Underreporting of Workplace Violence: Comparison of Self-Report and Actual Documentation of Hospital Incidents

Characteristics of aggressive incidents in emergency primary health care described by the Staff Observation Aggression Scale - Revised Emergency (SOAS-RE)

BACKGROUND

Workplace violence in emergency primary health care is prevalent, but longitudinal studies using validated assessment scales to describe the characteristics of workplace violence in these settings are lacking. The aim of the present study was to determine the characteristics of aggressive incidents in emergency primary health care clinics in Norway.

METHODS

Incidents of workplace violence were reported with the Staff Observation Aggression Scale - Revised Emergency (SOAS-RE). The study was conducted in ten emergency primary health care clinics over a period of one year.

RESULTS

A total of 320 aggressive incidents were registered. The mean overall SOAS-RE score for reported aggressive incidents was 9.7 on a scale from 0 to 22, and 60% of the incidents were considered severe. Incidents of verbal aggression accounted for 31.6% of all reported incidents, threats accounted for 24.7%, and physical aggression accounted for 43.7%. Verbal aggression was most often provoked by long waiting time. Physical aggression was most often provoked when the patient had to go through an involuntary assessment of health condition. Almost one third of the aggressors were females, and nurses were the most frequent targets of all aggression types. No differences in psychological stress were found between types of aggression.

CONCLUSIONS

This study shows that workplace violence in emergency primary health care clinics is a severe problem. Patterns in provocation and consequences of aggressive incidents can be used to improve our understanding of and prevention and follow-up procedures of such incidents.

Prevalence of workplace violence against healthcare workers: a systematic review and meta-analysis

We aim to quantitatively synthesise available epidemiological evidence on the prevalence rates of workplace violence (WPV) by patients and visitors against healthcare workers. We systematically searched PubMed, Embase and Web of Science from their inception to October 2018, as well as the reference lists of all included studies. Two authors independently assessed studies for inclusion. Data were double-extracted and discrepancies were resolved by discussion. The overall percentage of healthcare worker encounters resulting in the experience of WPV was estimated using random-effects meta-analysis. The heterogeneity was assessed using the I ² statistic. Differences by study-level characteristics were estimated using subgroup analysis and meta-regression. We included 253 eligible studies (with a total of 331 544 participants). Of these participants, 61.9% (95% CI 56.1% to 67.6%) reported exposure to any form of WPV, 42.5% (95% CI 38.9% to 46.0%) reported exposure to non-physical violence, and 24.4% (95% CI 22.4% to 26.4%) reported experiencing physical violence in the past year. Verbal abuse (57.6%; 95% CI 51.8% to 63.4%) was the most common form of non-physical violence, followed by threats (33.2%; 95% CI 27.5% to 38.9%) and sexual harassment (12.4%; 95% CI 10.6% to 14.2%). The proportion of WPV exposure differed greatly across countries, study location, practice settings, work schedules and occupation. In this systematic review, the prevalence of WPV against healthcare workers is high, especially in Asian and North American countries, psychiatric and emergency department settings, and among nurses and physicians. There is a need for governments, policymakers and health institutions to take actions to address WPV towards healthcare professionals globally.

Impact of a comprehensive prevention programme aimed at reducing incivility and verbal violence against healthcare workers in a French ophthalmic emergency department: an interrupted time-series study

OBJECTIVE AND SETTING

Primary prevention, comprising patient-oriented and environmental interventions, is considered to be one of the best ways to reduce violence in the emergency department (ED). We assessed the impact of a comprehensive prevention programme aimed at preventing incivility and verbal violence against healthcare professionals working in the ophthalmology ED (OED) of a university hospital.

INTERVENTION

The programme was designed to address long waiting times and lack of information. It combined a computerised triage algorithm linked to a waiting room patient call system, signage to assist patients to navigate in the OED, educational messages broadcast in the waiting room, presence of a mediator and video surveillance.

PARTICIPANTS

All patients admitted to the OED and those accompanying them.

DESIGN

Single-centre prospective interrupted time-series study conducted over 18 months.

PRIMARY OUTCOME

Violent acts self-reported by healthcare workers committed by patients or those accompanying them against healthcare workers.

SECONDARY OUTCOMES

Waiting time and length of stay.

RESULTS

There were a total of 22 107 admissions, including 272 (1.4%) with at least one act of violence reported by the healthcare workers. Almost all acts of violence were incivility or verbal harassment. The rate of violence significantly decreased from the pre-intervention to the intervention period (24.8, 95% CI 20.0 to 29.5, to 9.5, 95% CI 8.0 to 10.9, acts per 1000 admissions, p<0.001). An immediate 53% decrease in the violence rate (incidence rate ratio=0.47, 95% CI 0.27 to 0.82, p=0.0121) was observed in the first month of the intervention period, after implementation of the triage algorithm.

CONCLUSION

A comprehensive prevention programme targeting patients and environment can reduce self-reported incivility and verbal violence against healthcare workers in an OED.

TRIAL REGISTRATION NUMBER

NCT02015884.

An evaluation of proactive psychiatric consults on general medical units

OBJECTIVE

Recent studies have shown an association between proactive psychiatric consultation on medical units and shorter length of stay. The aim of this study was to assess the impact of implementing a proactive psychiatric consult service on general medical units in an urban teaching hospital on length of stay and qualitative measurement of satisfaction of adequacy of psychiatric services.

METHODS

Bivariate and multivariate analyses of demographic, clinical and outcome data were performed comparing patients seen by the proactive psychiatric consult team, patients seen contemporaneously on other general medical units by a traditional, reactive consult team and patients seen the prior year on the proactive intervention units by the reactive consult team. Length of stay was the primary outcome examined. Regression modeling was performed to assess further the relationship of length of stay with the three groups. Nursing and physician staff were queried before and after intervention regarding satisfaction with psychiatric resources on the intervention units.

RESULTS

Patients seen by the proactive team had shorter length of stay than those seen by contemporaneous reactive consult team (p = 0.005) or the prior year by the reactive team on the intervention units (p = 0.005). There was no significant difference between the latter two groups. Time to consult was also shorter for patients seen through the proactive model than the reactive model on other units at the same time (0.01) or the preceding year (<0.001). Nursing and physician satisfaction with psychiatric help increased significantly in three of four measures.

CONCLUSIONS

Proactive psychiatric consultation in our study correlated with shorter time to consult, shorter length of stay, and improved staff satisfaction compared to a reactive consult model.

Workplace Violence: Experiences of Internal Medicine Trainees at an Academic Medical Center

OBJECTIVES

Healthcare professionals are at higher risk for workplace violence (WPV) than workers in other sectors. This elevated risk exists despite the vast underreporting of WPV in the medical setting. The challenge of responding to this risk is compounded by limited empirical research on medical training environments. Understanding trainees' experience and educating them on workplace safety, WPV reporting, and awareness of resources are shared goals of educational and institutional leadership. In our setting, clear understanding and education were urgent after the enactment of a statewide "constitutional carry" law affording individuals a right to carry concealed firearms in all state-owned universities and hospitals, beginning in July 2017. We sought to examine the incidence of WPV affecting Internal Medicine trainees to understand the types of violence encountered, reporting rates, and the factors that influence reporting.

METHODS

We conducted a cross-sectional online survey of Internal Medicine residents and fellows in practice for the previous 12 months. Survey items included both forced choice and open-ended questions. Descriptive statistics were calculated and used to summarize the study variables. χ² tests were performed to examine whether sex differences existed for each of the survey questions. Qualitative responses were content analyzed and organized thematically.

RESULTS

Of 186 trainees, 88 completed the survey. Forty-seven percent of respondents experienced WPV, with >90% of cases involving a patient, a patient's family member, or a patient's friend. Verbal assault was the most common type of incident encountered. Trainees formally reported fewer than half of the violent incidents disclosed in the survey. Major factors that influenced reporting included the severity of the incident, condition of the patient, and clarity of the reporting mechanism.

CONCLUSIONS

Previous research indicates similar amounts and types of WPV. Likewise, a large percentage of the incidents are not reported. Addressing the key factors related to why physicians underreport can inform institutions on how to make systematic changes to reduce WPV and its negative impact. Future research is needed to examine whether specific interventions can be implemented to improve reporting and reduce the incidence of WPV.

Organizational response to workplace violence, and its association with depressive symptoms: A nationwide survey of 1966 Korean EMS providers

OBJECTIVES

This study investigated whether organizational responses modified the associations between experiencing violence and depressive symptoms among emergency workers.

METHODS

A nationwide survey of 1966 Korean emergency medical service (EMS) providers was analyzed. Experience of workplace violence (ie, physical violence, verbal abuse) was classified into four groups based on the victims' reporting and organizational responses: (i) "Not experienced," (ii) "Experienced, not reported," (iii) "Experienced, reported, responded by organization,"and (iv) "Experienced, reported, not responded by organization." Depressive symptoms were assessed by 11-item version of the Centers for Epidemiologic Studies Depression Scale.

RESULTS

Compared to "Not experienced" group, physical violence was significantly associated with depressive symptoms among EMS providers responding "Experienced, not reported" (PR: 1.67, 95% CI: 1.37, 2.03) and "Experienced, reported, not responded by organization" (PR: 2.58, 95% CI: 1.75, 3.82), after adjusting for confounders. No significant difference was detected for workers responding "Experienced, reported, responded by organization" group (PR: 1.45, 95% CI: 0.87, 2.41). Similar trends were observed in the analysis with verbal abuse.

CONCLUSIONS

Our findings suggest that organizational responses could play a critical role in mitigating depressive symptoms among EMS providers who experience violence at work.

Violence towards Emergency Nurses: The 2016 Italian National Survey-A cross-sectional study

AIM

To analyse the dimensions and characteristics of violence towards Emergency nurses in a national context (Italy).

BACKGROUND

Nurses are the most exposed to workplace violence, especially in Emergency Department contexts.

METHODS

A cross-sectional study was conducted in all Italian regions. Descriptive analyses were used to examine violence from patients and relatives (Type II violence) concerning personal characteristics of the Emergency nurses and perpetrators, environmental and organisational factors. Multinomial logistic regression analysis was used to investigate risk factors.

RESULTS

About 76.0% of Emergency nurses experienced verbal violence, 15.5% both verbal and physical violence and only 8.5% denied having experienced either. Older age and more experience in Emergency settings are protective factors. Working in the South of Italy significantly increases the probability of being exposed.

DISCUSSION

There are many factors explaining violence, but some correlations are not clear.

CONCLUSION

Factors that have a positive effect on this problem include: specific training for younger nurses, a strong alliance between users and health personnel to restore a relationship of trust between parties, physical barriers and appropriate architectural measures.

IMPLICATIONS FOR NURSING MANAGEMENT

Comprehensive approaches can represent an effective strategy to counteract workplace violence.

Holding the line against workplace violence

As caregivers, nurses often dismiss violent patient interactions as "just part of the job." This article addresses this misconception, differentiates between two types of violence present in healthcare settings, and stresses the importance of reporting and evaluating violent acts to plan mitigation strategies.

Frequency and Forms of Workplace Violence in Primary Health Care

INTRODUCTION

Violence at work has become an alarming problem worldwide. The real size of the problem is unknown because of underreporting. The aim of the survey was to estimate the prevalence of workplace violence (WPV) among primary health care professionals in the Public Institution Health Center of Sarajevo Canton (HCSC), Bosnia and Herzegovina, and determine possible association with demographic and work-related characteristics of participants.

AIM

The aim of the survey was to estimate the prevalence of workplace violence (WPV) among Primary health care professionals in the Public Institution Health Center of Sarajevo Canton (HCSC), Bosnia and Herzegovina, and determine possible association with demographic and work-related characteristics of participants.

METHODS

A cross-sectional study was conducted between March and May 2017. The sample consisted of medical professionals employed at HCSC. The data were collected by a questionnaire with 42 questions divided into 7 blocks of topic. Descriptive statistics were used to describe the sample. Binary logistic regression analysis was used to test the association between the occurrence of violence and independent variables (gender, age, years of work experience and office setting).

RESULTS

A total of 558 out of 983 health professionals employed in Primary health care were involved in this survey. The overall prevalence of WPV was 90.3%, with 498 (89.2%) exposed to verbal violence and 417 (74.7%) exposed to indirect physical violence. Binary logistic regression analysis indicated that the following demographic and work-related characteristics were positively significantly associated with WPV: women were associated with verbal violence [Odd ratio (OR) 1.91, 95% confidence interval (CI) 1.06, 1.47] and stalking [OR= 2.06, 95% CI (1.04, 4.08)]. Office setting (urban) was significantly positively associated with indirect physical violence [OR= 1.59, 95% CI (1.03, 2.47)].

CONCLUSION

Almost all health professionals in Sarajevo primary health care were subjected to different types of WPV. There is a need for intervention to provide safer workplace environment. Professional, administrative, legal support and protection of health professionals by the health authorities and institution management is urgently required.

International Survey of Violence Against EMS Personnel: Physical Violence Report

IntroductionEach year, Emergency Medical Services (EMS) personnel respond to over 30 million calls for assistance in the United States alone. These EMS personnel have a rate of occupational fatality comparable to firefighters and police, and a rate of non-fatal injuries that is higher than the rates for police and firefighters and much higher than the national average for all workers. In Australia, no occupational group has a higher injury or fatality rate than EMS personnel. Emergency Medical Services personnel in the US have a rate of occupational violence injuries that is about 22-times higher than the average for all workers. On average, more than one EMS provider in the US is killed every year in an act of violence.Hypothesis/ObjectiveThe objective of this epidemiological study was to identify the risks and factors associated with work-related physical violence against EMS personnel internationally.

METHODS

An online survey, based on a tool developed by the World Health Organization (WHO; Geneva, Switzerland), collected responses from April through November 2016.

RESULTS

There were 1,778 EMS personnel respondents from 13 countries; 69% were male and 54% were married. Around 55% described their primary EMS work location as "urban." Approximately 68% described their employer as a "public provider." The majority of respondents were from the US.When asked "Have you ever been physically attacked while on-duty?" 761 (65%) of the 1,172 who answered the question answered "Yes." In almost 10% (67) of those incidents, the perpetrator used a weapon. Approximately 90% of the perpetrators were patients and around five percent were patient family members. The influence of alcohol and drugs was prevalent. Overall, men experienced more assaults than women, and younger workers experienced more assaults than older workers.

CONCLUSIONS

In order to develop and implement measures to increase safety, EMS personnel must be involved with the research and implementation process. Furthermore, EMS agencies must work with university researchers to quantify agency-level risks and to develop, test, and implement interventions in such a way that they can be reliably evaluated and the results published in peer-reviewed journals. MaguireBJ, BrowneM, O'NeillBJ, DealyMT, ClareD, O'MearaP. International survey of violence against EMS personnel: physical violence report. Prehosp Disaster Med. 2018;33(5):526-531.

Workplace Violence

: How it affects health care, which providers are most affected, and what management and staff can do about it.

Organizational Determinants of Workplace Violence Against Hospital Workers

OBJECTIVE

To identify organizational factors contributing to workplace violence in hospitals.

METHODS

A questionnaire survey was conducted in 2013 among employees in a Midwestern hospital system (n = 446 respondents). Questions concerned employees' experiences of violence at work in the previous year and perceptions of the organizational safety climate. Logistic regressions examined staff interaction and safety climate factors associated with verbal and physical violence, respectively.

RESULTS

Interpersonal conflict was a risk factor for verbal violence (OR 1.49, 95% CI 1.04 to 2.12, P < 0.05) and low work efficiency was a risk factor for physical violence (OR .98, 0.97 to 0.99). A poor violence prevention climate was a risk factor for verbal (OR 0.48, 0.36 to 0.65, P < .001) and physical (OR 0.60, 0.45 to 0.82, P < .05) violence.

CONCLUSIONS

Interventions should aim at improving coworker relationships, work efficiency, and management promotion of the hospital violence prevention climate.

Preventing EMS workplace violence: A mixed-methods analysis of insights from assaulted medics

OBJECTIVE

To describe measures that assaulted EMS personnel believe will help prevent violence against EMS personnel.

METHODS

This mixed- methods study includes a thematic analysis and directed content analysis of one survey question that asked the victims of workplace violence how the incident might have been prevented.

RESULTS

Of 1778 survey respondents, 633 reported being assaulted in the previous 12 months; 203 of them believed the incident could have been prevented and 193 of them (95%) answered this question. Six themes were identified using Haddon's Matrix as a framework. The themes included: Human factors, including specialized training related to specific populations and de-escalation techniques as well as improved situational awareness; Equipment factors, such as restraint equipment and resources; and, Operational and environment factors, including advanced warning systems. Persons who could have prevented the violence were identified as police, self, other professionals, partners and dispatchers. Restraints and training were suggested as violence-prevention tools and methods CONCLUSIONS: This is the first international study from the perspective of victimized EMS personnel, to report on ways that violence could be prevented. Ambulance agencies should consider these suggestions and work with researchers to evaluate risks at the agency level and to develop, implement and test interventions to reduce the risks of violence against EMS personnel. These teams should work together to both form an evidence-base for prevention and to publish findings so that EMS medical directors, administrators and professionals around the world can learn from each experience.

Preventing and managing challenging behaviour

Patients exhibiting challenging behaviour, which includes any non-verbal, verbal or physical behaviour, is a significant issue in healthcare settings. Preventing such behaviour and the harm it can cause is important for healthcare organisations and individuals, and involves following a public health model comprised of three tiers: primary, secondary and tertiary prevention. Primary prevention aims to reduce the risk of challenging behaviour occurring in the first instance; secondary prevention involves reducing the risk associated with imminent challenging behaviour and its potential escalation; and tertiary prevention focuses on minimising the physical and emotional harm caused by challenging behaviours, during and after an event. De-escalation should be the first-line response to challenging behaviour, and healthcare staff should use a range of techniques - maintaining safety, self-regulation, effective communication, and assessment and actions - to reduce the incidence of challenging behaviour. In some situations, physical interventions may be required to protect the safety of the individual, healthcare staff and other individuals involved, and healthcare staff should be aware of local policies and procedures for this. Following a serious incident, where there was potential or actual harm to patients and healthcare staff, healthcare organisations should use post-incident reviews to learn from the situation, while healthcare staff should be offered the opportunity for debriefing. Positive responses to challenging behaviour at an organisational and individual level can lead to improved work environments for healthcare staff and optimal patient care and outcomes.

Workplace violence injury in 106 US hospitals participating in the Occupational Health Safety Network (OHSN), 2012-2015

BACKGROUND

Workplace violence is a substantial occupational hazard for healthcare workers in the United States.

METHODS

We analyzed workplace violence injury surveillance data submitted by hospitals participating in the Occupational Health Safety Network (OHSN) from 2012 to 2015.

RESULTS

Data were frequently missing for several important variables. Nursing assistants (14.89, 95%CI 10.12-21.91) and nurses (8.05, 95%CI 6.14-10.55) had the highest crude workplace violence injury rates per 1000 full-time equivalent (FTE) workers. Nursing assistants' (IRR 2.82, 95%CI 2.36-3.36) and nurses' (IRR 1.70, 95%CI 1.45-1.99) adjusted workplace violence injury rates were significantly higher than those of non-patient care personnel. On average, the overall rate of workplace violence injury among OHSN-participating hospitals increased by 23% annually during the study period.

CONCLUSION

Improved data collection is needed for OHSN to realize its full potential. Workplace violence is a serious, increasingly common problem in OHSN-participating hospitals. Nursing assistants and nurses have the highest injury risk.

Emergency Medical Service Personnel's Risk From Violence While Serving the Community

OBJECTIVES

To determine the risks of violence-related injury among emergency medical services (EMS) personnel in the United States.

METHODS

We analyzed 1630 violence-related occupational injury cases reported to the US Bureau of Labor Statistics for the years 2012 to 2015 and conducted secondary searches within the Bureau of Labor Statistics Web site.

RESULTS

The number of cases per year varied between 250 and 560. Perpetrators included patients (77%) and coworkers (8%). Female EMS personnel had a disproportionately greater risk of violence-related injuries. The most common (35%) injury type was "sprains-strains-tears"; about 4% of the assault cases resulted in fractures, 13% resulted in surface wounds, and 190 were head injuries. About a third of the cases were classified as intentional.

CONCLUSIONS

The findings indicate a clear need for reliable interventions. The differences in risk for women indicate that some interventions may need to be demographic-specific. Because of the limitations of national data, future researchers will need access to agency-level data that include hours worked and call volume by demographic factors such as gender.

Worksite Walkthrough Intervention: Data-driven Prevention of Workplace Violence on Hospital Units

OBJECTIVE

The aim of this study was to describe the implementation of a data-driven, unit-based walkthrough intervention shown to be effective in reducing the risk of workplace violence in hospitals.

METHODS

A structured worksite walkthrough was conducted on 21 hospital units. Unit-level workplace violence data were reviewed and a checklist of possible prevention strategies and an Action Plan form guided development of unit-specific intervention. Unit supervisor perceptions of the walkthrough and implemented prevention strategies were reported via questionnaires. Prevention strategies were categorized as environmental, behavioral, or administrative.

RESULTS

A majority of units implemented strategies within 12 months' postintervention. Participants found the walkthrough useful, practical, and worthy of continued use.

CONCLUSIONS

Structured worksite walkthroughs provide a feasible method for workplace violence reduction in hospitals. Core elements are standardized yet flexible, promoting fidelity and transferability of this intervention.

Validation de la version française canadienne du Perception of Prevalence of Aggression Scale auprès d’un échantillon d’intervenants en protection de la jeunesse1

Objectif. L’objectif de cette étude est d’évaluer la validité de construit de la version française de l’échellePerception Of Prevalence of Aggression Scale (POPAS), un questionnaire auto-rapporté mesurant l’exposition à la violence au travail commise par la clientèle du milieu de la santé et des services sociaux.Méthode. Un échantillon de 310 intervenants en protection de la jeunesse est utilisé afin de confirmer la structure interne à quatre facteurs de l’instrument. À défaut de confirmer cette structure, un modèle d’équation structurelle exploratoire est utilisé. Les facteurs retenus sont soumis aux tests d’alpha de Cronbach qui permettent d’évaluer leur cohérence interne. Ils sont corrélés avec la version française duPosttraumatic Stress Disorder Checklist Scale(PCLS) et du nombre de jours d’absence du travail causé par la violence afin d’évaluer la validité convergente. Il sont également corrélées avec leFelt Accountability(FA) afin d’évaluer la validité divergente. Des analyses de comparaison en fonction du lieu de travail permettent d’explorer la validité de critère.Résultats. L’analyse factorielle confirmatoire ne confirme pas la structure à quatre facteurs du POPAS. L’équation structurelle exploratoire valide une structure à trois facteurs : « violence verbale », « violence physique » et « violence envers soi-même ». Les deux premiers possèdent une bonne cohérence interne. Les corrélations positives entre ces deux facteurs et le PCLS, ainsi qu’entre ces deux facteurs et le nombre de jours d’absence appuient la validité convergente du POPAS. Toutefois, l’absence de corrélation significative entre le dernier facteur et le PCLS, et entre ce facteur et le nombre de jour d’absence n’appuient pas cette convergence. L’absence de corrélation des facteurs avec le FA appuie la validité divergente du POPAS. Les différences observées selon les environnements de travail attestent aussi de la validité de critère.Discussion. La validité de construit de la version française canadienne du POPAS suggère que l’outil permet d’évaluer la fréquence subjective de différentes formes de violence au travail vécues par les intervenants en protection de la jeunesse. Il offre ainsi une alternative aux données officielles (c.-à-d. déclaration d’incidents à l’employeur) qui reflètent peu la réalité de ces travailleurs compte tenu de la sous-déclaration des incidents de violence dans ce milieu.

Workplace Violence in Health Care-It's Not "Part of the Job"

IMPORTANCE

While health care workers comprise just 13% of the US workforce, they experience 60% of all workplace assaults. This violence is the second leading cause of fatal occupational injury. Women comprise 45% of the US labor force but 80% of health care workers, the highest proportion of females in any industry.

OBJECTIVE

The purpose was to describe the prevalence, forms, and consequences of health care workplace violence (WPV). The role and components of prevention programs for avoiding or mitigating violence are discussed, including opportunities for participation by obstetrician-gynecologists.

EVIDENCE ACQUISITION

A search of PubMed from 1990 to February 1, 2016, identified relevant manuscripts. Additional studies were found by reviewing the manuscripts' references. Government Web sites were visited for relevant data, publications, and resources.

RESULTS

Health care WPV continues to rise despite an overall decrease in US WPV. While workers are most likely to be assaulted by clients or patients, they are most frequently bullied and threatened by coworkers. All incidents are markedly underreported in the absence of physical injury or lost work time. Sequelae include physical and psychological trauma, adverse patient outcomes, and perceived lower quality of care.

CONCLUSIONS

The human, societal, and economic costs of health care WPV are enormous and unacceptable. Comprehensive prevention, planning, and intervention offer the best means of mitigating risks. As women's health physicians and health care workers, obstetrician-gynecologists should be encouraged to participate in such efforts.

The Patient Care Paradox: An Interprofessional Qualitative Study of Agitated Patient Care in the Emergency Department

OBJECTIVES

The emergency department (ED) has been recognized as a high-risk environment for workplace violence. Acutely agitated patients who perpetrate violence against healthcare workers represent a complex care challenge in the ED. Recommendations to improve safety are often based on expert opinion rather than empirical data. In this study we aim to describe the lived experience of staff members caring for this population to provide a broad perspective of ED patient violence. The findings of this study will contribute to the development of a comprehensive framework for ED agitated patient care that will guide safety interventions.

METHODS

We conducted uniprofessional focus groups and individual interviews using a phenomenologic approach with emergency medicine resident physicians, ED staff nurses, patient care technicians, and hospital police officers at an urban hospital in New York City. Audio recordings were transcribed and coded for thematic analysis using the constant comparison method.

RESULTS

We reached theoretical saturation with 31 interprofessional participants. Three broad themes emerged from our analysis: 1) ED healthcare workers provide high-quality care to a marginalized patient population that concurrently poses safety threats, creating a patient care paradox; 2) teamwork is critical to safely managing this population, but hierarchy and professional silos hinder coordinated care between healthcare professionals; and 3) environmental challenges and systems issues both in and outside the ED exacerbate threats to safety.

CONCLUSION

The experience of ED staff members while caring for agitated patients is complex and multidimensional. We identified issues that coalesced into four tiers of healthcare delivery at the individual, team, environment, and system levels. Future research is needed to determine applicability of our findings across institutions to build a comprehensive framework for ED agitated patient care.

Preventing Patient-to-Worker Violence in Hospitals: Outcome of a Randomized Controlled Intervention

OBJECTIVE

To evaluate the effects of a randomized controlled intervention on the incidence of patient-to-worker (Type II) violence and related injury in hospitals.

METHODS

Forty-one units across seven hospitals were randomized into intervention (n = 21) and control (n = 20) groups. Intervention units received unit-level violence data to facilitate development of an action plan for violence prevention; no data were presented to control units. Main outcomes were rates of violent events and injuries across study groups over time.

RESULTS

Six months post-intervention, incident rate ratios of violent events were significantly lower on intervention units compared with controls (incident rate ratio [IRR] 0.48, 95% confidence interval [CI] 0.29 to 0.80). At 24 months, the risk for violence-related injury was lower on intervention units, compared with controls (IRR 0.37, 95% CI 0.17 to 0.83).

CONCLUSIONS

This data-driven, worksite-based intervention was effective in decreasing risks of patient-to-worker violence and related injury.

Hospital workers bypass traditional occupational injury reporting systems when reporting patient and visitor perpetrated (type II) violence

BACKGROUND

Under-reporting of type II (patient/visitor-on-worker) violence by workers has been attributed to a lack of essential event details needed to inform prevention strategies.

METHODS

Mixed methods including surveys and focus groups were used to examine patterns of reporting type II violent events among ∼11,000 workers at six U.S. hospitals.

RESULTS

Of the 2,098 workers who experienced a type II violent event, 75% indicated they reported. Reporting patterns were disparate including reports to managers, co-workers, security, and patients' medical records-with only 9% reporting into occupational injury/safety reporting systems. Workers were unclear about when and where to report, and relied on their own "threshold" of when to report based on event circumstances.

CONCLUSIONS

Our findings contradict prior findings that workers significantly under-report violent events. Coordinated surveillance efforts across departments are needed to capture workers' reports, including the use of a designated violence reporting system that is supported by reporting policies. Am. J. Ind. Med. 59:853-865, 2016. © 2016 Wiley Periodicals, Inc.

Job demands-resources predicting burnout and work engagement among Belgian home health care nurses: A cross-sectional study

BACKGROUND

A better knowledge of the job aspects that may predict home health care nurses' burnout and work engagement is important in view of stress prevention and health promotion. The Job Demands-Resources model predicts that job demands and resources relate to burnout and work engagement but has not previously been tested in the specific context of home health care nursing.

PURPOSE

The present study offers a comprehensive test of the Job-Demands Resources model in home health care nursing. We investigate the main and interaction effects of distinctive job demands (workload, emotional demands and aggression) and resources (autonomy, social support and learning opportunities) on burnout and work engagement.

METHODS

Analyses were conducted using cross-sectional data from 675 Belgian home health care nurses, who participated in a voluntary and anonymous survey.

RESULTS

The results show that workload and emotional demands were positively associated with burnout, whereas aggression was unrelated to burnout. All job resources were associated with higher levels of work engagement and lower levels of burnout. In addition, social support buffered the positive relationship between workload and burnout.

CONCLUSIONS

Home health care organizations should invest in dealing with workload and emotional demands and stimulating the job resources under study to reduce the risk of burnout and increase their nurses' work engagement.

Worker-to-Worker Violence in Hospitals: Perpetrator Characteristics and Common Dyads

Worker-to-worker (Type III) violence is prevalent in health care settings and has potential adverse consequences for employees and organizations. Little research has examined perpetrator characteristics of this type of violence. The current study is a descriptive examination of the common demographic and work-related characteristics of perpetrators of Type III workplace violence among hospital workers. Analysis was based on documented incidents of Type III violence reported within a large hospital system from 2010 to 2012. Nurses were involved as either the perpetrator or target in the five most common perpetrator-target dyads. Incidence rate ratios revealed that patient care associates and nurses were significantly more likely to be perpetrators than other job titles. By examining characteristics of perpetrators and common worker dyads involved in Type III workplace violence, hospital stakeholders and unit supervisors have a starting point to develop strategies for reducing conflict between workers.

Catalysts of worker-to-worker violence and incivility in hospitals

AIMS AND OBJECTIVES

To identify common catalysts of worker-to-worker violence and incivility in hospital settings.

BACKGROUND

Worker-to-worker violence and incivility are prevalent forms of mistreatment in healthcare workplaces. These are forms of counterproductive work behaviour that can lead to negative outcomes for employees, patients and the organisation overall. Identifying the factors that lead to co-worker mistreatment is a critical first step in the development of interventions targeting these behaviours.

DESIGN

Retrospective descriptive study.

METHODS

Qualitative content analysis was conducted on the total sample (n = 141) of employee incident reports of worker-to-worker violence and incivility that were documented in 2011 at a large American hospital system.

RESULTS

More than 50% of the incidents involved nurses, and the majority of incidents did not involve physical violence. Two primary themes emerged from the analysis: Work Behaviour and Work Organisation. Incidents in the Work Behaviour category were often sparked by unprofessional behaviour, disagreement over responsibilities for work tasks or methods of patient care, and dissatisfaction with a co-worker's performance. Incidents in the Work Organisation category involved conflicts or aggression arising from failure to following protocol, patient assignments, limited resources and high workload.

CONCLUSION

Incidents of worker-to-worker violence and incivility stemmed from dissatisfaction with employee behaviour or from organisational practices or work constraints. These incident descriptions reflect worker dissatisfaction and frustration, resulting from poor communication and collaboration between employees, all of which threaten work productivity.

RELEVANCE TO CLINICAL PRACTICE

Violence and incivility between hospital employees can contribute to turnover of top performers, hinder effective teamwork and jeopardise the quality of patient care. Identification of common catalysts for worker-to-worker violence and incivility informs the development of mistreatment prevention programmes that can be used to educate hospital staff.