Skip to main content
NCBI home page
International Journal of Biological Sciences logoLink to International Journal of Biological Sciences
. 2019 Jan 29;15(4):749–756. doi: 10.7150/ijbs.28144

Prevalence of sexual harassment of nurses and nursing students in China: a meta-analysis of observational studies

Liang-Nan Zeng 1,#, Qian-Qian Zong 2,3,#, Ji-Wen Zhang 2,#, Li Lu 4,#, Feng-Rong An 3,#, Chee H Ng 5, Gabor S Ungvari 6,7, Fang-Yu Yang 2, Teris Cheung 8, Ligang Chen 1,✉, Yu-Tao Xiang 4,✉
PMCID: PMC6429024  PMID: 30906207

Abstract

Sexual harassment experienced by nurses and nursing students is common and significantly associated with negative consequences. This study is a meta-analysis of the pooled prevalence of sexual harassment of nurses and nursing students in China. Electronic databases (PubMed, EMBASE, PsycINFO, Web of Science and Ovid, China National Knowledge Internet, WanFang, SinoMed and Chinese VIP Information) were independently and systematically searched by two reviewers from their commencement date to 12 March 2018. Forty-one studies that reported the prevalence of sexual harassment were analyzed using the random-effects model. The pooled prevalence of sexual harassment was 7.5% (95% CI: 5.5%-10.1%), with 7.5% (5.5%-10.2%) in nurses and 7.2% (3.0%-16.2%) in nursing students. Subgroup analyses showed that the year of survey and sample size were significantly associated with the prevalence of sexual harassment, but not the seniority of nursing staff, department, hospital, economic region, timeframe, age, working experience or subtypes of harassment. In China, sexual harassment was found to be common in nurses and nursing students. Considering the significant negative impact of sexual harassment, effective preventive and workplace measures should be developed.

Keywords: Sexual harassment, nurses, China

Introduction

Sexual harassment, defined as repeated and unwelcome sexual behavior including its verbal, physical, mental or visual forms 1-3, is common in the workplace. Healthcare workers, especially nursing staff, are more likely to be exposed to offensive behaviors, including sexual harassment, than other professions 4, 5. Sexual harassment is associated with negative health consequences, such as physical and mental health problems and impaired occupational performance 6, 7.

The results across studies on the pattern of sexual harassment of nursing staff have been conflicting 8, probably due to different sampling methods, measures, and the given sociocultural context 4. For instance, the prevalence of sexual harassment of newly licensed registered nurses in Korea was 22.4% 9. Other studies reported that the prevalence of sexual harassment in nurses was 16.2% in Europe 8, while the corresponding figure was 13.02% in Ethiopia, 10% in Gambia 10, 11 and 3.9% in China 12.

In order to develop preventive measures and reduce the negative consequences of sexual harassment of nursing staff, it is necessary to understand the patterns of sexual harassment. However, due to variable sociocultural and economic impact of sexual harassment in different countries, findings in a country cannot be generalized to other countries or regions. Some studies have examined the patterns of sexual harassment of nursing staff in China, which yielded mixed results. For instance, the prevalence of sexual harassment in nurses was 63.4% in Wuhan 13, and 3.9% in another survey of 16 provinces of mainland China 12. In contrast, the corresponding figure was 12.9% in Taiwan and 4.6% in Macau 14, 15. The mixed findings in China gave the impetus to conduct a meta-analysis of the pooled prevalence of sexual harassment of nurses and nursing students in China and examined its associated factors. Both English and Chinese databases were searched for ascertaining studies for this meta-analysis.

Methods

Search strategy

This meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Both English (PubMed, EMBASE, PsycINFO, Web of Science and Ovid) and Chinese (China National Knowledge Internet, WanFang, SinoMed and Chinese VIP Information) databases were independently and systematically searched by two reviewers (ZLN and ZQQ) from their commencement date to 12 March 2018. The search terms are shown in Supplemental Table 1 (The asterisk “*” in Supplemental Table 1 is a commonly used wildcard symbol that broadens the search by finding words that start with the same letters). The reference lists of the selected papers were also searched manually to avoid missing any additional papers.

Study selection

Studies were included if they fulfilled the following criteria: (1) cross-sectional or cohort studies conducted in mainland China, Hong Kong, Macao and Taiwan (only baseline data were extracted in cohort studies); and (2) the prevalence of workplace sexual harassment or its different subtypes, such as physical or verbal sexual harassment, of nurses and/or nursing students were reported.

Three reviewers (ZLN, ZQQ and ZJW) independently screened the literature by reviewing titles and abstracts first, and then reading the full papers. Any discrepancies between the three reviewers in the process were discussed and resolved by involving a fourth reviewer (LL). If more than one paper was published based on the same study, only the paper with the largest sample size was included in the analyses.

Quality evaluation

The methodological quality of included studies was evaluated by a quality assessment instrument for epidemiological studies 16, which was completed by two independent reviewers (ZQQ and ZJW). The assessment instrument contains the following parts: (1) the targeted population was clearly defined; (2) the sample was recruited by random or consecutive sampling methods; (3) the response rate was equal or more than 70%; (4) the sample was representative; (5) a clear definition of sexual harassment was given; and (6) the instruments used to assess sexual harassment were validated measures. One point was given when a study satisfied each item and a total score was generated by adding the score of each item.

Statistical analysis

All data were analyzed using the Comprehensive Meta-Analysis statistical software (Version 2.0) (http://www.meta -analysis.com). Heterogeneity across studies was measured using the I2 statistics, with I2 statistics higher than 50% being defined as great heterogeneity. Due to diverse demographic characteristics, sampling methods and measures on sexual harassment, prevalence estimates were synthesized using the random-effect model 17. Subgroup analyses were conducted to investigate the potential sources of heterogeneity based on the following variables: age, working experience and seniority of nursing staff, department, hospital, economic region, geographic regions of greater China (i.e., mainland China vs. Hong Kong/Macao/Taiwan), year of survey, sample size, timeframe (1 year prevalence vs. others), and subtype of harassment. The seniority of nursing staff consists of nurses and nursing students. According to the National Chinese Bureau of Statistics 18, China is collapsed into four regions for the purpose of this study: east, west, central, and northeast of China. Hospital types included tertiary, secondary, primary hospitals 19. Year of survey, sample size, mean age and working experience were categorized using the median splitting method. Publication bias was assessed by funnel plot and the Egger's regression model 20. All analyses were two-tailed, and the significance level was set at 0.05.

Results

Literature search, study characteristics and quality assessment

The process of the literature search and selection process are shown in Figure 1. In total, 4,696 records were identified of which 41 studies (8 published in English and 33 in Chinese) covering 40,617 participants were included in the meta-analysis. Thirty-seven studies reported the overall prevalence of sexual harassment, two studies 21, 22 provided the prevalence of verbal and physical harassment separately, and another two 23, 24 only reported the prevalence of verbal harassment.

Figure 1.

Figure 1

Open in a new tab

Flowchart of study selection

Table 1 shows the basic characteristics of the studies included in the meta-analysis. They were published from 2004 to 2018; in the 34 studies with data on gender distribution, 95.81% of participants were females. Thirty-one studies had nurse participants, 9 had nursing student participants and one study had both nurses and nursing students 25.

Table 1.

Characteristics of the studies included in the meta-analysis

No. Studies
(First author, year)		 References Region Economic region Study year Assessment tools Population type Response
Rate (%)		 Sample
size		 Proportion of females (%) Age
(mean±SD)		 Hospital type& Department # Sampling method Quality score
1 Chen (2004) 57 Guangdong East 2003 SDQ N 100 273 97 NR Mix Emergency C1 6
2 Xia (2005) 27 NR NR NR SDQ NS NR 274 100 19.97 NR NR NR 5
3 Zhao (2005) 35 Gansu West 2003 SDQ N 100 21 100 36.08±8.86 NR Psychiatry C1 5
4 Kwok (2006) 31 Hong Kong - 2003-2004 WVQ N 25 420 91.89 NR NR Mix C1 5
5 Yang (2008) 58 Guangdong East 2006-2008 QDC N 91.35 1552 95.1 29.29±6.19 Mix Mix M 6
6 Chen (2009) 21 NR NR NR QDWP NS 97.25 657 91.78 22.56±1.07 Mix Mix C2 5
7 Guo (2009) 22 Liaoning Northeast NR QDWP N 95.5 188 NR NR Tertiary Emergency C1 6
8 Xu (2009) 59 Shandong East 2007 QDWP NS 100 536 NR 20.41±2.17 NR Mix C1, S 6
9 Gao (2010) 37 Sichuan West NR SDQ N 100 146 93.84 NR NR Psychiatry C1 5
10 Liu (2010) 38 NR NR 2008-2009 SDQ NS 97.1 126 100 NR Tertiary Mix C1 5
11 Pai (2011) 15 Taiwan - NR WVQ N 77.9 521 95.59 36.2±7.9 NR NR R 6
12 Chen (2011) 60 Guangdong East 2008 SDQ N NR 2339 NR NR Mix Mix C1, S 6
13 Liao (2011) 44 NR NR 2009 SDQ N 100 100 100 34.79±8.87 Mix Mix C2 6
14 Qiu (2011) 45 Guangdong East 2010 SDQ N 100 179 NR NR Tertiary Emergency C1, S 6
15 Xiong (2011) 39 Hunan Central NR QDD NS NR 436 100 20.37 NR Mix C1, S 5
16 Zhu (2011) 32 Henan Central NR SDQ N NR 689 NR NR NR Mix C1 5
17 Wu (2012) 33 NR NR 2009 SDQ N NR 1033 96.7 NR Mix Mix R 4
18 Yang (2012) 34 Henan Central NR SDQ N NR 673 NR NR NR Mix C1, R 5
19 Zhang (2012) 24 Guangdong East NR QDC N 93.75 143 88.11 30.45±5.74 Tertiary Emergency R 6
20 Liu (2013) 61 Jilin Northeast NR QDW N 100 420 100 34.65±9.28 Community NR C2 6
21 Xu (2013) 28 Jilin Northeast 2012-2013 SDQ NS 100 400 94.25 21.48 Tertiary Mix NR 4
22 Yu (2013) 23 Guangdong East 2011 QDC N NR 143 88.11 30.45±5.74 Tertiary Emergency C2 6
23 Fang (2014) 26 NR NR 2012-2013 SDQ NS NR 617 91.41 21.3 Mix Mix NR 4
24 Hu (2014) 62 Shandong East 2013 QDY N 98.79 395 79 33.72±7.85 Mix Psychiatry C1 6
25 Lian (2014) 40 Fujian East 2013 QDC N NR 1436 90.39 NR Mix Mix R 5
26 Zhang (2014) 29 Neimenggu West NR QDC N 98.31 58 91.38 26.34±3.85 NR Emergency NR 5
27 Guan (2015) 43 Beijing East 2010-2011 SDQ N NR 444 97.07 28 Mix Emergency C1 6
28 Su (2015) 63 Shanxi Central 2013-2014 QDC N NR 672 98.21 24.7 Mix Mix C1 6
29 Sun (2015) 25 Liaoning Northeast 2014 SDQ Both 98.9 975 98.15 NR Tertiary Mix R 6
30 Xiao (2015) 64 Hunan Central 2014 QDW N NR 778 93.19 28.9±5.26 Tertiary Mix R 6
31 Yu (2015) 65 Heilongjiang Northeast 2014 QDC N 94.6 1597 95.87 30.03±6.89 Tertiary Mix C2 6
32 Du (2016) 66 Beijing East NR QDWP NS NR 317 85.8 NR Tertiary Mix C2 6
33 Fan (2016) 41 NR NR NR QDWP NS NR 284 95.4 24.3±0.83 Mix Mix C1 5
34 Fang (2016) 67 NR NR NR QDC N 93.54 608 97.86 27.43±3.19 Mix Mix M 6
35 Cheung (2017) 14 Macao - 2014 WVQ N NR 613 NR NR NR Mix C2 5
36 Cheung (2017) a 30 Hong Kong - 2013 WVQ N 5.3 850 87.65 NR NR NR C1 5
37 Shi (2017) 12 NR NR 2014-2016 QDC N NR 15970 97.64 NR Mix Mix M, S 5
38 Zhang (2017) 42 NR NR 2014 WVQ N 92.97 3004 97.04 29.37±6.18 Mix Mix S 5
39 Niu (2017) 68 Beijing East 2014 QDY N 96.6 385 94.29 29.6±6 Mix Emergency C2 6
40 Yang (2018) 13 Hubei Central NR SDQ N NR 245 66.8 31.4±7.43 NR Psychiatry NR 4
41 Zhou (2018) 36 Henan Central 2014-2016 NR N NR 100 97 30.14 Tertiary Emergency C1 4
Open in a new tab

NR: Not reported. SD, standard deviation.

Population type: N: Nurse. NS: Nursing student.

Assessment tools: SDQ, self-designed questionnaire; WVQ, workplace violence in the health sector country case studies research instruments survey questionnaires;

QDC, questionnaire designed by Chen ZH; QDW, questionnaire designed by Wang SY; QDWP, questionnaire designed by Wang PX; QDD, questionnaire designed by Ding DW; QDY, questionnaire designed by Yang XD;

Sampling method: C1, cluster sampling; C2, convenient sampling; M, multistage sampling; R, random sampling; S, stratified sampling.

&: Hospital types include: tertiary, secondary, primary, community and county-level hospitals.

The mean score of the quality assessment was 5.1 ranging from 3 to 6. Five studies 13, 26-29 did not report sampling methods, and 6 studies 14, 30-34 did not report the response rate or the response rate was less than 70%. The definition of sexual harassment was not defined in 14 studies 12, 13, 21, 26, 28, 33, 35-42 and the instruments on sexual harassment were not validated in 11 studies 21, 26, 27, 32-36, 43-45.

Prevalence of sexual harassment against nursing staff

The overall prevalence of sexual harassment from the 37 studies covering 39,486 participants was 7.5% (95% CI: 5.5-10.1%) (Figure 2), 7.5% (5.5%-10.2%) in nurses and 7.2% in nursing students (3.0%-16.2%). The pooled 1-year prevalence of sexual harassment was 7.1% (95% CI: 5.1%-9.8%) (Table 2).

Figure 2.

Figure 2

Open in a new tab

Forest plot of the prevalence of sexual harassment of nurses and nursing students

Table 2.

Subgroup analyses by study characteristics

Subgroups Categories (No. of studies) Prevalence (%) 95% CI (%) Sample size Events I2 (%) P value within subgroup Q (P value across subgroups)
Population type Nurses (28) 7.5 5.5-10.2 35521 2127 97.79 <0.001 0.013 (0.909)
Nursing students (8) 7.2 3.0-16.2 2990 353 97.72 <0.001
Department Psychiatry (4) 28.5 9.1-61.4 807 234 98.09 <0.001 4.928 (0.085)
Emergency (9) 6.3 3.0-12.5 1991 168 94.28 <0.001
Others (4) # 8.7 4.9-14.9 967 84 81.95 <0.001
Hospital type Tertiary (12) 7.3 4.2-12.5 14554 905 98.15 <0.001 0.444 (0.801)
Secondary (3) 9.9 4.8-19.4 1225 176 90.97 <0.001
Primary (2) 7.9 3.0-18.9 380 37 73.00 0.054
Economic region Central (7) 12.0 4.8-27.1 3593 464 98.76 <0.001 3.643 (0.303)
East (10) 5.6 3.7-8.4 7856 642 95.13 <0.001
Northeast (4) 8.7 3.5-20.0 3392 314 98.29 <0.001
West (3) 13.8 3.5-41.6 225 27 88.58 <0.001
Regions of China Mainland China (28) 7.1 5.0-10.0 35690 2229 98.32 <0.001 0.261 (0.610)
Hong Kong, Macao and Taiwan (4) 5.7 2.5-12.4 2404 155 95.76 <0.001
Year of survey 2003-2012 (11) 11.1 7.1-17.1 7023 706 96.74 <0.001 6.022 (0.014)
2013-2016 (14) 5.2 3.4-7.8 27792 1309 97.69 <0.001
Sample size >436 (19) 5.3 4.1-7.0 34907 1840 96.60 <0.001 6.311 (0.012)
=/<436 (18) 11.1 6.7-17.9 4579 704 97.10 <0.001
Timeframe 1 year (23) 7.1 5.1-9.8 32723 2020 97.97 <0.001 0.007 (0.177)
Others (4) & 7.7 1.3-34.6 617 39 94.84 <0.001
Age (years) >28 (12) 11.2 6.2-19.4 9118 827 98.43 <0.001 1.825 (0.177)
=/<28 (10) 6.1 3.1-11.7 4329 408 97.23 <0.001
Working experience
(years)		 >3.4 (11) 9.6 5.1-17.5 8822 784 98.51 <0.001 0.279 (0.598)
=/<3.4 (9) 7.4 5.1-17.5 8822 784 98.51 <0.001
Types of harassment Physical harassment (6) 2.2 0.4-11.4 2227 135 97.57 <0.001 1.531 (0.216)
Verbal harassment (13) 7.0 3.3-14.2 4545 365 97.57 <0.001
Open in a new tab

Q, Cochran's Q.

Bold value: p<0.05

#: Others: contains departments of emergency, psychiatry, internal medicine, surgery, pediatrics and outpatient.

&: Others: timeframe contains 2, 4, 6 months of prevalence of sexual harassment

Subgroup analyses

Subgroup analyses revealed that the prevalence of sexual harassment reported in studies conducted before 2012 was higher than those after 2013 (11.1% vs. 5.2%, P=0.014), while the figure was lower in studies with sample size larger than 436 than those with simple size of =/< 436 (5.3% vs 11.1%, Q=6.311, P=0.012) (Table 2). In contrast, the prevalence of sexual harassment was not significantly associated with mean age, seniority and length of working experience of nursing staff, department, hospital, economic and geographic regions of China, and the timeframe (all p values>0.05).

Thirteen studies reported at least one type of sexual harassment: 6 studies reported both physical and verbal sexual harassments and 7 studies reported only verbal sexual harassment. The overall prevalence of physical and verbal harassment was 2.2% and 7.0%, respectively.

Publication bias

Figure 3 shows the results of the funnel plot and the Egger's test (t=0.574, 95% CI: -3.15, 5.64%, P=0.57) showing no publication bias.

Figure 3.

Figure 3

Open in a new tab

Funnel plot of publication bias for the 37 studies with available data on prevalence of sexual harassment

Discussion

To the best of our knowledge, this was the first meta-analysis of the prevalence of sexual harassment of nurses and nursing students in China. The overall prevalence of sexual harassment of nursing staff and nursing students was 7.5% and 7.2% respectively. This implies that of the estimated 3.79 and 1.8 million registered nurses and nursing students in China in 2017 and 2016, respectively 46, 47, around 284,250 nurses and 129,600 nursing students in China may have been subjected to sexual harassment.

The prevalence of sexual harassment of Chinese nursing staff in this study was lower than the figures reported from most other countries. For example, 13.0% of nurses reported sexual harassment in the past 6 months in Southern Ethiopia 10, while the corresponding figures were 22.8% in Malaysia 48 and 22.4% in South Korea. Different definitions, measures and time frames may partly contribute to the discrepancy between these results. In addition, it is possible that the training and campaign against sexual harassment in medical settings in China have resulted in the lower prevalence of sexual harassment of nursing staff.

In this study the prevalence of sexual harassment was associated with year of survey (2003-2012 vs. 2013-2016, P=0.014). In 2012, the law on the protection of rights of female employees was implemented in China 49, which may have reduced the risk of sexual harassment of female health workers. Similar to other studies 50, smaller simple size was associated with higher prevalence of sexual harassment in this study. There is no explanation for this observation except that the findings of studies with smaller sample size may not have been stable. Maybe participants in a smaller sample could have been more thoroughly interviewed and disclosed more cases of sexual harassment.

A survey in Italy 51 found that the prevalence of sexual harassment of nurses was higher than that of nursing students (13.9% vs. 5.8%; P<0.001), which was not confirmed in this study (7.5% vs. 7.2%; P=0.909). In this study, the prevalence of sexual harassment was highest in departments of psychiatry (28.5%), which is consistent with previous findings 52. Compared to patients in other medical departments, psychiatric patients are more likely to present with disinhibited or antisocial or aggressive behaviour including sexual harassment 53. Older nurses with longer working experience were more likely to experience sexual harassment 54, 55. This is partly because the experienced nurses are usually responsible for handling more challenging patients, which could increase the likelihood of workplace violence and sexual harassment. However, this finding was not confirmed in the current meta-analysis. Although the difference between verbal and physical harassments did not reach statistically significant level (7% vs. 2.2%, P=0.216), verbal harassment was more common, which is consistent with a Malaysian study (46.6% vs. 20.7%) 48.

There are several limitations to this meta-analysis. First, most studies did not report the perpetrators of sexual harassment, hence this variable could not be examined. Second, substantial heterogeneity was present in subgroup analyses as it is unavoidable in meta-analysis of epidemiological surveys 56. Third, most nurses in the included studies were females, therefore the prevalence of sexual harassment in male nurses could not be examined. Fourth, there have been no gold standard measures on sexual harassment, therefore the sexual harassment was measured by different instruments across studies. Finally, some relevant factors pertaining to sexual harassment, such as age and sex, were not reported in some studies, which may have affected the findings of subgroup analyses.

In conclusion, sexual harassment, particularly verbal harassment of nurses and nursing students, is common in China. Considering the significant negative impact of sexual harassment, effective preventive and workplace measures should be developed.

Supplementary Material

Supplementary table.

Click here for additional data file. (152.3KB, pdf)

Acknowledgments

The study was supported by the University of Macau (MYRG2015-00230-FHS; MYRG2016-00005-FHS), National Key Research & Development Program of China (No. 2016YFC1307200), Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support (No.ZYLX201607) and Beijing Municipal Administration of Hospitals' Ascent Plan (No. DFL20151801).

References

  • 1.Bronner G, Peretz C, Ehrenfeld M. Sexual harassment of nurses and nursing students. Journal of advanced nursing. 2003;42:637–44. doi: 10.1046/j.1365-2648.2003.02667.x. [DOI] [PubMed] [Google Scholar]
  • 2.Fallahi Khoshknab M, Oskouie F, Ghazanfari N, Najafi F, Tamizi Z, Afshani S. et al. The frequency, contributing and preventive factors of harassment towards health professionals in Iran. International journal of community based nursing and midwifery. 2015;3:156–64. [PMC free article] [PubMed] [Google Scholar]
  • 3.Nelson R. Sexual harassment in nursing: a long-standing, but rarely studied problem. The American journal of nursing. 2018;118:19–20. doi: 10.1097/01.NAJ.0000532826.47647.42. [DOI] [PubMed] [Google Scholar]
  • 4.Nielsen MBD, Kjaer S, Aldrich PT, Madsen IEH, Friborg MK, Rugulies R. et al. Sexual harassment in care work - dilemmas and consequences: A qualitative investigation. International journal of nursing studies. 2017;70:122–30. doi: 10.1016/j.ijnurstu.2017.02.018. [DOI] [PubMed] [Google Scholar]
  • 5.Prasad K. Sexual harassment in the work place. The Nursing journal of India. 2007;98:9–10. [PubMed] [Google Scholar]
  • 6.Abo Ali EA, Saied SM, Elsabagh HM, Zayed HA. Sexual harassment against nursing staff in Tanta university hospitals, Egypt. The Journal of the Egyptian Public Health Association. 2015;90:94–100. doi: 10.1097/01.EPX.0000470563.41655.71. [DOI] [PubMed] [Google Scholar]
  • 7.Lee SK, Song JE, Kim S. Experience and perception of sexual harassment during the clinical practice of Korean nursing students. Asian Nursing Research. 2011;5:170–6. doi: 10.1016/j.anr.2011.09.003. [DOI] [PubMed] [Google Scholar]
  • 8.Spector PE, Zhou ZE, Che XX. Nurse exposure to physical and nonphysical violence, bullying, and sexual harassment: a quantitative review. International journal of nursing studies. 2014;51:72–84. doi: 10.1016/j.ijnurstu.2013.01.010. [DOI] [PubMed] [Google Scholar]
  • 9.Chang HE, Cho SH. Workplace violence and job outcomes of newly licensed nurses. Asian nursing research. 2016;10:271–6. doi: 10.1016/j.anr.2016.09.001. [DOI] [PubMed] [Google Scholar]
  • 10.Fute M, Mengesha ZB, Wakgari N, Tessema GA. High prevalence of workplace violence among nurses working at public health facilities in Southern Ethiopia. BMC nursing. 2015;14:9. doi: 10.1186/s12912-015-0062-1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 11.Sisawo EJ, Ouedraogo S, Huang SL. Workplace violence against nurses in the Gambia: mixed methods design. BMC health services research. 2017;17:311. doi: 10.1186/s12913-017-2258-4. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 12.Shi L, Zhang DY, Zhou CY, Yang LB, Sun T, Hao TJ. et al. A cross-sectional study on the prevalence and associated risk factors for workplace violence against Chinese nurses. BMJ open. 2017;7:e013105. doi: 10.1136/bmjopen-2016-013105. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 13.Yang BX, Stone TE, Petrini MA, Morris DL. Incidence, type, related factors, and effect of workplace violence on mental health nurses: a cross-sectional survey. Archives of Psychiatric Nursing. 2018;32:31–8. doi: 10.1016/j.apnu.2017.09.013. [DOI] [PubMed] [Google Scholar]
  • 14.Cheung T, Lee PH, Yip PSF. Workplace violence toward physicians and nurses: prevalence and correlates in Macau. International Journal of Environmental Research & Public Health. 2017;14:04. doi: 10.3390/ijerph14080879. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 15.Pai HC, Lee S. Risk factors for workplace violence in clinical registered nurses in Taiwan. Journal of Clinical Nursing. 2011;20:1405–12. doi: 10.1111/j.1365-2702.2010.03650.x. [DOI] [PubMed] [Google Scholar]
  • 16.Parker G, Beresford B, Clarke S, Gridley K, Pitman R, Spiers G, Technical report for SCIE research review on the prevalence and incidence of parental mental health problems and the detection, screening and reporting of parental mental health problems [thesis]: University of York; 2008.
  • 17.Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ (Clinical research ed) 2003;327:557–60. doi: 10.1136/bmj.327.7414.557. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 18.The National Bureau of Statistics of China The method to classify China into four economic area. East, West, Central and Northeast (in Chinese). https://baike.so.com/doc/3057744-3223145 (accessed from Jun. 2018); 2011. [Google Scholar]
  • 19.Sun T, Gao L, Li F, Shi Y, Xie F, Wang J. et al. Workplace violence, psychological stress, sleep quality and subjective health in Chinese doctors: a large cross-sectional study. BMJ open. 2017;7:e017182. doi: 10.1136/bmjopen-2017-017182. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 20.Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ (Clinical research ed) 1997;315:629–34. doi: 10.1136/bmj.315.7109.629. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 21.Chen LL. Research on the impact of medical workplace violence on professional attitude of student nurses (in Chinese) [thesis] Shanxi: Shanxi Medical University; 2009. [Google Scholar]
  • 22.Guo GL. Correlation between job burnout and workplace violence of emergency department's nurses of six top-class hospitals in Shenyang (in Chinese) [thesis] Liaoning: China Medical University; 2009. [Google Scholar]
  • 23.Yu T, Hu AL, Wen RJ, Zhang YJ, Lin QP, Wang YS. Analysis on post-traumatic stress disorder and its relative factors of emergency department nurses after suffering from workplace violence (in Chinese) Chinese Journal of Practical Nursing. 2013;29:41–4. [Google Scholar]
  • 24.Zhang YJ, Yu T, Hu AL, Wen RJ, Lin QP, Yu N. Current status of workplace violence against emergency department nurses in Guangzhou (in Chinese) Clinical Medical Engineering. 2012;19:2045–7. [Google Scholar]
  • 25.Sun B. An investigation on the nurses hospital violence present situation and the cognition in one hospital of Dalian (in Chinese) [Thesis] Liaoning: Dalian Medical University; 2015. [Google Scholar]
  • 26.Fang J, Lu R, Fan HM, He JM. Present investigation about lateral violence which clinical practice nursing students encountered (in Chinese) The Journal of Medical Theory and Practice. 2014;27:1845–7. [Google Scholar]
  • 27.Xia LP. Investigation of sexual harassment among nursing students (in Chinese) Nursing Journal of Chinese People's Liberation Army. 2005;22:33–4. [Google Scholar]
  • 28.Xu J. The research on the current status of workplace sexual harassment against nursing students in Changchun (in Chinese) [thesis] Jilin: Jilin University; 2013. [Google Scholar]
  • 29.Zhang CY. Investigation of the Injury caused by workplace violence of nurses in emergency department (in Chinese) Inner Mongolia Medical Journal. 2014;46:1212–4. [Google Scholar]
  • 30.Cheung T, Yip PS. Workplace violence towards nurses in Hong Kong: prevalence and correlates. BMC public health. 2017;17:196. doi: 10.1186/s12889-017-4112-3. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 31.Kwok RPW, Law YK, Li KE, Ng YC, Cheung MH, Fung VKP. et al. Prevalence of workplace violence against nurses in Hong Kong. Hong Kong Medical Journal. 2006;12:6–9. [PubMed] [Google Scholar]
  • 32.Zhu W, Yang LF, Lou XP, Zhao XY, Wang K. The survey on the workplacel violence in medical workplaces of general hospitals in Zhengzhou (in Chinese) Chinese Health Service Management. 2011;28:334–6. [Google Scholar]
  • 33.Wu SY, Zhu W, Li HY, Lin SW, Chai WL, Wang XR. Workplace violence and influencing factors among medical professionals in China. American Journal of Industrial Medicine. 2012;55:1000–8. doi: 10.1002/ajim.22097. [DOI] [PubMed] [Google Scholar]
  • 34.Yang LP. The relationship between medical workplace violence and job bumout as well as sub-health in medical staffs in a city (in Chinese) [thesis] Henan: Zhengzhou University; 2012. [Google Scholar]
  • 35.Zhao WP, Luo LJ, Sun JX. Survey on sexual harassment against female nurses in psychiatry department (in Chinese) Journal of Clinical Psychosomatic Diseases. 2005;11:148–9. [Google Scholar]
  • 36.Zhou YJ. Investigation on attack events of nurses in emergency department and its influence on psychological stress (in Chinese) Chinese Journal of Health Psychology. 2018;26:392–5. [Google Scholar]
  • 37.Gao YE. Occupational hazard factors and protective measures for nurses in psychiatry department (in Chinese) Medical Journal of Chinese People's Health. 2010;22:506–7. [Google Scholar]
  • 38.Liu MQ, Zhuang JY, Rao SQ, Huang XM. Investigation on the sexual harassment of female nursing students at workplace (in Chinese) Chinese Journal of Modern Nursing. 2010;16:281–3. [Google Scholar]
  • 39.Xiong XL. The survey of internship nurse abuse in Hunan province and its relationship with anxiety and depression (in Chinese) [thesis] Hunan: Central South University; 2011. [Google Scholar]
  • 40.Lian JJ. Investigation of the prevalence of workplace violence among nurses in general hospitals in Fuzhou area (in Chinese) Fujian Medical Journal. 2014;36:132–4. [Google Scholar]
  • 41.Fan YY, Cui BH, Shang QM, Lv QY. Research on the workplace violence and its effect on the professional commitment of nursing students (in Chinese) China Higher Medical Education; 2016. pp. 33–4. +124. [Google Scholar]
  • 42.Zhang LY, Wang AN, Xie X, Zhou YH, Li J, Yang LJ. et al. Workplace violence against nurses: a cross-sectional study. International Journal of Nursing Studies. 2017;72:8–14. doi: 10.1016/j.ijnurstu.2017.04.002. [DOI] [PubMed] [Google Scholar]
  • 43.Guan RY, Ge BL, Gu BH, Sun HY. Relationship of tension to structural violence and social acknowledgement in emergency nurses (in Chinese) Chinese Mental Health Journal. 2015;29:452–6. [Google Scholar]
  • 44.Liao MR, Ao F, Wang AQ. Investigation on patient-commited sexual harassment on female nurses (in Chinese) Journal of Nursing Science. 2011;26:57–8. [Google Scholar]
  • 45.Qiu YR, Wang JW, Wu HW. The effect of workplace violence on mental health of nurses in emergency department (in Chinese) Chinese Journal of Modern Nursing. 2011;17:2995–7. [Google Scholar]
  • 46.National Bureau of Statistic of the People's Republic of China Statistical communique of the People's Republic of China on national economic and social development in 2017 (in Chinese) http://www.stats.gov.cn/tjsj/zxfb/201802/t20180228_1585631.html (accessed from June 15. 2018); 2017. [Google Scholar]
  • 47.Ministry of Education of People's Republic of China. Initially establish the standardized medical education system with Chinese characteristics, and major breakthroughs in medical education reform in China (in Chinese). http://www.moe.gov.cn/jyb_xwfb/s5147/201707/t20170711_309097.html (accessed from June 15. 2018); 2017. [Google Scholar]
  • 48.Suhaila O, Rampal KG. Prevalence of sexual harassment and its associated factors among registered nurses working in government hospitals in Melaka State, Malaysia. The Medical journal of Malaysia. 2012;67:506–17. [PubMed] [Google Scholar]
  • 49.The Central People's Government of the People's Republic of China. Special regulations for the protection of female employees (in Chinese) http://www.gov.cn/flfg/2012-05/07/content_2131582.htm (accessed from June 15. 2018); 2012. [Google Scholar]
  • 50.Cao XL, Wang SB, Zhong BL, Zhang L, Ungvari GS, Ng CH. et al. The prevalence of insomnia in the general population in China: A meta-analysis. PloS one. 2017;12:e0170772. doi: 10.1371/journal.pone.0170772. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 51.Magnavita N, Heponiemi T. Workplace violence against nursing students and nurses: an Italian experience. Journal of nursing scholarship. 2011;43:203–10. doi: 10.1111/j.1547-5069.2011.01392.x. [DOI] [PubMed] [Google Scholar]
  • 52.Nijman H, Bowers L, Oud N, Jansen G. Psychiatric nurses' experiences with inpatient aggression. Aggressive Behavior. 2005;31:217–27. [Google Scholar]
  • 53.Inoue M, Tsukano K, Muraoka M, Kaneko F, Okamura H. Psychological impact of verbal abuse and violence by patients on nurses working in psychiatric departments. Psychiatry and clinical neurosciences. 2006;60:29–36. doi: 10.1111/j.1440-1819.2006.01457.x. [DOI] [PubMed] [Google Scholar]
  • 54.Celik Y, Celik SS. Sexual harassment against nurses in Turkey. Journal of nursing scholarship: an official publication of Sigma Theta Tau International Honor Society of Nursing. 2007;39:200–6. doi: 10.1111/j.1547-5069.2007.00168.x. [DOI] [PubMed] [Google Scholar]
  • 55.Valente SM, Bullough V. Sexual harassment of nurses in the workplace. Journal of nursing care quality. 2004;19:234–41. doi: 10.1097/00001786-200407000-00010. [DOI] [PubMed] [Google Scholar]
  • 56.Li L, Wang YY, Wang SB, Zhang L, Li L, Xu DD. et al. Prevalence of sleep disturbances in Chinese university students: a comprehensive meta-analysis. Journal of sleep research. 2018;27:e12648. doi: 10.1111/jsr.12648. [DOI] [PubMed] [Google Scholar]
  • 57.Chen ZH, Wang SY. Investigation of psychological workplace violence against nurses in emergency department (in Chinese) Journal of Nursing Science. 2004;19:3–6. [Google Scholar]
  • 58.Yang XD. A descriptive study of workplace violence against nurses in general hospitals in Shenzhen city (in Chinese) [thesis] Beijing: Peking Union Medical College; 2008. [Google Scholar]
  • 59.Xu ZQ. The influence of workplace violence on the work attitude of nursing students (in Chinese) China Medical Herald. 2009;6:116–8. [Google Scholar]
  • 60.Chen ZH. An epidemiological study of hospital workplace violence in Guangzhou city (in Chinese) [thesis] Guangdong: Southern Medical University; 2011. [Google Scholar]
  • 61.Liu LT. A study of the current status and correlative factors of workplace violence against community nurses (in Chinese) [thesis] Jilin: Jilin University; 2013. [Google Scholar]
  • 62.Hu CF. Study on the relationship among workplace violence organizational commitment and turnover intention in psychiatric nurses (in Chinese) [thesis] Shandong: Shan Dong University; 2014. [Google Scholar]
  • 63.Su TZ, Ding MC. The current situation and prevention strategies of Taiyuan general hospitals' nurses suffer from the medical violence (in Chinese) China Health Law. 2015;23:89–94. [Google Scholar]
  • 64.Xiao J, Xiong Y, Sha DR, Qiu XR. Investigation on the status of workplace violence of nurses in Changsha city (in Chinese) Medical Information. 2015;28:111. [Google Scholar]
  • 65.Yu Y, Sui SJ. The prevalence and predictors of workplace violence against nurses in Harbin (in Chinese) Journal of Nursing Science. 2015;30:1–5. [Google Scholar]
  • 66.Du SS, Wang YP, Xin YY. The influence and its countermeasures of workplace violence on the professional attitude of nursing students (in Chinese) Medical Information. 2016;29:322–3. [Google Scholar]
  • 67.Fang LM, Ding MC, Wang PQ. Research on workplace violence from the perspective of social conflict theory (in Chinese) Hospital Management Forum. 2016;33:20–4. [Google Scholar]
  • 68.Niu YT, Xiao GQ, Lu Q, Li XE. A survey of workplace violence and its related cognition and demands of nurses in emergency department (in Chinese) Journal of Modern Nursing. 2017; 23: 1117-21.

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Supplementary table.

Click here for additional data file. (152.3KB, pdf)

Articles from International Journal of Biological Sciences are provided here courtesy of Ivyspring International Publisher

RESOURCES