Luo Lanjun, Wu Yuze, Li Siyuan, Li Fengling, Wang Xueyan, Wei Xuemei
School of Management, Affiliated Hospital of North Sichuan Medical College, North Sichuan Medical College, Nanchong, China.
J Nurs Manag. 2025 Apr 2;2025:5578698. doi: 10.1155/jonm/5578698. eCollection 2025.
Workplace violence, defined as any disruptive behavior or threat to employees, seriously threatens junior nurses. Compared with senior nurses, junior nurses are more vulnerable to workplace violence due to inexperience, low professional recognition, and limited mental resilience. However, there is an absence of research discussing the workplace violence risk of junior nurses, in particular, the lack of analysis of critical factors within the multiple influences and the lack of targeted risk prediction models. Considering the multiple influencing factors faced by junior nurses, this study aims to predict the risk of workplace violence using interpretable machine learning models and identify the critical influencing factors and their nonlinear effects. An observational, cross-sectional study design. A total of 5663 junior registered nurses in 90 tertiary hospitals in Sichuan Province, China. Data are all obtained through a questionnaire survey. An interpretable machine learning framework, including the Light Gradient Boosting Machine (LightGBM) model and two post hoc interpretable methods, Accumulate Local Effect and SHapely Additive exPlanations (SHAP), are conjoined. The LightGBM model is more accurate than other machine learning methods, achieving an area under the receiver operating characteristic curve of 0.761 and a Brier score of 0.198 on the workplace violence prediction task. Among the dozens of potential influences input into the predictive model, seeing medical complaints, psychological demands, professional identity, etc., are the most critical predictors of workplace violence. The proposed LightGBM-SHAP-ALE approach dynamically and effectively identifies junior nurses at high risk of workplace violence, providing a foundation for timely detection and intervention.
工作场所暴力被定义为对员工的任何破坏性行为或威胁,严重威胁着初级护士。与资深护士相比,初级护士由于缺乏经验、职业认可度低和心理韧性有限,更容易受到工作场所暴力的影响。然而,目前缺乏关于初级护士工作场所暴力风险的研究,特别是缺乏对多种影响因素中的关键因素的分析以及针对性的风险预测模型。考虑到初级护士面临的多种影响因素,本研究旨在使用可解释的机器学习模型预测工作场所暴力风险,并识别关键影响因素及其非线性效应。采用观察性横断面研究设计。在中国四川省90家三级医院中选取了5663名初级注册护士。数据均通过问卷调查获得。将一个可解释的机器学习框架,包括轻梯度提升机(LightGBM)模型和两种事后可解释方法,累积局部效应和SHapely加性解释(SHAP)相结合。LightGBM模型在工作场所暴力预测任务上比其他机器学习方法更准确,在接收器操作特征曲线下的面积为0.761,布里尔分数为0.198。在输入预测模型的数十种潜在影响因素中,看到医疗投诉、心理需求、职业认同等是工作场所暴力最关键的预测因素。所提出的LightGBM - SHAP - ALE方法动态有效地识别出工作场所暴力高风险的初级护士,为及时检测和干预提供了基础。