A qualitative study on the consequences of workplace violence in psychiatric settings

Background

Violence against health care workers in psychiatric settings presents worrying data in the literature. Violence effects for healthcare professionals and organizations are absence from work for injury or illness, decreased job satisfaction and lower quality of work. The aim of the study was to identify the consequences of violence on health, work habits and performance of nurses who work with psychiatric patients.

Methods

The study was carried out by using a semi-structured interview with 12 nurses from different hospital and territorial psychiatric settings in Southern Italy. The interviews were conducted from July to October 2020 by telephone and recorded with the consent of the participants. The collected data were transcribed and analyzed.

Results

The data show that 91.7% of the interviewees were assaulted by patients. Eight nurses (66.7%) were aggressed several times and six (50%) suffered physical violence. The narratives revealed that patients mainly suffered from drug addiction and that half of them were on pharmacological treatment. Nurses reported feelings of anger, helplessness, fear and frustration; five nurses experienced health consequences, including low mood, anxiety, stress and nervousness. Some of them described pain from physical injuries and permanent effects caused by the assault. An attacked nurse has been absent from work for injury. The aggressions resulted in a change of nurses' work habits and performances; they were more careful after the aggression and modified their approach to the patient. Some of them developed skills and strategies to protect themselves and avoid aggression, others developed greater faith in the efficacy of the prescribed drug. However, the events also caused job dissatisfaction.

Conclusions

Aggression has a negative impact on nurses' health and work performance. Healthcare organizations should take into account the self-protection strategies identified by professionals and support them to prevent violence.

Key messages

Violence at work compromises nurses' health and work performance in psychiatric settings. Safer work settings could improve nurses' job satisfaction and the quality of patient care.

Study of submerged cases of violence on healthcare workers in an emergency department

Background

Violence at work has negative effects on both workers and organizations. Among healthcare workers, nurses are the professionals most at risk, especially those who work in emergency departments. However, literature data are estimated to be the tip of the iceberg. The study aims at analyze violence events that are not reported by professionals via common reporting system, in order to measure the real extent of the problem and allow the organizations introducing adequate prevention measures.

Methods

The study took place in November 2016 in an emergency department in Southern Italy. A retrospective analysis was carried out by reviewing both the delivery registers (DR) used by nurses and doctors during the service, and the reports of security guards (RSG), in the period between 2011 and 2015.

Results

The results show that violence frequency was higher than that present in the risk management reporting (only one case). In the DR, 40 violence events were reported, yet in the RSG, 109 cases were registered. More nurses (n = 33) than doctors (n = 8) reported violence events in the DR. In the RSG, guards reported the same number of cases involving nurses, and 26 cases for doctors. In 50 cases, the professional involved was not specified. The violence type was physical (5 DR vs 13 RSG), physical threats or attempted violence (4 DR vs 13 RSG), and verbal (24 DR vs 67 RSG). Weapons (e.g., knife, hammer, syringe) were used in 2 cases as reported in DR and in 4 cases according to RSG. The aggressor was mainly the patient (15 DR vs 83 RSG) and the companion (14 DR vs 16 RSG). The shifts with more frequency of events are afternoon (15 DR vs 40 RSG) and night (12 DR vs 48 RSG).

Conclusions

The data show an amount of submerged cases and highlight a discrepancy between report of professionals and violence events where security guards intervened.

Key messages

Under-reporting violence cases require attention by the organizations. Prevention and protection strategies must be implemented. The use of the reporting system must be improved.

Comparison of fall risk assessment scales in the triage of an Italian emergency department

Background

Falls in hospital are adverse events with serious consequences for the patient. Fall risk assessment requires easy tools that are suitable for the specific clinical context. This is important to quickly identify preventing measures. The aim of the study is to identify an appropriate scale for assessing fall risk in patients from an emergency department.

Methods

For the fall risk assessment in the emergency department, three scales were identified in literature: Kinder 1, MEDFRAT, and Morse. MEDFRAT and Morse classify the patient in high, moderate, and low risk; Kinder 1 split patients “at risk” (also when there is only one positive item) and “non-risk” (in which all items are negative). The study was carried out in July 2019 in an Italian emergency department. Patients who arrived in triage were assessed for the fall risk using the three scales.

Results

On a sample of 318 patients, the used scales show different levels of fall risk. For Kinder 1, 83.02% is at risk and 16.98% is not at risk; for MEDFRAT, 14.78% is at high risk, 15.09% moderate, and 70.13% low risk; for Morse, 8.81% is at high risk, 35.53% moderate, and 56.66% low risk. As Kinder 1 implies as “high risk” that all items of the questionnaire are positive, to compare Kinder 1 to the other scales with three measurements, we assumed only one positive response as “moderate risk”, all negative responses as “low risk”. Thus, Kinder 1 shows no cases at high risk, 83.02% moderate risk, and 16.98% low risk. All the scales show that the moderate-high risk increases with age. MEDFRAT and Morse have concordant percentages for young (13.6%), elderly (61.2%), and long-lived (66.6%) people. Kinder 1, 59%, 96.7%, and 100%, respectively.

Conclusions

The comparison between scales shows inhomogeneity in identifying the level of risk. MEDFRAT and Morse appear more reliable and consistent.

Key messages

An appropriate assessment scale is important to identify the fall risk level. Identifying accurate fall risk levels allows for implementing specific prevention actions.

Organizational well-being among healthcare workers of middle management: a pilot study

Background

The organizational well-being assessment makes possible to identify risks for health in workers and organizations and to introduce health promotion actions in the workplace. The aim of the study is to analyze the organizational well-being among health professional managers who manage professional groups (e.g., nurses, midwives, physiotherapists) in hospital and identify potential main discomfort factors of these middle management workers.

Methods

A bicentric pilot study was performed in October 2019. A questionnaire with validated scales was administered to all the health professional managers of two Italian hospitals. The scales investigated variables such as distress, stress risk factors (e.g., physical and emotional workload, job control, job autonomy, role clarity, relationships, support), well-being, and job satisfaction.

Results

A self-reported questionnaire was administered to 38 out of 40 managers. They were male for 21% and female for 79%. The average age was 53.9 years. T-test analysis showed no significant difference between the two hospitals. The entire sample shows low general distress level, but 25% of the sample declares moderate distress and 8% high distress. The managers refer pace and workloads often (37%) or always (47%) excessive, they refer to not be able to 'detach' themselves from work issues when they get off work (60%) and to be too tired to live their lives (63%). They report that rarely (29%) or never (43%) have a say in how to do their job and refer that their direct supervisor is never available to listen their work problems (43%). The managers often or always perceive tension in working relationships (49%) and refer to do not have the needed support from colleagues (56%). Thirteen percent of managers applied for move into another ward.

Conclusions

This study shows that health professional managers experience general working discomfort and perceive problems with regard workload and poor support from colleagues and supervisors.

Key messages

Managers’ well-being can be compromised by both organizational and relationship factors. Middle management well-being should be improved to reduce distress risk and increase professional team efficacy.

Assessing hand hygiene compliance among healthcare workers in six Intensive Care Units

INTRODUCTION

Healthcare associated infections (HAIs) are a cause of high morbidity, disability and reduced quality of life, as well as mortality and rising costs for health systems. Preventing the HAI risk by planning and implementing effective preventive strategies is important to safeguard patient health.

METHODS

The study aimed to evaluate the presence of procedures and protocols for infection control, to assess the adhesion to the different aspects of hand hygiene (HH) and hand washing technique by healthcare workers in six ICUs. A perspective observational study was conducted in six ICUs. In each ICU, the adherence by health care workers to both hand hygiene practices and standard precautions was assessed, as well as the presence of procedures and written protocols.

RESULTS

The findings showed that in all the involved ICUs, 73 of 142 required protocols and procedures were available. Specifically, 59 of 79 were available for general measure of risk control, 12 of 15 for hand hygiene, and 24 of 48 for standard precautions and isolation measures. Also, the results showed highly variable levels of adherence to the best hygiene practices in all the ICUs involved in the study, with compliance rates ranging from 3% to 100%, and 73 of 142 required protocols were available at the study time.

CONCLUSIONS

Overall, the involved ICUs showed low levels of adherence to best hygiene practices. This suggests the need to implement immediate strategies for infection control in the ICUs. A multidisciplinary intervention could be effective in preventing and control the HAI risk.score was reached only by the third year students with regard to the proper HH. The level of knowledge about HAI was inadequate.A periodically check of nursing students' knowledge would be advisable in order to fill any gaps, improve training, reduce HAI and increase prevention measures compliance.

Current preventive policies and practices against Vaccine-Preventable Diseases and tuberculosis targeted for workers from hospitals of the Sardinia Region, Italy

INTRODUCTION

Health care Workers are exposed to infectious diseases more than the general population. Many of these infections are preventable by vaccination. The objective in this study is to investigate whether, how, and which vaccination underwent Sardinia Health Care Workers (HCWs) and the variability of policies in different Hospital Health Managements of the whole region.

METHODS

In March 2013, we enrolled the Hospital Health Management of all the 32 Sardinia hospitals. We investigate on immunity against vaccine-preventable diseases and education campaigns about recommended vaccinations for HCWs. Flu, hepatitis B, measles-mumps-rubella, varicella and tuberculosis were the objects of our research.

RESULTS

In most of the hospitals, influenza vaccination coverage among HCWs is less than 6%. Hepatitis B antibody assay was performed in all the respondent hospitals but only 14 had available data as collected electronically. Most of the hospitals did not perform serological tests for the evaluation of antibodies against Varicella, Measles, Mumps and Rubella in their HCWs. In 30 hospitals Mantoux test was replaced or integrated by "in vitro" test for health surveillance protocols.

CONCLUSIONS

This method produced a large amount of data in small time and at a low cost. Sending back data to respective Hospital Health Management (HHM) we took a step towards greater awareness of the issue of biological risks of HCWs and of vaccine coverage.

[Pilot study for the assessment of perceived critical organizational aspects in a hospital of Local Health Authority of Cagliari, Italy]

INTRODUCTION

In Italy, the effectiveness of public health services must be assessed trhoug the assessment of efficency of employees.

OBJECTIVE

To acquire from this activity useful information to assess and promote the well being at work.

METHODS

During the assessment activities, a questionnaire was administered to assess the efficency of the management in manage perceived critical organizational aspects.

RESULTS

The 44-58% consider not sufficient the management efficency in manage perceived critical organizational aspects, exspecially for quality of services, communication, vocational training and risks for worker's health and safety.

CONCLUSIONS

The study provide useful suggestions to better assess and manage the risk of work-related stress and exploit the key consultant role of occupational physician in the organizational context.

Bye-bye chiro-inositol - myo-inositol: true progress in the treatment of polycystic ovary syndrome and ovulation induction

Polycystic ovary syndrome (PCOS) is a multifactorial syndrome affecting 10% of women in reproductive age. Insulin sensitizer agents are the best therapeutic option for PCOS patients; among which there is Inositol. Inositol is a polyalcohol existing as nine different stereoisomers, two of which have been shown to be insulin mediators: myo-inositol (MI) and D-chiro-inositol (DCI). So far only MI have been show to be present in the follicular fluid and in a direct comparison between MI and DCI only MI was able to improve oocyte and embryo quality. Therefore, Could we say "bye-bye D-chiro-Inositol" in the practice of clinical gynecology and reproductive medicine?

Upper-rim CMPO-substituted calix[6]- and calix[8]arene extractants for the An3+/Ln3+separation from radioactive waste

Two new ligands (1and2) for actinide/lanthanide separation derived from calix[6]- and calix[8]arenes functionalised at the upper rim with six or eight CMPO binding units were synthesised. These ligands, having a methoxy group at the lower rim, are conformationally mobile in solution at room temperature. Extraction data from water to a NPHE/n-octanol (90/10) solution of ligands1and2, in the presence of bromo-cosan as synergist, show that these derivatives are less efficient and selective than the previously reported homologues derived from calix[4]arenes or from the lower rim CMPO calix[6]- and calix[8]arenes, especially at high nitric acid concentrations. However, although compound1and2do not appear promising for the actinide/lanthanide separation from high acidity radioactive waste, the results obtained in this work disclose some important structural results which can be useful for the design of new efficient and selective polytopic ligands.

[Is the patient's charter a tool for the implementation of health policies promoting health care quality? Results of a survey on Italian local health units over the period 1995-98]

Patient's Charter was introduced in Italy in the last decade with the aim of increasing community participation to the quality of health care. The Charter with reference to primary care services, should include information about the admission and standards of service that people can expect to receive. The purpose of the study was to assess, on the basis of a series of indicators, the presence of differences among different organisational model of Local Health Unit Districts. As regards Prevention Department, the association between quality indicators and geographic location was studied. We evaluated 112 Charters, 49.3% on the total amount of Italian Local Health Unit (LHU) that were issued during the period 1996-1998, using a data form with multiple choice questions. 104 out of 112 Charters showed quality items for Districts and Prevention Departments. Significant differences among the different groups of district organization model were shown for three indicators (waiting time, administrative details and chief in charge) respectively in General Practitioner area and in Psychiatric one. As regards Prevention Departments, no association was shown between geographic area and frequency of quality indicators, although a trend of higher frequence was found in Northern Area versus Central Area and Southern one. This study emphasizes the fact that data drawn from Patient's Charter can show the impact of different organisational and geographic conditions on quality of healthcare.

[Hypnotic drugs in a population. Prescriptions by the specialist and the general practitioner]

The aims of our survey were to estimate the prevalence of hypnotic drug prescription in a representative sample of population in 5 cities of Northern Italy and to analyse the pattern of prescription of these drugs by general practitioners (GPs) and psychiatrists. The data were collected with the collaboration of pharmacists working in 145 pharmacies. All consecutive patients presenting a prescription for a hypnotic drug were interviewed by the pharmacists during a two-week period. The pharmacists interviewed 7744 consecutive patients. The highest prevalence of prescriptions for hypnotic drugs was found in the elderly and in women. The majority of prescriptions were for benzodiazepines (BDZ), with lorazepam and triazolam accounting for about 50% of the total prescriptions. Short-acting and ultra-short-acting BDZ were more frequently prescribed for sleep induction by GPs than by psychiatrists. Approximately 73% of subjects reported that they had been taking the prescribed drug for one year or more. The high proportion of long-term BDZ users may be a consequence of the short period surveyed, which produced data weighted toward long-term consumption. Our data, however, do not permit to establish whether long-term use is appropriate from a clinical point of view or is the consequence of a physical dependence. We must be aware that this practice needs to be studied more accurately, with the aim to assess the risk/benefit ratio of long-term BDZ use.

Patterns of hypnotic drug prescription in Italy. A two-week community survey

BACKGROUND

In Italy a number of studies have been published on psychotropic drug use in general practice and community settings. However, the present study is the first Italian study to focus on hypnotic drug prescriptions in a large community sample.

METHOD

Data were collected from 145 of the total of 404 pharmacies of five large cities in north-eastern Italy. All consecutive patients presenting a prescription for a hypnotic drug were interviewed by the pharmacists during a two-week period.

RESULTS

The pharmacists interviewed 7/44 consecutive patients. The highest prevalence of prescriptions for hypnotic drugs was found in the elderly and in women. The majority (96%) of prescriptions were for benzodiazepines, with lorazepam and triazolam accounting for 50%. Short-acting and ultra-short-acting benzodiazepines were more frequently prescribed for sleep induction by general practitioners (GPs) than by psychiatrists and other physicians. Frequently the benzodiazepine used as a hypnotic was also prescribed for day time sedation. Approximately 72% of subjects reported they had been taking the prescribed drug for one year or more.

CONCLUSIONS

In Italy benzodiazepines are the most frequently prescribed drugs for sleep induction; as they are widely prescribed for elderly people by GPs often for long periods of time, educational programmes and guidelines on the rational use of benzodiazepines in general practice are needed.