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Touzet S, Buchet-Poyau K, Denis A, Occelli P, Jacquin L, Potinet V, Sigal A, Delaroche-Gaudin M, Fayard-Gonon F, Tazarourte K, Douplat M. Impact of the presence of a mediator on patient violent or uncivil behaviours in emergency departments: a cluster randomised crossover trial. Eur J Emerg Med 2024; 31:201-207. [PMID: 38329117 DOI: 10.1097/mej.0000000000001121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
BACKGROUND AND IMPORTANCE Several studies reported that violent behaviours were committed by patients against healthcare professionals in emergency departments (EDs). The presence of mediators could prevent or resolve situations of tension. OBJECTIVE To evaluate whether the presence of mediators in EDs would have an impact on violent behaviours committed by patients or their relatives against healthcare professionals. Design, settings and participants A 6-period cluster randomised crossover trial was performed in 4 EDs during 12 months. Patients aged ≥18 and their relatives were included. INTERVENTION In order to prevent or resolve situations of tension and conflict, four mediators were recruited.Outcome measure and analysis Using a logistic regression mixed model, the rate of ED visits in which at least one act of violence was committed by a patient or their relatives, reported by healthcare professionals, was compared between the intervention group and the control group. RESULTS A total of 50 429 ED visits were performed in the mediator intervention group and 50 851 in the control group. The mediators reported 1365 interventions; >50% of the interventions were to answer questions about clinical management or waiting time. In the intervention group, 173 acts of violence were committed during 129 ED visits, and there were 145 acts of violence committed during 106 ED visits in the control group. The rate of ED visits in which at least one act of violence was committed, was 0.26% in the intervention group and 0.21% in the control group (OR = 1.23; 95% CI [0.73-2.09]); on a 4-level seriousness scale, 41.6% of the acts of violence were rated level-1 (acts of incivility or rudeness) in the intervention group and 40.0% in the control group. CONCLUSION The presence of mediators in the ED was not associated with a reduction in violent or uncivil behaviours committed by patients or their relatives. However, the study highlighted that patients had a major need for information regarding their care; improving communication between patients and healthcare professionals might reduce the violence in EDs. TRIAL REGISTRATION Clinicaltrials.gov (NCT03139110).
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Affiliation(s)
- Sandrine Touzet
- Hospices Civils de Lyon, Pôle de Santé Publique
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1
| | | | | | - Pauline Occelli
- Hospices Civils de Lyon, Pôle de Santé Publique
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1
| | - Laurent Jacquin
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service d'Accueil des Urgences
| | - Véronique Potinet
- Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Service d'Accueil des Urgences
| | - Alain Sigal
- Hospices Civils de Lyon, Hôpital de la Croix-Rousse, Service d'Accueil des Urgences, Lyon, France
| | | | - Florence Fayard-Gonon
- Hospices Civils de Lyon, Hôpital de la Croix-Rousse, Service d'Accueil des Urgences, Lyon, France
| | - Karim Tazarourte
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service d'Accueil des Urgences
| | - Marion Douplat
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1
- Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Service d'Accueil des Urgences
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Antoine C, Luc MS, Gross G, Schwitzer T, Hettal L, Conart JB, Angioi-Duprez K. [Aggressiveness and violence in daily ophthalmology practice: Descriptive analysis of a survey sent to residents and assistants in Grand Est and Bourgogne-Franche-Comté]. J Fr Ophtalmol 2024; 47:103994. [PMID: 37903682 DOI: 10.1016/j.jfo.2023.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 07/23/2023] [Accepted: 07/26/2023] [Indexed: 11/01/2023]
Abstract
INTRODUCTION The goal of this study was to estimate the prevalence of workplace violence in a population of young ophthalmologists in France and to characterize these situations. METHODS We conducted an epidemiological descriptive, cross-sectional, multi-center study based on an anonymous questionnaire. We submitted a questionnaire to all ophthalmology residents and fellows (n=157) in the Grand Est and Bourgogne-Franche-Comté regions between December 2020 and March 2021. RESULTS The overall response rate was 76.4% (n=120, 55% female and 45% male) of whom 81.6% reported having faced aggression at least once. For 50.9% of participants, aggression had occurred several times per year. These situations occurred during the first year of residency in 64.3% of cases. They mainly consisted of verbal aggression (98.8%) by a patient or their relatives (43.7% and 29.8%). The main complaints voiced by these individuals concerned the wait time (40%) and the feeling of lack of competence or improper medical care (26.8%). Fifty-seven percent of people who faced these situations thought about it for at least a week, and 20.4% of those exposed felt anxiety at work after the incident. CONCLUSION We found high prevalence of verbal aggression in professional ophthalmology practice. Although these situations were mainly verbal aggression without significant consequences, they sometimes lead to anxiety in the aftermath. We should prepare medical students to manage them, through appropriate theoretical and practical training, such as medical simulation described in this article.
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Affiliation(s)
- C Antoine
- Service d'ophtalmologie, centre hospitalier universitaire de Nancy, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France.
| | - M-S Luc
- Service d'ophtalmologie, centre hospitalier universitaire de Nancy, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France
| | - G Gross
- Centre psychothérapeutique de Nancy, 1, rue Dr-Archambault, 54520 Laxou, France
| | - T Schwitzer
- Centre psychothérapeutique de Nancy, 1, rue Dr-Archambault, 54520 Laxou, France
| | - L Hettal
- CNRS UMR 168, institut Curie, université PSL, Sorbonne Université, 26, rue d'Ulm, 75005 Paris, France
| | - J-B Conart
- Service d'ophtalmologie, centre hospitalier universitaire de Nancy, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France
| | - K Angioi-Duprez
- Service d'ophtalmologie, centre hospitalier universitaire de Nancy, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France
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Bass GA, Chang CWJ, Winkle JM, Cecconi M, Kudchadkar SR, Akuamoah-Boateng K, Einav S, Duffy CC, Hidalgo J, Rodriquez-Vega GM, Gandra-d'Almeida AJ, Barletta JF, Kaplan LJ. Concise Definitive Review: In-Hospital Violence and Its Impact on Critical Care Practitioners. Crit Care Med 2024:00003246-990000000-00273. [PMID: 38236075 DOI: 10.1097/ccm.0000000000006189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
OBJECTIVES To provide a narrative review of hospital violence (HV) and its impact on critical care clinicians. DATA SOURCES Detailed search strategy using PubMed and OVID Medline for English language articles describing HV, risk factors, precipitating events, consequences, and mitigation strategies. STUDY SELECTION Studies that specifically addressed HV involving critical care medicine clinicians or their practice settings were selected. The time frame was limited to the last 15 years to enhance relevance to current practice. DATA EXTRACTION Relevant descriptions or studies were reviewed, and abstracted data were parsed by setting, clinician type, location, social media events, impact, outcomes, and responses (agency, facility, health system, individual). DATA SYNTHESIS HV is globally prevalent, especially in complex care environments, and correlates with a variety of factors including ICU stay duration, conflict, and has recently expanded to out-of-hospital occurrences; online violence as well as stalking is increasingly prevalent. An overlap with violent extremism and terrorism that impacts healthcare facilities and clinicians is similarly relevant. A number of approaches can reduce HV occurrence including, most notably, conflict management training, communication initiatives, and visitor flow and access management practices. Rescue training for HV occurrences seems prudent. CONCLUSIONS HV is a global problem that impacts clinicians and imperils patient care. Specific initiatives to reduce HV drivers include individual training and system-wide adaptations. Future methods to identify potential perpetrators may leverage machine learning/augmented intelligence approaches.
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Affiliation(s)
- Gary A Bass
- Division of Trauma, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Julie M Winkle
- Emergency Medicine, UC Health, University of Colorado Hospital, Aurora, CO
| | - Maurizio Cecconi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Sapna R Kudchadkar
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medicine, Baltimore, MD
| | - Kwame Akuamoah-Boateng
- Department of Surgery Acute Care Surgical Services, Mary Baldwin University and Virginia Commonwealth University Health Richmond, Richmond, VA
| | - Sharon Einav
- General Intensive Care Unit of the Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University School of Medicine, Jerusalem, Israel
| | - Caoimhe C Duffy
- Department of Anesthesiology and Critical Care Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jorge Hidalgo
- Division of Critical Care, Karl Heusner Memorial Hospital, Belize City, Belize
| | - Gloria M Rodriquez-Vega
- Department of Critical Care Medicine - HIMA-San Pablo, Caguas Puerto Rico
- University of Puerto Rico, School of Medicine, Caguas, Puerto Rico
| | | | - Jeffrey F Barletta
- Pharmacy Practice, Midwestern University, College of Pharmacy-Glendale Campus, Glendale, AZ
| | - Lewis J Kaplan
- Division of Trauma, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Ostroff C, Benincasa C, Rae B, Fahlbusch D, Wallwork N. Eyes on incivility in surgical teams: Teamwork, well-being, and an intervention. PLoS One 2023; 18:e0295271. [PMID: 38033091 PMCID: PMC10688855 DOI: 10.1371/journal.pone.0295271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 11/16/2023] [Indexed: 12/02/2023] Open
Abstract
Incivility in surgery is prevalent and negatively impacts effectiveness and staff well-being. The purpose of this study was to a) examine relationships between incivility, team dynamics, and well-being outcomes, and b) explore a low-cost intervention of 'eye' signage in operating theater areas to reduce incivility in surgical teams. A mixed methods design was used in an orthopedic hospital. Surveys of incivility, teamwork, and well-being were administered three months apart in a small private hospital. An intervention of signage with eyes was placed in the theater area after administration of the first survey, using a pretest-posttest design. Participants also responded to an open-ended question about suggestions for improvements at the end of the survey which was then thematically analyzed. At the individual level (n = 74), incivility was statistically significantly related to team dynamics which in turn was significantly related to burnout, stress, and job attitudes. At the aggregate level, reported incivility was statistically significantly lower after the 'eye' sign intervention. Thematic analysis identified core issues of management behaviors, employee appreciation, communication, and work practices. Incivility in surgical teams has significant detrimental associations with burnout, stress, and job attitudes, which occurs through its impact on decreased team dynamics and communication. A simple intervention that evokes perceptions of being observed, such as signage of eyes in theater areas, has the potential to decrease incivility at least in the short term, demonstrating that incivility is amenable to being modified. Additional research on targeted interventions to address incivility are needed to improve teamwork and staff well-being.
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Affiliation(s)
- Cheri Ostroff
- University of South Australia Centre for Workplace Excellence, Adelaide, Australia
| | - Chelsea Benincasa
- University of South Australia Rosemary Bryant AO Research Centre, Adelaide, Australia
| | - Belinda Rae
- University of South Australia Centre for Workplace Excellence, Adelaide, Australia
| | - Douglas Fahlbusch
- University of South Australia Clinical and Health Sciences, Adelaide, Australia
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Townsley A, Li-Wang J, Katta R. When Patient Rudeness Impacts Care: A Review of Incivility in Healthcare. Cureus 2023; 15:e40521. [PMID: 37461785 PMCID: PMC10350303 DOI: 10.7759/cureus.40521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2023] [Indexed: 07/20/2023] Open
Abstract
Healthcare workers increasingly face incivility and rude behaviors from patients, families, and visitors. Although these are less severe than other types of mistreatment, studies have documented that they may still impact healthcare worker well-being and patient care. Defining and measuring incivility can be challenging because current research relies on the perceptions of the targets. Furthermore, there is often overlap among different types of mistreatment, and much of it goes unreported by those who experience it. Nevertheless, multiple studies have documented that incivility is common in healthcare and has been associated with burnout and intent to leave. In clinical settings, multiple consequences for patient care have been documented, including adverse consequences in the diagnostic and intervention performance of teams, as well as team processes. One theory is that incivility incidents divert cognitive resources away from the intervention and that these experiences may interfere with higher-order reasoning. Although limited research has been performed in the areas of prevention, response to incidents of incivility, and best practices for ameliorating the effects of incivility, some promising interventions have been reported in the literature.
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Affiliation(s)
| | | | - Rajani Katta
- Internal Medicine, Baylor College of Medicine, Houston, USA
- Dermatology, University of Texas Health Science Center at Houston, Houston, USA
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6
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Recsky C, Moynihan M, Maranghi G, Smith OM, PausJenssen E, Sanon PN, Provost SM, Hamilton CB. Evidence-Based Approaches to Mitigate Workplace Violence From Patients and Visitors in Emergency Departments: A Rapid Review. J Emerg Nurs 2023:S0099-1767(23)00059-4. [PMID: 37074250 DOI: 10.1016/j.jen.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/11/2023] [Accepted: 03/19/2023] [Indexed: 04/20/2023]
Abstract
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.
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Alkan Ö, Serçemeli C, Özmen K. Verbal and psychological violence against women in Turkey and its determinants. PLoS One 2022; 17:e0275950. [PMID: 36215284 PMCID: PMC9550074 DOI: 10.1371/journal.pone.0275950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 09/26/2022] [Indexed: 11/07/2022] Open
Abstract
Verbal and psychological violence against women is considered an important sociological and legal problem and a serious threat within the context of basic human rights. The aim of this study was to detect the factors affecting verbal and psychological violence against women in Turkey, a developing country. The micro data set of the National research on domestic violence against women in Turkey, which was conducted by the Hacettepe University Institute of Population Studies, was employed in this study. The factors affecting women's exposure to verbal and psychological violence by their husbands or partners in Turkey were determined using binary logistic and binary probit regression analyses. Women whose husbands or partners cheated and used alcohol were more exposed to verbal and psychological violence compared to others. In addition, women who were exposed to physical, economic, and sexual violence were more exposed to verbal and psychological violence compared to others. Exposure to violence by first-degree relatives increases the possibility of exposure to verbal and psychological violence. More effective results can be achieved by prioritizing women likelier to be exposed to violence in policies aimed at preventing acts of verbal violence against women in our country. There are few studies on verbal and psychological violence against women. Therefore, it will be useful to conduct relevant studies from different perspectives.
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Affiliation(s)
- Ömer Alkan
- Department of Econometrics, Ataturk University, Erzurum, Turkey
| | - Ceyhun Serçemeli
- Department of Labor Economics and Industrial Relations, Ataturk University, Erzurum, Turkey
| | - Kenan Özmen
- Bulanik Vocational School, Mus Alparslan University, Muş, Turkey
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Pagnucci N, Ottonello G, Capponi D, Catania G, Zanini M, Aleo G, Timmins F, Sasso L, Bagnasco A. Predictors of events of violence or aggression against nurses in the workplace: A scoping review. J Nurs Manag 2022; 30:1724-1749. [PMID: 35420236 PMCID: PMC9796891 DOI: 10.1111/jonm.13635] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/27/2022] [Accepted: 04/12/2022] [Indexed: 02/03/2023]
Abstract
AIM To identify predictors and consequences of violence or aggression events against nurses and nursing students in different work contexts. BACKGROUND Workplace violence against nurses and nursing students is a very common and widespread phenomenon. Actions to manage or prevent violent events could be implemented knowing the risk factors and consequences. However, there is a lack of systematic reviews that summarize knowledge on the predictors and consequences of workplace violence. EVALUATION A scoping review was conducted using electronic databases including APA PsycInfo, CINAHL, Cochrane, Ovid Medline, PubMed and Scopus. KEY ISSUES After full text analysis, 87 papers were included in the current scoping review. Risk factors of horizontal violence were grouped into 'personal' and 'Environmental and organizational', and for violence perpetrated by patients into 'personal', 'Environmental and organizational' and 'Characteristics of the perpetrators'. CONCLUSIONS The results of this scoping review uncover problems that often remain unaddressed, especially where these episodes are very frequent. Workplace violence prevention and management programmes are essential to counter it. IMPLICATIONS FOR NURSING MANAGEMENT The predictors and the consequents identified constitute the body of knowledge necessary for nurse managers to develop and implement policy and system actions to effectively manage or prevent violent events.
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Affiliation(s)
| | | | | | | | - Milko Zanini
- Department of Health SciencesUniversity of GenoaGenoa
| | - Giuseppe Aleo
- Department of Health SciencesUniversity of GenoaGenoa
| | - Fiona Timmins
- School of Nursing, Midwifery & Health SystemsUniversity College DublinDublinIreland
| | - Loredana Sasso
- School of Nursing, Midwifery & Health SystemsUniversity College DublinDublinIreland
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Sommovigo V, Bernuzzi C, Setti I. Helping others not always helps ourselves: the relationship between victim incivility and emergency workers' burnout through work-to-family conflict. INTERNATIONAL JOURNAL OF WORKPLACE HEALTH MANAGEMENT 2022. [DOI: 10.1108/ijwhm-09-2021-0183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PurposeThis study aims to analyse whether and when victim incivility may be related to work-to-family conflict and then burnout among emergency workers.Design/methodology/approachA total of 304 Italian emergency workers from five firehouses and six emergency rooms completed questionnaires, examining: victim incivility, work-to-family conflict, social support seeking and burnout symptoms. Descriptive analyses, confirmatory factor analyses and structural equation models were conducted.FindingsVictim incivility was positively associated with burnout symptoms, both directly and indirectly, as mediated by work-to-family conflict. Additionally, social support seeking exacerbated (rather than mitigated) the impact of work-to-family conflict on burnout symptoms.Practical implicationsOrganisations can greatly benefit from implementing family-friendly practices and providing their workers with training programmes on how to deal with difficult victims.Originality/valueThis study contributes to the existing literature on workplace incivility and work–life interface by supporting for the first time the notion that victim incivility can spill over into emergency workers' family domain and by clarifying how and when victim incivility is related to burnout symptoms.
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10
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Interventions for Workplace Violence Prevention in Emergency Departments: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168459. [PMID: 34444208 PMCID: PMC8392011 DOI: 10.3390/ijerph18168459] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/06/2021] [Accepted: 08/08/2021] [Indexed: 11/17/2022]
Abstract
Emergency departments (EDs) are high-risk settings for workplace violence, but interventions to prevent violent incidents and to prepare staff are not yet consistently implemented, and their effectiveness is often unclear. This study aims to summarise evidence on workplace violence prevention interventions that were implemented in EDs to reduce violent incidents caused by patients/relatives or to increase the knowledge, skills or feelings of safety of ED staff. A systematic review was conducted. The databases MEDLINE, Web of Science, Cochrane Library, CINAHL and PsycINFO were searched for studies dated between January 2010 and May 2021. Interventional and observational studies reporting on behavioural, organisational or environmental interventions among healthcare workers in hospital EDs were included. Studies were assessed for methodological quality using the Johanna Briggs Institute Tools. Key findings of studies were summarised narratively. Fifteen studies were included, of which eleven examined behavioural interventions (classroom, online or hybrid training programmes) on de-escalation skills, violent person management or self-defence techniques. Four studies included in addition, organisational and environmental interventions. Most studies showed that interventions had a positive effect in the form of a reduction of violent incidents or an improvement in how prepared staff were to deal with violent situations; however, evidence is still sparse. Further studies should consider in particular, environmental and organisational interventions and ensure a high methodological quality.
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Timmins F, Timmins B. An integrative review of waiting time, queuing, and design as contributory factors to emergency department violence. J Evid Based Med 2021; 14:139-151. [PMID: 34032010 DOI: 10.1111/jebm.12432] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Reports of violence in health care are continuously increasing. Globally there are attempts to manage this phenomenon. However, while risk factors have been identified, there is a tendency to over accentuate the extent of their contribution. Alcohol and drug misuse, for example, are frequently reported, with limited consideration of the ED environment. By far the biggest cause of violence appears to be the presentation of conditions related to or accompanied by mental illness and the impact of queuing and crowded departments on patients and their families. This study aims to examine the extent to which ED waiting times, design and queuing are linked to ED violence. METHODS An integrative literature review was performed using CINAHL Complete and MEDLINE databases. 110 papers were initially selected, and the final analysis included 25 papers. RESULTS The literature revealed three emerging themes: the nature of emergency department violence, environmental contributory factors and its management and control. CONCLUSION The findings of this review reveal several causes of violence. Surprisingly most approaches take a victim blaming approach aimed at identifying potential perpetrators rather than taking a holistic approach to prevention that would also address environmental and societal issues. More is needed in terms of implementation of more far-reaching, practical, and effective management solutions to promote health care workers' safety and adequately support vulnerable patients.
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Affiliation(s)
- Fiona Timmins
- School of Nursing, Midwifery & Health Systems, University College Dublin, Belfied, Dublin, Ireland
| | - Bernard Timmins
- School of Engineering & Built Environment, Technological University of Dublin, Bolton Street, Dublin, Ireland
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Madson M, Goodwin K. Color Coding the "Labyrinth": How Staff Perceived a Two-Part Intervention to Improve Wayfinding in an Adult Emergency Department. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2021; 14:429-441. [PMID: 33715485 DOI: 10.1177/1937586721994593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES, PURPOSE, OR AIM We report a two-part wayfinding intervention, considering four quality criteria (visibility, usability, efficiency and overall effectiveness) from staff perspectives. BACKGROUND Few studies to date have explored wayfinding in the Emergency Department (ED). Yet, as ED usage continues to grow, effective wayfinding in these high-stress, fast-paced environments is likely to become increasingly important. At an adult ED located in the U.S. Southeast, wayfinding has been a persistent problem. We subsequently developed a two-part wayfinding intervention: colored routes to key destinations in the ED and corresponding visitor badges. METHODS Quality criteria were formulated using the Donabedian model: visibility (structure), usability (process), efficiency (process), and overall effectiveness (outcome). Assessments consisted of staff surveys, which were distributed from March to early April 2019. RESULTS The strong ratings across quality criteria, added to affirmative comments from staff, provide evidence that the color coding system made a positive impact on wayfinding. CONCLUSIONS While the results should be generalized with caution, the two-part intervention may be highly portable to other contexts. Future studies might examine the effect of colored routes alone. They might illuminate relations between structure, process, and outcomes as they relate to the assessment of wayfinding. They might also expand wayfinding quality criteria. Ultimately, such studies should improve not only the productivity but also the accessibility and user experience of the ED.
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Affiliation(s)
| | - Kelsie Goodwin
- Adult Emergency Department, Medical University of South Carolina, Charleston, SC, USA.,Chest Pain Center, Medical University of South Carolina, Charleston, SC, USA
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13
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Charrier P, Occelli P, Buchet-Poyau K, Douplat M, Delaroche-Gaudin M, Fayard-Gonon F, Jacquin L, Potinet V, Sigal A, Tazarourte K, Touzet S. Strategies used by emergency care professionals to handle interpersonal difficulties with patients: a qualitative study. BMJ Open 2021; 11:e042362. [PMID: 33558353 PMCID: PMC7871700 DOI: 10.1136/bmjopen-2020-042362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Identify the strategies implemented by emergency care professionals when facing tension and interpersonal violence from patients and their friends and family. DESIGN Descriptive qualitative study based on 38 semidirective interviews. PARTICIPANTS Doctors, nurses, nursing assistants and administrative staff. SETTING Four emergency departments (EDs) from three French university hospitals. RESULTS According to the medical professionals interviewed, the difficulties that they encounter with patients or their accompanying family members can be explained by a lack of understanding of the functioning of EDs, by a general increase in individualistic behaviours leading to a lack of civility or by deviant behaviours (related to toxic substance abuse or mental illness). While managing deviant behaviours may sometimes require a collective intervention, ED staff also implement what are essentially individual communication strategies (with the use of rational explanation, seduction and empathy), confrontation or flight to deal with interpersonal difficulties. CONCLUSIONS Strategies used by staff members tend to be individualised for the most part, and some, such as confrontational or escape strategies, may not be adapted to all situations. In the face of difficulties between staff and patients, mediators, specialised in resolving conflict, could entrust some cases to professionals. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT03139110).
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Affiliation(s)
- Philippe Charrier
- Centre Max Weber (UMR 5283), University Lumière Lyon 2, F-69007 Lyon, France
- Public Health Department, Hospices Civils de Lyon, F-69003 Lyon, France
| | - Pauline Occelli
- Public Health Department, Hospices Civils de Lyon, F-69003 Lyon, France
- Health Services and Performance Research Lab (HESPER EA 7425), University Claude Bernard Lyon 1, F-69008 Lyon, France
| | | | - Marion Douplat
- Health Services and Performance Research Lab (HESPER EA 7425), University Claude Bernard Lyon 1, F-69008 Lyon, France
- Emergency Department, Centre Hospitalier Lyon Sud, F-69310 Pierre-Bénite, France
| | | | | | - Laurent Jacquin
- Emergency Department, Edouard Herriot Hospital, F-69008 Lyon, France
| | - Véronique Potinet
- Emergency Department, Centre Hospitalier Lyon Sud, F-69310 Pierre-Bénite, France
| | - Alain Sigal
- Emergency Departement, Croix-Rousse Hospital, F-69004 Lyon, France
| | - Karim Tazarourte
- Health Services and Performance Research Lab (HESPER EA 7425), University Claude Bernard Lyon 1, F-69008 Lyon, France
- Emergency Department, Edouard Herriot Hospital, F-69008 Lyon, France
| | - Sandrine Touzet
- Public Health Department, Hospices Civils de Lyon, F-69003 Lyon, France
- Health Services and Performance Research Lab (HESPER EA 7425), University Claude Bernard Lyon 1, F-69008 Lyon, France
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Okubo CVC, Silveira RCCP, Galdino MJQ, Fernandes DR, Moreira AAO, Martins JT. Effectiveness of interventions for the prevention of occupational violence against professionals in health services: a protocol for a systematic review. BMJ Open 2020; 10:e036558. [PMID: 32998918 PMCID: PMC7528362 DOI: 10.1136/bmjopen-2019-036558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Occupational violence affects several categories of workers; however, the health sector category has been considered at a high risk, exposing workers to physical and psychological abuse. Thus, occupational violence has decreased the quality of care in health service. This review aims to evaluate the effectiveness of interventions for the prevention and reduction of occupational violence against health professionals. METHODS AND ANALYSIS This protocol is consistent with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. Searches will be conducted in PubMed, Embase, Cochrane Library, LILACS, Web of Science, Scopus, CINAHL and LIVIVO along with a comprehensive review of grey literature. The search will be conducted on August 1 st 2020, without language and time restrictions. Following the eligibility criteria, two independent reviewers will select the titles and abstracts and subsequently screen the full articles. If necessary, a third reviewer will assess any disagreements. All references will be imported into EndNote, and any duplicates will be removed. The data will be extracted using an extraction-based form from Cochrane. Statistical analyses will be performed using the software Cochrane Review Manager, and a meta-analysis will be performed if possible for the statistical combination of at least two studies. The risk of bias of the randomised clinical trials will be evaluated by the Risk of Bias tool from Cochrane, and the risk of bias of the non-randomised intervention studies will be evaluated using the Downs and Black scale. The quality of the evidence and strength of the classification recommendations will be assessed by the Grading of Recommendations, Assessment, Development and Evaluation. ETHICS AND DISSEMINATION This review will not evaluate individual patient information and therefore does not require ethical approval. The results will be disseminated through publications in peer-reviewed journals, presentations at conferences and the doctoral thesis of the leading author. PROSPERO REGISTRATION NUMBER CRD42018111383.
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Affiliation(s)
- Caroline Vieira Cláudio Okubo
- PhD student in Nursing, State University of Londrina, Londrina, Paraná, Brazil
- Nurse, Federal University of Paraná Clinics Hospital, Curitiba, Paraná, Brazil
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