Impact and Prevalence of Physical and Verbal Violence Toward Healthcare Workers

The importance and feasibility of hospital interventions to prevent and manage patient aggression and violence against physicians in China: a Delphi study

BACKGROUND

Aggression and violence by patient (and their relatives/friends) is widely acknowledged as a serious occupational hazard, with physicians being particularly susceptible to witnessing and experiencing such incidents within hospitals. Research has shown that the negative consequences of such aggression and violence are not only felt at the individual level, but also at the team and organizational levels. Understanding how to prevent and manage this behavior towards physicians in hospitals is urgent and not fully researched. While there are many potentially effective interventions, it is unclear which ones would be valuable and feasible for Chinese hospitals. Because patient aggression and violence may occur more frequently in Chinese hospitals than in other countries, this suggests that cultural differences play a role and that tailored interventions may be needed.

METHOD

We conducted a Delphi study to reach a consensus on the importance and feasibility of hospital interventions to prevent and manage patient (and their relatives/friends) aggression and violence against physicians in Chinese hospitals. Seventeen experts in China were invited to complete online questionnaires over three rounds.

RESULTS

After three rounds, consensus was achieved concerning 44 interventions, five other interventions were rejected, and no consensus was reached on another two. These interventions were clustered into eight categories: environment design, access and entrance, staffing and working practices, leadership and culture, training and education, support, during/after-the-event actions, and hospital policy. Each category is considered important in preventing and managing patient (and their relatives/friends) aggression and violence towards physicians in Chinese hospitals. This study also investigated the feasibility of the suggested interventions and found that 36 of the 44 interventions were considered not only relevant, but also feasible for implementation in Chinese hospitals.

CONCLUSIONS

This study provides an overview of interventions that can be implemented in Chinese hospitals to prevent and manage patient (and their relatives/friends) aggression and violence before, during, and after a violent incident occurs.

Student-to-Teacher Victimization and Its Negative Impact on Teaching Approaches: Applying Propensity Score Matching

The negative impact of student-to-teacher victimization on teachers' perceptions of the work environment and their well-being is supported by growing empirical literature. For instance, violence in the classroom can have a negative impact on teachers themselves and hinder teachers from playing crucial roles in students' classroom experiences, resulting in adverse effects on student performance. However, the research field is limited in understanding the adverse effects on teachers' perceptions more directly related to student learning, such as teacher neglect. To fill the gap in the literature, the current study analyzes data from a nationwide sample of 1,054 middle and high school teachers in South Korea where teachers are generally treated with high regard and social status, often exerting a strong influence and authority over students in both an educational and parental way. Specifically, we conduct propensity score matching to investigate potential influences that student-to-teacher victimization can have on the following three outcome variables: teacher neglect, commitment, and pride. Results of mean comparisons after accounting for other confounding factors show that when compared with nonvictims, victims of student-to-teacher victimization are more likely to neglect their students; these victims also tend to exhibit less pride as teachers. Yet, the results also showed no significant statistical difference in teacher commitment. The current findings highlight the importance of developing programs to prevent and intervene in students' aggressive behaviors toward teachers. Particularly, administrators are recommended to consider providing training for teachers, specific to understanding student-to-teacher victimization in order to promote a more positive school environment and better student-to-teacher relationships in classrooms, including improving teachers' job performance.

Factors affecting intent to perpetrate violence against nurses: Theory of Planned Behavior approach

BACKGROUND

The Theory of Planned Behavior (TPB) has been found to predict target behaviors. The literature examining this model lacks attention to violence toward nurses.

PURPOSE

To explore the association between the public's exposure to violence and intention to employ violence toward nurses, under the TPB framework.

METHODS

A cross-sectional study (705 participants) employed a self-report questionnaire. Path analysis assessed TPB variables' mediation between prior exposure to violence and violent intent toward nurses.

DISCUSSION

The TPB variables, that is attitudes, subjective norms, and perceived control, mediated only the association between exposure to physical violence and intention to act violently. Subjective norms were the strongest mediator. The explained variance was 31%.

CONCLUSION

When addressing violence against nurses, policymakers must consider attitudes, subjective norms, and perceived control among patients and their attendants. Violence directed at nurses and health care workers reflects societal violence and the "upstream approaches" needed to mitigate violence in health care settings.

The Prevalence of Type II Workplace Violence in US Nurses 2000 to 2022: A Meta-Analysis

BACKGROUND

Physical violence against nurses is a concern in the United States; however, its prevalence is not well quantified.

OBJECTIVE

We sought to describe the prevalence of workplace violence against nurses in the United States over a 22-year period.

METHODS

A meta-analysis was performed following a literature search of English texts through Scopus, CINAHL Plus, and Ovid MEDLINE. Inclusion criteria included the following: (1) primary reports of workplace violence incidents in the United States against nurses, (2) perpetrator was a patient, family member, or visitor, and (3) publications between January 1, 2000, and June 21, 2022. Reports where prevalence rates for nurses could not be calculated were excluded. Study quality was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology checklist.

RESULTS

Thirty-seven studies met the inclusion criteria; 27 030 nurses were included. The pooled prevalence of workplace violence was 0.35 (95% confidence interval [CI]: 0.29-0.42; Q = 3189.40; I2 = 98.87). Pooled rates of workplace violence increased from 30% in 2000 to 2004 to 43% in 2020 to 2022; however, the overlapping CIs indicate that the increase may not be statistically significant. The mean prevalence of reported workplace violence among nurses who work in the emergency department, in corrections, and psychiatric mental health settings (pooled prevalence = 0.59, 95% CI: 0.46-0.71) was higher than that of nurses who worked in all other settings (pooled prevalence = 0.24, 95% CI: 0.18-0.30).

CONCLUSIONS

Workplace violence is a significant and potentially increasing problem for nurses in the United States. This critical problem requires an effective response from nurse policymakers.

Utilization of the Fordham Risk Screening Tool for violence risk assessment in an emergency department

BACKGROUND

Violence is a critical problem in the emergency department (ED) and patients experiencing mental health crises are at greater violence risk; however, tools appropriate for assessing violence risk in the ED are limited. Our goal was to evaluate the utility of the Fordham Risk Screening Tool (FRST) in reliability assessing violence risk in adult ED patients with acute mental health crises through evaluation of test characteristics compared to a reference standard.

METHODS

We evaluated performance of the FRST when used with a convenience sample of ED patients undergoing acute psychiatric evaluation. Participants underwent assessment with the FRST and an established reference standard, the Historical Clinical Risk Management-20, Version 3 (HCR-20 V3). Diagnostic performance was assessed through evaluation of test characteristics and area under the receiver operating characteristic curve (AUROC). Psychometric assessments examined the measurement properties of the FRST.

RESULTS

A total of 105 participants were enrolled. In comparison to the reference standard, the AUROC for the predictive ability of the FRST was 0.88 (standard error 0.39, 95% confidence interval [CI] 0.81-0.96). Sensitivity was 84% (95% CI 69%-94%) while specificity was 93% (95% CI 83%-98%). The positive predictive value was 87% (95% CI 73%-94%) and negative predictive value was 91% (95% CI 83%-86%). Psychometric analyses provided reliability and validity evidence for the FRST when used in the ED setting.

CONCLUSIONS

These findings support the potential utility of the FRST when used to assess violence risk in adult ED patients experiencing a mental health crisis. Future research with more diverse populations and ED settings is warranted.

The frequency of workplace violence against healthcare workers and affecting factors

BACKGROUND

Workplace violence has become a global issue, especially among healthcare workers. This study aimed to determine the influencing factors and legal processes of workplace violence incidents, as well as the frequency of workplace violence in a tertiary hospital.

METHODS

This observational, descriptive, retrospective frequency study was conducted between January 2020 and March 2022. This study examined the workplace violence records of 135 healthcare professionals at a tertiary hospital's Patient Rights and Employee Safety and Law departments. Factors affecting workplace violence were categorized as noncompliance with the procedure, communication, and dissatisfaction.

RESULTS

Workplace violence frequency was observed in the cumulative total of 10821 healthcare workers at 1.2%. In terms of workplace violence types, 71.9% were verbal and 28.1% were physical. In terms of exposure to workplace violence, doctors accounted for 62.3%, nurses for 20%, and medical secretaries for 7.4%. Most cases were observed in outpatient clinics (34.8%), followed by emergency departments (25.9%). Among the main reasons for workplace violence against healthcare workers, non-compliance with procedures (49.6%), communication (27.4%), and dissatisfaction (23.1%) were identified. Legal aid was provided to all notifications of workplace violence. 37.1% were not prosecuted, 55.5% were under investigation, 4.4% were accepted indictments, and 3.0% were punished by a judicial fine.

CONCLUSION

This study can provide significant contributions to the formulation of workplace violence prevention policies and programs by analyzing white-code notifications for workplace violence frequency and preventable factors. Healthcare workers may have underreported workplace violence events due to the length of the proceedings and the perceived lack of protection from legal regulations.

Caring Knowledge as a Strategy to Mitigate Violence against Nurses: A Discussion Paper

Violence against nurses is a disturbing trend in healthcare that has reached epidemic proportions globally. These violent incidents can result in physical and psychological injury, exacerbating already elevated levels of stress and burnout among nurses, further contributing to absenteeism, turnover, and intent to leave the profession. To ensure the physical and mental well-being of nurses and patients, attention to the development of strategies to reduce violence against nurses must be a priority. Caring knowledge-rooted in the philosophy of care-is a potential strategy for mitigating violence against nurses in healthcare settings. We present what caring knowledge is, analyze its barriers to implementation at the health system and education levels and explore potential solutions to navigate those barriers. We conclude how the application of models of caring knowledge to the nurse-patient relationship has the potential to generate improved patient safety and increased satisfaction for both nurses and patients.

Screening for Behavioral Health Patient Aggression in Emergency Departments to Reduce Workplace Violence

INTRODUCTION

Patient violence in health care facilities occurs daily. Structured risk assessments, when regularly completed, have been effective in prompting interventions to reduce aggression in Behavioral Health (BH) settings.

METHODS

This quasi-experimental study evaluated the effectiveness of the Dynamic Appraisal of Situational Aggression - Inpatient Version (DASA) validated screening tool to reduce aggressive outbursts in an emergency department (ED) setting with BH patients awaiting transfer to a psychiatric facility. The tool was used in 4 non-psychiatric EDs from a large health care system. Chart audits were completed to record initial patient DASA scores observed at triage and at subsequent intervals during the ED encounter. ED staff documented interventions used for patients. Inclusion criteria included adults 21 years and older following a telepsychiatry consultation with a recommendation for BH inpatient admission. Pre-/post-implementation aggressive events were collected to assess ED DASA use. DASA scores from BH ED patients were examined to increase understanding of patient utilization. Staff workplace safety was examined to compare staff safety perception pre- and post-DASA implementation.

RESULTS

Violent events were reported statistically significantly higher post-DASA implementation. There was an increased risk of elevated DASA scores for specific diagnoses and genders. An increased awareness of the importance of reporting workplace violence improved documentation.

DISCUSSION

Using an evidence-based screening tool helped identify BH patients with behaviors associated with aggressive ED events. Proactive use of interventions, including use of Comfort Cart items, de-escalation, and prescribed medications, can positively influence reduction of risk from aggressive behaviors within BH patient populations in EDs.

Support Decent Work for All as a Public Health Goal in the United States. (APHA Policy Statement Number 20223, Adopted November 2022)

This policy promotes decent work as a U.S. public health goal through a comprehensive approach that builds upon existing APHA policy statements and addresses statement gaps. The International Labour Organization defines decent work as work that is "productive, delivers a fair income, provides security in the workplace and social protection for workers and their families, offers prospects for personal development and encourages social interaction, gives people the freedom to express their concerns and organize and participate in the decisions affecting their lives and guarantees equal opportunities and equal treatment for all across the entire lifespan." The World Health Organization has emphasized that "health and employment are inextricably linked" and "health inequities attributable to employment can be reduced by promoting safe, healthy and secure work." Here evidence is presented linking decent work and health and action steps are proposed to help achieve decent work for all and, thus, improve public health. In the United States, inadequacies in labor laws, structural racism, failed immigration policies, ageism, and other factors have increased income inequality and stressful and hazardous working conditions and reduced opportunities for decent work, adversely affecting workers' health and ability to sustain themselves and their families. The COVID-19 pandemic highlighted these failures through higher mortality rates among essential and low-wage workers, who were disproportionately people of color. This policy statement provides a strategic umbrella of tactics for just, equitable, and healthy economic development of decent work and proposes research partnerships to develop, implement, measure, and evaluate decent work in the United States.

Evidence-Based Approaches to Mitigate Workplace Violence From Patients and Visitors in Emergency Departments: A Rapid Review

INTRODUCTION

This is a rapid review of the published evidence on the effectiveness of interventions for mitigating workplace violence against staff in hospital emergency departments. Focused on the specific needs of an urban emergency department in Canada, this project sought to address the question, "What interventions have evidence regarding effectiveness for addressing workplace patient/visitor violence toward staff in the emergency department?"

METHODS

Following Cochrane Rapid Review methods, 5 electronic databases (MEDLINE via PubMed, Cochrane CENTRAL, Embase, PsycINFO, CINAHL) and Google Scholar were searched in April 2022 for intervention studies to reduce or mitigate workplace violence against staff in hospital emergency departments. Critical appraisal was conducted using Joanna Briggs Institute tools. Key study findings were synthesized narratively.

RESULTS

Twenty-four studies (21 individual studies, 3 reviews) were included in this rapid review. A variety of strategies for reducing and mitigating workplace violence were identified and categorized as single or multicomponent interventions. Although most studies reported positive outcomes on workplace violence, the articles offered limited descriptions of the interventions and/or lacked robust data to demonstrate effectiveness. Insights from across the studies offer knowledge users information to support the development of comprehensive strategies to reduce workplace violence.

DISCUSSION

Despite a large body of literature on workplace violence, there is little guidance on effective strategies to mitigate workplace violence in emergency departments. Evidence suggests that multicomponent approaches targeting staff, patients/visitors, and the emergency department environment are essential to addressing and mitigating workplace violence. More research is needed that provides robust evidence on effective violence prevention interventions.

Exploring workplace violence on surgical wards in Sweden: a cross-sectional study

BACKGROUND

Workplace violence is a global threat to healthcare professionals' occupational health and safety and the situation has worsened during the COVID-19 pandemic. This study aimed to explore workplace violence directed against assistant and registered nurses working on surgical wards in Sweden.

METHODS

This cross-sectional study was conducted in April 2022. Using a convenience sampling procedure, 198 assistant and registered nurses responded to an online questionnaire developed for this specific study. The questionnaire comprised 52 items and included, among other items, subscales from validated and previously used instruments. Data analysis included descriptive statistics, the chi-square test, and independent-samples t-test.

RESULTS

The most frequently reported type of workplace violence was humiliation (28.8%), followed by physical violence (24.2%), threats (17.7%), and unwanted sexual attention (12.1%). Patients and patients' visitors were reported as the main perpetrators of all kinds of exposure. Additionally, one third of the respondents had experienced humiliation from colleagues. Both threats and humiliation showed negative associations with work motivation and health (p < 0.05). Respondents classified as working in a high- or moderate-risk environment were more frequently exposed to threats (p = 0.025) and humiliation (p = 0.003). Meanwhile, half of the respondents were unaware of any action plans or training regarding workplace violence. However, of those who indicated that they had been exposed to workplace violence, the majority had received quite a lot or a lot of support, mainly from colleagues (range 70.8-80.8%).

CONCLUSION

Despite a high prevalence of workplace violence, and especially of humiliating acts, there appeared to be low preparedness within the hospital organizations to prevent and/or handle such incidents. To improve these conditions, hospital organizations should place more emphasis on preventive measures as part of their systematic work environment management. To help inform such initiatives, it is suggested that future research should focus on the identification of suitable measures regarding different types of incidents, perpetrators, and settings.

Workplace violence against healthcare workers using nationally representative estimates of emergency department data, 2015-2017

INTRODUCTION

Workers in the healthcare industry are at increased risk for workplace violence. The goal of this analysis is to determine the rate of injuries healthcare workers incurred as a result of intentional violence by patients in the workplace.

METHODS

Injuries linked to workplace violence that were treated in US emergency departments from 2015 to 2017 were identified using data from the National Electronic Injury Surveillance System-Occupational Supplement (NEISS-Work). All estimates and 95% confidence intervals were calculated using SAS® 9.4 Proc Survey to incorporate the stratified sample design of NEISS-Work.

RESULTS

Approximately 1.14 million injuries to workers in the healthcare industry were treated in US hospital emergency departments between 2015 and 2017. Intentional injuries by another person accounted for 15% of these healthcare-related injuries. The results also showed that male healthcare workers' rate of injuries was 2.3 times higher than their female counterparts despite composing a smaller proportion of the workforce. Injury rates were highest among the less-than-25 age group, and decreased as healthcare workers' age increased.

CONCLUSIONS

Workplace violence is a serious problem in today's healthcare settings that affects both employees and patient care. Although violence in the healthcare industry has been researched for decades, there has been an increase in violent incidents in this industrial sector. The disparity in injury rates by sex and age are areas of concern. Further research in these areas is necessary to understand the root causes of these incidents and inform violence prevention strategies.

Effects of verbal violence on job satisfaction, work engagement and the mediating role of emotional exhaustion among healthcare workers: a cross-sectional survey conducted in Chinese tertiary public hospitals

OBJECTIVE

Recently, Chinese ministries and commissions have issued a series of policies and systems in response to violent injuries to doctors, physical violence have been managed to a certain extent. However, verbal violence has not been deterred and is still prevalent, it has not received appropriate attention. This study thus aimed to assess the impact of verbal violence on the organisational level and identify its risk factors among healthcare workers, so as to provide practical methods for verbal violence reduction and treatment of the complete period.

METHODS

Six tertiary public hospitals were selected in three provinces (cities) in China. After excluding physical and sexual violence, a total of 1567 remaining samples were included in this study. Descriptive, univariate, Pearson correlation and mediated regression analyses were employed to assess the difference between the variables, emotional responses of healthcare workers to verbal violence and the relationship between verbal violence and emotional exhaustion, job satisfaction, and work engagement.

RESULTS

Nearly half of the healthcare workers in China's tertiary public hospitals experienced verbal violence last year. Healthcare workers who experienced verbal violence had strong emotional response. The exposure of healthcare workers to verbal violence significantly positively predicted the emotional exhaustion (r=0.20, p<0.01), significantly negatively predicted job satisfaction (r=-0.17, p<0.01) and work engagement (r=-0.18, p<0.01), but was not associated with turnover intention. Emotional exhaustion partially mediated the effects of verbal violence on job satisfaction and work engagement.

CONCLUSIONS

The results indicate that the incidence of workplace verbal violence in tertiary public hospitals in China is high and cannot be ignored. This study is to demonstrate the organisational-level impact of verbal violence experienced by healthcare workers and to propose training solutions to help healthcare workers reduce the frequency and mitigate the impact of verbal violence.

Characteristics of International Staff Victims of Psychiatric Patient Assaults: Review of Published Findings, 2017-2022

Psychiatric patient assaults on staff are a worldwide occupational hazard for health care staff that results in medical injury, human suffering, and dollar cost expense. International research through 2000-2017 documented the continued frequency of these assaults and a continuing high risk for nursing personnel. This present paper reviewed the international published literature on staff victims of patient assaults during the next five-year period of 2017-2022. There were 39,034 assaults on 34,679 employee victims. The findings indicate that assaults on staff remain a serious worldwide issue as it has been since the 1990s and that nursing personnel continued to be at greater risk. Aggression management approaches, post-incident interventions, and an updated methodological inquiry are presented.

Staff and ward factors associated with aggression development on an acute closed psychiatric ward: an experience sampling method study

Aggression on psychiatric wards develops under influence of patient, staff and ward factors. Assessment of naturalistic derived staff and ward factors might increase better understanding of how aggressive incidents develop on psychiatric wards.

OBJECTIVE

Studying staff and ward factors including interactions between patients and nurses prior and after development of aggression, within a naturalistic closed ward setting.

DESIGN

A prospective naturalistic experience sampling method (ESM) study.

SETTING AND PARTICIPANTS

A high intensive care unit of a mental health institution in The Netherlands where 29 nurses answered beeps generated by an app during approximately 7 consecutive days with questions regarding their subjective feelings, ward atmosphere, location, interaction they had with patients and their colleagues and whether an incident took place.

MAIN OUTCOME MEASURES

Associations were established between different staff and ward factors and the occurrence of aggressive incidents on the ward.

RESULTS

Risk for aggression was associated with the nurse being with a patient (OR=2.26, 95% CI 0.99 to 5.15, p=0.05). No significant association was found between discussing with the patient and setting a limit or physical absence of the nurse on the one hand and aggression on the other. More experienced nurses encountered more aggression (OR=3.5, 95% CI 1.32 to 8.26, p=0.01). Age and gender of the nurse were not associated with aggression development. Exceeding the maximum bed capacity was associated with a greater risk for aggression (OR=5.36, 95% CI 1.69 to 16.99, p=0.004). There was no significant association when analysing a more positive atmosphere on the ward or positive affect of the nurse, but negative affect of the nurses showed a trend for an association with less aggression.

CONCLUSION

Aggression is a problem that should be managed from a multidimensional perspective. The quality of interaction between nurses and patients is crucial. Exceeding the maximum bed capacity is likely associated with more aggression.

Job security among healthcare workers in Guangdong, China

Objective

The objective of this study was to explore the sense of job security and its influencing factors among healthcare workers in Guangdong, China.

Methods

This cross-sectional study used stratified random sampling to enroll healthcare workers employed by hospitals across Guangdong province between September 2020 and October 2020.

Results

A total of 4,173 questionnaires were distributed, and 4,076 were returned for an effective recovery rate of 97.68%. The overall score for the sense of security was 64.85 ± 20.09, and the item means score was 2.95 ± 0.91. Multiple-linear regression analysis showed that work experience (years), education level, job position, specialty unit, employment type, marital status, job satisfaction, WPV frequency, daily sleep duration, weekly overtime hours, average monthly earnings (RMB), hospital level, and region were significantly associated with senses of poor security among healthcare workers (all P < 0.05).

Conclusions

Hospital workers in Guangdong reported relatively low levels of job security. Levels of job security were significantly associated with multiple factors which could be addressed by hospital practices to improve the sense of job security among healthcare workers.

A Scoping Review of Recommendations and Training to Respond to Patient Microaggressions

OBJECTIVE

Patient microaggressions affect practitioners in all fields of healthcare and especially psychiatry. In multiple studies, healthcare professionals reported high rates of patient microaggressions and discrimination. To date, this is the first scoping review of recommendations and trainings on patient microaggressions.

METHOD

A scoping review of articles indexed in PubMed, PsycINFO, Medline, ERIC, and MedEdPORTAL was conducted from July 2020 to August 2020 to identify recommendations and solutions for healthcare professionals on responding to patient microaggressions.

RESULTS

The review identified 27 studies that provide recommendations and trainings for healthcare professionals to address patient microaggressions. Twenty studies outlined recommendations for healthcare professionals and systems on how to respond to patient offenses. These 20 studies were grouped into establishing a supportive culture, addressing the microaggression, supporting the targets of microaggressions, discriminatory requests, and institutional responses. Six articles described trainings that equip providers with tools to address patient microaggressions, including the ERASE framework ("Expect/Recognize/Address/Support/Establish, Encourage"); Stop, Talk, and Roll; interrupting microaggressions; XYZ ("I felt X when Y because Z"); the ACTION model ("Ask/Come/Tell/Impact/Own/Next"); and the OWTFD tool ("Observe/Why/Think/Feel/Desire").

CONCLUSION

Recommendations and trainings for the response to microaggressions are emerging, and results of trainings are encouraging. However, more work is needed to evaluate the effectiveness of these trainings in clinical settings and longitudinally.

Nurse, Provider, and Emergency Department Technician: Perceptions and Experiences of Violence and Aggression in the Emergency Department

INTRODUCTION

Patient/visitor violence and aggression (V&A) in the emergency department occurs daily. Few interventions exist to decrease V&A. Research describing prevalence, severity, and perceived safety among ED clinicians is limited.

METHODS

A descriptive survey explored V&A against ED clinicians in one urban emergency department. A sample of nurses, ED technicians, physicians and advanced practice providers participated. Participants completed a demographic survey, Personal Workplace Safety Instrument for Emergency Nurses (PWSI-EN), and ENA V&A frequency checklist. Analysis of Variance (ANOVA) for unadjusted and Analysis of Covariance (ANCOVA) for adjusted associations were used to assess differences in the PWSI-EN survey composite score and "feeling safe in the ED" among ED roles. ANCOVA was adjusted for potential confounders: sex, race, years working in emergency department, and shift worked.

RESULTS

Sixty-five (46.4%) of the 140 ED clinicians returned surveys, which were almost evenly distributed between ED clinician roles and sex. Mean age was 37.2 (range: 21-64) years. All (100%) nurses and providers reported being verbally abused. More nurses reported physical violence (n = 21, 87.5%) than providers (n = 7, 36.8%) and ED technicians (n = 11, 55%). Nurses and ED technicians reported experiencing greater prevalence of physical violence than providers (p < .05). Nurses (mean 3.29, range 2.95 to 3.63) were more fearful for their personal safety than ED technicians (mean 3.88, range 3.48 to 4.28) (p < .03).

DISCUSSION

V&A are common creating a fearful environment. However, little research regarding clinician perceptions exists. Our study aids in identifying areas for clinician-targeted strategies to prevent ED V&A.

Effectiveness of anger-focused emotional management training in reducing aggression among nurses

AIM

The aim of this study was to conduct a 5-h training programme on anger-focused emotional management for nurses and verify its effectiveness.

DESIGN

The study used a one-group pretest-posttest design.

METHODS

Participants (N = 283) attended a programme comprising lectures and exercises. The Japanese version of the Buss-Perry Aggression Questionnaire was administered pre-, post- and 3-month posttraining. Regression analyses were used to assess the effects of the programme by gender.

RESULTS

For the total aggression score, the difference between the pre- and posttraining scores was -2.827 points and remained at -1.602 points 3-month posttraining. Physical aggression scores decreased posttraining, but the scores increased after 3 months. There were statistically significant gender differences in hostility scores; pre-training scores were slightly higher for men than for women and lower for men after 3 months. Total and physical aggression scores were higher for men than for women. The training programme decreased aggression, and the effect persisted after 3 months.

Verbal Violence and Turnover Intention Among New Nurses in Korea: A Time-Lagged Survey

AIM

To test a model examining the impact of verbal violence against new nurses on their turnover intention and the mediating effects of emotional reaction and burnout based on affective events theory.

BACKGROUND

In Korea, turnover rate of nurses, especially new nurses, is at a serious level. Verifying the paths is important by which nurses decide to turnover intention after experiencing verbal violence, which is the most common form of workplace violence. In particular, Research on new nurses who are vulnerable to exposure to verbal violence and have a high turnover rate is insufficient.

METHODS

Data was collected using a time-lagged online surveys from 212 Korean new nurses. Structural equation modelling was used to test the hypothesized model.

RESULTS

The level of the turnover intention of new nurses was almost 4 out of 5. Verbal violence not only has a direct effect on turnover intention, but also has an indirect effect through burnout. Emotional reactions and burnout sequentially mediated the relationship between verbal violence and turnover intention; these variables explained approximately 57% of turnover intention.

CONCLUSIONS

To decrease negative emotional reactions and burnout caused by verbal violence may benefit to reduction of turnover intention of new nurses.

IMPLICATIONS FOR NURSING MANAGEMENT

The critical need for new nurses' violence interventions that focus on emotional reactions and burnout, and subsequently improving desirable patient-coworker-nurse relationships and quality of life for new nurses.

Is there a role for ethics in addressing healthcare incivility?

In a healthcare setting, a multitude of ethical and moral challenges are often present when patients and families direct uncivil behavior toward clinicians and staff. These negative interactions may elicit strong social and emotional reactions among staff, other patients, and visitors; and they may impede the normal functioning of an institution. Ethics Committees and Clinical Ethics Consultation Services (CECSs) can meaningfully contribute to organizational efforts to effectively manage incivility through two distinct, yet inter-related channels. First, given their responsibility to promote a humane, respectful, and professional climate, many CECSs and Ethics Committees may assist institutional leadership in evaluating and monitoring incivility policies and procedures. Second, when confronted with individual incidents of patient/family incivility, Ethics Consultants can and often do work with all stakeholders to address and mitigate potentially deleterious impacts. This manuscript presents an overview of the multifaceted ethical implications of incivility in the healthcare environment, discusses the inherent qualifications of Ethics Consultants for assisting in the management of incivility, and proposes specific mitigating actions within the purview of CECSs and Ethics Committees. We also invite healthcare organizations to harness the skills and reputation of their CECSs and Ethics Committees in confronting incivility through comprehensive policies, procedures, and training.

Instruments for Measuring Violence on Acute Inpatient Psychiatric Units: Review and Recommendations

OBJECTIVE

Violence by patients against inpatient psychiatric unit staff is common, causing considerable suffering. Despite the Joint Commission's 2018 requirement for behavioral health organizations to use standardized instruments, no identified gold standard measures of violence and aggression exist. Therefore, accurate data are lacking on the frequency of patient-to-staff violence to guide development of safer institutional clinical policies or to assess the impact of targeted interventions to reduce violence. To inform recommendations for developing standardized scales, the authors reviewed the scoring instruments most commonly used to measure violence in recent studies.

METHODS

A comprehensive literature search for violence measurement instruments in articles published in English from June 2008 to June 2018 was performed. Review criteria included use of instruments measuring patient-to-staff violence or aggression in acute, nonforensic, nongeriatric populations. Exclusion criteria included child or adolescent populations, staff-to-staff violence, and staff- or visitor-to-patient violence.

RESULTS

Overall, 74 studies were identified, of which 74% used structured instruments to measure aggression and violence on inpatient psychiatric units during the past 10 years. The instruments were primarily variants of the Observed Aggression Scale (OAS); 26% of the studies used unstructured clinical notes and researcher questionnaires. Major obstacles to implementing measurement instruments included time and workflow constraints and difficulties with use.

CONCLUSIONS

In the past 10 years, OAS variants with evidence of validity and reliability that define aggression and violence have been consistently used. The authors propose that adapting the Modified OAS to collect real-time clinical data could help overcome barriers to implementing standardized instruments to quantify violence against psychiatric staff.

Prevalence of Aggressive Behavior Toward Fellows, Residents, and Nurses at a Tertiary Care Hospital in Riyadh, Saudi Arabia

Background Workplace bullying (WPB) is a form of mistreatment toward an individual manifested by physical, verbal, or indirect aggression. Affected victims display a wide range of signs and symptoms that impact their health. This study aimed to investigate the prevalence of aggressive behavior toward healthcare workers and its effects on job satisfaction, general health, and mental health. Methodology An online survey comprising a revised version of the Negative Acts Questionnaire-Revised (NAQ-R) was distributed to the fellows, residents, and nurses working in a tertiary care hospital. The survey collected information regarding the group's demographics and their exposure to WPB encountered in the work environment while maintaining confidentiality. Survey results were analyzed using SPSS Statistics version 25 (IBM Corp., Armonk, NY, USA). Results Among the 339 participants who filled the survey, 53% of healthcare practitioners in different services had experienced some form of WPB. Among the targeted group, it was noted that female gender (50%), age between 31 and 41 years (57.03%), nurses (51.98%), non-Saudi practitioners (41.94%), and those working in inpatient settings (49.74%) were the most commonly affected individuals in the medical facility. Furthermore, higher bullying prevalence was correlated with lower job satisfaction and mental health levels. Conclusions Age, gender, job, and nationality were factors associated with increased susceptibility to WPB. WPB in any facility is an unfortunate event, especially in a healthcare setting. It affects health practitioners by decreasing job satisfaction, jeopardizing health, and increasing the risk of harm to patients. WPB will eventually have a negative impact on the medical facility and the healthcare sector. Hence, hospital administrations should be alarmed about the rise in WPB, and adequate measures must be taken to deal with the root cause of the problem.

Violence in Health Care: Trends and Disparities, Bureau of Labor Statistics Survey Data of Occupational Injuries and Illnesses, 2011-2017

Background: The health care sector is one of the most rapidly growing industry sectors in the United States. This study examined differences in the rates and trends of violent occupational injuries among health care workers in the United States. Methods: This study used data about violent occupational injuries among health care workers in the United States collected by the Bureau of Labor Statistics (BLS) Survey of Occupational Injuries and Illnesses (SOII). The BLS SOII collects data about injuries that result in at least one lost workday. Violent injuries are defined as intentional injury by another person. Data were obtained for years 2011 to 2017. We examined injury rates and trends according to industry and occupation, as well as age, sex, and race/ethnicity. Results: Intentional injuries increased among health care workers between 2011 and 2017. Rates, expressed as injuries per 10,000 workers, were particularly elevated in residential care facilities (44.07) and among health practitioner support technologists and technicians (22.54); nursing, psychiatric, and home health aides (28.13); and occupational therapy and physical therapist assistants and aides (39.72). Black health care support and practitioners workers had injury rates three times higher than White workers. Conclusions/Application to practice: Efforts should be made to address the increasing rates of intentional occupational injuries among health care workers. These efforts should focus on comprehensive programs enforcing policies for prevention and management (including reporting and training) and employee engagement in such efforts. High-rate industries and occupations should receive particular attention.

Inpatient violence in a psychiatric hospital in the middle of the pandemic: clinical and community health aspects

Healthcare workers are at a high risk of violence all over the world. The hostility toward nurses, physicians, and hospital staff has reached the point that it can be considered a public health problem. In this paper, we focus on the harassment, aggression, and violence that many healthcare workers have encountered while treating unstable psychiatric patients in the middle of the COVID-19 pandemic. We present a case with a history of violence toward mental health workers, review psychopathological and clinical aspects, and discuss how both the COVID-19 pandemic and current challenges in psychiatric hospital settings increase the frequency and severity of these attacks and how this affects the team on inpatient psychiatric units. We used the CARE guidelines to provide the most accurate and transparent information about the patient and relevant psychosocial aspects. We also pooled more than 20 unique sources to cover all aspects of violent behaviors in all psychiatric settings for all age groups. We concluded that a lack of nursing staff, the mental burden imposed by difficult patients, and poor communication between team members are some of the factors contributing to patient violence. An incomplete understanding of the problem creates barriers to change on both personal and systematic levels. Constant violence and abuse against healthcare workers cause stress, decreased productivity, and work dissatisfaction. To improve the safety of healthcare professionals, especially in inpatient psychiatric settings, several system-based changes should be implemented.

Perceptions of Hospital-at-Home Among Stakeholders: a Meta-synthesis

BACKGROUND

Hospital-at-home (HaH) provides acute healthcare in patients' homes as an alternative to traditional hospital inpatient care. HaH has been shown to improve clinical outcomes, increase patient satisfaction, and reduce hospitalization costs. Despite its effectiveness, the uptake of HaH remains slow and little is known about factors that impact the quality and transferability of HaH. This review aimed to qualitatively synthesize existing literature to examine the perspectives of stakeholders to identify areas of improvement in this model of care.

METHODOLOGY

Six electronic databases (Cumulative Index of Nursing and Allied Health Literature, PubMed, Embase, PsychINFO, Scopus, and Mednar) were searched from inception date until 3 February 2021. The included studies were assessed for quality using the Critical Appraisal Skills Program tool. This review was registered on the International Prospective Register of Systematic Reviews. The meta-synthesis was completed according to Sandelowski and Barroso's guidelines.

RESULTS

Sixteen articles met the inclusion criteria. The overarching synthesized theme was "the intricacies of developing HaH," and the four main themes were (1) factors influencing patient selection, (2) advantages of HaH, (3) challenges of HaH, and (4) enablers for HaH development.

CONCLUSION

Overall, high levels of satisfaction were expressed by various stakeholders. Continuity of care remains an important factor for patient-centeredness in HaH. Caregivers should be involved in the decision-making process and supported throughout the HaH duration to prevent caregiver burnout. Collaboration and coordination among healthcare professionals are vital and can be strengthened through training and technological advancements of remote patient monitoring. Institutional and organizational support for stakeholders may make HaH a viable solution to modern healthcare challenges.

Rethinking "zero tolerance": A moderated mediation model of mental resilience and coping strategies in workplace violence and nurses' mental health

AIMS

This study aimed to investigate whether the impact of workplace violence (WPV) on nurses' mental health varies with mental resilience and coping strategies.

BACKGROUND

Workplace violence is a serious threat to nurses' mental health, and its impact on nurses' mental health is influenced by many factors.

METHOD

A cross-sectional study involving 349 participants was conducted over 12 months. The data were analyzed using SPSS 25.0 and SPSS PROCESS macro.

RESULTS

In total, 82.52% of nurses were exposed to WPV. WPV not only affects mental health directly but also indirectly through mental resilience. Coping strategies had a moderating effect among WPV, mental resilience and mental health. When nurses coped with psychological violence with intolerance, WPV had a stronger negative effect on their mental health. When nurses coped with psychological violence with tolerance but coped with physical violence with intolerance, mental resilience had a stronger positive effect on their mental health.

CONCLUSIONS

Good mental resilience and coping with psychological violence with tolerance while coping with physical violence with intolerance can help buffer WPV and promote mental health.

CLINICAL RELEVANCE

Employers who have a "zero tolerance" policy regarding WPV need to re-examine how they currently operate.

General Hospital Agitation Management Under the Lens of Leadership Theory and Health Care Team Best Practices Using TeamSTEPPS

BACKGROUND

Acute agitation management is an emergency clinical intervention, often presenting acute danger to patients and medical staff. Unlike many other emergency clinical interventions, acute agitation management lacks a substantial evidence base regarding leadership and teamwork best practices. The Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) framework is a comprehensive strategy for improving health care outcomes in acute clinical situations.

OBJECTIVE

Practical application of TeamSTEPPS frameworks in team-based acute agitation management in the medical setting.

METHODS

A literature review was performed from January 1990 to March 2021 for verbal de-escalation in acute agitation management, leadership and teamwork in psychiatry and medicine, and TeamSTEPPS.

RESULTS

No literature was found that applied TeamSTEPPS for acute agitation management in the general medical unit context although limited application has been trialed in the inpatient psychiatric context. The verbal de-escalation literature describes applicable content including conflict management approaches, communication strategies, security presence management, modeling therapeutic behavior, and debriefing strategies. Several articles were found regarding a rapid response team model for acute agitation management and describing handoff tools in psychiatric care contexts. Translation of the TeamSTEPPS approach provided many additional approaches for operation of a rapid response team in acute agitation management.

CONCLUSIONS

The leadership and teamwork best practices in TeamSTEPPS provide a clear and actionable framework for team-based acute agitation management as an emergency clinical intervention.

Workplace Violence Prevention: Flagging Practices and Challenges in Hospitals

BACKGROUND

Flagging is a standardized way to communicate the risk of patient violence to workers. We add to the limited body of research on flagging by describing hospitals' approaches to and challenges with flagging patients with a history of violent behavior.

METHODS

We used a qualitative case study approach of hospitals in Ontario, Canada and their patient flagging practices. Key informants and our advisory committee identified 11 hospitals to invite to participate. Hospitals assisted in recruiting frontline clinical and allied health workers and managers to an interview or focus group. A document analysis of hospitals' flagging policies and related documents was conducted. Thematic analysis was used to analyze interview and focus group data.

FINDINGS

Five hospitals participated. Of the five hospitals, four had a flagging policy where frontline clinical workers (n = 58), frontline allied health workers (n = 31), and managers (n = 42) participated in an interview (n = 43) or focus group (n = 15). Participants described three challenges: patient stigmatization, patient privacy, and gaps in policy and procedures.

CONCLUSION/APPLICATION TO PRACTICE

Flagging patients with a history of violent behavior is one intervention that hospitals use to keep workers safe. While violence prevention was important to study participants, a number of factors can affect implementation of a flagging policy. Study findings suggest that hospital leadership should mitigate patient stigmatization (real and perceived) and perception of patient rights infringement by educating all managers and frontline workers on the purpose of flagging and the relationship between occupational health and safety and privacy regulations. Leadership should also actively involve frontline workers who are the most knowledgeable about how policies work in practice.

Empathy With Patients and Post-Traumatic Stress Response in Verbally Abused Healthcare Workers

OBJECTIVE

The current study examined the differential empathic capacity, post-traumatic symptoms, and coping strategies in healthcare workers (HCWs) according to the exposure of verbal or physical workplace violence (WPV).

METHODS

Using online survey, a total of 422 HCWs employed at a training general hospital of South Korea participated and completed self-reporting questionnaires including the WPV questionnaire with coping strategy, the Jefferson Scale of Physician Empathy.

RESULTS

Those who experienced either only verbal violence or both physical and verbal violence had lower Jefferson Scale of Physician Empathy scores (p<0.05). Posttraumatic stress symptom severity was higher among people who experienced verbal violence than physical violence. HCWs' exposure to verbal violence was associated with severe posttraumatic symptoms and a low level of empathy with patients (p<0.05). More than half of the victims of verbal violence responded that they did not take any action, receive organizational protection, or peer support, while most physically-abused HCWs received institutional intervention or help from others.

CONCLUSION

Our findings highlight the critical importance of reducing verbal violence, which may represent a larger psychological burden compared to physical violence, by actively implementing effective strategies and policies at the institutional level.

It Takes Two to Tango: Public Attitudes Toward Prevention of Workplace Violence Against Health Care Staff: A Mixed-Methods Study

Workplace violence (WPV) directed toward health care staff by patients and their relatives has become one of the major problems faced by health care systems around the world. Incidences of WPV have increased over the past decade, crossing borders and cultures and creating a worrisome global phenomenon. To date, most of the research has examined health care workers' perceptions of strategies that might prevent violence. Although the public, as prospective patients, has a central role in this state of affairs, little is known about public attitudes to prevention of violence in health care settings. In light of this, the current mixed-methods study aimed to explore public attitudes toward appropriate preventive and punitive measures that should be employed to diminish the occurrence of WPV incidents in health care settings. Five hundred sixty Jewish Israeli individuals participated in the study. Quantitative findings indicate the public's overall agreement and positive attitudes toward preventive and punitive measures aimed at reducing WPV against health care staff. Qualitative findings revealed two main themes: "focusing on the staff" by improving their work conditions, training them to deal with violence, and providing a sense of security, as well as "focusing on the public" by teaching tolerance, raising awareness of zero tolerance to violence, and punitive measures. The Israeli public believes that to deal with the problem of violence in the health care system, it is necessary to act simultaneously on two levels: health staff and the health care system, and the general public. In view of these findings, we recommend that policy makers address this issue by adopting preventive measures, such as increasing the number of health care personnel, workshops for the staff on dealing with violence, campaigns against violence in health care settings, and enforcing appropriate punitive measures against attackers.

Development and effectiveness of tabletop exercises in preparing health practitioners in violence prevention management: A sequential explanatory mixed methods study

BACKGROUND

Workplace violence in healthcare remains a significant issue for healthcare professional, in terms of risk to patients and staff. One part of a workplace violence prevention and management programme is to educate staff in their response to critical events. Drawn from the disaster management literature, tabletop exercises were used in this study to simulate workplace violence and educate staff on the appropriate emergency response during a violent event. The use of tabletop exercise in this context is a novel approach to workplace violence prevention management.

AIM AND OBJECTIVE

This study describes the development and effectiveness of tabletop exercises in preparing health practitioners in violence prevention and management emergency response systems.

METHODS

Using a sequential explanatory mixed method design. The study comprised of two phases 1) quasi-experimental (quantitative) and 2) focus group (qualitative) to evaluate the effectiveness of the violence prevention management tabletop exercises. COREQ guidelines were followed the qualitative arm of the study and the TREND statement for the quantitative part of the study.

RESULTS

Statistically significant improvements in healthcare professional confidence levels were found two weeks post the tabletop exercises. A post focus group revealed three categories concerning the participant's experiences of the tabletop exercises, (role clarity, adult learning and organisational support).

CONCLUSION

Tabletop exercise may provide a, low cost, context specific novel approach to educating staff in emergency violence response systems at a tertiary referral hospital. Educators and policy makers may consider the use of tabletop exercises in the ongoing work in preparing health care staff for workplace violence.

RELEVANCE TO CLINICAL PRACTICE

Successful tabletop exercises should consider a local ward level context, the use of adult learning principles, have high level organisational support and cover role clarity as a key learning area.

Mediating role of coping styles on anxiety in healthcare workers victim of violence: a cross-sectional survey in China hospitals

OBJECTIVE

The purposes of this study were to evaluate the rate of workplace violence in county hospitals in China and its impact on healthcare workers and to explore the relationship between hospital violence, coping styles and anxiety to provide effective procedures for reducing anxiety among healthcare workers.

METHODS

The study used stratified sampling to select 1200 healthcare workers from 30 county hospitals in China to conduct a questionnaire survey. Of these, 1030 were valid questionnaires, and the effective response rate was 85.83%. We collected demographic characteristics of our participants and administered the following scales to them: Workplace Violence, Trait Coping Style, Self-rating Anxiety. Data were statistically analysed.

RESULTS

The results showed that 67.28% of healthcare workers in county hospitals in China had experienced workplace violence in the previous 12 months, with prevalent verbal violence (66.12%) followed by physical violence (15.24%). Workplace violence in hospitals was negatively related to positive coping (r=-0.091, p<0.01) but positively related to negative coping (r=0.114, p<0.001) and anxiety (r=0.298, p<0.001). Positive and negative coping was negatively (r=-0.085, p<0.01) and positively (r=0.254, p<0.001) associated with anxiety respectively. Positive and negative coping influenced both hospital workplace violence and anxiety in healthcare workers who were victims of violence. Compared with positive coping, the mediating effect of negative coping was stronger (95% CI -0.177 to -0.006).

CONCLUSIONS

The incidence of workplace violence among healthcare workers in county-level hospitals in China is relatively high, and there is a correlation between hospital violence, coping styles and anxiety. Positive and negative coping play a mediating role in the impact of hospital violence on healthcare workers' anxiety. Therefore, hospital administrators should actively promote healthcare workers' transition to positive coping strategies and minimise the negative impact of anxiety on them.

Relationships between nurses' experiences of workplace violence, emotional exhaustion and patient safety

BACKGROUND

The rising rate of workplace violence in hospitals is a serious concern. While leading organisations recommend implementing interventions to address workplace violence, little is known about the workplace violence relationship between patients and visitors, and how it affects nurses' emotional exhaustion and their perceptions of patient safety.

AIMS

The study's purpose was to understand the status of workplace violence in hospitals and the relationships between nurses' experiences of workplace violence, emotional exhaustion, and perceptions of patient safety.

METHODS

This cross-sectional analysis used data from a survey conducted at a large academic medical centre using the Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture plus additional measures of workplace violence and emotional exhaustion.

RESULTS

Nurses reported more occurrences of verbal violence than physical violence. Nurses' experiences of workplace violence negatively affect nurses' emotional exhaustion and patient-safety perceptions. Moreover, nurses' emotional exhaustion mediated the relationship between verbal abuse and patient-safety perceptions.

CONCLUSIONS

Interventions to reduce nurses' emotional exhaustion and strengthen resilience can mitigate the negative effects of verbal abuse and to some extent the effects of physical violence.

Frequency of violence towards healthcare workers in the United States' inpatient psychiatric hospitals: A systematic review of literature

The purpose of this systematic review is to determine the frequency of violent or aggressive behaviour towards healthcare workers in inpatient psychiatric settings in the United States. To achieve this aim, five databases were searched to find English-language quantitative studies reporting prevalence or incidence data of violence or aggression directed towards staff members in inpatient psychiatric settings. No limitations were set based on publication date, and intervention studies were included only if baseline data were provided. Of 335 total studies found, 38 full-text articles were suitable for full-text analysis based on inclusion and exclusion criteria, and 14 were included in the final review. Years of data collection ranged from 1986 to 2018, and a range of psychiatric facilities were represented, from small, private hospital units to large forensic institutions. Researchers utilized surveys, real-time incident reporting tools, and government databases, or a combination of strategies, to collect data related to workers' experiences on the job. Included research indicates that workplace violence in the U.S. inpatient psychiatric setting is a widespread problem, with 25-85% of survey respondents reporting an incident of physical aggression within the year prior to survey, and statewide workers' compensation findings indicating 2-7 claims due to assault per 100 000 employee hours. There are substantial differences between findings based on measurement strategy, making it difficult to arrive at a single estimate of prevalence nationally. As management of this persistent problem receives continued attention from stakeholders, it becomes increasingly important to define and measure the problem with the most appropriate tools.

Determination of the Society's Perceptions, Experiences, and Intentions to Use Violence Against Health Professionals

Background

Violence against health professionals is an increasing problem in Turkey. This study aims to determine the societal perception of violence, experience of violence, and the intentions to use violence against health professionals.

Methods

This descriptive study sample comprised 484 individuals. Data were collected by using the “Descriptive Information Form” and “Intentions to Use Violence against Health Professionals Scale.”

Results

Of the participants, 8.3% used violence against health professionals. Most of the participants (81.2%) stated that violence was not a solution, and 65.9% believed that health professionals did not deserve violence. Past behavior of the participants was the most influential factor on the intention to use violence (β = .473, p = 0.000).

Conclusions

More than half of the participants believed that health professionals did not deserve violence and violence was not a solution. We found that intention to use violence was affected by past experiences.

The Assaultive Staff Action Program (ASAP): Thirty Year Program Analysis

The Assaulted Staff Action Program (ASAP) is a voluntary, system-wide, peer-help, crisis intervention program to address the psychological sequellae in staff victims of patient assaults. Its functions and service provisions have been reported in previous five-year intervals. ASAP has been associated with providing quality counseling services to employee victims of these patient assaults as well as declines in assaults facility-wide in some agencies after an ASAP team was fielded. The present paper presents a summary of both its most recent five-year interval (2015-2020) and an overview of its 30 years of service during which it has responded to 10,651 patient assaults on staff.

When Our Work Hits Home: Trauma and Mental Disorders in Correctional Officers and Other Correctional Workers

Background: International estimates suggest that up to one in three public safety personnel experience one or more mental disorders, including post-traumatic stress disorder (PTSD). Canadian data have been sparse until very recently, and correctional officers and forensic psychiatric staff have rarely been included. Working as a correctional officer is associated with negative health outcomes and increased work-related stress, with several variables affecting reported levels of stress. Healthcare staff also report higher rates of PTSD, especially those who are exposed to aggression in their workplace. In the present study, we compare current symptoms of diverse staff working in correctional occupations. Method: Data were collected from a Canadian national online survey of public safety personnel, including employees of correctional services at the federal level. Correctional officers and wellness services staff were compared for prevalence of mental disorders and suicidal ideation. Results: Correctional officers self-reported statistically significantly more exposure to potentially psychologically traumatic events than wellness services employees. Correctional officers also self-reported higher rates of symptoms of mental disorders, including PTSD, social anxiety, panic disorder, and depression. There were no statistically significant differences in reports of suicidal thoughts, plans, or attempts. Contribution to Society: Correctional and forensic staff contribute to society by working with justice-involved individuals in correctional institutions. Trauma-related disorders and other mental health problems threaten the well-being of correctional and forensic staff. Mental health likely impacts the ability of correctional and forensic staff to develop a therapeutic or working alliance with persons in custody. Staff well-being must be recognized and addressed to ensure that prisoners and staff receive optimal treatment in prison. Conclusion: Our results add to the limited knowledge about the well-being of staff, particularly wellness staff in prisons, who provide daily treatment and care for prisoners with serious mental disorders. Our work is a step toward identifying avenues for promoting staff well-being.

Workplace violence against doctors in a tertiary care hospital

AIM

This study aimed to evaluate the magnitude and factors associated with violence against doctors.

MATERIALS AND METHODS

An online survey of doctors working in a tertiary care hospital in India was done by using the modified version of the workplace violence (WPV) in the Health Sector Questionnaire, developed by the World Health Organization.

RESULTS

Out of the 353 participants, 193 doctors (54.6%) reported being exposed to violence at their workplace in the past 6 months. Participants from the medical branches (57.8%), senior residents (60.3%), and those who were posted in emergency services (79.4%) and night duty (56.1%) reported more violence. The most common type of WPV was verbal abuse (91.2%), and the perpetrators were relatives of the patients (51.7%). The possible perceived reasons for WPV were patient overload (69.7%), prolonged duty hours and excessive workload (69.7%), and long waiting periods for patients/caregivers (66.9%). The majority of the participants considered that recruiting an adequate number of professional and paraprofessional staff (75.6%) can lead to a reduction in WPV.

CONCLUSIONS

The present study suggests that more than half of the doctors working in a tertiary care hospital in India face WPV. There is a lack of specific redressal mechanism to address WPV. Accordingly, there is a need to develop a mechanism for reporting of WPV and to implement preventive strategies at the individual level and at the system level. There is need for strengthening and implementing laws and making new policies to reduce WPV.

Ensuring Workplace Safety: Evidence Supporting Interventions for Nurse Administrators

Healthcare workplace violence is a growing concern among nurses; however, nurse administrators and managers may not be fully aware of the level, frequency, or extent of the trauma that staff nurses experience. This information gap is influenced by nurses' failure to report violent incidents, their belief that they are expected to care for violent/assaultive patients, time required for extensive documentation about these incidents, and perceptions that minimal follow-up to mitigate future episodes will occur. This article describes the evidence-based structures, processes, and practices supported to minimize organizational risk and protect nurses and other staff from being physically or emotionally injured and/or traumatized in the workplace.

Workplace Violence in Asian Emergency Medical Services: A Pilot Study

Workplace violence among Asian emergency medical services (EMS) has rarely been examined. A cross-sectional, mainly descriptive study using a standardized, paper-based, self-reported questionnaire survey was conducted between August and October 2018 among emergency medical technicians (EMTs) in the Tainan City Fire Bureau, Taiwan. A total of 152 EMT-paramedics responded to the questionnaire survey, constituting an overall response rate of 96.2%. The participants were predominantly male (96.1%), college-educated (4-year bachelor’s degree) (49.3%), and middle-aged (35–44 years old) (63.8%). Among them, 113 (74.3%) and 75 (49.3%) participants had experienced verbal and physical assaults at work, respectively. Only 12 (7.9%) participants were familiar with relevant regulations or codes. The assaults predominantly occurred during evening shifts (16:00–24:00) and at the scene of the emergency. The most predominant violence perpetrators included patients, patients’ families, or patients’ friends. Nearly 10% of participants had experienced verbal assaults from hospital personnel. EMTs who encountered workplace violence rarely completed a paper report, filed for a lawsuit, or sought a psychiatric consultation. Fifty-eight (38.2%) and 16 (10.5%) participants were victims of frequent (at least once every 3 months) verbal and physical forms of violence, respectively; however, no statistically significant association was observed in terms of EMT gender, age, working years, education level, or the number of EMS deployments per month. The prevalence of workplace violence among Asian EMS is considerable and is comparable to that in Western countries. Strategies to prevent workplace violence should be tailored to local practice and effectively implemented.

Aggression Management Training in Undergraduate Nursing Students: A Scoping Review

Recent events and media coverage have put aggression and violence toward healthcare workers on the agenda of many governments and healthcare providers. Shown to cause poor job satisfaction, attrition and higher rates of turnover, aggression and violence toward healthcare workers is a substantial problem in the provision of quality care. We aim to determine the feasibility of providing aggression management training to undergraduate nursing students to better prepare them for the workforce. This review found seven studies utilizing various methods of providing aggression management training to students. Delivery was diverse in terms of format, content and duration, and the efficacy of training was typically determined in a pre- and post-test fashion. The findings in reviewed studies indicate significant improvements in competence and attitudes, however some methodological caveats exist. We conclude that aggression management training for undergraduate nursing students is indeed feasible within certain constraints: methodological approaches to demonstrating efficacy need to evolve beyond pre- and post-test designs and changes in content delivery incorporating new and novel methods, such as simulation, need to be considered and incorporated. Aggression management training should be considered as essential in the nursing curriculum in order to provide neophyte nurses with the skills and capabilities to manage aggression and violence in their future workplaces.

Working conditions and absence from work during pregnancy in a cohort of healthcare workers

OBJECTIVES

To assess the relationship between exposure to occupational risk factors during pregnancy and absence from work using two different social benefits.

METHOD

Three working pregnancy trajectories (WPT) were identified in a cohort of 428 pregnant workers from a healthcare institution (period 2010-2014), based on absence days and using cluster analysis. WPT1 included absences mainly covered by sickness absence benefit (32.0% of women), WPT2 included absences covered by pregnancy occupational risk (POR) benefit (28.3%) and WPT3 were pregnant workers with few absences (39.9%). Exposure to occupational risk factors was assessed by experts and association with trajectories was analysed using logistic regression. Relative risks (RR) and their 95% CIs were adjusted for age, type of contract and shift work.

RESULTS

WPT2 was associated with exposure to physical (RR=1.86, 95%CI 1.17 to 2.97), safety (RR=2.10, 95%CI 1.61 to 2.73), ergonomic (RR=2.52, 95%CI 1.89 to 3.36) and psychosocial (RR=1.79, 95%CI 1.31 to 2.46) factors, and with exposure level. For physicians, WPT1 was associated with safety risks (RR=3.13, 95%CI 1.22 to 7.99), WPT2 with chemical and ergonomic for administrative/technical support (RR=12.20, 95%CI 1.69 to 88.09; RR=14.09, 95%CI 1.34 to 148.61, respectively), with safety and ergonomic risks for nursing aides (RR=1.84, 95%CI 1.12 to 3.02; RR=3.94, 95% CI 2.38 to 6.53, respectively), and with physical (RR=1.72, 95%CI 1.04 to 2.86), safety (RR=2.21, 95%CI 1.62 to 3.03), ergonomic (RR=2.02, 95%CI 1.44 to 2.86) and psychosocial factors (RR=1.96, 95%CI 1.32 to 2.90) for nurses.

CONCLUSIONS

Absences from work covered by POR benefit show a consistent relationship with exposure to occupational risks. Sickness absence is the most frequent benefit used by pregnant workers. Current social benefits are apparently used adequately for protecting women from occupational exposures. Future studies are needed to clarify this further.