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

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

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

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

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

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

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