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NURSING SCIENCE
Prevalence of lateral violence in nurse workplace: A systematic review and meta-analysis

Article Critique by Alexis Hayes, PhD, MSN-Ed, APRN, FNP-BC

Lateral-Workplace-Violence.jpg
Title:
Prevalence of lateral violence in nurse workplace: A systematic review and meta-analysis
Published: February 22, 2022
Level of Evidence: Level A
What was the purpose?
The purpose of this study was to measure the percentage of nurses affected by lateral violence in the workplace through a systematic review and meta-analysis. A systematic review is usually undertaken to perform a rigorous appraisal, identification, and synthesis of the literature that has been completed. Conclusions drawn from systematic reviews present the highest level of evidence for evaluating the literature.2 A meta-analysis is a systematic review that incorporates quantitative methods to compare studies.2
What was the population studied?
Zhang et al. (2022) 4 reviewed a total of 14 studies that included 6,124 nurses (male and female). The nursing population consisted of nurses (not specified), registered nurses, nurse leaders and neurosurgery nurses. Five of the studies included a random sampling of the nurses while convenience sampling was utilized in the remaining eight studies. The sample size for each study ranged from 118-1690 nurses.
Was the setting comparable to Houston Methodist? Were the nurses like our nurses?
In a review of the subgroups of each study, there were only three studies conducted within the United States (U.S.) while the remaining studies were conducted in China (6), Korea (2), Russia (1), and Saudi Arabia (2). The description of population subgroups was further categorized into Asian and non-Asian groups without notation of the diversity within each category.
Did they use appropriate methods?
The authors utilized the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA 2020) guidelines for this study which included cross-sectional, case-control and cohort studies.3 Databases searched included Cochrane, CINAHL, EMBASE, PUBMED and two Chinese databases (CNKI and Wanfang). Data analysis was utilized to measure the observed and expected differences between studies, which are known as the Chi-squared statistic (X 2). Due to the study being a meta-analysis, a variation or consistency in the outcomes between each study was measured. A p-value of <0.05 served as a good indicator of variation among studies. The methods used were appropriate to generalize conclusions from the studies included in this systematic review and meta-analysis.2,3
What were their findings?
Across the 13 studies in the meta-analysis, the prevalence of lateral violence amongst nurses was significant (p=<0.001). Lateral violence was more prominent in the Asian population (41.6%) versus the Non-Asian population (13.9%) which was significant (p=<0.001).4
Do their findings make sense?
The findings reported make sense, however, the meta-analysis and descriptors used can make it difficult for the novice literature reviewer. The variations of lateral violence in the workplace worldwide warrant further investigation. For example:
  • Would we see a variation in lateral violence among specific races and/or cultures outside of Asian and non-Asian? This study only specified Asian and non-Asian populations. Even though the studies included male and female nurses, the authors did not discuss any of the prevalence of lateral violence in women vs men.
  • There were three significant studies conducted in the U.S. included in this study, should more be included? Studies within the U.S. were significant (p=<0.040); however, most of the studies focusing on lateral violence were performed outside of the U.S. The authors noted that a limitation of the review and meta-analyses was that there were no studies from Europe, Africa and other regions included.
  • A study by Cheung et al. (2017) 1 was removed from the meta-analysis due to having an “impact” on the final study results. For this reason, the study was not included in the meta-analysis but was included in the systematic review. The impact could be due to the larger sample size of 850 nurses with only a 5.3% response rate. Sample size, type of sampling, and response rate were all significant in affecting prevalence estimates.
  • The authors concluded that Asian nurses had a higher prevalence of lateral violence than non-Asian nurses. Further explanation reveals that this could be due to collectivism and how lateral violence is managed within the Asian culture. The U.S. had the lowest prevalence of lateral violence compared to other regions. In China, which had the lowest prevalence of lateral violence among all Asian cultures, nurses report that violence would not cause any changes in the workplace.
How did things change?
In comparing findings to the literature, it is recommended that nurse managers pay special attention to the attitudes and experiences of nurses. Consideration should be given to how long they have been nursing, cultural differences and how the nurse perceives lateral violence or bullying. Although this study was worldwide and by database search only, the author suggests a further review of gray literature, which would give more insight into lateral violence.
How is this important for nursing?
This study is the only systematic review addressing the prevalence of lateral violence in nurses nationally. There continues to be a dearth of literature on the nurse’s perception of lateral violence and lateral violence within U.S. hospitals. Further study is warranted to not only address nurses’ perceptions but cultural perceptions, leadership styles, new graduate nurses versus experienced nurses, and its impact on health and well-being.
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References:
Cheung, T., & Yip, P. S. (2017). Workplace violence towards nurses in Hong Kong: prevalence and correlates. BMC public health, 17(1), 196. https://doi.org/10.1186/s12889-017-4112-3
 Deeks JJ, Higgins JPT, Altman DG (editors). Chapter 10: Analysing data and undertaking meta-analyses. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors). Cochrane Handbook for Systematic Reviews of Interventions version 6.3 (updated February 2022). Cochrane, 2022. Available from www.training.cochrane.org/handbook.
Migliavaca, C. B., Stein, C., Colpani, V., Barker, T. H., Ziegelmann, P. K., Munn, Z., Falavigna, M., & Prevalence Estimates Reviews-Systematic Review Methodology Group (PERSyst) (2022). Meta-analysis of prevalence: I2 statistic and how to deal with heterogeneity.  Research synthesis methods, 13(3), 363–367. https://doi.org/10.1002/jrsm.1547
Zhang, Y., Cai, J., Yin, R., Qin, S., Wang, H., Shi, X., & Mao, L. (2022). Prevalence of lateral violence in nurse workplace: a systematic review and meta-analysis. BMJ open, 12(3), e054014. https://doi.org/10.1136/bmjopen-2021-054014