Aggression against Nursing Personnel during the First Wave of COVID-19 Pandemic: An Internet-Based Survey
, Thelma Beatriz González-Castro 3, Isela Esther Juárez-Rojop 4, Carlos Alfonso Tovilla-Zárate 1,* and Humberto Nicolini 5,*
Round 1
Reviewer 1 Report
the method and in general terms the article complies with the journal's requirements, butThe publication after 3 years of the covid is out of context, I consider that for this reason it should not be published
Author Response
Review 1. the method and in general terms the article complies with the journal's requirements, but the publication after 3 years of the covid is out of context, I consider that for this reason it should not be published
Response. We deeply appreciate the reviewer´s suggestion. We have added the discussion about the implications of the present study in the last paragraph of the discussion section.
Change in the manuscript. Page 8. Line 296-303. Our study is an initial contribution on the attacks suffered by Latino nursing personnel during the COVID-19 pandemic. Although the COVID-19 pandemic is over, reports of violence against nursing staff continue [45]. Studies report violence against nursing staff mainly within the hospital institution [46]. It is noteworthy that the violence reported in this study was outside the health institution. Finally, the literature report that the number of events of aggression against nursing staff is similar with and without the COVID-19 pandemic. However, more studies are required to understand the phenomenon more clearly in order to establish appropriate recommendations.
Reviewer 2 Report
The manuscript is about the aggression against nursing personnel during the
COVID-19 pandemic in Latin America. The subject is important but the methodology, and data presentation have serious problems that makes the manuscript not appropriate for publishing:
1- The manuscript needs massive English editing.
2- The introduction doesn't provide adequate information about the subject.
3- Sample size calculation is not presented, and sample size doesn't seem to be adequate to cover the situation in Latin America.
4- Sampling framework is not clear and about 9 to 16 nurses from every country can not provide valid information.
4- Data gathering is not explained.
5- Most of the violence have happened in streets, markets, and neighborhood and not in the workplace. How you relate these aggressions to the occupation? How the people in the street know that someone is nurse?
The manuscript needs English editing.
Author Response
The manuscript is about the aggression against nursing personnel during the
COVID-19 pandemic in Latin America. The subject is important but the methodology, and data presentation have serious problems that makes the manuscript not appropriate for publishing:
- The manuscript needs massive English editing.
Response: We apologize for the mistakes in the manuscript. We also carefully checked and corrected the entire manuscript for typographic, grammatical and formatting errors. Language presentation was improved with assistance from an English speaker with appropriate research background.
- The introduction doesn't provide adequate information about the subject.
Response: We deeply appreciate the reviewer´s suggestion, and have augmented the information. Now, we show the prevalence of aggression against nursing personal in Latin America, before and during the pandemic.
Change in the manuscript. Page 2. Line 65 to 72. Previously to COVID-19 pandemic, in Latin America was estimated that 11.1% of healthcare workers had physical violence; of these, the 47.4 % were in nursing staff. In more detail, psychologic violence was observed in 42.1% of healthcare workers; where 62.3% belongs to nursing staff [16]. Moreover, the violence and aggression against healthcare workers in Latin America increased during the COVID-19 pandemic until 54.8% in the workplace [17]. However, the health personnel were also attacked outside their workplace. The lack of scientific reports keeps the magnitude of the problem unknown.
- Sample size calculation is not presented, and sample size doesn't seem to be adequate to cover the situation in Latin America.
Response: We apologized for the fact that we did not show a size calculation. In the present study we used a non-probabilistic sampling (Page 3, Line 122). We recognized the small size of sample as a limitation in our study (Page 8, Line 272-276).
Change in the manuscript.
Page3, Line 122. A non-probabilistic sampling was performed.
Page 9, Line 279-293. Second, the small size of sample. Although our survey was broadcasted on various social networks and nurses chat rooms, it was not answered in all Latin American countries. Also, a large number of participants did not complete the survey. Therefore, our sample is small and does not represent all the countries in Latin America.
- Sampling framework is not clear and about 9 to 16 nurses from every country can not provide valid information.
Response: Thanks for your kind comments. As it was written in the manuscript. We make the invitations through media groups. One limitation and we consider a decrease in the number of participants is that to publish in this type of groups they must be authorized by the group administrator. That on many occasions delayed the publication of the invitation. We recognized the small number of nurses for each country. However, show the state in his moment of the COVID-19 pandemic. And, we recognized this as a limitation in our study.
Change in the manuscript. Page 9, Line 289-293. Second, the small size of sample. Although our survey was broadcasted on various social networks and nurses chat rooms, it was not answered in all Latin American countries. Also, a large number of participants did not complete the survey. Therefore, our sample is small and does not represent all the countries in Latin America.
- Data gathering is not explained.
Response: We agree. In this revised version we provide more information over the tools and instrument and data collection. Specially in the measurements subsection. We consider that now this easier to readers.
Change in the manuscript. Page 3, Line 97-99, and line 118-120.
Page 3, Line 97-99. The survey we used was designed in SurveyMonkey [18] and was distributed through social networks. The nurses were invite to participate in the romms of social media. The invitation included the objective of the study. And ended with a link to survey.
Line 118-120. The final of capitation period the survey was finished. Then we downloaded in Excel format. Finally, we checked the duplication of the IP address for excluded a possible duplication.
- Most of the violence have happened in streets, markets, and neighborhood and not in the workplace. How you relate these aggressionsto the occupation? How the people in the street know that someone is nurse?
Response: We apologized for the fact that we did not clearly describe the relationship between aggression and occupation. Actually, we rewrite discussion section for added the explication as in this region of the globe is a common the use of uniforms outside of workplace.
Change in the manuscript. Page 7 line 210-216 and page 8 line 217-2018. Some possible factors could be associated to the reasons for the link between aggression and occupation. How can the perpetrator identify the nursing staff? In Mexico, it is common for health personnel to wear a uniform. College students and doctors wear work uniforms, and even outside their workplace. Nursing staff wear their uniform from home to work or to do daily activities; like going to the supermarket. For their part, the medical staff wears a white gown. This is used outside the hospital system. On the other hand, in Latin America, for example, Colombia, the use of surgical gowns is widely used. Either with the identification of the health institution or the medical school. Therefore, anywhere outside the health system, it is easy to identify health personnel.
Reviewer 3 Report
Not very important as research
However, it seems to be an important document that verbalizes what is known the facts
It is recommended to add references.
During the COVID-19 pandemic in Latin America, there was a high incidence of aggression against nursing staff. The attacks on healthcare staff have increased during the pandemic. Most cases of discrimination and attacks against healthcare staff seem to occur in Mexico, where the current pandemic has seen an increase in violence. The nursing staff who experienced aggression during the pandemic also presented emotional and psychological symptoms. Therefore, it is necessary to develop policies of security and protection for nursing staff and provide mental health care to those who are in the frontline against COVID-19.
The fear and concerns related to COVID-19 have a greater impact on stress, anxiety, and depression symptoms. During the pandemic, a variety of situations appear to have promoted attacks against healthcare workers. A National Nurses United survey in late 2020 of more than 15,000 US registered nurses showed that about 20% of participants said they faced increased on-the-job violence, which they attributed to COVID-19–related staffing shortages, changes in their patient population, and restrictions for visitors. COVID-19 has created a healthcare environment "ripe for aggression and violence"
References
1) La Cruz JPS, González-Castro TB, Pool-García S, López-Narváez ML, Tovilla-Zárate CA. Estado emocional y psicológico del personal de enfermería agredido durante la pandemia de COVID-19 en Latinoamérica [Emotional and psychological status of nursing staff attacked during the COVID-19 pandemic in Latin America]. Rev Colomb Psiquiatr. 2021 Oct 8. Spanish. doi: 10.1016/j.rcp.2021.08.006. Epub ahead of print. PMID: 34642505; PMCID: PMC8498689.
2) Rosales Vaca KM, Cruz Barrientos OI, Girón López S, Noriega S, More Árias A, Guariente SMM, Zazula R. Mental health of healthcare workers of Latin American countries: a review of studies published during the first year of COVID-19 pandemic. Psychiatry Res. 2022 May;311:114501. doi: 10.1016/j.psychres.2022.114501. Epub 2022 Mar 7. PMID: 35320759; PMCID: PMC8900936.
Author Response
Not very important as research
However, it seems to be an important document that verbalizes what is known the facts
Response. We deeply appreciate the reviewer´s suggestion. We have added the discussion about the implications of the present study in the last paragraph of the discussion section.
Change in the manuscript. Page 8. Line 296-303. Our study is an initial contribution on the attacks suffered by Latino nursing personnel during the COVID-19 pandemic. Although the COVID-19 pandemic is over, reports of violence against nursing staff continue [45]. Studies report violence against nursing staff mainly within the hospital institution [46]. It is noteworthy that the violence reported in this study was outside the health institution. Finally, the literature report that the number of events of aggression against nursing staff is similar with and without the COVID-19 pandemic. However, more studies are required to understand the phenomenon more clearly in order to establish appropriate recommendations.
It is recommended to add references.
During the COVID-19 pandemic in Latin America, there was a high incidence of aggression against nursing staff. The attacks on healthcare staff have increased during the pandemic. Most cases of discrimination and attacks against healthcare staff seem to occur in Mexico, where the current pandemic has seen an increase in violence. The nursing staff who experienced aggression during the pandemic also presented emotional and psychological symptoms. Therefore, it is necessary to develop policies of security and protection for nursing staff and provide mental health care to those who are in the frontline against COVID-19.
The fear and concerns related to COVID-19 have a greater impact on stress, anxiety, and depression symptoms. During the pandemic, a variety of situations appear to have promoted attacks against healthcare workers. A National Nurses United survey in late 2020 of more than 15,000 US registered nurses showed that about 20% of participants said they faced increased on-the-job violence, which they attributed to COVID-19–related staffing shortages, changes in their patient population, and restrictions for visitors. COVID-19 has created a healthcare environment "ripe for aggression and violence"
References
1) La Cruz JPS, González-Castro TB, Pool-García S, López-Narváez ML, Tovilla-Zárate CA. Estado emocional y psicológico del personal de enfermería agredido durante la pandemia de COVID-19 en Latinoamérica [Emotional and psychological status of nursing staff attacked during the COVID-19 pandemic in Latin America]. Rev Colomb Psiquiatr. 2021 Oct 8. Spanish. doi: 10.1016/j.rcp.2021.08.006. Epub ahead of print. PMID: 34642505; PMCID: PMC8498689.
2) Rosales Vaca KM, Cruz Barrientos OI, Girón López S, Noriega S, More Árias A, Guariente SMM, Zazula R. Mental health of healthcare workers of Latin American countries: a review of studies published during the first year of COVID-19 pandemic. Psychiatry Res. 2022 May;311:114501. doi: 10.1016/j.psychres.2022.114501. Epub 2022 Mar 7. PMID: 35320759; PMCID: PMC8900936.
Response. We deeply appreciate the reviewer #3 your suggestion. We following your suggestion and have add the references as augmented the information in the introduction section.
Change in the manuscript. These attacks have occurred within hospitals and in emergency rooms, mainly [15]; nursing staff being the most affected [13,15,16]
Reviewer 4 Report
First of all, I want to thank you for giving me the opportunity to review this study.
The study design should be indicated in the methodology.
How the sample value of 374 nursing professionals was obtained.
Has this study passed an Ethics Committee?
There are old bibliographic citations that must be updated.
Author Response
The study design should be indicated in the methodology.
Response. We deeply appreciate the reviewer´s comment. We have added the study design in the measurements subsection.
Change in the manuscript. Page 2, Line 93. We conducted a cross-sectional, comparative, retrospective study.
How the sample value of 374 nursing professionals was obtained?
Response: We apologized for the fact that we did not show a size calculation. In the present study we used a non-probabilistic sampling (Page 3, Line 122). We recognized the small size of sample as a limitation in our study (Page 8, Line 272-276).
Change in the manuscript.
Page3, Line 122. A non-probabilistic sampling was performed.
Page 9, Line 279-293. Second, the small size of sample. Although our survey was broadcasted on various social networks and nurses chat rooms, it was not answered in all Latin American countries. Also, a large number of participants did not complete the survey. Therefore, our sample is small and does not represent all the countries in Latin America.
Has this study passed an Ethics Committee?
Response: Thank you review for this comment. As was set in Institutional Review Board Statement: “The study was conducted in accordance with the Declaration of Helsinki, and approved by the Institutional Review Board (or Ethics Committee) of Juarez Autonomous University of Tabasco (103/CIPDACS/2020).”
Page 10, Line 321-323.
There are old bibliographic citations that must be updated.
Response: We deeply appreciate the reviewer´s suggestion. In this revised version of the manuscript. We have added the bibliographic citations as you suggest and other review similarly suggested.
Change in the manuscript.
Page 2, Line 62-72. [13,14]. These attacks have occurred within hospitals and in emergency rooms, mainly [15]; nursing staff being the most affected [13,15,16].
Previously to COVID-19 pandemic, in Latin America was estimated that 11.1% of healthcare workers had physical violence; of these, the 47.4 % were in nursing staff. In more detail, psychologic violence was observed in 42.1% of healthcare workers; where 62.3% belongs to nursing staff [17]. Moreover, the violence and aggression against healthcare workers in Latin America increased during the COVID-19 pandemic until 54.8% in the workplace [18]. However, the health personnel were also attacked outside their workplace [19]. The lack of scientific reports keeps the magnitude of the problem unknown.
Page 9, Lines 297-304. Our study is an initial contribution on the attacks suffered by Latino nursing personnel during the COVID-19 pandemic. Although the COVID-19 pandemic is over, reports of violence against nursing staff continue [47]. Studies report violence against nursing staff mainly within the hospital institution [48].
Round 2
Reviewer 1 Report
I have reflected on its modification, I consider that it should be published, but it would be interesting to add: if there are similar results in men in other studies, the usefulness of the results in future pandemics and mention the possible strategies being implemented in other contexts for aggression against personnel sanitary
Author Response
Review #1
I have reflected on its modification, I consider that it should be published, but it would be interesting to add: if there are similar results in men in other studies, the usefulness of the results in future pandemics and mention the possible strategies being implemented in other contexts for aggression against personnel sanitary.
Response: We appreciate your comment. A common idea in the beginning of Ebola epidemic or COVID-19 pandemic is the idea that the healthcare workers are that spread of the virus. In this study we ask over the violence and attack against nurse staff. Most of the reports of attacks on nursing staff are reported in the press and local news. We believe that this manuscript presents evidence of the attack suffered by nursing staff in the past COVID-19 pandemic. Also, we add possible strategies for the prevention of attack to nurse staff in the future.
Chang in the manuscript.
Page 7, Line 250 – 256. This suggests that the aggression is associated with the idea that healthcare workers are who spread the virus, more than the attention in the service of health. Interestingly, the level of health care and the nurses’ profile were not related to the aggressions. These results show the need that in a new epidemic or pandemic, the news and social media need help to educate the general population and make them understand that health care workers do not spread of the virus.
Page 9, Line 291- 305. Given the large number of attacks against nursing personnel in Latin America during the COVID-19 pandemic, the following recommendations are issued: 1) Nursing personnel should avoid wearing hospital or institutional uniforms when leaving their workplaces or in public places; changing their clothing may be a strategy that prevents them from being identified as health personnel on public areas. 2) Institutions must provide conflict mitigation techniques, communication techniques and body language reading; the objective is to develop skills to identify possible aggressors. 3) Provide mental health support to reduce the burden of work stress, this will allow the nursing staff to act more serenely / calmly in case of being assaulted. 4) The medical institutions must establish protocols for situations of aggression within the work centers, increase security and request the identification of each person who enters the health establishments. 5) The foregoing can guarantee that reports of attacks are made to the relevant authorities. 6) Latin American countries should create new public policies that guarantee safety and protection for nursing and health personnel in situations of aggression. Additionally, the psychiatric and psychological support is necessary in the individual that has been attack [52].
Reviewer 2 Report
The manuscript is about the aggression against nursing personnel during the first wave of 2 COVID-19 pandemic in Latin America. The manuscript has improved considerably, but unfortunately I think it is not proper for publishing because of serious method problems that can not be revised. First the sample size is small and the numbers of nurses in every country is not adequate, and they are not good representative of the Latin America nurses. This problem can not be fixed, and I think the data are not valid.
The manuscript is about the aggression against nursing personnel during the first wave of 2 COVID-19 pandemic in Latin America. The manuscript has improved considerably, but unfortunately I think it is not proper for publishing because of serious method problems that can not be revised. First the sample size is small and the numbers of nurses in every country is not adequate, and they are not good representative of the Latin America nurses. This problem can not be fixed, and I think the data are not valid.
Author Response
Reviewer #2
The manuscript is about the aggression against nursing personnel during the first wave of COVID-19 pandemic in Latin America. The manuscript has improved considerably, but unfortunately I think it is not proper for publishing because of serious method problems that can not be revised. First the sample size is small and the numbers of nurses in every country is not adequate, and they are not good.
representative of the Latin America nurses. This problem can not be fixed, and I think the data are not valid.
Response: We thank reviewer #2 for this comment. We have rewritten the manuscript and we believe that in this revised version, we have overcome the observed methodological problems. As an example. We have changed the title to "Aggression against nursing personnel during the first wave of COVID-19 pandemic: An internet-based survey". Now we do not emphasize that it is a study in the Latin American population. Now we show that it is a study based on internet surveys. Second. We have rewrite the Material and Methods. this to clarify the methodology. From the ethical aspects, as well as the inclusion and exclusion criteria, the procedure, recruitment and analysis of the results. We hope that it could be helpful for general nurse that those interested in this field to prevention of aggression to nurse staff.
