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Sama SR, Quinn MM, Gore RJ, Galligan CJ, Kriebel D, Markkanen PK, Lindberg JE, Fallon PJ. The Safe Home Care Intervention Study: Implementation Methods and Effectiveness Evaluation. J Appl Gerontol 2024:7334648241246472. [PMID: 38652665 DOI: 10.1177/07334648241246472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Abstract
Home care (HC) aides experience numerous safety hazards in clients' homes; many hazards also put clients at risk. We hypothesized that safety coaching led by nurse managers (NMs) during their initial HC needs assessment could prompt clients to improve safety conditions in their homes. Following a 2-arm proof-of-concept intervention study design, intervention NMs used motivational interviewing (MI), facilitated by a safety handbook and video, to coach clients on home safety improvements. Control arm NMs performed intake assessments with no changes to usual practices. Intervention effectiveness was assessed by NMs and aides. Three HC agencies and two elder services contributed 35 intervention and 23 control homes. NMs coached 97% of clients and reported that 94% were engaged; 63% implemented improvements. NMs' and aides' assessments were consistent; homes with clients reported by NMs as resistant to safety changes had higher aides' hazard scores. Client coaching can be effective for improving HC safety.
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Affiliation(s)
- Susan R Sama
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts, Lowell, MA, USA
| | - Margaret M Quinn
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts, Lowell, MA, USA
| | - Rebecca J Gore
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts, Lowell, MA, USA
| | - Catherine J Galligan
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts, Lowell, MA, USA
| | - David Kriebel
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts, Lowell, MA, USA
| | - Pia K Markkanen
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts, Lowell, MA, USA
| | - John E Lindberg
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts, Lowell, MA, USA
| | - Pamela J Fallon
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts, Lowell, MA, USA
- Employee Health and Wellness, Southern New Hampshire Health, Nashua, NH, USA
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2
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Markkanen PK, Gore RJ, Sama SR, Lindberg JE, Galligan CJ, Quinn MM. Coaching Home Care Clients to Prepare Their Homes for Safe Care Visits: A Mixed-Methods Study to Evaluate a Nurse-Led Educational Intervention Process. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:360. [PMID: 38541359 PMCID: PMC10970455 DOI: 10.3390/ijerph21030360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/10/2024] [Accepted: 03/14/2024] [Indexed: 04/11/2024]
Abstract
Assuring home care (HC) workers' safety is challenging because the work environment is a private home. This paper presents the process evaluation for a proof-of-concept safety intervention study to assess whether nurse-led safety coaching, using motivational interviewing and a safety handbook, could enable HC clients to improve safety in their homes. The process evaluation objectives were to (i) document the intervention's implementation progress and (ii) assess the intervention's dose delivery, dose reception, and fidelity. Five agencies employing liaisons (n = 5) and nurse managers (NMs, n = 8) implemented this study's intervention and control arms. NMs assigned to the intervention arm (n = 6) coached 34 clients. Process evaluation metrics were assessed with mixed-methods data from (i) surveys completed by NMs during the intervention, (ii) postintervention audio-recorded and transcribed interviews (n = 6) with NMs and liaisons, and (iii) study progress tracking tools. The delivered dose efficiency was 85%, measured by the distribution of safety handbook copies to clients. About 94% of clients (n = 32) were considered "engaged" or "maybe engaged" during the safety coaching. Most coached clients (n = 30) were reachable for follow-up by NMs to assess intervention progress. Despite challenges, the intervention was implemented with good fidelity. Safety coaching can be applied in many HC contexts in larger populations.
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Affiliation(s)
- Pia K. Markkanen
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell (UMASS Lowell), Lowell, MA 01854, USA; (R.J.G.); (S.R.S.); (J.E.L.); (C.J.G.); (M.M.Q.)
| | - Rebecca J. Gore
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell (UMASS Lowell), Lowell, MA 01854, USA; (R.J.G.); (S.R.S.); (J.E.L.); (C.J.G.); (M.M.Q.)
- Department of Biomedical Engineering, Francis College of Engineering, University of Massachusetts Lowell (UMASS Lowell), Lowell, MA 01854, USA
| | - Susan R. Sama
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell (UMASS Lowell), Lowell, MA 01854, USA; (R.J.G.); (S.R.S.); (J.E.L.); (C.J.G.); (M.M.Q.)
| | - John E. Lindberg
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell (UMASS Lowell), Lowell, MA 01854, USA; (R.J.G.); (S.R.S.); (J.E.L.); (C.J.G.); (M.M.Q.)
| | - Catherine J. Galligan
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell (UMASS Lowell), Lowell, MA 01854, USA; (R.J.G.); (S.R.S.); (J.E.L.); (C.J.G.); (M.M.Q.)
| | - Margaret M. Quinn
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell (UMASS Lowell), Lowell, MA 01854, USA; (R.J.G.); (S.R.S.); (J.E.L.); (C.J.G.); (M.M.Q.)
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King EC, Chan J, Benn A, Michener MB, Van Belle TA, McKay SM. Shifting the Safety Culture: Evaluation of a Novel Approach to Understanding and Responding to Workplace Harassment and Violence Experienced by Homecare Workers. Workplace Health Saf 2024:21650799241232148. [PMID: 38454778 DOI: 10.1177/21650799241232148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
BACKGROUND Workplace violence and harassment are commonplace for healthcare workers and most incidents are unreported. Normalization of these experiences, lack of confidence in reporting systems, and fear of the consequences of reporting contribute to the invisibility of these experiences. Challenges are exacerbated in homecare settings and for precarious workforces including Personal Support Workers (PSWs). We created, piloted, and evaluated an intervention to enhance safety culture and encourage reporting of workplace violence and harassment. METHODS A multi-stakeholder steering committee designed an intervention combining policy changes, a pre-visit screening tool, education, and brief end-of-visit reporting. This was piloted with a PSW care team which provided >55,000 client visits during the 32-week intervention. Operational metrics characterized screening, education, and reporting uptake. Pre- and post-intervention surveys characterized PSWs' experiences with workplace violence and harassment, reporting experiences, training history and intervention feedback. FINDINGS PSWs reported increased comfort discussing workplace violence and harassment, and increased confidence managing client-to-worker incidents. The screening went smoothly with most clients in private homes. Most PSWs (75%) engaged at least once with end-of-visit reporting and nearly half submitted reports regularly. During the pilot, 21% of PSWs reported incidents and 52% of reports shared client-specific strategies for managing these situations. APPLICATION TO PRACTICE Changes in comfort and behavior with reporting indicated a shift toward a more open culture surrounding workplace violence and harassment. Tools created for this intervention and lessons for implementation are shared for consideration by occupational health practitioners throughout the homecare sector.
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Affiliation(s)
- Emily C King
- Dalla Lana School of Public Health, University of Toronto
- VHA Home HealthCare
| | | | | | | | | | - Sandra M McKay
- VHA Home HealthCare
- Institute of Health Policy, Management and Evaluation, University of Toronto
- Department of Physical Therapy, University of Toronto
- Ted Rogers School of Management, Toronto Metropolitan University
- The Institute for Education Research, University Health Network
- The Michener Institute of Education, University Health Network
- Michael Garron Hospital, Toronto East Health Network
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Small TF. Workplace Violence Prevention Training for Home Care Workers. Home Healthc Now 2024; 42:120-121. [PMID: 38437050 DOI: 10.1097/nhh.0000000000001246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Affiliation(s)
- Tamara Felice Small
- Tamara Felice Small, PhD, APRN, FNP-C , is a Professor, Department of Nursing, The University of Rio Grande, Founder and CEO, The Institute for Employee Safety, Cincinnati, Ohio
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Tsui EK, LaMonica M, Boerner K, Baron S. "A Major Issue": The Impact of the COVID-19 Pandemic on How Home Care Leaders Perceive and Promote Aides' Mental Health and Well-Being. J Appl Gerontol 2024:7334648241236245. [PMID: 38414156 DOI: 10.1177/07334648241236245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024] Open
Abstract
Home care aides play a critical role in the care of older adults, but they do this under difficult working conditions. The COVID-19 pandemic exacerbated aides' stress and worsened their mental health, raising the question of how agencies can better support aides. We explore how home care industry leaders in New York perceived and addressed home care aides' mental health and well-being prior to and during the pandemic through in-depth interviews conducted in 2019 (n = 8 agencies) and 2022 (n = 14 agencies). We found that these topics became more central in leaders' thinking, reflected in a range of new internally and externally funded agency actions, albeit limited by ongoing financial constraints. Maintaining a skilled and reliable aide workforce is critical to societal health but will remain challenging without continued investment in aide support of the kind described in the Surgeon General's Framework for Workplace Mental Health and Well-Being.
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Affiliation(s)
- Emma K Tsui
- Department of Community Health & Social Sciences, CUNY Graduate School of Public Health & Health Policy, New York, NY, USA
| | - Marita LaMonica
- Department of Community Health & Social Sciences, CUNY Graduate School of Public Health & Health Policy, New York, NY, USA
| | - Kathrin Boerner
- Department of Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
- Department of Gerontology, University of Massachusetts Boston, Boston, MA, USA
| | - Sherry Baron
- Barry Commoner Center for Health and the Environment, Queens College, City University of New York, New York, NY, USA
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Cho MS, Min KB, Min JY. Workplace Violence Experienced by Personal Care Workers in a District in Seoul, Republic of Korea: A Comparison Study with Office and Service Workers. Healthcare (Basel) 2024; 12:320. [PMID: 38338205 PMCID: PMC10855380 DOI: 10.3390/healthcare12030320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/02/2024] [Accepted: 01/18/2024] [Indexed: 02/12/2024] Open
Abstract
This study compared the level of workplace violence experienced by personal healthcare workers in a district in Seoul, Republic of Korea, with those experienced by workers in office or service jobs. We matched 150 personal care workers with 150 office workers and 150 service workers using a propensity score. Workplace violence was categorized into psychological violence and physical violence. Of the surveyed personal care workers, 53.3% reported experiencing psychological violence, and 42.0% reported experiencing physical violence. After adjusting for self-reported work-related symptoms, personal care workers had significantly higher odds of experiencing psychological violence than office workers (OR = 5.01; 95% CI: 2.80-8.97) or service workers (OR = 7.54; 95% CI: 3.93-14.47). The adjusted odds for physical violence were also significantly higher for personal care workers compared with those for office workers (OR = 5.83; 95% CI: 2.96-11.50) and service workers (OR = 6.00; 95% CI: 2.88-12.49). In terms of specific types of workplace violence, personal care workers were 7-10 times more likely to experience unwanted sexual attention, sexual harassment, and physical violence than office or service workers. We found that personal care workers were more prone to workplace violence than office or service workers, with gender-based or physical violence being the most common types. Considering the negative impact of workplace violence on workers' well-being and health services, policy updates and interventions focusing on personal care workers are needed to reduce workplace violence, safeguard workers' rights, and establish a secure working environment.
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Affiliation(s)
- Mi-Suk Cho
- Veterans Health Service Medical Center, Veterans Medical Research Institute, Seoul 05368, Republic of Korea;
| | - Kyoung-Bok Min
- Department of Preventive Medicine, College of Medicine, Seoul National University, Seoul 03080, Republic of Korea;
| | - Jin-Young Min
- Veterans Health Service Medical Center, Veterans Medical Research Institute, Seoul 05368, Republic of Korea;
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Derk SJ, Hendricks KJ, Hartley D. National Estimates of Home Care Workers Nonfatal Emergency Department-Treated Injuries, United States 2015-2020. J Occup Environ Med 2024; 66:e26-e31. [PMID: 37853688 DOI: 10.1097/jom.0000000000002999] [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: 10/20/2023]
Abstract
OBJECTIVE Home care workers (HCWs) are a critical resource contributing to the well-being of others. Presented are data on HCWs nonfatal emergency department (ED)-treated injuries. METHODS Nonfatal injuries among HCWs were extracted from the NEISS-Work data between 2015 and 2020. RESULTS Review of NEISS-Work data indicated 117,000 HCWs with nonfatal ED-treated injuries; female HCWs accounted for 93%. Overexertion and bodily reactions accounted for 52% of the injuries. Violence and other injuries by persons or animals accounted for 15% and falls, slips, and trips also accounted for 15% of the HCWs ED-treated injuries. CONCLUSIONS The growing demand for home care services is increasing the number of workers at risk for injury. Future analyses should prioritize injury events among HCWs to gain a better understanding of the events contributing to injuries among HCWs.
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Affiliation(s)
- Susan J Derk
- From the Surveillance and Field Investigations Branch, Division of Safety Research, National Institute for Occupational Safety and Health, Morgantown, West Virginia (S.J.D., K.J.H.); and Office of the Director, Office of Extramural Programs, National Institute for Occupational Safety and Health, Morgantown, West Virginia (D.H.)
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8
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Lucas M, Elliott B. Safety Considerations for Home Care Providers. Home Healthc Now 2023; 41:256-262. [PMID: 37682738 DOI: 10.1097/nhh.0000000000001190] [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: 09/10/2023]
Abstract
Home care is one of the fastest growing industries in the United States, projected to continue increasing as the population ages. However, there are unique safety concerns associated with home care compared to the more controlled hospital or clinic settings, such as driving distractions, potentially dangerous neighborhoods, and in-home risks categorized as environmental, biological, chemical, and emotional. Each home is essentially a new worksite with its own set of safety hazards, increasing the need for home care providers to be aware of safety risks in these ever-changing environments. Ensuring worker safety is essential to the recruitment and retention of home care workers. This article discusses safety risks unique to home care and offers solutions that increase the safety of home care providers. Education around workplace violence, implementation of evidence-based practices, and establishing and adhering to safety policies are paramount.
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Tsui EK, Wyka K, Beato L, Verkuilen J, Baron S. How client death impacts home care aides' workforce outcomes: an exploratory analysis of return to work and job retention. Home Health Care Serv Q 2023; 42:230-242. [PMID: 36739614 DOI: 10.1080/01621424.2023.2175758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Home health aides face a range of stressors that may result in departing the workforce. One stressor that has emerged in multiple qualitative studies as potentially influencing retention is client death. Using 2019 data from a single agency in New York City employing approximately 1700 aides, we used logistic and linear regression to explore case and aide factors associated with workforce outcomes after client death. We found that longer case length (Beta = 0.01, p < .001) was associated with longer return to work for aides experiencing client death and longer job tenure (Beta = -0.002, p = .002) was associated with shorter return to work (n = 67). We found no difference in retention between aides who experienced client death and those who did not (n 216). This analysis suggests the importance of research on the period of time following client death and of offering support to aides after clients die, particularly after longer cases.
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Affiliation(s)
- Emma K Tsui
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York, USA
| | - Katarzyna Wyka
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy, New York, NY, USA
| | - Latifa Beato
- Cooperative Home Care Associates, Bronx, NY, USA
| | | | - Sherry Baron
- Barry Commoner Center for Health and the Environment, Queens College, Queens, NY, USA
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10
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Janssen LM, Abbott KM. "It Hits Me Right Here at my Heart": Promoting Emotional Health of Home Care Workers. J Appl Gerontol 2023; 42:680-688. [PMID: 36305376 DOI: 10.1177/07334648221127690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Demand for home and community-based services continues to outpace employment of home care workers (HCWs) who provide this vital assistance. HCWs face challenges that contribute to inadequate staff retention. Of particular concern is the lack of research on HCWs' emotional health. This research describes facilitators and resources that support HCW emotional health. Qualitative descriptive interviews were conducted with a purposive sample of HCWs (n = 17) who were formally recognized for their success. Interviews were audio recorded, transcribed verbatim, and coded in Dedoose. Thematic analysis revealed three facilitators of emotional health that HCWs link to their professional success: "right state of mind," practicing self-care, and a combined sense of appreciation and support. HCWs highlight specific, practicable resources that promote their emotional health. Policy implications connects low wages and benefits to HCW emotional health, and practice implications for enhancing training and support to retain these important workers.
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Affiliation(s)
- Leah M Janssen
- Scripps Gerontology Center, 6403Miami University, Oxford, OH, USA
| | - Katherine M Abbott
- Scripps Gerontology Center, Department of Sociology & Gerontology, 6403Miami University, Oxford, OH, USA
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11
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Brouillette NM, Markkanen PK, Quinn MM, Galligan CJ, Sama SR, Lindberg JE, Karlsson ND. Aide and Client Safety "Should Go Hand-In-Hand": Qualitative Findings From Home Care Aides, Clients, and Agency Leaders. J Appl Gerontol 2023; 42:571-580. [PMID: 36565062 PMCID: PMC9996781 DOI: 10.1177/07334648221146769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 12/02/2022] [Accepted: 12/05/2022] [Indexed: 12/25/2022] Open
Abstract
Retention of the home care (HC) aide workforce is essential to meet the needs of our aging population. Some studies suggest that improving HC safety could increase job retention. This study objective was to explore qualitatively the connection between aide and client safety and factors impacting this care relationship. Data consisted of audio-recorded, verbatim responses to open-ended questions of two focus groups with aides (n = 10), two in-person interviews with HC agency managers, and 37 phone interviews with those working in (aides, n = 16; managers, n = 12) and receiving (clients, n = 9) HC. Clients reported home layout and accessibility as safety concerns. Aides and managers reported that client family members can make the care job more challenging. The aide-client connection was affected by communication style, family and HC agency support, allotted care time, and job task boundaries. Interventions that address the safety of both clients and aides can influence HC job satisfaction and retention.
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Affiliation(s)
- Natalie M Brouillette
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, 52311University of Massachusetts Lowell, Lowell, MA, USA
| | - Pia K Markkanen
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, 52311University of Massachusetts Lowell, Lowell, MA, USA
| | - Margaret M Quinn
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, 52311University of Massachusetts Lowell, Lowell, MA, USA
| | - Catherine J Galligan
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, 52311University of Massachusetts Lowell, Lowell, MA, USA
| | - Susan R Sama
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, 52311University of Massachusetts Lowell, Lowell, MA, USA
| | - John E Lindberg
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, 52311University of Massachusetts Lowell, Lowell, MA, USA
| | - Nicole D Karlsson
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, 52311University of Massachusetts Lowell, Lowell, MA, USA
- Environmental Public Health Tracking Program, Division of Public Health Services, New Hampshire Department of Health and Human Services, Concord, NH, USA
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12
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Ruco A, Nichol K, Edwards B, Roy M, Morgan D, Holness DL, McKay S. Spot It, Prevent It: Evaluation of a Rapid Response Algorithm for Managing Workplace Violence Among Home Care Workers. Workplace Health Saf 2022; 70:493-499. [PMID: 35975760 PMCID: PMC9630957 DOI: 10.1177/21650799221110891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background: Workplace violence incidents remain pervasive in health care. Home care
workers like personal support workers (PSWs) provide services for clients
with dementia, which has been identified as a risk factor for workplace
violence. The objective of this study was to evaluate whether the
implementation of a rapid response algorithm resolved unsafe working
conditions associated with responsive behaviors and decreased perception of
risk. Methods: A nonexperimental pre- and post-evaluation design was utilized to collect
data from PSWs and supervisors. PSWs completed an online survey about their
experience with workplace violence and perception of risk. Bi-weekly
check-ins were conducted with supervisors to track incidents and their level
of resolution in the algorithm. Semi-structured interviews were also
conducted to gather in-depth feedback about the algorithm in practice. Findings: We found no difference in risk perception among PSWs pre- and
post-implementation. However, PSWs who had been employed for less than 1
year had a significantly higher risk perception. Overall, the algorithm was
found to be helpful in resolving workplace violence incidents. Conclusion and Application to Practice: Opportunity exists to further refine the algorithm and ongoing dissemination,
and implementation of the algorithm is recommended to continually address
incidents of workplace violence. Newly hired PSWs may require additional
supports. Ongoing education and training were identified as key mitigation
strategies.
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Affiliation(s)
- Arlinda Ruco
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto.,Institute of Health Policy, Management and Evaluation, University of Toronto
| | - Kathryn Nichol
- VHA Home HealthCare.,Dalla Lana School of Public Health, University of Toronto.,Centre for Research Expertise in Occupational Disease
| | - Brydne Edwards
- VHA Home HealthCare.,Occupational Science and Occupational Therapy Department, University of Toronto
| | | | | | - D Linn Holness
- Dalla Lana School of Public Health, University of Toronto.,Centre for Research Expertise in Occupational Disease.,Centre for Urban Health Solutions, Unity Health Toronto.,Department of Medicine, University of Toronto.,Division of Occupational Medicine, Department of Medicine, St. Michael's Hospital, Unity Health Toronto
| | - Sandra McKay
- VHA Home HealthCare.,Department of Physical Therapy, University of Toronto
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13
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Abuse and Wellbeing of Long-Term Care Workers in the COVID-19 Era: Evidence from the UK. SUSTAINABILITY 2022. [DOI: 10.3390/su14159620] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The UK long-term care workforce has endured difficult working conditions for many years. During the pandemic, the sector faced unprecedented challenges, which further exacerbated these conditions and brought concerns about workplace abuse and violence. Such experiences can vary by personal and work characteristics, particularly affecting minority ethnic groups. They can subsequently impact workers’ wellbeing and the sector overall. Drawing on the first wave of a UK longitudinal workforce survey, this article examined the impact of COVID-19 on social care workers’ working conditions, general health and wellbeing, and intentions to leave the employer and sector altogether. The analysis is based on both quantitative and qualitative responses 1037 valid responses received between April and June 2021. The respondents were predominantly female, working in direct care roles and mainly serving older adults (including those with dementia). The findings highlighted worrying experiences of abuse in relation to COVID-19, which differed significantly by nationality, ethnicity and care settings. The analysis further showcased the negative impact of experienced abuse on work-life balance and intentions to leave the current employer or the care sector altogether. The findings emphasise the need for targeted measures that promote workers’ physical, emotional and financial wellbeing.
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Small TF, Gillespie GL, Hutton S, Davis KG, Smith CR. Workplace Violence Prevalence and Reporting in Home Health Care: A Cross Sectional Survey. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2022. [DOI: 10.1177/10848223221116144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Workplace violence (WV) is a significant occupational hazard for home health care workers (HHCWs). HHCWs are frequently exposed to Type II (customer/client) WV incidents but minimal evidence exists about exposure to Type III (coworker) WV and exposure to Type IV (personal relationship) WV is unknown. Furthermore, exposure to WV incidents is often underreported by HHCWs. The Haddon Matrix guided this research study. A cross- sectional research design was used with HHCWs (n = 50) working in Southwest Ohio in April 2020. HHCWs completed the Workplace Violence Reporting Survey, a 76-item tool used to estimate the frequency and reporting of WV incidents. Data were analyzed using frequencies, percentages, means, and standard deviations. HHCWs were 86% female (n = 43). Patients (28.3%) followed by their families (17.4%) and intimate partners (10.9%) are the primary aggressors of verbal abuse. The incident was too minor (6.5%), no action would be taken (6.5%), and it’s part of the job (4.3%) are major reasons HHCWs underreported WV. Type II WV is most pervasive when the aggressor is the patient. HHCWs experience physical assault and sexual abuse in their work environment. HHCWs underreported verbal abuse and physical assault when the aggressor was an intimate partner.
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Affiliation(s)
| | | | - Scott Hutton
- Veterans Health Administration, Cincinnati, OH, USA
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15
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Small TF, Smith CR, Hutton S, Davis KG, Gillespie GL. Workplace Violence Prevention Training, Safety Resources, and Commitment to HHCWs' Safety. Workplace Health Saf 2022; 70:325-331. [PMID: 35466840 DOI: 10.1177/21650799221076871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The threat of workplace violence (WPV) is a primary safety concern for home health care workers (HHCWs). WPV prevention training is a critical tool for HHCWs' safety. Yet, most existing WPV prevention training is limited or not specific to HHCWs' environment, the patient's home, and neighborhood. The purpose of this study was to describe WPV prevention training, resources used, and commitment to HHCWs' safety. METHODS Using a cross-sectional design, HHCWs from two sites located in Southwestern Ohio completed the Violence Against Home Healthcare and Hospice Workers survey, a 37-item survey used to describe frequency and characteristics of WPV prevention training and resources. Descriptive statistics were used to analyze the data. FINDINGS Half (n = 25) of the HHCWs received WPV prevention training. Training content focused on characteristics of aggressive/violent patients and family members (n = 19, 82.6%), but limited content about characteristics of hazardous neighborhoods (n = 15, 65.2%). Cellular phones (n = 43, 97.7%) were primarily used as a resource to promote safety, few cellular phones (n = 1, 2.3%) were provided by the agency. CONCLUSIONS/APPLICATION TO PRACTICE HHCWs described WPV prevention training content and resources used to promote safety. WPV prevention training is deficient in procedures for seeking psychological care, screening patients for violent behavior, skills for self-protection, characteristics of hazardous neighborhoods, and physical maneuvers and verbal methods to diffuse or avoid aggressive behavior. Access to WPV prevention training and resources for HHCWs needs to be strengthened. Occupational Health Nurses can assist their employers with developing WPV prevention training for HHCWs.
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Phoo NNN, Reid A. Determinants of violence towards care workers working in the home setting: A systematic review. Am J Ind Med 2022; 65:447-467. [PMID: 35352369 PMCID: PMC9314693 DOI: 10.1002/ajim.23351] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/14/2022] [Accepted: 03/14/2022] [Indexed: 11/29/2022]
Abstract
Background Home care is a rapidly growing industry. Violence towards home care workers is common, while also likely underreported. This violence adversely affects the physical and mental health of both workers and care recipients. The current study aims to identify and appraise recent evidence on the determinants of violence towards care workers working in the home setting. Methods Six electronic databases: the Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, Informit, Medline, PsycINFO, and Web of Science, were systematically searched. A systematic review was conducted in accordance with the Joanna Briggs Institute manual for evidence synthesis. Results A total of 18 papers met the inclusion criteria. All were cross‐sectional surveys. The majority of studies were from the United States. The most commonly investigated associations were those between the medical history of clients, workers' apprehension of violence, worker‐client relationship, or care plans, and any form of violence or verbal abuse. Conclusion Violence was common in clients with cognitive disorders, substance abuse disorder, and limited mobility; toward workers who feared that violence might happen; toward those who had very close or very distant worker‐client relationships; and when care plans were not inclusive of clients' needs. The current review highlights a gap in evidence on determinants of violence towards care workers working in the home setting, and suggests potential areas to be addressed to reduce such violence.
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Affiliation(s)
- Nang Nge Nge Phoo
- School of Population Health, Faculty of Health Sciences Curtin University Bentley Western Australia Australia
| | - Alison Reid
- School of Population Health, Faculty of Health Sciences Curtin University Bentley Western Australia Australia
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Tsui EK, LaMonica M, Hyder M, Baron S. "We want to hear your problems and fix them": A case study of pandemic support calls for home health aides. Home Health Care Serv Q 2022; 41:124-138. [PMID: 35212257 DOI: 10.1080/01621424.2022.2035295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Home health aides and home care agencies, who operate in a high work stress environment under normal conditions, were placed under extraordinary demands during the COVID-19 pandemic. In this paper, we examine the unfolding effort at one agency in New York City to offer phone-based support calls to aides. We used a qualitative, single case study design involving semi-structured interviews with call staff and agency leaders (n = 9) and analysis of one year of thematic notes from the calls. We found that the calls resulted in multidirectional communication between agency staff and aides, an increased sense of empathy among staff, and a greater integration of aides into the agency's overall infrastructure. We explore how these calls might contribute to aide retention, worker voice, and mental health. We note the facilitators and barriers to implementing this type of job-based support to help other agencies that may be considering similar models.
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Affiliation(s)
- Emma K Tsui
- Department of Community Health & Social Sciences, CUNY Graduate School of Public Health and Health Policy, U.S.A
| | - Marita LaMonica
- Department of Community Health & Social Sciences, CUNY Graduate School of Public Health and Health Policy, U.S.A
| | | | - Sherry Baron
- Barry Commoner Center for Health and the Environment, Queens College, U.S.A
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18
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Morioka N, Kashiwagi M, Hamano J. Adherence to PPE use in home-care service agencies during COVID-19 in Japan: A cross-sectional survey. J Am Med Dir Assoc 2022; 23:930-935.e2. [PMID: 35337791 PMCID: PMC8882398 DOI: 10.1016/j.jamda.2022.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/09/2022] [Accepted: 02/19/2022] [Indexed: 11/21/2022]
Abstract
Objectives To assess adherence to personal protective equipment (PPE) use among home care workers during usual care at the agency level during the COVID-19 pandemic in Japan and determine whether agency-level action toward infection prevention and control (IPC) is associated with adherence to PPE use. Design A nationwide cross-sectional study. Setting and Participants Home care service agencies in Japan were randomly selected from all agencies nationwide. Methods An online survey was conducted between January and February 2021. The administrators at home care service agencies responded to the following items: adherence to PPE (disposable masks, gloves, and aprons) use during diaper change among their home care workers, agency-level actions toward IPC, including monitoring of infection outbreak among users, existing manual for IPC, training opportunities on IPC for care workers, and other agency and administrator characteristics. Results Of the 1942 agencies, 197 were included in the analysis (response rate: 10.1%). Although 145 (73.6%) of the agencies always used both masks and gloves during diaper change, 32 (16.2%) agencies fully adhered to wearing masks, gloves, and aprons. Agencies monitoring infectious disease outbreaks among service users were more likely to adhere to PPE use (adjusted odds ratio: 5.97, 95% confidence interval: 1.30–27.31). Conclusions and Implications Low adherence to PPE use, especially apron use, during diaper change among home care service agencies during the COVID-19 pandemic in Japan was revealed, despite the widespread availability of a manual for IPC and/or training opportunities. To ensure safety and quality home care services for both users and home care workers, agencies should not simply create manuals or training systems as a structure; instead, they should implement effective processes for appropriate PPE use.
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Baron SL, Tsui EK, Quinn MM. Work as a Root Cause of Home Health Workers' Poor Health. Am J Public Health 2022; 112:9-11. [PMID: 34936390 PMCID: PMC8713610 DOI: 10.2105/ajph.2021.306582] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2021] [Indexed: 01/03/2023]
Affiliation(s)
- Sherry L Baron
- Sherry L. Baron is with the Barry Commoner Center for Health and the Environment, Queens College, City University of New York, Queens, NY. Emma K. Tsui is with the City University of New York Graduate School of Public Health and Health Policy, New York, NY. Margaret M. Quinn is with the Safe Home Care Project, Lowell Center for Sustainable Production, and the Department of Public Health, University of Massachusetts Lowell
| | - Emma K Tsui
- Sherry L. Baron is with the Barry Commoner Center for Health and the Environment, Queens College, City University of New York, Queens, NY. Emma K. Tsui is with the City University of New York Graduate School of Public Health and Health Policy, New York, NY. Margaret M. Quinn is with the Safe Home Care Project, Lowell Center for Sustainable Production, and the Department of Public Health, University of Massachusetts Lowell
| | - Margaret M Quinn
- Sherry L. Baron is with the Barry Commoner Center for Health and the Environment, Queens College, City University of New York, Queens, NY. Emma K. Tsui is with the City University of New York Graduate School of Public Health and Health Policy, New York, NY. Margaret M. Quinn is with the Safe Home Care Project, Lowell Center for Sustainable Production, and the Department of Public Health, University of Massachusetts Lowell
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Quinn MM, Markkanen PK, Galligan CJ, Sama SR, Lindberg JE, Edwards MF. Healthy Aging Requires a Healthy Home Care Workforce: the Occupational Safety and Health of Home Care Aides. Curr Environ Health Rep 2021; 8:235-244. [PMID: 33982149 PMCID: PMC8114970 DOI: 10.1007/s40572-021-00315-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE OF REVIEW To identify important home care (HC) aide occupational safety and health (OSH) hazards and examine how addressing these can improve aide health and the delivery of HC services overall. Specifically, this review seeks to answer: Why is HC aide OSH important? What are the most significant OSH challenges? How can improving HC aide OSH also improve the safety and health of their clients? What implications do the findings have for future research? RECENT FINDINGS HC is one of the fastest growing US industries. Aides comprise its largest workforce and are increasingly needed to care for the rapidly aging population. There is an aide shortage due in part to instabilities in HC work organization and to serious job-specific hazards, resulting in aides losing work time. Recent social, economic, and technological factors are rapidly changing the nature of HC work, creating OSH hazards similar to those found in nursing homes. At the same time, aides are experiencing social and economic inequities that increase their vulnerability to OSH hazards. These hazards are also a burden on employers who are challenged to recruit, retain, and train aides. OSH injuries and illness interrupt the continuity of care delivery to clients. Many OSH hazards also put HC clients and families at risk. A new framework and methodologies are needed to assess aide and client safety together in order to guide future HC research, policies, and practices. Government, industry, and labor commitment is needed to fund and coordinate a comprehensive, multidisciplinary research program.
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Affiliation(s)
- M. M. Quinn
- Safe Home Care Project, Lowell Center for Sustainable Production and Department of Public Health, University of Massachusetts Lowell, 600 Suffolk Street, Suite 520, Lowell, MA 01854 USA
| | - P. K. Markkanen
- Safe Home Care Project, Lowell Center for Sustainable Production and Department of Public Health, University of Massachusetts Lowell, 600 Suffolk Street, Suite 520, Lowell, MA 01854 USA
| | - C. J. Galligan
- Safe Home Care Project, Lowell Center for Sustainable Production and Department of Public Health, University of Massachusetts Lowell, 600 Suffolk Street, Suite 520, Lowell, MA 01854 USA
| | - S. R. Sama
- Safe Home Care Project, Lowell Center for Sustainable Production and Department of Public Health, University of Massachusetts Lowell, 600 Suffolk Street, Suite 520, Lowell, MA 01854 USA
| | - J. E. Lindberg
- Safe Home Care Project, Lowell Center for Sustainable Production and Department of Public Health, University of Massachusetts Lowell, 600 Suffolk Street, Suite 520, Lowell, MA 01854 USA
| | - M. F. Edwards
- Safe Home Care Project, Lowell Center for Sustainable Production and Department of Public Health, University of Massachusetts Lowell, 600 Suffolk Street, Suite 520, Lowell, MA 01854 USA
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Affiliation(s)
- Tamara F Small
- Tamara F. Small PhD, APRN, FNP-C , is a Nurse Practitioner, Home Care Manager, Complex Care Solutions, Cincinnati, Ohio
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22
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Karlsson ND, Markkanen PK, Kriebel D, Galligan CJ, Quinn MM. "That's not my job": A mixed methods study of challenging client behaviors, boundaries, and home care aide occupational safety and health. Am J Ind Med 2020; 63:368-378. [PMID: 31833084 DOI: 10.1002/ajim.23082] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 11/18/2019] [Accepted: 12/03/2019] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Home care (HC) aide is among the fastest-growing jobs. Aides often work in long-term care relationships with elders or people with disabilities in clients' homes, assisting with daily activities. The purpose of this mixed-methods paper is to elucidate aides' experiences around the boundary-challenging behaviors of clients asking for services beyond aides' job duties and to identify possible interventions. METHODS A cross-sectional survey of HC aides in Massachusetts (n = 1249) provided quantitative data. Post-survey qualitative data were collected from nine HC aide focus groups (n = 70) and seven in-depth interviews with HC industry and labor representatives. RESULTS Quantitatively, aides who reported often being asked to do tasks outside their job duties were more likely to report abuse (prevalence ratio [PR] = 1.93; 95%CI: 1.47-2.52 for verbal, PR = 1.81; 95%CI: 1.13-2.91 for physical/sexual) and pain/injury with lost work time or medical care (PR = 1.58; 95%CI: 1.11-2.25). They were also less likely to want to remain in their job (PR = 0.94; 95%CI: 0.89-1.00) or recommend it to others (PR = 0.94; 95%CI: 0.90-0.98). Qualitative data showed that clients' requests for tasks beyond job duties were frequent and can lead to injuries, abuse, and psychosocial stress. Yet, requests often reflected genuine need. Helping clients stay at home, compassion, and feeling appreciated contributed to job satisfaction; therefore, aides can feel conflicted about refusing requests. CONCLUSION Client task requests outside HC services are a complex problem. Employer support, training, care plans, and feeling part of a care team can help aides navigate professional boundaries while delivering high quality care.
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Affiliation(s)
- Nicole D Karlsson
- Department of Public Health, University of Massachusetts Lowell, Lowell, Massachusetts
| | - Pia K Markkanen
- Department of Public Health, University of Massachusetts Lowell, Lowell, Massachusetts
| | - David Kriebel
- Department of Public Health, University of Massachusetts Lowell, Lowell, Massachusetts
| | - Catherine J Galligan
- Department of Public Health, University of Massachusetts Lowell, Lowell, Massachusetts
| | - Margaret M Quinn
- Department of Public Health, University of Massachusetts Lowell, Lowell, Massachusetts
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Small TF, Gillespie GL, Kean EB, Hutton S. Workplace Violence Interventions Used by Home Healthcare Workers: An Integrative Review. Home Healthc Now 2020; 38:193-201. [PMID: 32618777 DOI: 10.1097/nhh.0000000000000874] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The threat of workplace violence (WPV) is a significant occupational hazard for home healthcare workers (HHCWs). The purpose of this integrative review is to examine WPV interventions used by HHCWs to stay safe while working in the patient's home and community. The methodology used was the integrative review by , which allows for inclusion of experimental and non-experimental research, reflecting the state of the science on interventions used by HHCWs to mitigate and prevent WPV. A total of 17 articles pertained to interventions used by HHCWs. Interventions were further categorized by WPV Type. There are a number of interventions used for Type I and II WPV. However, interventions for Type III WPV are minimal and interventions for Type IV WPV are obsolete. Safety and health training were shown to be significant in increasing HHCWs' confidence and knowledge about WPV prevention. Researchers demonstrated safety and health training are effective in promoting a safe work environment and reducing incidents of WPV. This review begins to fill the gap in the literature on interventions used by HHCWs to mitigate and prevent WPV.
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Affiliation(s)
- Tamara F Small
- Tamara F. Small, MSN, APRN, FNP-C, is a PhD Candidate, University of Cincinnati, College of Nursing, Cincinnati, Ohio. Gordon Lee Gillespie, PhD, DNP, RN, FAAN, is a Professor & Deputy Director, Graduate Occupational Health Nursing Program, College of Nursing, University of Cincinnati, Cincinnati, Ohio. Emily B. Kean, MSLS, is a Research and Education Librarian, Donald C. Harrison Health Sciences Library, University of Cincinnati Libraries, Cincinnati, Ohio. Scott Hutton, PhD, RN, MBA, FAAN, is Director of Operations, Workplace Violence Prevention Program, VHA CO, Office of Mental Health and Suicide Prevention (10NC5), Cincinnati, Ohio
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Gerberich SG. Verbal abuse against home care aides: another shot across the bow in violence against health care and other workers. Occup Environ Med 2019; 76:593-594. [PMID: 31413182 DOI: 10.1136/oemed-2019-105925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 07/21/2019] [Indexed: 11/03/2022]
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