychological consequences of sexual harassment further weaken their work performance. Therefore, providing a safe and comfortable practice environment for nurses in the operating room is necessary for surgical safety and the construction of a magnetic hospital.
Influencing factors of sexual harassment
Personality traits are important for sexual behavior and health. We found that individuals with agreeableness and openness personalities had 6.865 and 4.431 times higher likelihood, respectively, of experiencing sexual harassment compared to those with emotional stability personality traits. Neuroticism characterized by difficulty in balancing emotions of anxiety, hostility, repression, self-consciousness, impulsivity, which affect emotional stability. In contrast, the openness personality has traits such as imagination, aesthetics, emotional richness, dissimulation, creativity, and intelligence; and the agreeableness personality has traits such as trust, altruism, straightforwardness, dependence, humility, and empathy [44]; higher emotional value and comfortable and pleasant feelings can be obtained when spending time with people with these personalities, and they may be more favored by abusers. In addition, different personalities exhibit different sexual tensions, with neuroticism personalities being relatively conservative in terms of sexual topics and needs [45]; whereas openness personality traits have been associated with liberal sexual attitudes, and agreeableness personalities have been associated with sexual infidelity [44], both of which exhibit more tolerant and open sexual attitudes through internalization, and may therefore give the abuser an inch. Previous studies have mostly concluded that young and beautiful women are more likely to suffer sexually harassed [1, 2], but in a closed environment such as an operating room, where there is a uniform of hand-washing gowns, masks and hats, and less visual impact, the attraction of appearance and age to the harasser is not so absolute, and the role of personality factors is strengthened. Being comfortable with each other and having a good conversation is more likely to make the abuser want to get into trouble. Therefore, it is important to provide more care and assistance to people with agreeableness and openness personalities, and to teach them how to avoid and deal with sexual harassment. Such as not being alone in a room with a doctor, avoiding exposure to inappropriate remarks and behavior, and reporting any sexual harassment to the hospital.
Drinkers in this study were more likely to suffer sexual harassment, which is consistent with the study of Weldesenbet et al. [46]. In our study, it is mainly related to the geographic culture in which this study was conducted. Southwestern Sichuan Province is located in the Yangtze River Basin, which is the birthplace of Wuliangye, Luzhou Laojiao, Langjiu, and other alcoholic beverages, and has a strong alcohol culture. Wine is an important means of socialization and conversation, and those who can drink are more likely to be accosted or invited. However, this is only a phenomenon arising from the particular culture of the region, and further research is needed on the relationship between alcohol consumption and sexual harassment.
Previous Studies found that males are more likely to experience sexual harassment than females [8, 47], and there are also studies that show that females are more likely to experience sexual harassment [35, 48], the results of our study show that gender does not have a significant effect on sexual harassment behaviors, probably because of the small sample size of males that were included. However, the probability of men (80.5%) experiencing sexual harassment in this study was much higher than that of women (63.0%), and it is possible that the abusers think that men’s perceptions of sexual harassment were normalized, and even if the fact of sexual harassment existed, they were reluctant to define it as sexual harassment, and the emotional distress it caused them was minimal [7]. Moreover, there is insufficient legislation in China to protect men; in a patriarchal culture, their self-esteem also makes it difficult for them to publicize their experiences of sexual harassment. In the past, much attention has been paid to the sexual harassment of female nurses, who are seen as a vulnerable group and are more likely to experience emotional distress and physical problems [5], but more recently, research has begun to focus on cases of sexual harassment of male nurses [2], which has proven that the case should be treated equally by both genders, and that male nurses are also in need of appropriate support and protection.
Younger nurses (18–25 years old) in this study were more likely to experience sexual harassment than older nurses (> 45 years old), which is the same as previous studies [1, 8]; however, the difference is that those who are in love and married are more likely to experience sexual harassment than those who are single. It is possible that abusers think that married people are better able to tolerate and endure sexual harassment and then commit harassment. On the other hand, in Southwest China, young singles usually do not talk about sex in the workplace because they are more conservative than in the West and coastal areas of China, whereas romantically involved or married people have experienced sex and are more open to the idea of sex, and sexual harassment under certain circumstances will not lead to resentment or consequences.
Our study also found that the higher the level of social support, including family, friends, the hospital management system, and the attitude of leaders, the lower the probability of sexual harassment. Consistent with the study of Alhassan et al. [16]. The establishment of sexual harassment reporting mechanisms and responsible departments in hospitals, encouraging victims to report, and psychological communication and counseling on related safety issues may reduce the incidence of sexual harassment in the operating room. In addition, the attitude of bystanders is also very critical. Operating room work is a team that includes surgeons, anesthesiologists, instrument nurses, and visiting nurses in the operating room, and when sexual harassment occurs or is about to occur, if bystanders are able to help in a timely manner, they may be able to reduce or prevent the occurrence of sexual harassment and its negative impacts by changing the topic of conversation and resolving the embarrassment. Managers can promote an anti-sexual harassment team culture, conducting awareness-raising and training activities against sexual harassment at the same time.
Limitations and prospects
This multicenter study was conducted to gain the prevalence of sexual harassment among operating room nurses in southern Sichuan, China, the forms of harassment, social support in hospitals, and the reasons for victims’ silence, as well as to explore related influencing factors. Moreover, the hospitals included in this study were all secondary or higher level hospitals, and the sexual harassment of nurses in operating rooms of community and township health centers was not explored, which affects the extrapolation of the findings. In addition, the way the retrospective questionnaire was self-reported, as well as the sensitivity of the topic, there was recall bias and reporting bias. For example, many people may be reluctant to admit that they have been sexually harassed; the fact that sexual harassment exists, but the victim does not perceive it as harassment due to a lack of knowledge, may affect the reporting of sexual harassment. Cross-sectional surveys can only describe the current situation and show that these factors are related to sexual harassment, but they cannot infer a causal relationship. Moreover, The sample size of this study is small, may limit the generalizability of the findings.Cross-sectional surveys can only provide a description of the status quo, suggesting that these factors are associated with sexual harassment, but unable to Infer the causal relationship between the two. convenience sampling could introduce selection bias, as the participants may not represent the broader population of operating room nurses. It is suggested that future studies may expand the scope of population and institutions, supplemented by qualitative research methods, to dig deeper into the factors related to sexual harassment in the operating room, such as the abuser’s psychological state and motivation, the way of coping with different personalities, and the reaction of the bystanders, so as to formulate the strategies of safety in the occupational environment.
Conclusion
The results of this study show that the incidence of sexual harassment in the operating room is high and affects nurses’ productivity and physical and mental health. Operating room nurses had insufficient knowledge of the law on sexual harassment and lacked support from hospital organizations. agreeableness and openness personality traits, alcohol consumption, age, being married, and lack of social support were influential factors of sexual harassment in the operating room. Healthcare organizations should encourage reporting, care for victims, and join with the police department, judiciary, and women’s federation to develop reporting procedures and training programs on sexual harassment knowledge to create a safe and comfortable professional environment.
Acknowledgements
I would like to acknowledge the support of operation room nurses who completed this survey and the medical institutions who helped distribute the survey.
Abbreviations
- OR*
Operating Room
- OR
Odds Ratio
- SEQ
Sexual Experience Questionnaire
- WSEQ
Workplace Sexual Harassment Questionnaire
Author contributions
Lingyu Tang conceptualized the study; was responsible for the methodology, investigation, resources, visualization, and data curation; analyzed the data; prepared the original draft of the manuscript. Xingli Yu conceptualized the study; was responsible for investigation, resources, visualization, and software; analyzed the data; prepared the original draft of the manuscript. Yanshu Liu was responsible for investigation, resources, visualization, and software; analyzed the data. Jie Zhou reviewed and edited the manuscript.Daiying Zhang reviewed and edited the manuscript.Juan Wang supervised the study and administrated the project. Qingyan Liu reviewed and edited the manuscript; supervised the study and administrated the project. The all authors read and approved the final manuscript.
Funding
The author reports no funding for this research.
Data availability
Due to the sensitivity and privacy of the topic of this study, especially in the relatively culturally conservative western China, we are not prepared to publicize the data, and if the researchers concerned have a need for the study, the data for this paper can be obtained by sending an e-mail to the corresponding author (lqycz0104@126.com), who will give it at her discretion.
Declarations
Ethical approval and consent to participate
This study was approved by the Ethics Committee of the Affiliated Hospital of Southwest Medical University (KY2023316) and registered with the China Clinical Trials Center (ChiCTR2300078557). All participants provided informed consent. Participant involvement was voluntary, and those who were unwilling to continue and quit any stage of the process were able to do so without any restriction. Data were carefully analysed to ensure the anonymity, privacy, and confidentiality of the participant nurses.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Contributor Information
Juan Wang, Email: 383029930@qq.com.
Qingyan Liu, Email: lqycz0104@126.com.
References
- 1.Lu L, Dong M, Lok G, K I, et al. Worldwide prevalence of sexual harassment towards nurses: A comprehensive meta-analysis of observational studies [J]. J Adv Nurs. 2020;76(4):980–90. 10.1111/jan.14296. [DOI] [PubMed] [Google Scholar]
- 2.Jeong S, Chang HE. Workplace sexual harassment toward male nurses in South Korea: a cross-sectional online survey [J]. BMC Nurs. 2022;21(1):303. 10.1186/s12912-022-01091-x. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Raj A, Johns NE, Jose R. Gender Parity at Work and Its Association With Workplace Sexual Harassment [J]. Workplace Health Saf. 2020;68(6):279–92. 10.1177/2165079919900793. [DOI] [PubMed] [Google Scholar]
- 4.Hahn S, Hantikainen V, Needham I, et al. Patient and visitor violence in the general hospital, occurrence, staff interventions and consequences: a cross-sectional survey [J]. J Adv Nurs. 2012;68(12):2685–99. 10.1111/j.1365-2648.2012.05967.x. [DOI] [PubMed] [Google Scholar]
- 5.Kahsay WG, Negarandeh R, Nayeri ND, et al. Sexual harassment against female nurses: a systematic review [J]. BMC Nurs. 2020;19(1). 10.1186/s12912-020-00456-4. [DOI] [PMC free article] [PubMed]
- 6.Hanson LLM, Nyberg A, Mittendorfer-Rutz E, et al. Work related sexual harassment and risk of suicide and suicide attempts: prospective cohort study [J]. BMJ-British Med J. 2020;370:m2984. 10.1136/bmj.m2984. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Farkas AH, Scholcoff C, Machen JL, et al. The Experience of Male Physicians with Sexual and Gender-Based Harassment: a Qualitative Study [J]. J Gen Intern Med. 2020;35(8):2383–8. 10.1007/s11606-020-05695-4. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Dagnaw EH, Sisay FA, Tadesse SG, et al. Sexual Harassment at the Workplace is Still a Hindrance among Midwives and Nurses Working in Northwestern Ethiopia Referral Hospitals: A Multicenter Cross-Sectional Study [J]. J Multidiscip Healthc. 2022;15:2453–9. 10.2147/JMDH.S368061. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Rabelo VC, Cortina LM. Two Sides of the Same Coin: Gender Harassment and Heterosexist Harassment in LGBQ Work Lives [J]. Law Hum Behav. 2014;38(4):378–91. 10.1037/lhb0000087. [DOI] [PubMed] [Google Scholar]
- 10.Mclaughlin H, Uggen C, Blackstone A, Sexual, Harassment. Workplace Authority, and the Paradox of Power [J]. Am Sociol Rev. 2012;77(4):625–47. 10.1177/0003122412451728. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11.Parini S, Azzolina D, Lucidi D, et al. Women in thoracic, cardiac and vascular surgery claim for a change in the working situation: an Italian national survey [J]. J Thorac Dis. 2023;15(12):6623–33. 10.21037/jtd-23-1123. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.Freedman-Weiss MR, Coppersmith NA, Chiu AS, et al. Sexual Harassment in Surgery-Is Operating Room Culture the Culprit? [J]. Am Surg. 2023;89(12):6121–6. 10.1177/00031348231189832. [DOI] [PubMed] [Google Scholar]
- 13.Higgins BL, Macintosh J. Operating room nurses’ perceptions of the effects of physician-perpetrated abuse [J]. Int Nurs Rev. 2010;57(3):321–7. 10.1111/j.1466-7657.2009.00767.x. [DOI] [PubMed] [Google Scholar]
- 14.Minkyung GU, Kim YS, Sohyune S. Factors influencing turnover intention among operating room nurses in South Korea [J]. J Nurs Res 2022, 30(1): e192. 10.1097/jnr.0000000000000467 [DOI] [PubMed]
- 15.Nayyar A, Scarlet S, Strassle PD, Ollila DW, Erdahl LM, Mcguire KP, Gallagher KKA. National survey of sexual harassment among surgeons. paper presented at: 14thAnnual Academic Surgical Congress; February 5–7. 2019.Accessed January 15,2024. https://www.asc-abstracts.org/abs2019/85-06-a-national-survey-of-sexual-harassmentamong-surgeons/
- 16.Alhassan AK, Alsaqat RT, Al Sweleh FS. Sexual workplace violence in the health sector in Saudi Arabia: a cross sectional study [J]. BMC Health Serv Res. 2023;23(1):1065. 10.1186/s12913-023-10080-y. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.Fallahi KM, Okogie F, Ghazanfari N, Najafi F, Tamizi Z, Afshani S, et al. The frequency, contributing and preventive factors of harassment towards health professionals in Iran [J]. Int J Commun Based Nurs Midw. 2015;3(3):156–146. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4495323/. [PMC free article] [PubMed] [Google Scholar]
- 18.Kamchuchat C, Chongsuvivatwong V, Oncheunjit S, et al. Workplace violence directed at nursing staff at a general hospital in southern Thailand [J]. J Occup Health. 2008;50(2):201–7. 10.1539/joh.o7001. [DOI] [PubMed] [Google Scholar]
- 19.Tekin YE, Bulut H. Verbal, physical and sexual abuse status against operating room nurses in Turkey [J]. Sex Disabil. 2014;32:85–97. 10.1007/s11195-014-9339-7. [Google Scholar]
- 20.Park M, Cho SH, et al. Prevalence and perpetrators of workplace violence by nursing unit and the relationship between violence and the perceived work environment [J]. J Nurs Scholarsh. 2015;47(1):87–95. 10.1111/jnu.12112. [DOI] [PubMed] [Google Scholar]
- 21.Nukala M, Freedman-Weiss M, Yoo P et al. Sexual Harassment in Vascular Surgery Training Programs [J]. Annals of vascular surgery, 2020, 62:92–7. 10.1016/j.avsg.2019.05.011 [DOI] [PubMed]
- 22.Huang Y, Chua TC, Saw RPM, et al. Discrimination, Bullying and Harassment in Surgery: A Systematic Review and Meta-analysis [J]. World J Surg. 2018;42(12):3867–73. 10.1007/s00268-018-4716-5. [DOI] [PubMed] [Google Scholar]
- 23.Giglio V, Schneider P, Madden K et al. Perpetrators of Gender-Based and Sexual Harassment in the Field of Orthopaedic Surgery [J]. JB & JS open access, 2022, 7(1):e21.00098. 10.2106/JBJS.OA.21.00098 [DOI] [PMC free article] [PubMed]
- 24.Gostlow H, Vega CV, Marlow N, et al. Do Surgeons React? A Retrospective Analysis of Surgeons’ Response to Harassment of a Colleague During Simulated Operating Theatre Scenarios [J]. Ann Surg. 2018;268(2):277–81. 10.1097/SLA.0000000000002434. [DOI] [PubMed] [Google Scholar]
- 25.Kurpisz J, Mak M, et al. Personality traits, gender roles and sexual behaviours of young adult males.[J]. Ann Gen Psychiatry. 2016;15:28. 10.1186/s12991-016-0114-2. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 26.Bondü R, Birke JB, Aggression-Related S. Prevalence Rates, Sex Differences, and Links With Personality, Attitudes, and Behavior [J]. J Sex Med. 2021;18(8):1383–97. 10.1016/j.jsxm.2021.06.006. [DOI] [PubMed] [Google Scholar]
- 27.Carvalho J, Nobre PJ, et al. Five-Factor Model of Personality and Sexual Aggression [J]. Int J Offender Ther Comp Criminol. 2019;63(5):797–814. 10.1177/0306624X13481941. [DOI] [PubMed] [Google Scholar]
- 28.Lake ET, Sanders J, Duan R et al. A Meta-Analysis of the Associations Between the Nurse Work Environment in Hospitals and 4 Sets of Outcomes [J]. 2019, 57(5): 353–61. 10.1097/MLR.0000000000001109 [DOI] [PMC free article] [PubMed]
- 29.Sandelin A, Kalman S, Gustafsson B. Prerequisites for safe intraoperative nursing care and teamwork-Operating theatre nurses’ perspectives: A qualitative interview study [J]. J Clin Nurs. 2019;28(13–14):2635–43. 10.1111/jocn.14850. [DOI] [PubMed] [Google Scholar]
- 30.Cortina LM, Wasti SA. Profiles in coping: responses to sexual harassment across persons, organizations, and cultures [J]. J Appl Psychol. 2005;90(1):182–92. 10.1037/0021-9010.90.1.182. [DOI] [PubMed] [Google Scholar]
- 31.ThØrrisen m m. The Ten-Item Personality Inventory (TIPI): a scoping review of versions, translations and psychometric properties [J]. Front Psychol. 2023;14:1202953. 10.3389/fpsyg.2023.1202953. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 32.Li J. Reliability and validity test of the Chinese 10-item Big Five Personality Inventory (TIPI-C) [J]. Chinese Journal of Health Psychology [J]. 2013, 21(11): 1688–1692. 10.13342/j.cnki.cjhp.2013.11.008. (Available from Cnki).
- 33.Qianyi Y. The impact of workplace sexual harassment on female employees’ interpersonal stress [D]. Dissertation, Jinan Univ., 2019. https://kns.cnki.net/kns8s/defaultresult/index?crossids=YSTT4HG0%2CLSTPFY1C%2CJUP3MUPD%2CMPMFIG1A%2CWQ0UVIAA%2CBLZOG7CK%2CPWFIRAGL%2CEMRPGLPA%2CNLBO1Z6R%2CNN3FJMUV%26korder=SU%26kw=%E8%81%8C%E5%9C%BA%E6%80%A7%E9%AA%9A%E6%89%B0%E5%AF%B9%E5%A5%B3%E6%80%A7%E5%91%98%E5%B7%A5%E4%BA%BA%E9%99%85%E5%85%B3%E7%B3%BB%E5%8E%8B%E5%8A%9B%E7%9A%84%E5%BD%B1%E5%93%8D. (Available from Cnki.).
- 34.Papantoniou P. Are male nurses sexually harassed? A cross-sectional study in the Greek Health System [J]. BMC Nurs. 2021;20(1):137. 10.1186/s12912-021-00656-6. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 35.Papantoniou P. Comparative analysis of sexual harassment between male and female nurses: A cross-sectional study in Greece [J]. J Nurs Adm Manag. 2022;30(6):1470–81. 10.1111/jonm.13419. [DOI] [PubMed] [Google Scholar]
- 36.Papantoniou P. Sexual harassment and organisational silencing in nursing: a cross-sectional study in Greece [J]. BMJ open. 2021;11(11):e050850. 10.1136/bmjopen-2021-050850. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 37.Mohammed A, Ansah EW, Apaak D. Sexual harassment as experienced by nurses from selected healthcare facilities in Ghana [J]. BMC Nurs. 2023;22(1):117. 10.1186/s12912-023-01228-6. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 38.Song CY, Wang GL, Wu HY. Frequency and barriers of reporting workplace violence in nurses: An online survey in China [J]. Int J Nurs Sci. 2021;8(1):65–70. 10.1016/j.ijnss.2020.11.006. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 39.Zeighami M, Shahrbabaki PM, Zakeri MA, et al. Loss of Individual and Social Identity: Consequences of Sexual Harassment of Iranian Nurses in the Workplace [J]. Front Psychol. 2021;12:770859. 10.3389/fpsyg.2021.770859. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 40.Kaur A, Ahamed F, Sengupta P, et al. Pattern of workplace violence against doctors practising modern medicine and the subsequent impact on patient care, in India [J]. PLoS ONE. 2020;15(9):e0239193. 10.1371/journal.pone.0239193. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 41.Zhu L, Li L, Lang J. Gender differences in workplace violence against physicians of obstetrics and gynecology in China: A questionnaire in the national congress [J]. PLoS ONE. 2018;13(12):e0208693. 10.1371/journal.pone.0208693. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 42.Sun T, Gao L, Li FJ, et al. Workplace violence, psychological stress, sleep quality and subjective health in Chinese doctors: a large cross-sectional study [J]. BMJ open. 2017;7(12):e017182. 10.1136/bmjopen-2017-017182. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 43.Herzberg wait. Zhang Zhan. Herzberg’s two-factor theory [M]. Herzberg’s two-factor theory, China Renmin University Press, 2009. ISBN: 978-7-300-10723-3. https://xueshu.baidu.com/usercenter/paper/show?paperid=333ce4955906b3537550c2a0b8d1a1cf&site=xueshu_se&hitarticle=1. (Available from from Baidu Academic).
- 44.Allen MS, Walter EE. Linking big five personality traits to sexuality and sexual health: A meta-analytic review [J]. Psychol Bull. 2018;144(10):1081–110. 10.1037/bul0000157. [DOI] [PubMed] [Google Scholar]
- 45.Allen MS, Desille AE. Personality and sexuality in older adults [J]. Psychol Health. 2017;32(7):843–59. 10.1080/08870446.2017.1307373. [DOI] [PubMed] [Google Scholar]
- 46.Weldesenbet H, Yibeltie J, Hagos T. Sexual Harassment and Associated Factors Among Female Nurses: The Case of Addis Ababa Public Hospitals [J]. Psychol Res Behav Manage. 2022;15:3053–68. 10.2147/PRBM.S372422. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 47.Bekalu YE, Wudu MA. Prevalence of Workplace Violence and Associated Factors Against Nurses Working in Public Hospitals in Northeastern Ethiopia, 2022 [J]. Sage Open Nurs. 2023;9:23779608231171776. 10.1177/23779608231171776. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 48.Chen W, Schilling BK, Bourne DA, et al. A Report of Gender Bias and Sexual Harassment in Current Plastic Surgery Training: A National Survey [J]. Plast Reconstr Surg. 2021;147(6):1454–68. 10.1097/PRS.0000000000007994. [DOI] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
Due to the sensitivity and privacy of the topic of this study, especially in the relatively culturally conservative western China, we are not prepared to publicize the data, and if the researchers concerned have a need for the study, the data for this paper can be obtained by sending an e-mail to the corresponding author (lqycz0104@126.com), who will give it at her discretion.