Investigating work-related stress and violence in nursing homes: A pilot study in Emilia-Romagna, Italy

Introduction: Workplace violence is a significant occupational risk in healthcare, particularly in nursing homes (NHs), where staff face emotional and physical demands. This pilot study aimed to assess how workplace violence is reported and analyzed in NHs in the Emilia-Romagna region, considering internal violence (between colleagues), external violence (by patients or relatives), and outward-directed violence (towards patients). Methods: A semi-structured interview protocol was developed based on literature review and expert consultation. It was administered in 36 randomly selected NHs (10% of regional facilities). Group interviews were conducted with 149 professionals, including managers, occupational physicians, safety officers, and union representatives. Data was analyzed using grounded theory and content analysis to identify barriers and inform the development of a structured questionnaire. Results: Only 56% of NHs had comprehensive measures for violence prevention and reporting. Major barriers included inconsistent reporting systems, lack of training, high workload, communication issues, and inadequate organizational responses. Nine main risk factors were identified, ranging from patient instability to staff turnover. Positive findings included widespread de-escalation training and low relevance of alcohol use and biomechanical overload. A structured questionnaire was developed to support future in-depth assessments. Discussion: The findings underscore the need for a standardized, organization-wide approach to address workplace violence in NHs. Training, shared definitions, and effective reporting tools are essential to foster a culture of safety. The proposed questionnaire may support systematic risk assessment and guide targeted interventions to improve staff well-being and care quality.