Why Seemingly Trivial Events Sometimes Evoke Strong Emotional Reactions: The Role of Social Exchange Rule Violations

De-Escalation Training for Managing Patient Aggression in High-Incidence Care Areas

Health care personnel who have close, face-to-face patient contact experience more workplace violence (WPV) than employees in other fields. Certain health care departments (i.e., high-incidence care areas) have elevated rates of WPV that can have adverse emotional, physical, and financial consequences for patients, employees, and institutions. Health care workers need de-escalation training to efficiently manage patient aggression while also safeguarding patients' dignity and patient-provider trust. The current Plan, Do, Study, Act quality improvement project used insights from an in-depth literature review to create a 1-hour, evidence-based, in-service de-escalation training for personnel from high-incidence care areas. A pre/post design was used to evaluate participants' responses to the Confidence Coping with Patient Aggression Instrument. Post-training, participants reported significantly increased feelings of safety regarding potential patient aggression (p = 0.001) and more efficacy regarding their aggression management techniques (p = 0.039). Based on the training's results, recommendations were made for future institutional de-escalation initiatives. [Journal of Psychosocial Nursing and Mental Health Services, 61(8), 17-24.].

The shift from disbelieving underperformance to recognising failure: A tipping point model

CONTEXT

Coming face to face with a trainee who needs to be failed is a stern test for many supervisors. In response, supervisors have been encouraged to report evidence of failure through numerous assessment redesigns. And yet, there are lingering signs that some remain reluctant to engage in assessment processes that could alter a trainee's progression in the programme. Failure is highly consequential for all involved and, although rare, requires explicit study. Recent work identified a phase of disbelief that preceded identification of underperformance. What remains unknown is how supervisors come to recognise that a trainee needs to be failed.

METHODS

Following constructivist grounded theory methodology, 42 physicians and surgeons in British Columbia, Canada shared their experiences supervising trainees who profoundly underperformed, required extensive remediation or were dismissed from the programme. We identified recurring themes using an iterative, constant comparative process.

RESULTS

The shift from disbelieving underperformance to recognising failure involves three patterns: accumulation of significant incidents, discovery of an egregious error after negligible deficits or illumination of an overlooked deficit when pointed out by someone else. Recognising failure was accompanied by anger, certainty and a sense of duty to prevent harm.

CONCLUSION

Coming to the point of recognising that a trainee needs to fail is akin to the psychological process of a tipping point where people first realise that noise is signal and cross a threshold where the pattern is no longer an anomaly. The co-occurrence of anger raises the possibility for emotions to be a driver of, and not only a barrier to, recognising failure. This warrants caution because tipping points, and anger, can impede detection of improvement. Our findings point towards possibilities for supporting earlier identification of underperformance and overcoming reluctance to report failure along with countermeasures to compensate for difficulties in detecting improvement once failure has been verified.

Incidence and prevalence of violence toward health care workers in emergency departments: a multicenter cross-sectional survey

Background

Workplace violence and abuse in the emergency department (ED) has increasingly become a serious and alarming phenomenon worldwide where health care professionals are more prone to violence compared with other specialties.

Aims

We aimed to estimate prevalence, and types of work place violence made against health care workers (HCW) in emergency departments of Arabian Gulf area.

Methods

We performed a descriptive cross-sectional study at several emergency departments in Saudi Arabia and United Arab Emirates wherein a previously validated questionnaire was distributed among health care workers. The survey consisted of 22 questions that assessed respondent’s workplace violence and/or abuse encounters, protective measures, available work place policies, and actions implemented to detect and deal with violence and abuse against healthcare providers. Descriptive statistics was used and P value < 0.05 was considered significant for all statistical tests performed.

Results

Seven hundred HCW in eleven emergency departments agreed to participate in the survey. Four hundred ninety-two completed the questionnaire with a response rate of 70%. More than 90% of the respondents were in the 20–39 years old bracket with an approximately equal gender distribution. Then, 20.9% of the respondents stated that they were physically attacked and 32.3% were attacked with a weapon. Most of the respondents (75.6%) reported that they were verbally abused or bullied by patients or relatives of patients. Staff responses to emotional abuse varied among respondents with the most frequent response of “told the person to stop” (22%), followed by “took no action” (19%). Further, 83.3% of respondents stated that there was an existing policy and procedure guidelines for reporting work place violence while 30.1% reported that they had not used any of these measures.

Conclusion

Workplace violence among HCW in the emergency departments are common in the Gulf area and can be serious in as far as use of weapons. Staff awareness focus on this under reported issue, and staff training to recognize and report potential aggression can predict a significant reduction of incidents.

Disgust uniquely predicts coping and interpersonal processes beyond anxiety and dysphoria in the context of naturalistic stressors

BACKGROUND

Disgust is theorized to serve a unique function of motivating avoidance of noxious stimuli and setting interpersonal boundaries to prevent contamination. Research has established the relevance of disgust to OCD, posttraumatic stress, and phobias, suggesting transdiagnostic features. However, research has not always accounted for overlap of disgust with other negative emotions, obscuring unique contributions. Moreover, studies have not disentangled between-person (mean levels) and within-person (state) effects. The present study examined within- and between-person relationships of disgust, anxiety, and dysphoria with responses to daily social stressors. We expected disgust would uniquely predict cognitive avoidance and boundary-setting interpersonal behavior.

METHOD

Individuals (N = 159) meeting ADIS-V anxiety/depressive disorder criteria (n = 55) and healthy controls (n = 104) completed online journals about naturalistic social stressors over five weeks (1,923 records), reporting disgust, anxiety, dysphoria, and responses to social stressors.

RESULTS

As expected, disgust uniquely predicted lower acceptance, greater thought suppression, greater self-assertion, and less prosocial behavior, above and beyond anxiety and dysphoria. Several disgust effects were present at both between- and within-person levels, suggesting the relevance of both mean disgust and state fluctuations.

CONCLUSIONS

Results demonstrate unique relevance of disgust for how individuals respond to social stressors.

Looking on the bright side of life: Gratitude and experiences of interpersonal transgressions in adulthood and daily life

OBJECTIVE

Gratitude plays an important role in individual and social well-being. However, less is known about the link between gratitude and experiences of interpersonal stressors. The current research examined the associations between gratitude and interpersonal transgressions.

METHOD

One cross-sectional study with a broad age range and two daily diary studies (total N = 2,348; total age range: 18-91) were used to test the associations on the between- and within-person level.

RESULTS

A consistent result across all studies was that dispositionally grateful individuals tended to report fewer interpersonal transgressions than less grateful people. In turn, people who generally reported more interpersonal transgressions were less grateful in daily life. Moreover, higher gratitude on one specific day was associated with fewer reported transgressions on the same day. However, the results from the daily diary studies indicated differences between the samples. Whereas gratitude was consistently associated with interpersonal transgressions in one daily diary sample, the findings in the second daily diary sample were less consistent.

CONCLUSION

The present findings suggest that grateful people tend to perceive their social exchanges differently and/or actually experience fewer interpersonal transgressions. Future work is needed to test the underlying mechanisms of this negative association.