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Amberson T, Graves JM, Sears JM. Overview of Occupational Injuries Among Registered Nurses in Washington State, 2007 to 2019. Workplace Health Saf 2024; 72:187-195. [PMID: 38158830 DOI: 10.1177/21650799231214235] [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: 01/03/2024]
Abstract
BACKGROUND Registered nurses (RNs) represent the largest segment of the health care workforce and have unique job demands and occupational health considerations. The purpose of this study was to describe the incidence, cost, and causes of occupational injuries among RNs in Washington State and to quantify the cumulative cost and burden of each type of injury, relative to all injuries among RNs. METHODS Annual injury claims data covered under Washington State workers' compensation (WC) fund were analyzed over a 13-year period (2007-2019). Annual mean incidence and cost of injuries were calculated and stratified by nature, source, and event/exposure. Negative binomial regression models were used to examine trends in injury incidence over time, for injury incidence overall, and by the most common injury classifications. RESULTS Between 2007 and 2019, 10,839 WC claims were filed and accepted for Washington State RNs (annual M = 834), totaling more than US$65 million. No significant trend in overall injury incidence was observed (incidence rate ratio [IRR]: 0.99, 95% confidence interval [CI] = [0.94, 1.05]). The most common injury exposures were bodily reaction and exertion, contact with objects and equipment, falls, and assaults and violent acts. DISCUSSION To our knowledge, this is the first broad study of the incidence and costs of occupational injuries among RNs across all workplace settings. We identified high-cost, high-frequency incidence rates of musculoskeletal, sharp, and violence-related occupational injury claims, highlighting intervention targets. Implications for Occupational Health Practice: Policy makers, health systems, and occupational health nurse leaders can use this information to identify priority areas where evidence-based occupational health and prevention programs are most needed.
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Affiliation(s)
- Taryn Amberson
- Department of Health Systems and Population Health, University of Washington
| | - Janessa M Graves
- College of Nursing, Washington State University
- Harborview Injury Prevention & Research Center
| | - Jeanne M Sears
- Department of Health Systems and Population Health, University of Washington
- Harborview Injury Prevention & Research Center
- Department of Environmental & Occupational Health Sciences, University of Washington
- Institute for Work & Health
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Hu Y, Huang J, Zhao D, Zhang C, Xia J, Lu XM. Effect of safety and security equipment on patient and visitor violence towards nurses in multiple public hospitals of China during the COVID-19 pandemic: a retrospective, difference-in-difference analysis. BMJ Open 2024; 14:e078598. [PMID: 38296297 PMCID: PMC10831433 DOI: 10.1136/bmjopen-2023-078598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 01/17/2024] [Indexed: 02/03/2024] Open
Abstract
OBJECTIVES This study aimed to analyse whether safety and security equipment decreased patient and visitor violence (PVV) towards nurses in the COVID-19 period and quantify to what extent safety and security equipment affects PVV. DESIGN Controlled before and after study and difference-in-difference (DID) analysis. SETTING A large hospital medical group, consisting of three public tertiary teaching hospitals, namely, Xinjiekou Branch, Huilongguan Branch and Xinlongze Branch of Beijing Jishuitan Hospital, located in the west and north parts of Beijing, China. PARTICIPANTS A panel of nine departments recruited using two-step sampling method, administered online surveys in 2021 and 2022. A total of 632 eligible nurses participated in the survey in 2021 and 725 eligible nurses in 2022. MEASURES We assessed impacts of the safety and security equipment on the PVV. The policy had been enacted in June 2020, and the corresponding measures were established after mid-December 2020, and therefore, we use a DID design to evaluate changes in nurses' PVV incidence. Departments are classified as either department installed or non installed, and nurses are classified based on their department. RESULTS Within the treatment group, the incidence of physical PVV significantly decreased from 13.8% in 2020 to 2.0% in 2021. In the control group, the incidence of physical PVV increased from 0.6% in 2020 to 2.7% in 2021. The application of the safety and security equipment decreased the incidence of physical PVV by 13.93% (95% CI: -23.52% to -4.34%). In contrast, no difference was observed between the treatment and control groups for the incidence of psychological PVV (6.23%, 95% CI: -11.56% to 24.02%) and overall PVV (0.88, 95% CI: -20.90% to 22.66%). CONCLUSION The safety and security equipment reduced the incidence of physical PVV towards nurses. For hospital managers in public hospitals, longer-term strategies roadmap for PVV prevention measures are needed to create a more supportive work environment in employees.
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Affiliation(s)
- Yanzhen Hu
- Department of Nursing, Beijing Jishuitan Hospital, Capital Medical University, Beijing, Beijing, China
| | - Ju Huang
- Institute of Medical Information, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Dan Zhao
- Department of Nursing, Beijing Jishuitan Hospital, Capital Medical University, Beijing, Beijing, China
| | - Cheng Zhang
- Institute of Medical Information, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jinghua Xia
- Department of Nursing, Beijing Jishuitan Hospital, Capital Medical University, Beijing, Beijing, China
| | - Xue-Mei Lu
- Department of Nursing, Beijing Jishuitan Hospital, Capital Medical University, Beijing, Beijing, China
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Abregú-Tueros LF, Bravo-Esquivel CJ, Abregú-Arroyo SK, Dos Santos-Rosa R, Galve-Manzano JL. Consensus on relevant psychosocial interventions applied in health institutions to prevent psychological violence at work: Delphi method. BMC Res Notes 2024; 17:19. [PMID: 38183078 PMCID: PMC10768250 DOI: 10.1186/s13104-023-06680-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 12/20/2023] [Indexed: 01/07/2024] Open
Abstract
OBJECTIVE Studies on psychological violence in the workplace (PVW) in Latin America have focused on incidence values. In contrast, studies on preventive interventions (PIs) in the health sector are very limited. Our objective was to determine to what extent there is consensus on the most relevant characteristics of the psychosocial interventions applied in the prevention of PVW in health institutions in Peru. To that end, health professionals with knowledge and experience in PVW at the national level were recruited, and the Delphi consensus technique was applied. RESULTS The consensus study was developed in four stages that included three phases of Delphi consultation. In the third consultation phase, 428 experts participated in 25 analysis groups from 66 health institutions in the country. A total of 70.3% of the participants were women, and 27.6% of the participants worked in nursing and emergency services. After the Delphi consensus analysis, we obtained a list of 10 hierarchical psychosocial interventions to prevent PVW in the country. Most notable were interventions based on the prior resolution of interprofessional conflicts, on the visibility of incidents to generate an inverse effect and on experiential training to improve assertive and empathic communication skills.
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Ferrari G, Lwamushi SM, Balaluka GB, Lafta RK, Schindler C, Bugugu D, Lurhangire E, Tediosi F, Mendoza JR, Merten S. Understanding context of violence against healthcare through citizen science and evaluating the effectiveness of a co-designed code of conduct and of a tailored de-escalation of violence training in Eastern Democratic Republic of Congo and Iraq: a study protocol for a stepped wedge randomized controlled trial. Trials 2023; 24:814. [PMID: 38110997 PMCID: PMC10729574 DOI: 10.1186/s13063-023-07839-3] [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: 06/28/2023] [Accepted: 11/28/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Violence against health care workers (HCWs) is a multifaceted issue entwined with broader social, cultural, and economic contexts. While it is a global phenomenon, in crisis settings, HCWs are exposed to exceptionally high rates of violence. We hypothesize that the implementation of a training on de-escalation of violence and of a code of conduct informed through participatory citizen science research would reduce the incidence and severity of episodes of violence in primary healthcare settings of rural Democratic Republic of Congo (DRC) and large hospitals in Baghdad, Iraq. METHODS In an initial formative research phase, the study will use a transdisciplinary citizen science approach to inform the re-adaptation of a violence de-escalation training for HCWs and the content of a code of conduct for both HCWs and clients. Qualitative and citizen science methods will explore motivations, causes, and contributing factors that lead to violence against HCWs. Preliminary findings will inform participatory meetings aimed at co-developing local rules of conduct through in-depth discussion and input from various stakeholders, followed by a validation and legitimization process. The effectiveness of the two interventions will be evaluated through a stepped-wedge randomized-cluster trial (SW-RCT) design with 11 arms, measuring the frequency and severity of violence, as well as secondary outcomes such as post-traumatic stress disorder (PTSD), job burnout, empathy, or HCWs' quality of life at various points in time, alongside a cost-effectiveness study comparing the two strategies. DISCUSSION Violence against HCWs is a global issue, and it can be particularly severe in humanitarian contexts. However, there is limited evidence on effective and affordable approaches to address this problem. Understanding the context of community distrust and motivation for violence against HCWs will be critical for developing effective, tailored, and culturally appropriate responses, including a training on violence de-escalation and a community behavioral change approach to increase public trust in HCWs. This study aims therefore to compare the effectiveness and cost-effectiveness of different interventions to reduce violence against HCWs in two post-crisis settings, providing valuable evidence for future efforts to address this issue. TRIAL REGISTRATION ClinicalTrial.gov Identifier NCT05419687. Prospectively registered on June 15, 2022.
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Affiliation(s)
- Giovanfrancesco Ferrari
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123, Allschwil, Switzerland.
- Universität Basel, Petersplatz, 1, P.O. Box, CH-4001, Basel, Switzerland.
| | - Samuel Makali Lwamushi
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123, Allschwil, Switzerland
- Universität Basel, Petersplatz, 1, P.O. Box, CH-4001, Basel, Switzerland
- Ecole Régionale de Santé Publique, Université Catholique de Bukavu (ERSP-UCB), Bukavu, Democratic Republic of the Congo
| | - Ghislain Bisimwa Balaluka
- Ecole Régionale de Santé Publique, Université Catholique de Bukavu (ERSP-UCB), Bukavu, Democratic Republic of the Congo
| | - Riyadh K Lafta
- College of Medicine, Al Mustansiriyah University, Baghdad, Iraq
| | - Christian Schindler
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123, Allschwil, Switzerland
- Universität Basel, Petersplatz, 1, P.O. Box, CH-4001, Basel, Switzerland
| | - Daniella Bugugu
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123, Allschwil, Switzerland
| | - Emmanuel Lurhangire
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123, Allschwil, Switzerland
| | - Fabrizio Tediosi
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123, Allschwil, Switzerland
- Universität Basel, Petersplatz, 1, P.O. Box, CH-4001, Basel, Switzerland
| | | | - Sonja Merten
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123, Allschwil, Switzerland
- Universität Basel, Petersplatz, 1, P.O. Box, CH-4001, Basel, Switzerland
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Zhang Y, Cai J, Qin Z, Wang H, Hu X. Evaluating the impact of an information-based education and training platform on the incidence, severity, and coping resources status of workplace violence among nurses: a quasi-experimental study. BMC Nurs 2023; 22:446. [PMID: 38007470 PMCID: PMC10675880 DOI: 10.1186/s12912-023-01606-0] [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: 01/12/2023] [Accepted: 11/14/2023] [Indexed: 11/27/2023] Open
Abstract
BACKGROUND Workplace violence among nurses has emerged as a critical issue, posing a significant threat to their occupational safety. Education and training are the primary measures employed to prevent and respond to workplace violence. However, the current approaches have proven ineffective, possibly due to a lack of consideration for the specific needs of clinical nurses. Therefore, it is essential to explore the effectiveness of an informational education and training platform tailored to nurses' requirements. This study aimed to investigate the impact of such a platform on the incidence, severity, and coping resources of WPV in nurses. METHODS This research was a quasi-experimental study. An information-based education and training platform focused on nurse workplace violence was developed through literature reviews, expert meetings, consultations with software development companies, and a trial run. A tertiary general hospital in Suzhou was selected, in which hospital district A was the intervention group and hospital district B was the control group. A total of 276 nurses were recruited, 140 in the intervention group and 136 in the control group. The nurses' incidence, severity, coping resources status, and evaluation of the application were measured before the intervention and at 1, 3, and 6 months after the intervention. RESULTS The overall incidence of workplace violence, verbal aggression, and verbal threat among nurses showed statistically significant differences (P < 0.05) for the time effect, while the incidence of physical aggression demonstrated statistically significant differences (P < 0.05) for the between-group effect and the time effect. The severity of physical violence among nurses exhibited statistically significant differences (P < 0.05) for the between-group effect and time effect, and the severity of psychological violence showed statistically significant differences (P < 0.05) for the time effect. Nurses' total coping resources score and dimensions also showed statistically significant differences in terms of group, time, and interaction effects (P < 0.001). The evaluation questionnaire for the mobile application indicated usefulness scores of 2 (1, 2); ease of learning scores of 2 (1, 2); ease of use scores of 2 (1, 2); trust scores of 2 (1, 2.75); acceptance score of 1 (1, 2); and satisfaction scores of 2 (1, 2). CONCLUSIONS Implementing the nurse workplace violence information-based education and training platform proved beneficial in reducing the incidence and severity of workplace violence among nurses and enhancing their coping resources. This outcome suggested the platform's potential for further application and promotion in clinical settings.
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Affiliation(s)
- Ying Zhang
- The First Affiliated Hospital of Soochow University, Suzhou, China
- Department of Nursing, Soochow University, Suzhou, China
| | - Jianzheng Cai
- The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Ziyu Qin
- The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Haifang Wang
- The First Affiliated Hospital of Soochow University, Suzhou, China.
| | - Xiuying Hu
- Department of Nursing, West China Hospital of Sichuan University, Sichuan, China.
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Ose SO, Lohmann-Lafrenz S, Kaspersen SL, Berthelsen H, Marchand GH. Registered nurses' exposure to workplace aggression in Norway: 12-month prevalence rates, perpetrators, and current turnover intention. BMC Health Serv Res 2023; 23:1272. [PMID: 37974173 PMCID: PMC10655393 DOI: 10.1186/s12913-023-10306-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 11/09/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Identifying occupational health hazards among Registered Nurses (RNs) and other health personnel and implementing effective preventive measures are crucial to the long-term sustainability of health services. The objectives of this study were (1) to assess the 12-month prevalence rates of exposure to workplace aggression, including physical violence, threats of violence, sexual harassment, and bullying; (2) to identify whether the perpetrators were colleagues, managers, subordinates, or patients and their relatives; (3) to determine whether previous exposure to these hazards was associated with RNs' current turnover intention; and (4) to frame workplace aggression from an occupational health and safety perspective. METHODS The third version of the Copenhagen Psychosocial Questionnaire (COPSOQ III) was used to assess RNs' exposure to workplace aggression and turnover intention. A national sample of 8,800 RNs in Norway, representative of the entire population of registered nurses in terms of gender and geography, was analysed. Binary and ordinal logistic regression analyses were conducted, and odds for exposure and intention to leave are presented, with and without controls for RNs' gender, age, and the type of health service they work in. RESULTS The 12-month prevalence rates for exposure were 17.0% for physical violence, 32.5% for threats of violence, 12.6% for sexual harassment, and 10.5% for bullying. In total, 42.6% of the RNs had experienced at least one of these types of exposure during the past 12 months, and exposure to more than one of these hazards was common. Most perpetrators who committed physical acts and sexual harassment were patients, while bullying was usually committed by colleagues. There was a strong statistical association between exposure to all types of workplace aggression and RNs' intention to leave. The strongest association was for bullying, which greatly increased the odds of looking for work elsewhere. CONCLUSIONS Efforts to prevent exposure to workplace aggression should be emphasised to retain health personnel and to secure the supply of skilled healthcare workers. The results indicate a need for improvements. To ensure the sustainability of health services, labour and health authorities should join forces to develop effective workplace measures to strengthen prevention, mitigation, and preparedness regarding incidents of workplace aggression in health services and the response and recovery regarding incidents that could not be prevented.
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Affiliation(s)
| | | | | | - Hanne Berthelsen
- Centre for WorkLife and Evaluation Studies, Malmö University, Malmö, Sweden
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Seddik SA, Abdelhai R, Aboushady AT, Nawwar AE, El Essawy RA, Hegazy AA. Violence against healthcare workers during the COVID-19 pandemic: a cross-sectional survey at Cairo University Hospital. Front Public Health 2023; 11:1277056. [PMID: 38045967 PMCID: PMC10693415 DOI: 10.3389/fpubh.2023.1277056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 10/19/2023] [Indexed: 12/05/2023] Open
Abstract
Introduction Healthcare workers have a significant chance of experiencing violence, with physical violence impacting anywhere from 8 to 38% of healthcare professionals throughout their careers. Besides physical abuse, many healthcare workers are subject to verbal aggression or threats, with patients and visitors being the most frequent sources of such incidents. Methods This research examines the work atmosphere of healthcare professionals at Kasr Al-Aini University Hospital in Cairo, Egypt, during the pandemic. The study aims to evaluate the frequency of violence toward healthcare workers and health professionals training through a cross-sectional survey conducted among them. The research was conducted on Egyptian healthcare workers over 6 months, from November 2020 until the end of January 2021, using convenience sampling in a cross-sectional study. Over half of the respondents reported experiencing violence. Results Among those who experienced violence, 93% reported verbal aggression, 43% reported physical and verbal abuse, and 59% claimed that violence increased during the pandemic. Additionally, 97% of those who experienced violence reported it occurring within the 4 months following the survey. About 42.5% of the respondents were female, and nearly 65% were over 30. 82% of the respondents did not receive training on handling violence while performing their job. Conclusion This study highlights the high prevalence of verbal assaults in healthcare settings, primarily by patients' families or acquaintances. Despite reporting such incidents, most respondents did not see any significant government action. Furthermore, the COVID-19 pandemic did not significantly change the frequency of violent incidents, indicating that the root causes of violence are systemic and extend beyond the pandemic. These findings underscore the need for systemic changes in healthcare organizations to address and prevent violence against healthcare workers.
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Affiliation(s)
- Salma Abdelrehim Seddik
- Department of Public Health and Community Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Rehab Abdelhai
- Department of Public Health and Community Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | | | | | - Amira Aly Hegazy
- Department of Public Health and Community Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
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Cai J, Wu S, Wang H, Zhao X, Ying Y, Zhang Y, Tang Z. The effectiveness of a workplace violence prevention strategy based on situational prevention theory for nurses in managing violent situations: a quasi-experimental study. BMC Health Serv Res 2023; 23:1164. [PMID: 37885009 PMCID: PMC10605776 DOI: 10.1186/s12913-023-10188-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 10/20/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Workplace violence (WPV) poses a significant occupational hazard for nurses. The efficacy of current education and training programs in mitigating WPV incidence among nurses remains uncertain, possibly due to insufficient consideration of clinical contexts and nurses' specific needs. Therefore, this study developed a WPV prevention strategy based on the actual requirements of clinical nurses and situational prevention theory and aimed to explore its application effects. METHODS Under the guidance of situational prevention theory, a WPV prevention strategy for nurses was constructed through literature review, semi-structured interviews and focus group discussion. This study adopted a self-controlled research design, and trained 130 nurses selected from a comprehensive tertiary grade A hospital in Suzhou in this WPV prevention strategy. Data were collected through structured questionnaires, including the revised WPV questionnaire, WPV severity grading scale, and hospital WPV coping resources scale. The WPV incidence, severity, and WPV coping resource scores of nurses were collected before the intervention, as well as at 3 months, 6 months, and 9 months after training. RESULTS The WPV prevention strategy comprised 11 prevention plans based on 11 high-risk situational elements of WPV. Each prevention plan included the WPV prevention flowchart, treatment principle, and communication strategy. The strategy demonstrated excellent feasibility and practicality. Following the intervention, the overall incidence of WPV among nurses significantly decreased from 63.85% (baseline) to 46.15% (9 months after training) (P < 0.05). After the training, the severity of psychological violence (Wald χ² = 20.066, P < 0.001) and physical violence (Wald χ² = 9.100, P = 0.028) reported by nurses decreased compared to the baseline (P < 0.05). Moreover, the overall WPV coping resource score significantly increased from [66.50 (57.00, 77.25) points] (baseline) to [80.00 (68.00, 97.25) points] (9 months after training) (P < 0.05). CONCLUSIONS The described WPV prevention strategy, grounded in situational prevention theory and tailored to the needs of clinical nurses, effectively reduced WPV incidence, mitigated its severity, and enhanced nurses' WPV coping resources. This approach offered new avenues for nurses in the prevention of WPV.
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Affiliation(s)
- Jianzheng Cai
- Department of Nursing, the First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Sisi Wu
- Medical Branch, Shanghai Jiao Tong University Press, Shanghai, 200030, China
| | - Haifang Wang
- Department of Nursing, the First Affiliated Hospital of Soochow University, Suzhou, 215006, China.
| | - Xiaoqing Zhao
- Department of Nursing, the First Affiliated Hospital of USTC, Hefei, 230036, China.
| | - Yajie Ying
- Department of Nursing, the First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Yingying Zhang
- Department of Nursing, the First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Zhaofang Tang
- Department of Emergency, the First Affiliated Hospital of Soochow University, Suzhou, 215006, China
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Beringer V, Wirth T, Kazmierczak L, Reißmann S, Schnieder W, Kottkamp HW, Ullrich G, Nienhaus A, Harth V, Schablon A, Mache S. [Emergency care as a high-risk workplace-Measures to deal with violence against employees]. Med Klin Intensivmed Notfmed 2023; 118:540-548. [PMID: 36107195 PMCID: PMC9476433 DOI: 10.1007/s00063-022-00960-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 06/29/2022] [Accepted: 08/27/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Many employees in the field of emergency care experience verbal and physical violence caused by patients or visitors. The aim of this project is to gain insights into which measures are available to deal with violence in emergency care and how employees subjectively evaluate them. METHODS A nationwide cross-sectional online survey was conducted in 2020. The questionnaire contained items on violence prevention, intervention, and follow-up measures. Quantitative data were analysed descriptively and free text data according to Mayring's qualitative content analysis. RESULTS A total of 349 respondents, including 115 supervisors participated in the survey. The availability of security staff and standardised reporting of incidents were considered important measures for dealing with violence. Of the managers, 67% reported not having a security service, while 56% claimed that reported incidents of violence were not dealt with in a structured way. A high workload in emergency care can impede the implementation of measures. Overall, the demand for increased support by supervisors and the hospital management became clear. CONCLUSION It is evident that employees consider certain measures to be effective; however, these measures are often not consistently implemented. There is a need for structured reporting of violent incidents against employees to facilitate a realistic recording of the prevalence. In addition to increasing the (nursing) staff, restricting access for visitors can decrease the conflict potential.
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Affiliation(s)
- Vanessa Beringer
- Zentralinstitut für Arbeitsmedizin und Maritime Medizin (ZfAM), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Deutschland
- Fakultät für Erziehungswissenschaft, Universität Hamburg, Hamburg, Deutschland
| | - Tanja Wirth
- Zentralinstitut für Arbeitsmedizin und Maritime Medizin (ZfAM), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Deutschland.
| | - Lena Kazmierczak
- Zentralinstitut für Arbeitsmedizin und Maritime Medizin (ZfAM), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Deutschland
- Institut für Psychologie, Universität Jena, Jena, Deutschland
| | - Sonja Reißmann
- Zentralinstitut für Arbeitsmedizin und Maritime Medizin (ZfAM), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Deutschland
| | | | - Hans-Werner Kottkamp
- Zentrale Notaufnahme, Evangelisches Klinikum Bethel (EvKB), Bielefeld, Deutschland
| | - Greta Ullrich
- Zentrale Notaufnahme, Paracelsus-Klinik Henstedt-Ulzburg, Henstedt-Ulzburg, Deutschland
| | - Albert Nienhaus
- Competenzzentrum Epidemiologie und Versorgungsforschung bei Pflegeberufen (CVcare), Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Deutschland
- Abteilung Arbeitsmedizin, Gefahrstoffe und Gesundheitswissenschaften (AGG), Berufsgenossenschaft für Gesundheitsdienst und Wohlfahrtspflege (BGW), Hamburg, Deutschland
| | - Volker Harth
- Zentralinstitut für Arbeitsmedizin und Maritime Medizin (ZfAM), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Deutschland
| | - Anja Schablon
- Competenzzentrum Epidemiologie und Versorgungsforschung bei Pflegeberufen (CVcare), Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Deutschland
| | - Stefanie Mache
- Zentralinstitut für Arbeitsmedizin und Maritime Medizin (ZfAM), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Deutschland
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Maguire BJ, Al Amiry A, O’Neill BJ. Occupational Injuries and Illnesses among Paramedicine Clinicians: Analyses of US Department of Labor Data (2010 - 2020). Prehosp Disaster Med 2023; 38:581-588. [PMID: 37559197 PMCID: PMC10548021 DOI: 10.1017/s1049023x23006118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 05/06/2023] [Accepted: 05/14/2023] [Indexed: 08/11/2023]
Abstract
OBJECTIVE Paramedicine clinicians (PCs) in the United States (US) respond to 40 million calls for assistance every year. Their fatality rates are high and their rates of nonfatal injuries are higher than other emergency services personnel, and much higher than the average rate for all US workers. The objectives of this paper are to: describe current occupational injuries among PCs; determine changes in risks over time; and calculate differences in risks compared to other occupational groups. METHODS This retrospective open cohort study of nonfatal injuries among PCs used 2010 through 2020 data from the US Department of Labor (DOL), Bureau of Labor Statistics; some data were unavailable for some years. The rates and relative risks (RRs) of injuries were calculated and compared against those of registered nurses (RNs), fire fighters (FFs), and all US workers. RESULTS The annual average number of injuries was: 4,234 over-exertion and bodily reaction (eg, motion-related injuries); 3,935 sprains, strains, and tears; 2,000 back injuries; 580 transportation-related injuries; and over 400 violence-related injuries. In this cohort, women had an injury rate that was 50% higher than for men. In 2020, the overall rate of injuries among PCs was more than four-times higher, and the rate of back injuries more than seven-times higher than the national average for all US workers. The rate of violence-related injury was approximately six-times higher for PCs compared to all US workers, seven-times higher than the rate for FFs, and 60% higher than for RNs. The clinicians had a rate of transportation injuries that was 3.6-times higher than the national average for all workers and 2.3-times higher than for FFs. Their overall rate of cases varied between 290 per 10,000 workers in 2018 and 546 per 10,000 workers in 2022. CONCLUSIONS Paramedicine clinicians are a critical component of the health, disaster, emergency services, and public health infrastructures, but they have risks that are different than other professionals.This analysis provides greater insight into the injuries and risks for these clinicians. The findings reveal the critical need for support for Emergency Medical Services (EMS)-specific research to develop evidence-based risk-reduction interventions. These risk-reduction efforts will require an enhanced data system that accurately and reliably tracks and identifies injuries and illnesses among PCs.
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Affiliation(s)
- Brian J. Maguire
- Leidos Inc., Reston, VirginiaUSA
- Central Queensland University - School of Medical and Applied Sciences, Queensland, Australia
| | - Ala’a Al Amiry
- College of Pharmacy and Health Sciences, Ajman University, Ajman, United Arab Emirates
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11
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López-Ros P, López-López R, Pina D, Puente-López E. User violence prevention and intervention measures to minimize and prevent aggression towards health care workers: A systematic review. Heliyon 2023; 9:e19495. [PMID: 37809629 PMCID: PMC10558594 DOI: 10.1016/j.heliyon.2023.e19495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 08/22/2023] [Accepted: 08/24/2023] [Indexed: 10/10/2023] Open
Abstract
Workplace violence in the health care setting is a social problem of great interest both at the health care level and in research in recent decades. The most common type of violence is the one coming from the user towards the professional. Although the bibliography includes multiple preventive actions focused on working with professionals, there are hardly any studies that explore and collect actions aimed at the user. The aim of this study is to analyze the results of the literature to provide an overview of the current evidence. Specifically, it aims to describe the various user-directed strategies or interventions aimed at reducing workplace violence experienced by professionals within the healthcare sector. A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), methodology of publications published up to December 2022 in the main databases. Studies that met the previously established eligibility criteria were identified. A peer review of the risk of bias was performed and the data were extracted from a previously elaborated template. The search yielded 5231 articles of which 11 were finally included in the review. Of these, 3 had a quantitative design, 7 had a qualitative design and one had a combined design. Of these, 38 measures or actions aimed at the user were compiled, grouped into four blocks according to the attitudinal objective pursued: Improvement of communication and creation of links, involvement of the user in joint decisions with the staff, informing and training the user, and other independent proposals. This study makes it possible to explore actions aimed at users with the objective of reducing violence towards health professionals. It collects and makes available to the scientific community a set of measures aimed at making a change of attitude in the perpetrator themselves, with the involvement of the perpetrator in the health system. This set of collected measures provides researchers with a basis to be taken into account for the implementation of future prevention plans according to the new multicomponent prevention models and with the involvement of the perpetrator themselves.
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Affiliation(s)
- Paloma López-Ros
- Department of Behavioral Sciences and Health, University Miguel Hernández, Elche, Spain
| | - Reyes López-López
- Applied Psychology Service (SEPA), University of Murcia, Murcia, Spain
| | - David Pina
- Applied Psychology Service (SEPA), University of Murcia, Murcia, Spain
- Department of Socio-Sanitary Sciences, University of Murcia, Murcia, Spain
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12
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Willer F, Chua D, Ball L. Patient aggression towards receptionists in general practice: a systematic review. Fam Med Community Health 2023; 11:e002171. [PMID: 37414572 PMCID: PMC10335458 DOI: 10.1136/fmch-2023-002171] [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: 07/08/2023] Open
Abstract
OBJECTIVE General practice receptionists provide an essential function in the healthcare system but routinely encounter acts of incivility and aggression from patients, including hostility, abuse and violence. This study was conducted to summarise what is known about patient-initiated aggression towards general practice receptionists, including impacts on reception staff and existing mitigation strategies. DESIGN Systematic review with convergent integrated synthesis. ELIGIBILITY CRITERIA Studies published at any time in English that examine patient aggression experiences of reception staff in primary care settings. INFORMATION SOURCES Searches of five major databases were performed (CINAHL Complete, Scopus, PubMed, Healthcare Administration Database and Google Scholar) to August 2022. RESULTS Twenty studies of various designs were included, ranging from the late 1970s to 2022 and originating from five OECD countries. Twelve were assessed as high quality using a validated checklist. Reviewed articles represented 4107 participants; 21.5% were general practice receptionists. All studies reported that displays of aggression towards receptionists by patients were a frequent and routine occurrence in general practice, particularly verbal abuse such as shouting, cursing, accusations of malicious behaviour and use of racist, ablest and sexist insults. Although infrequent, physical violence was widely reported. Inefficient appointment scheduling systems, delayed access to doctors and prescription denial appeared common precipitators. Receptionists adapted their behaviour and demeanour to placate and please patients to avoid escalation of patient frustrations at the cost of their own well-being and clinic productivity. Training in patient aggression management increased receptionist confidence and appeared to decrease negative sequalae. Coordinated support for general practice reception staff who had experienced patient aggression was generally lacking, with a small proportion receiving professional counselling. CONCLUSIONS Patient aggression towards reception staff is a serious workplace safety concern for general practices and negatively affects healthcare sector function more broadly. Receptionists in general practice deserve evidence-based measures to improve their working conditions and well-being for their own benefit and that of the community. REGISTRATION Pre-registered in Open Science Framework (osf.io/42p85).
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Affiliation(s)
- Fiona Willer
- Centre for Community Health and Wellbeing, The University of Queensland, Saint Lucia, Queensland, Australia
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - David Chua
- Centre for Community Health and Wellbeing, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Lauren Ball
- Centre for Community Health and Wellbeing, The University of Queensland, Saint Lucia, Queensland, Australia
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13
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Doucette ML, Surber SJ, Bulzacchelli MT, Dal Santo BC, Crifasi CK. Nonfatal Violence Involving Days Away From Work Following California's 2017 Workplace Violence Prevention in Health Care Safety Standard. Am J Public Health 2022; 112:1668-1675. [PMID: 36223587 PMCID: PMC9558198 DOI: 10.2105/ajph.2022.307029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Abstract
Objectives. To examine the impact of the California Occupational Safety and Health Administration's (Cal/OSHA's) 2017 workplace violence (WPV) prevention in health care safety standard on nonfatal violent injuries among health care workers (HCWs). Methods. We accessed estimated counts of WPV from the survey of occupational injuries and illness from 2011 to 2019 specific to HCWs. We used the Current Population Survey estimates of HCWs to create rates per 10 000. We conducted a longitudinal panel analysis and a comparative interrupted time-series analysis to examine the change in incidence and in rates associated with California's new standard. Results. Adoption of the 2017 safety standard led to an additional 3.48 reported WPV injuries per 10 000 HCWs in California, or an additional 473 injuries. Sensitivity analyses suggest other injuries did not change in the same period. Conclusions. It appears that the Cal/OSHA standard increased reporting of WPV injuries among HCWs in the first year of its adoption compared with the United States. Mandating reporting of all WPV incidents in the health care setting may be a means to ensure a more complete understanding of this public health problem. (Am J Public Health. 2022;112(11):1668-1675. https://doi.org/10.2105/AJPH.2022.307029).
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Affiliation(s)
- Mitchell L Doucette
- Mitchell L. Doucette is with the Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Sarah J. Surber is with the Department of Public Health, Wayne State University, Detroit, MI. Maria T. Bulzacchelli is with the Undergraduate Public Health Studies Program, Johns Hopkins University, Baltimore, MD. Brooke C. Dal Santo is a master of science in public health student with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health. Cassandra K. Crifasi is with the Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health
| | - Sarah J Surber
- Mitchell L. Doucette is with the Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Sarah J. Surber is with the Department of Public Health, Wayne State University, Detroit, MI. Maria T. Bulzacchelli is with the Undergraduate Public Health Studies Program, Johns Hopkins University, Baltimore, MD. Brooke C. Dal Santo is a master of science in public health student with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health. Cassandra K. Crifasi is with the Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health
| | - Maria T Bulzacchelli
- Mitchell L. Doucette is with the Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Sarah J. Surber is with the Department of Public Health, Wayne State University, Detroit, MI. Maria T. Bulzacchelli is with the Undergraduate Public Health Studies Program, Johns Hopkins University, Baltimore, MD. Brooke C. Dal Santo is a master of science in public health student with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health. Cassandra K. Crifasi is with the Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health
| | - Brooke C Dal Santo
- Mitchell L. Doucette is with the Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Sarah J. Surber is with the Department of Public Health, Wayne State University, Detroit, MI. Maria T. Bulzacchelli is with the Undergraduate Public Health Studies Program, Johns Hopkins University, Baltimore, MD. Brooke C. Dal Santo is a master of science in public health student with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health. Cassandra K. Crifasi is with the Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health
| | - Cassandra K Crifasi
- Mitchell L. Doucette is with the Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Sarah J. Surber is with the Department of Public Health, Wayne State University, Detroit, MI. Maria T. Bulzacchelli is with the Undergraduate Public Health Studies Program, Johns Hopkins University, Baltimore, MD. Brooke C. Dal Santo is a master of science in public health student with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health. Cassandra K. Crifasi is with the Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health
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14
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Yi M, Cao Y, Zhou Y, Cao Y, Zheng X, Wang J, Chen W, Wei L, Zhang K. Association between hospital legal constructions and medical disputes: A multi-center analysis of 130 tertiary hospitals in Hunan Province, China. Front Public Health 2022; 10:993946. [PMID: 36159280 PMCID: PMC9490230 DOI: 10.3389/fpubh.2022.993946] [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] [Received: 07/14/2022] [Accepted: 08/12/2022] [Indexed: 01/26/2023] Open
Abstract
Background Medical disputes are common in hospitals and a major challenge for the operations of medical institutions. However, few studies have looked into the association between medical disputes and hospital legal constructions. The purpose of the study was to investigate the relationship between hospital legal constructions and medical disputes, and it also aimed to develop a nomogram to estimate the likelihood of medical disputes. Methods Between July and September 2021, 2,716 administrators from 130 hospitals were enrolled for analysis. The study collected seventeen variables for examination. To establish a nomogram, administrators were randomly split into a training group (n = 1,358) and a validation group (n = 1,358) with a 50:50 ratio. The nomogram was developed using data from participants in the training group, and it was validated in the validation group. The nomogram contained significant variables that were linked to medical disputes and were identified by multivariate analysis. The nomogram's predictive performance was assessed utilizing discriminative and calibrating ability. A web calculator was developed to be conducive to model utility. Results Medical disputes were observed in 41.53% (1,128/2,716) of participants. Five characteristics, including male gender, higher professional ranks, longer length of service, worse understanding of the hospital charters, and worse construction status of hospital rule of law, were significantly associated with more medical disputes based on the multivariate analysis. As a result, these variables were included in the nomogram development. The AUROC was 0.67 [95% confident interval (CI): 0.64-0.70] in the training group and 0.68 (95% CI: 0.66-0.71) in the validation group. The corresponding calibration slopes were 1.00 and 1.05, respectively, and intercepts were 0.00 and -0.06, respectively. Three risk groups were created among the participants: Those in the high-risk group experienced medical disputes 2.83 times more frequently than those in the low-risk group (P < 0.001). Conclusion Medical dispute is prevailing among hospital administrators, and it can be reduced by the effective constructions of hospital rule of law. This study proposes a novel nomogram to estimate the likelihood of medical disputes specifically among administrators in tertiary hospitals, and a web calculator can be available at https://ymgarden.shinyapps.io/Predictionofmedicaldisputes/.
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Affiliation(s)
- Min Yi
- Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yanlin Cao
- Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China,*Correspondence: Yanlin Cao
| | - Yujin Zhou
- Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuebin Cao
- Health Commission of Hunan Province, Changsha, China
| | - Xueqian Zheng
- Chinese Hospital Association Medical Legality Specialized Committee, Beijing, China
| | | | - Wei Chen
- Beijing Jishuitan Hospital, Beijing, China
| | | | - Ke Zhang
- Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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15
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Okubo CVC, Martins JT, Malaquias TDSM, Galdino MJQ, Haddad MDCFL, Cardelli AAM, Silveira RCDCP. Effectiveness of the interventions against workplace violence suffered by health and support professionals: A meta-analysis. Rev Lat Am Enfermagem 2022; 30:e3638. [PMID: 35976359 DOI: 10.1590/1518-8345.5923.3638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 04/27/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to assess the effectiveness of the interventions targeted at preventing and reducing the workplace violence suffered by health and support professionals. METHOD a systematic review with meta-analysis conducted in eight databases and in the gray literature. Risk of bias was assessed by means of the Cochrane tools and certainty of the evidence, through Grading of Recommendations Assessment, Development and Evaluation. The analysis was performed in a descriptive manner and through the meta-analysis, including a heterogeneity assessment. RESULTS a total of 11 randomized and quasi-randomized studies were eligible, of which six (54.5%) implemented individual skills, four used a multiple approach (36.4%) and one (9.1%) resorted to governmental actions. Four studies (36.4%) exerted a positive and significant effect on reducing violence. Risk of bias was classified as high or uncertain. The meta-analysis was performed with two studies that tested individual skill (intervention group) versus individual skill (comparator group), although there was no scientific evidence (95% CI: -0.41 - 0.25, p=0.64) for the violence prevention/reduction outcome. CONCLUSION this review did not obtain a high level of evidence in the prevention or reduction of workplace violence. The reduced number of randomized trials, the lack of studies with low risk of bias and the high consistency may have been factors that hindered recommending effective interventions.
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Affiliation(s)
| | | | | | | | - Maria do Carmo Fernandez Lourenço Haddad
- Universidade Estadual de Londrina, Departamento de Enfermagem, Londrina, PR, Brasil.,Bolsista do Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brasil
| | | | - Renata Cristina de Campos Pereira Silveira
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Centro Colaborador da OPAS/OMS para o Desenvolvimento da Pesquisa em Enfermagem, Ribeirão Preto, SP, Brasil
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16
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Tuominen J, Tölli S, Häggman-Laitila A. Violence by clients and patients against social and healthcare staff - An integrative review of staff's well-being at work, implementation of work and leaders' activities. J Clin Nurs 2022. [PMID: 35739639 DOI: 10.1111/jocn.16425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/09/2022] [Accepted: 06/01/2022] [Indexed: 02/03/2023]
Abstract
AIM The aim of this study was to compile, assess and synthesise empirical research on violence by social and healthcare clients or patients against staff and its connections to staff's well-being at work, implementation of work and activities of leaders related to it. BACKGROUND Workplace violence against social and healthcare staff is a global and daily problem. One in three employees encounters violence from patients or clients and the risk of this is 16 times higher compared to other professions. None of the recent reviews on this topic were focused on the well-being at work, implementation of work or leaders' role in the cases of violence of clients or patients against the staff. DESIGN An integrative review reported according to PRISMA Checklist. METHODS The search was conducted to CINAHL, PubMed, PsychINFO and Scopus databases resulting in 21 articles. The quality of the articles was evaluated, and the data were analysed narratively. RESULTS The workplace violence committed by clients and patients was negatively connected to staff's psychological, emotional and physical well-being at work and to their work performance and commitment. The leaders found this form of workplace violence challenging and ethically conflicted and felt that they were left alone without training and support. The employees expressed disappointment with their leaders' activities and suggested many measures to make environment safer to staff and patients. CONCLUSIONS In future, intervention studies are needed for prevention of workplace violence by patients and clients against staff and for supporting the well-being at work of staff in relation to violent incidents. RELEVANCE TO CLINICAL PRACTICE Workplaces should introduce uniform protocols for reporting, preventing and processing workplace violence committed by clients and patients. An open dialogue with leaders and co-workers of the cases is of high importance. Leaders and staff need training that ensure patient and work safety.
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Affiliation(s)
- Jutta Tuominen
- Lahti Mental Disabilities Psychiatry Unit, Eteva Municipal Association, Lahti, Finland
| | - Sirpa Tölli
- Department of Nursing Science, Faculty of Health Science, Oulu University of Applied Science, University of Eastern Finland, Kuopio, Finland
| | - Arja Häggman-Laitila
- Department of Nursing Science, Faculty of Health Science, University of Eastern Finland, Kuopio, Finland.,Department of Social Services and Health Care, City of Helsinki, Finland
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17
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Välimäki M, Lantta T, Lam YTJ, Cheung T, Cheng PYI, Ng T, Ip G, Bressington D. Perceptions of patient aggression in psychiatric hospitals: a qualitative study using focus groups with nurses, patients, and informal caregivers. BMC Psychiatry 2022; 22:344. [PMID: 35585520 PMCID: PMC9118596 DOI: 10.1186/s12888-022-03974-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 05/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Aggression in psychiatric hospitals has been of interest to researchers. Information on how different stakeholders perceive patient aggression remains equivocal. Even less is known about possible similarities or differences in stakeholders' perceptions of how aggressive behaviour is understood, managed and prevented in psychiatric hospitals. We aimed to explore multiple viewpoints on patient aggression, its possible causes and outcomes, and development ideas for prevention and management. METHODS A qualitative design was adopted. The data were collected using focus group interviews. A thematic approach was used for interpretation. The data were collected on 15 adult wards in two inpatient psychiatric settings in Hong Kong. Participants were nurses working on the psychiatric inpatient wards, patients admitted to the wards, and informal caregivers visiting inpatient wards (N = 94). RESULTS Commonalities between all groups were found on how patient aggression is perceived, and why it occurs. Patients and especially nurses described how patient aggression occurred with no clear reason or forewarning and how patients were physically controlled or restricted after aggressive events. Only nurses and patients expressed experiencing physical burden, while all groups considered psychological burden to be a consequence of aggression. All groups proposed that helpful attitudes among nurses, better communication, structural changes, and better self-management skills would prevent patient aggression. Risk assessment was proposed only by nurses and patients, while safety measures were proposed by nurses and informal caregivers only. The use of restrictive interventions to manage aggressive events was proposed by all groups. CONCLUSIONS Despite the complex diversity of perspectives in different stakeholder groups regarding patient aggression, the findings highlighted that it is possible to achieve some mutual understanding of aggression in psychiatric hospitals and identify areas to be developed. Staffs' attitudes and skills for engagement and communication with patients and informal caregivers should be improved. There is also still room to develop the therapeutic environment and culture toward meaningful activities during the treatment period.
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Affiliation(s)
- Maritta Välimäki
- Xiangya School of Nursing, Xiangya Center for Evidence-Based Practice & Healthcare Innovation, Central South University, 172 Tongzipo Road, Changsha, 410013, Hunan, China. .,Department of Nursing Science, ICT-city, University of Turku, 20014, Turku, Finland.
| | - Tella Lantta
- grid.1374.10000 0001 2097 1371Department of Nursing Science, ICT-city, University of Turku, 20014 Turku, Finland
| | - Yuen Ting Joyce Lam
- grid.16890.360000 0004 1764 6123School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong (SAR), China
| | - Teris Cheung
- grid.16890.360000 0004 1764 6123School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong (SAR), China
| | - Po Yee Ivy Cheng
- grid.417134.40000 0004 1771 4093Community Psychiatric Services, 12/F, Block A, Pamela Youde Nethersole Eastern Hospital, Hospital Authority, Hong Kong (SAR), China
| | - Tony Ng
- grid.417134.40000 0004 1771 4093Department of Psychiatry, Pamela Youde Nethersole Eastern Hospital, Hospital Authority, Hong Kong (SAR), China
| | - Glendy Ip
- grid.415585.80000 0004 0469 9664Central Nursing Division, Kwai Chung Hospital, Hospital Authority, Hong Kong (SAR), China
| | - Daniel Bressington
- grid.1043.60000 0001 2157 559XCollege of Nursing and Midwifery, Charles Darwin University, Ellengowan Drive, Casuarine, Darwin, NT 0909 Australia
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18
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Spelten E, van Vuuren J, O'Meara P, Thomas B, Grenier M, Ferron R, Helmer J, Agarwal G. Workplace violence against emergency health care workers: What Strategies do Workers use? BMC Emerg Med 2022; 22:78. [PMID: 35524175 PMCID: PMC9074314 DOI: 10.1186/s12873-022-00621-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 03/28/2022] [Indexed: 12/01/2022] Open
Abstract
Background Workplace violence by patients and bystanders against health care workers, is a major problem, for workers, organizations, patients, and society. It is estimated to affect up to 95% of health care workers. Emergency health care workers experience very high levels of workplace violence, with one study finding that paramedics had nearly triple the odds of experiencing physical and verbal violence. Many interventions have been developed, ranging from zero-tolerance approaches to engaging with the violent perpetrator. Unfortunately, as a recent Cochrane review showed, there is no evidence that any of these interventions work in reducing or minimizing violence. To design better interventions to prevent and minimize workplace violence, more information is needed on those strategies emergency health care workers currently use to prevent or minimize violence. The objective of the study was to identify and discuss strategies used by prehospital emergency health care workers, in response to violence and aggression from patients and bystanders. Mapping the strategies used and their perceived usefulness will inform the development of tailored interventions to reduce the risk of serious harm to health care workers. In this study the following research questions were addressed: (1) What strategies do prehospital emergency health care workers utilize against workplace violence from patients or bystanders? (2) What is their experience with these strategies? Methods Five focus groups with paramedics and dispatchers were held at different urban and rural locations in Canada. The focus group responses were transcribed verbatim and analyzed using thematic analysis. Results It became apparent that emergency healthcare workers use a variety of strategies when dealing with violent patients or bystanders. Most strategies, other than generic de-escalation techniques, reflect a reliance on the systems the workers work with and within. Conclusion The study results support the move away from focusing on the individual worker, who is the victim, to a systems-based approach to help reduce and minimize violence against health care workers. For this to be effective, system-based strategies need to be implemented and supported in healthcare organizations and legitimized through professional bodies, unions, public policies, and regulations.
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Affiliation(s)
- Evelien Spelten
- Violet Vines Marshman Research Centre, Rural Health School, La Trobe University, Melbourne, Australia.
| | - Julia van Vuuren
- Violet Vines Marshman Research Centre, Rural Health School, La Trobe University, Melbourne, Australia
| | - Peter O'Meara
- Department of Paramedicine, Monash University, Melbourne, Australia
| | - Brodie Thomas
- Violet Vines Marshman Research Centre, Rural Health School, La Trobe University, Melbourne, Australia
| | | | - Richard Ferron
- Niagara Emergency Medical Services, Niagara Region, Niagara, Canada
| | - Jennie Helmer
- School of Population and Public Health, University of British Columbia, Vancouver, Canada.,British Columbia Emergency Health Services, Vancouver, Canada
| | - Gina Agarwal
- Department of Family Medicine, McMaster University, Hamilton, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
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Thomas B, O'Meara P, Edvardsson K, McCann D, Spelten E. Perpetrator and situational characteristics associated with security alerts in regional Australian emergency departments. BMC Emerg Med 2022; 22:48. [PMID: 35331156 PMCID: PMC8943498 DOI: 10.1186/s12873-022-00608-6] [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] [Received: 07/23/2021] [Accepted: 03/15/2022] [Indexed: 11/24/2022] Open
Abstract
Background Workplace violence is a regular feature of emergency departments (ED) and reported to be increasing in frequency and severity. There is a paucity of data from regional EDs in Australia. The aim of this study was to identify the perpetrator and situational characteristics associated with security alerts in regional emergency departments. Methods This retrospective descriptive study was conducted in two regional Australian hospital EDs. All incident reports, hospital summary spreadsheets, and patient medical records associated with a security alert over a two-year period (2017 - 2019) were included. The situational and perpetrator characteristics associated with security alerts in the ED were recorded. Results One hundred fifty-one incidents were reported in the two-year period. Incidents most frequently occurred on late shifts and in an ED cubicle. Most incidents included multiple disciplines such as ED staff and paramedics, police and psychiatric services. One hundred twenty-five incidents had sufficient information to categorise the perpetrators. Mental and behavioural disorders (MBD) were the most frequent perpetrator characteristic present in security alerts (n = 102, 81.6%) and were associated with increased severity of incidents. MBDs other than psychoactive substance use (PSU) were associated with 59.2% (n = 74) of incidents and 66.7% (n = 18) of injuries. PSU was associated with 42.4% (n = 53) of incidents. Following PSU and MBDs other than PSU, repeat perpetrators were the next most prominent perpetrator category (24.8% n = 31) and were almost always associated with an MBD (93.5% n = 29). Conclusions Violence incidents in the ED are often complex, patients present with multiple issues and are managed across disciplines. Interventions need to extend from one size fits all approaches to targeting specific perpetrator groups. Since MBDs are one of the most significant perpetrator factors, interventions focussing on this characteristic are needed to address workplace violence in EDs.
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Affiliation(s)
- Brodie Thomas
- La Trobe Rural Health School, La Trobe University, Mildura, Australia.
| | - Peter O'Meara
- Department of Paramedicine, Monash University, Frankston, Australia
| | - Kristina Edvardsson
- School of Nursing and Midwifery, La Trobe University, Bundoora, Australia.,Judith Lumley Centre, La Trobe University, Melbourne, Australia
| | - Damhnat McCann
- School of Nursing, University of Tasmania, Launceston, Australia
| | - Evelien Spelten
- La Trobe Rural Health School, La Trobe University, Mildura, Australia
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20
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Schaller A, Gernert M, Klas T, Lange M. Workplace health promotion interventions for nurses in Germany: a systematic review based on the RE-AIM framework. BMC Nurs 2022; 21:65. [PMID: 35313866 PMCID: PMC8935842 DOI: 10.1186/s12912-022-00842-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 03/09/2022] [Indexed: 12/03/2022] Open
Abstract
Background The German health care system is faced with a serious shortage of nurses. This is associated, amongst other things, with difficult working conditions and work-related health burdens. Workplace health promotion (WHP) is considered a promising approach to promote the health of nurses. The present review aims to give an overview on existing interventions in different nursing settings (acute care hospitals, long-term care (LTC) facilities and home-based long-term care) in Germany. Methods A systematic literature search was conducted in PubMed and PubPsych. Studies were included if published after 2010 and provided data of intervention studies on workplace health promotion among nurses in Germany (RCTs, non-RCTs, non-controlled intervention studies and pilot studies). The setting in which the study was conducted (acute medical care hospital, inpatient LTC facilities, home-based LTC, cross-setting) as well as the health issue assessed (physical health, mental health and/or violence experience) were extracted. The intervention was reported against the background of the quality criteria for prevention measures of the statutory health insurers in Germany. The results of the studies were presented according to the RE-AIM framework. Results Eleven studies on WHP for nurses were included, whereof seven studies were conducted in acute medical care hospitals and four in LTC facilities. No study reported results on WHP for nurses working in the setting of home-based LTC. Most studies aimed at improving mental health. The intervention contents and forms of implementation were heterogeneous. According to the RE-AIM criteria, the reporting of most studies showed several limitations, especially a lack of reporting on Implementation and Adoption. Most studies showed no statistically significant effect on the respective outcomes (Effectiveness). Four studies reported results on Maintenance indicating a sustained effectiveness. Conclusion Despite the high relevance for health promotion for nurses, our review showed a striking lack of intervention studies in this field. From this we derive a high need of tailored interventions, taking into account the setting-specific development, implementation of WHP interventions for nurses. With regard to the evaluation, the RE-AIM criteria should be taken more into account in order to meet the requirements of evaluating complex interventions and thus contribute to evidence development of WHP in nursing. In terms of content, the topic of violence prevention and dealing with experiences of violence should also be taken into account. Regarding the settings, the working conditions and health burdens in LTC facilities, home-based LTC and acute medical hospitals must be considered. Trial registration PROSPERO registration number: CRD42021231891
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Affiliation(s)
- Andrea Schaller
- Working Group Physical Activity-Related Prevention Research, Institute of Movement Therapy and Movement-Oriented Prevention and Rehabilitation, German Sport University Cologne, Cologne, Germany.
| | - Madeleine Gernert
- Working Group Physical Activity-Related Prevention Research, Institute of Movement Therapy and Movement-Oriented Prevention and Rehabilitation, German Sport University Cologne, Cologne, Germany
| | - Teresa Klas
- Working Group Physical Activity-Related Prevention Research, Institute of Movement Therapy and Movement-Oriented Prevention and Rehabilitation, German Sport University Cologne, Cologne, Germany
| | - Martin Lange
- Department of Fitness and Health, IST University of Applied Sciences, Erkrather Straße 220 a-c, 40233, Düsseldorf, Germany
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21
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Caruso R, Toffanin T, Folesani F, Biancosino B, Romagnolo F, Riba MB, McFarland D, Palagini L, Belvederi Murri M, Zerbinati L, Grassi L. Violence Against Physicians in the Workplace: Trends, Causes, Consequences, and Strategies for Intervention. Curr Psychiatry Rep 2022; 24:911-924. [PMID: 36445636 PMCID: PMC9707179 DOI: 10.1007/s11920-022-01398-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/07/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Violence against healthcare professionals has become an emergency in many countries. Literature in this area has mainly focused on nurses while there are less studies on physicians, whose alterations in mental health and burnout have been linked to higher rates of medical errors and poorer quality of care. We summarized peer-reviewed literature and examined the epidemiology, main causes, consequences, and areas of intervention associated with workplace violence perpetrated against physicians. RECENT FINDINGS We performed a review utilizing several databases, by including the most relevant studies in full journal articles investigating the problem. Workplace violence against doctors is a widespread phenomenon, present all over the world and related to a number of variables, including individual, socio-cultural, and contextual variables. During the COVID-19 pandemic, incidence of violence has increased. Data also show the possible consequences in physicians' deterioration of quality of life, burnout, and traumatic stress which are linked to physical and mental health problems, which, in a domino effect, fall on patients' quality of care. Violence against doctors is an urgent global problem with consequences on an individual and societal level. This review highlights the need to undertake initiatives aimed at enhancing understanding, prevention, and management of workplace violence in healthcare settings.
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Affiliation(s)
- Rosangela Caruso
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Via Fossato di Mortara 64a, 44121 Ferrara, Italy ,Integrated Department of Mental Health and Pathological Addictions, S. Anna University Hospital and Local Health Trust, Ferrara, Italy
| | - Tommaso Toffanin
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Via Fossato di Mortara 64a, 44121 Ferrara, Italy
| | - Federica Folesani
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Via Fossato di Mortara 64a, 44121, Ferrara, Italy.
| | - Bruno Biancosino
- Integrated Department of Mental Health and Pathological Addictions, S. Anna University Hospital and Local Health Trust, Ferrara, Italy
| | - Francesca Romagnolo
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Via Fossato di Mortara 64a, 44121 Ferrara, Italy
| | - Michelle B. Riba
- Department of Psychiatry, University of Michigan, Ann Arbor, MI USA
| | - Daniel McFarland
- Department of Medicine, Northwell Health Cancer Institute, Lenox Hill Hospital, New York, NY USA
| | - Laura Palagini
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Via Fossato di Mortara 64a, 44121 Ferrara, Italy ,Integrated Department of Mental Health and Pathological Addictions, S. Anna University Hospital and Local Health Trust, Ferrara, Italy
| | - Martino Belvederi Murri
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Via Fossato di Mortara 64a, 44121 Ferrara, Italy ,Integrated Department of Mental Health and Pathological Addictions, S. Anna University Hospital and Local Health Trust, Ferrara, Italy
| | - Luigi Zerbinati
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Via Fossato di Mortara 64a, 44121 Ferrara, Italy ,Integrated Department of Mental Health and Pathological Addictions, S. Anna University Hospital and Local Health Trust, Ferrara, Italy
| | - Luigi Grassi
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Via Fossato di Mortara 64a, 44121 Ferrara, Italy ,Integrated Department of Mental Health and Pathological Addictions, S. Anna University Hospital and Local Health Trust, Ferrara, Italy
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22
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Dafny HA, Beccaria G, Muller A. Australian nurses' perceptions about workplace violence management, strategies and support services. J Nurs Manag 2021; 30:1629-1638. [PMID: 34806236 DOI: 10.1111/jonm.13522] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 11/11/2021] [Accepted: 11/16/2021] [Indexed: 11/29/2022]
Abstract
AIMS This study ascertained nurses' perceptions about workplace violence management, strategies and support services. BACKGROUND Nurses regularly encounter verbal and physical violence in their workplace. Workplace violence has long-term consequences on nurses' personal lives and professional work ability. However, more needs to be known about nurses' perceptions of violence management and interventions used. METHODS Ninety-eight nurses from a regional public hospital in Queensland, Australia, completed a survey about workplace violence. Nurses worked in the Emergency Department, Intensive Care Unit or Mental Health Department. RESULTS Ninety-five per cent of nurses stated that all violence should be reported, but 18% would take no action, and 22% would not complete an incident from. Perceptions and preferred responses differed for verbal and physical violence. Low-level interventions and aggression management training were preferred by nurses. Nearly all nurses felt that they should be involved in the development of workplace violence policies. CONCLUSIONS Nurses rate aggression management training highly, and they desire more input into violence policies. The under-reporting of violent incidents remains an issue for future management. IMPLICATIONS FOR NURSING MANAGEMENT Understanding nurses' perceptions of workplace violence management enables the identification of gaps when applying policy and adopting practical approaches to reduce the incidence and severity of workplace violence.
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Affiliation(s)
- Hila A Dafny
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
| | - Gavin Beccaria
- School of Psychology and Counselling, Faculty of Health Engineering and Sciences, University of Southern Queensland, Toowoomba, Australia
| | - Amanda Muller
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
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23
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Cai J, Qin Z, Wang H, Zhao X, Yu W, Wu S, Zhang Y, Wang Y. Trajectories of the current situation and characteristics of workplace violence among nurses: a nine-year follow-up study. BMC Health Serv Res 2021; 21:1220. [PMID: 34763686 PMCID: PMC8582131 DOI: 10.1186/s12913-021-07245-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/29/2021] [Indexed: 11/21/2022] Open
Abstract
Background Workplace violence (WPV) among nurses has become an increasingly serious public health issue worldwide. Investigating the status quo and characteristics of WPV among nurses in different time periods can help hospital managers understand the current status of WPV and its trends over time. This study aimed to understand the current situation of WPV among nurses in Suzhou general hospitals from 2010 to 2019 and analyze changes over time. Methods A cross-sectional study was conducted to investigate 942, 2,110 and 2,566 nurses in 6 fixed polyclinic hospitals in Suzhou in 2010, 2015 and 2019, respectively. This study used the revised version of the hospital WPV questionnaire. The count data are described as frequencies and percentages, and the measurement data are represented as means and standard deviations. The general data of nurses during different time periods, the incidence of WPV, nurses’ cognition and attitudes toward WPV and the attitudes and measures of hospitals regarding WPV were analyzed by the chi-square test. Results The incidence of WPV among nurses in Suzhou general hospitals in 2015 (69.0 %) and in 2019 (68.4 %) was higher than the incidence of 62.4 % in 2010 (P<0.05), and there were significant differences among periods in the specific types of violence (P˂0.05). Nurses who participated in the surveys in 2015 and 2019 scored higher on “having heard of WPV before”, “thinking WPV coping management organizations are needed” and “supporting a zero-tolerance policy” than those who participated in 2010 (P<0.05). The attitudes and responses of hospitals with regard to WPV among nurses have greatly improved, as evidenced by the results for the items “offering training”, “encouraging reporting of WPV to supervisors”, “equipped with a WPV managing department”, “handling WPV efficiently” and “hospital’s attitudes” (P<0.005). Conclusions Despite an increase in nurses’ awareness and attitudes regarding WPV and significant improvements in hospitals’ attitudes and responses to WPV, the incidence of WPV remains high. Hospitals should continue to explore scientific training modes that are in accordance with the needs of nurses to reduce the incidence of WPV.
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Affiliation(s)
- Jianzheng Cai
- Department of Nursing, the First Affiliated Hospital of Soochow University, 899 Pinghai Road, Gusu District, 215006, Suzhou, Jiangsu, China
| | - Ziyu Qin
- Department of Nursing, the First Affiliated Hospital of Soochow University, 899 Pinghai Road, Gusu District, 215006, Suzhou, Jiangsu, China
| | - Haifang Wang
- Department of Nursing, the First Affiliated Hospital of Soochow University, 899 Pinghai Road, Gusu District, 215006, Suzhou, Jiangsu, China.
| | - Xiaoqing Zhao
- Department of Nursing, the First Affiliated Hospital of Soochow University, 899 Pinghai Road, Gusu District, 215006, Suzhou, Jiangsu, China
| | - Weixia Yu
- Department of Nursing, the First Affiliated Hospital of Soochow University, 899 Pinghai Road, Gusu District, 215006, Suzhou, Jiangsu, China
| | - Sisi Wu
- Department of Nursing, the First Affiliated Hospital of Soochow University, 899 Pinghai Road, Gusu District, 215006, Suzhou, Jiangsu, China
| | - Ying Zhang
- Department of Nursing, the First Affiliated Hospital of Soochow University, 899 Pinghai Road, Gusu District, 215006, Suzhou, Jiangsu, China
| | - Yalan Wang
- Department of Nursing, the First Affiliated Hospital of Soochow University, 899 Pinghai Road, Gusu District, 215006, Suzhou, Jiangsu, China
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24
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Somani R, Muntaner C, Hillan E, Velonis AJ, Smith P. A Systematic Review: Effectiveness of Interventions to De-escalate Workplace Violence against Nurses in Healthcare Settings. Saf Health Work 2021; 12:289-295. [PMID: 34527388 PMCID: PMC8430427 DOI: 10.1016/j.shaw.2021.04.004] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 04/21/2021] [Accepted: 04/25/2021] [Indexed: 01/08/2023] Open
Abstract
Workplace violence (WPV) is an increasing cause of concern around the globe, and healthcare organizations are no exception. Nurses may be subject to all kinds of workplace violence due to their frontline position in healthcare settings. The purpose of this systematic review is to identify and consider different interventions that aim to decrease the magnitude/prevalence of workplace violence against nurses. The standard method by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA, 2009) has been used to collect data and assess methodological quality. Altogether, twenty-six studies are included in the review. The intervention procedures they report on can be grouped into three categories: stand-alone trainings designed to educate nurses; more structured education programs, which are broader in scope and often include opportunities to practice skills learned during the program; multicomponent interventions, which often include organizational changes, such as the introduction of workplace violence reporting systems, in addition to workplace violence training for nurses. By comparing the findings, a clear picture emerges; while standalone training and structured education programs can have a positive impact, the impact is unfortunately limited. In order to effectively combat workplace violence against nurses, healthcare organizations must implement multicomponent interventions, ideally involving all stakeholders.
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Affiliation(s)
- Rozina Somani
- Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Carles Muntaner
- Faculty of Nursing and Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Edith Hillan
- Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Alisa J Velonis
- School of Public Health, Division of Community Health Sciences, University of Illinois Chicago, USA
| | - Peter Smith
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Institute for Work & Health, Toronto, Canada
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25
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Ramacciati N, Guazzini A, Caldelli R, Rasero L. User-friendly system (a smartphone app) for reporting violent incidents in the Emergency Department: an Italian multicenter study. LA MEDICINA DEL LAVORO 2021; 112:68-81. [PMID: 33635296 PMCID: PMC8023056 DOI: 10.23749/mdl.v112i1.9984] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 09/29/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Nurses, particularly emergency nurses, are among the health workers most exposed to workplace violence. Although reporting systems are increasingly used, under-reporting remains high. Recent studies suggest that the use of easy registration systems could facilitate violence reporting. OBJECTIVES To verify if a friendly reporting system based on a Mobile-app can facilitate the reporting of violent episodes and reduce under-reporting. METHODS Twenty emergency departments of five North and Central Italian regions participated in an interventional, multicentric, pre-post study to verify if a user-friendly reporting system based on a mobile app can facilitate the reporting of violent episodes and reduce under-reporting. RESULTS Three hundred and eighty-four out of 754 potentially eligible nurses answered the short questionnaire at time T0, and 318 registered for the use of the app. One hundred and eighty-nine answered the questionnaire at time T1. The t-Test for Paired Samples, although with a low mean difference, shows a significant difference in the change in the frequency of the reporting of violent episodes. The correlational tests showed no significant differences in the subgroups divided by demographic and professional characteristics. The usability of the app was considered very high. CONCLUSIONS The simplification of the reporting system and the preliminary acquisition of data on the characteristics of the ED and each nurse, can save time and facilitate the reporting, but technology alone is not enough to solve the under-reporting.
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Affiliation(s)
- Nicola Ramacciati
- Experimental Medicine Department, University of Perugia, Perugia, Italy; Training and Quality Department, Azienda Ospedaliera di Perugia, Perugia, Italy.
| | - Andrea Guazzini
- Education, Languages, Intercultures, Literatures and Psychology Department, University of Florence, Florence, Italy.
| | - Roberto Caldelli
- National Interuniversity Consortium for Telecommunications (CNIT), Parma, Italy.
| | - Laura Rasero
- Health Sciences Department, University of Florence, Florence, Italy.
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26
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Thomas B, McGillion A, Edvardsson K, O'Meara P, Van Vuuren J, Spelten E. Barriers, enablers, and opportunities for organisational follow-up of workplace violence from the perspective of emergency department nurses: a qualitative study. BMC Emerg Med 2021; 21:19. [PMID: 33579206 PMCID: PMC7880205 DOI: 10.1186/s12873-021-00413-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 01/31/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND A lack of follow-up of violence incidents and assaulted staff has been associated with high levels of workplace violence. There is a paucity of literature on the barriers, enablers and opportunities for organisational follow-up of workplace violence. The aim of this study was to explore the barriers, enablers and opportunities for organisational follow-up of workplace violence from the perspective of Emergency Department nurses. METHODS This qualitative study comprised two focus groups with Emergency Department nurses. Data were analysed thematically. COREQ guidelines were followed for the design and reporting of the study. RESULTS The barriers to follow-up in this study relate to the type of perpetrator, the initial incident response, the incident reporting process and organisational action. The enablers included hospital initiatives to manage violence and support staff wellbeing. The opportunities included strategies to improve follow-up and ideas for new follow-up strategies. CONCLUSIONS Organisational follow-up is important for the emotional and professional wellbeing of staff who experience workplace violence. Opportunities for follow-up include exploring different approaches to patients with mental health issues and focussing on reoffenders by providing appropriate support and consequences. Managers should advocate for efficient and standardised reporting processes and ensure assaulted staff have a clear perception of follow-up and are included in the follow-up process. Including the perpetrators in the follow-up process may reduce workplace violence.
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Affiliation(s)
- Brodie Thomas
- La Trobe Rural Health School, La Trobe University, 471 Benetook Ave, Mildura, VIC, 3500, Australia.
| | - Anthony McGillion
- School of Nursing and Midwifery, La Trobe University, Plenty Rd & Kingsbury Dr, Bundoora, VIC, 3086, Australia
| | - Kristina Edvardsson
- School of Nursing and Midwifery, La Trobe University, Plenty Rd & Kingsbury Dr, Bundoora, VIC, 3086, Australia
- Judith Lumley Centre, La Trobe University, Melbourne, Australia
| | - Peter O'Meara
- Department of Emergency Health and Paramedic Practice, Monash University, McMahons Road, Frankston, VIC, 3199, Australia
| | - Julia Van Vuuren
- La Trobe Rural Health School, La Trobe University, 471 Benetook Ave, Mildura, VIC, 3500, Australia
| | - Evelien Spelten
- La Trobe Rural Health School, La Trobe University, 471 Benetook Ave, Mildura, VIC, 3500, Australia
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27
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Charrier P, Occelli P, Buchet-Poyau K, Douplat M, Delaroche-Gaudin M, Fayard-Gonon F, Jacquin L, Potinet V, Sigal A, Tazarourte K, Touzet S. Strategies used by emergency care professionals to handle interpersonal difficulties with patients: a qualitative study. BMJ Open 2021; 11:e042362. [PMID: 33558353 PMCID: PMC7871700 DOI: 10.1136/bmjopen-2020-042362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Identify the strategies implemented by emergency care professionals when facing tension and interpersonal violence from patients and their friends and family. DESIGN Descriptive qualitative study based on 38 semidirective interviews. PARTICIPANTS Doctors, nurses, nursing assistants and administrative staff. SETTING Four emergency departments (EDs) from three French university hospitals. RESULTS According to the medical professionals interviewed, the difficulties that they encounter with patients or their accompanying family members can be explained by a lack of understanding of the functioning of EDs, by a general increase in individualistic behaviours leading to a lack of civility or by deviant behaviours (related to toxic substance abuse or mental illness). While managing deviant behaviours may sometimes require a collective intervention, ED staff also implement what are essentially individual communication strategies (with the use of rational explanation, seduction and empathy), confrontation or flight to deal with interpersonal difficulties. CONCLUSIONS Strategies used by staff members tend to be individualised for the most part, and some, such as confrontational or escape strategies, may not be adapted to all situations. In the face of difficulties between staff and patients, mediators, specialised in resolving conflict, could entrust some cases to professionals. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT03139110).
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Affiliation(s)
- Philippe Charrier
- Centre Max Weber (UMR 5283), University Lumière Lyon 2, F-69007 Lyon, France
- Public Health Department, Hospices Civils de Lyon, F-69003 Lyon, France
| | - Pauline Occelli
- Public Health Department, Hospices Civils de Lyon, F-69003 Lyon, France
- Health Services and Performance Research Lab (HESPER EA 7425), University Claude Bernard Lyon 1, F-69008 Lyon, France
| | | | - Marion Douplat
- Health Services and Performance Research Lab (HESPER EA 7425), University Claude Bernard Lyon 1, F-69008 Lyon, France
- Emergency Department, Centre Hospitalier Lyon Sud, F-69310 Pierre-Bénite, France
| | | | | | - Laurent Jacquin
- Emergency Department, Edouard Herriot Hospital, F-69008 Lyon, France
| | - Véronique Potinet
- Emergency Department, Centre Hospitalier Lyon Sud, F-69310 Pierre-Bénite, France
| | - Alain Sigal
- Emergency Departement, Croix-Rousse Hospital, F-69004 Lyon, France
| | - Karim Tazarourte
- Health Services and Performance Research Lab (HESPER EA 7425), University Claude Bernard Lyon 1, F-69008 Lyon, France
- Emergency Department, Edouard Herriot Hospital, F-69008 Lyon, France
| | - Sandrine Touzet
- Public Health Department, Hospices Civils de Lyon, F-69003 Lyon, France
- Health Services and Performance Research Lab (HESPER EA 7425), University Claude Bernard Lyon 1, F-69008 Lyon, France
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Abstract
OBJECTIVES To explore the type of education needed for nurses when dealing with aggression from patients and their families. DESIGN A two-phase sequential mixed-methods study. SETTING This study was conducted in Japan, with phase I from March to November 2016 and phase II in November 2018. MAIN OUTCOME MEASURES The challenges faced by nurses when dealing with incidents of aggression from the neutral perspective of neither nurse nor patient/family and perceptions of the educational contents developed in this study. Descriptive analyses were used to examine the data retrieved from both phases. PARTICIPANTS Phase I entailed semistructured interviews among 11 neutral-party participants who observed aggressive incidents between nurses and patients/families. Phase II consisted of a web survey conducted among 102 nursing students and 308 nursing professionals. RESULTS Phase I resulted in the identification of the following five main educational components: understanding the mechanisms of anger and aggression, maintaining self-awareness, observant listening, managing the self-impression, and communicating based on specific disease characteristics. Each component was related to improved communication through self-awareness. The results of phase II indicated that participants positively perceived these educational contents as likely to be effective for dealing with aggression from patients/families. CONCLUSIONS This study clarified the type of education needed for nurses when dealing with aggression based on multiple viewpoints. Specifically, neutral-party interviews revealed that communication should be improved through self-awareness. A subsequent survey among nurses and nursing students showed that the identified educational contents were positively received.
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Affiliation(s)
- Kana Sato
- Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Yoshimi Kodama
- School of Nursing and Rehabilitation Sciences, Showa University, Yokohama, Kanagawa, Japan
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29
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Geoffrion S, Hills DJ, Ross HM, Pich J, Hill AT, Dalsbø TK, Riahi S, Martínez-Jarreta B, Guay S. Education and training for preventing and minimizing workplace aggression directed toward healthcare workers. Cochrane Database Syst Rev 2020; 9:CD011860. [PMID: 32898304 PMCID: PMC8094156 DOI: 10.1002/14651858.cd011860.pub2] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Workplace aggression constitutes a serious issue for healthcare workers and organizations. Aggression is tied to physical and mental health issues at an individual level, as well as to absenteeism, decreased productivity or quality of work, and high employee turnover rates at an organizational level. To counteract these negative impacts, organizations have used a variety of interventions, including education and training, to provide workers with the knowledge and skills needed to prevent aggression. OBJECTIVES: To assess the effectiveness of education and training interventions that aim to prevent and minimize workplace aggression directed toward healthcare workers by patients and patient advocates. SEARCH METHODS CENTRAL, MEDLINE, Embase, six other databases and five trial registers were searched from their inception to June 2020 together with reference checking, citation searching and contact with study authors to identify additional studies. SELECTION CRITERIA Randomized controlled trials (RCTs), cluster-randomized controlled trials (CRCTs), and controlled before and after studies (CBAs) that investigated the effectiveness of education and training interventions targeting aggression prevention for healthcare workers. DATA COLLECTION AND ANALYSIS Four review authors evaluated and selected the studies resulting from the search. We used standard methodological procedures expected by Cochrane. We assessed the certainty of evidence using the GRADE approach. MAIN RESULTS We included nine studies-four CRCTs, three RCTs, and two CBAs-with a total of 1688 participants. Five studies reported episodes of aggression, and six studies reported secondary outcomes. Seven studies were conducted among nurses or nurse aides, and two studies among healthcare workers in general. Three studies took place in long-term care, two in the psychiatric ward, and four in hospitals or health centers. Studies were reported from the United States, Switzerland, the United Kingdom, Taiwan, and Sweden. All included studies reported on education combined with training interventions. Four studies evaluated online programs, and five evaluated face-to-face programs. Five studies were of long duration (up to 52 weeks), and four studies were of short duration. Eight studies had short-term follow-up (< 3 months), and one study long-term follow-up (> 1 year). Seven studies were rated as being at "high" risk of bias in multiple domains, and all had "unclear" risk of bias in a single domain or in multiple domains. Effects on aggression Short-term follow-up The evidence is very uncertain about effects of education and training on aggression at short-term follow-up compared to no intervention (standardized mean difference [SMD] -0.33, 95% confidence interval [CI] -1.27 to 0.61, 2 CRCTs; risk ratio [RR] 2.30, 95% CI 0.97 to 5.42, 1 CBA; SMD -1.24, 95% CI -2.16 to -0.33, 1 CBA; very low-certainty evidence). Long-term follow-up Education may not reduce aggression compared to no intervention in the long term (RR 1.14, 95% CI 0.95 to 1.37, 1 CRCT; low-certainty evidence). Effects on knowledge, attitudes, skills, and adverse outcomes Education may increase personal knowledge about workplace aggression at short-term follow-up (SMD 0.86, 95% CI 0.34 to 1.38, 1 RCT; low-certainty evidence). The evidence is very uncertain about effects of education on personal knowledge in the long term (RR 1.26, 95% CI 0.90 to 1.75, 1 RCT; very low-certainty evidence). Education may improve attitudes among healthcare workers at short-term follow-up, but the evidence is very uncertain (SMD 0.59, 95% CI 0.24 to 0.94, 2 CRCTs and 3 RCTs; very low-certainty evidence). The type and duration of interventions resulted in different sizes of effects. Education may not have an effect on skills related to workplace aggression (SMD 0.21, 95% CI -0.07 to 0.49, 1 RCT and 1 CRCT; very low-certainty evidence) nor on adverse personal outcomes, but the evidence is very uncertain (SMD -0.31, 95% CI -1.02 to 0.40, 1 RCT; very low-certainty evidence). Measurements of these concepts showed high heterogeneity. AUTHORS' CONCLUSIONS Education combined with training may not have an effect on workplace aggression directed toward healthcare workers, even though education and training may increase personal knowledge and positive attitudes. Better quality studies that focus on specific settings of healthcare work where exposure to patient aggression is high are needed. Moreover, as most studies have assessed episodes of aggression toward nurses, future studies should include other types of healthcare workers who are also victims of aggression in the same settings, such as orderlies (healthcare assistants). Studies should especially use reports of aggression at an institutional level and should rely on multi-source data while relying on validated measures. Studies should also include days lost to sick leave and employee turnover and should measure outcomes at one-year follow-up. Studies should specify the duration and type of delivery of education and should use an active comparison to prevent raising awareness and reporting in the intervention group only.
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Affiliation(s)
- Steve Geoffrion
- École de psychoéducation, Université de Montreal, Montreal, Canada
| | - Danny J Hills
- School of Health, Federation University, Ballarat, Australia
| | - Heather M Ross
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Jacqueline Pich
- Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - April T Hill
- College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | | | - Sanaz Riahi
- Ontario Shores Centre for Mental Health Sciences, Whitby, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | | | - Stéphane Guay
- School of Criminology, University of Montreal, Montreal, Canada
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Spelten E, Thomas B, O'Meara PF, Maguire BJ, FitzGerald D, Begg SJ. Organisational interventions for preventing and minimising aggression directed towards healthcare workers by patients and patient advocates. Cochrane Database Syst Rev 2020; 4:CD012662. [PMID: 32352565 PMCID: PMC7197696 DOI: 10.1002/14651858.cd012662.pub2] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Workplace aggression is becoming increasingly prevalent in health care, with serious consequences for both individuals and organisations. Research and development of organisational interventions to prevent and minimise workplace aggression has also increased. However, it is not known if interventions prevent or reduce occupational violence directed towards healthcare workers. OBJECTIVES To assess the effectiveness of organisational interventions that aim to prevent and minimise workplace aggression directed towards healthcare workers by patients and patient advocates. SEARCH METHODS We searched the following electronic databases from inception to 25 May 2019: Cochrane Central Register of Controlled Trials (CENTRAL) (Wiley Online Library); MEDLINE (PubMed); CINAHL (EBSCO); Embase (embase.com); PsycINFO (ProQuest); NIOSHTIC (OSH-UPDATE); NIOSHTIC-2 (OSH-UPDATE); HSELINE (OSH-UPDATE); and CISDOC (OSH-UPDATE). We also searched the ClinicalTrials.gov (www.ClinicalTrials.gov) and the World Health Organization (WHO) trials portals (www.who.int/ictrp/en). SELECTION CRITERIA We included randomised controlled trials (RCTs) or controlled before-and-after studies (CBAs) of any organisational intervention to prevent and minimise verbal or physical aggression directed towards healthcare workers and their peers in their workplace by patients or their advocates. The primary outcome measure was episodes of aggression resulting in no harm, psychological, or physical harm. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods for data collection and analysis. This included independent data extraction and 'Risk of bias' assessment by at least two review authors per included study. We used the Haddon Matrix to categorise interventions aimed at the victim, the vector or the environment of the aggression and whether the intervention was applied before, during or after the event of aggression. We used the random-effects model for the meta-analysis and GRADE to assess the quality of the evidence. MAIN RESULTS We included seven studies. Four studies were conducted in nursing home settings, two studies were conducted in psychiatric wards and one study was conducted in an emergency department. Interventions in two studies focused on prevention of aggression by the vector in the pre-event phase, being 398 nursing home residents and 597 psychiatric patients. The humour therapy in one study in a nursing home setting did not have clear evidence of a reduction of overall aggression (mean difference (MD) 0.17, 95% confidence interval (CI) 0.00 to 0.34; very low-quality evidence). A short-term risk assessment in the other study showed a decreased incidence of aggression (risk ratio (RR) 0.36, 95% CI 0.16 to 0.78; very low-quality evidence) compared to practice as usual. Two studies compared interventions to minimise aggression by the vector in the event phase to practice as usual. In both studies the event was aggression during bathing of nursing home patients. In one study, involving 18 residents, music was played during the bathing period and in the other study, involving 69 residents, either a personalised shower or a towel bath was used. The studies provided low-quality evidence that the interventions may result in a medium-sized reduction of overall aggression (standardised mean difference (SMD -0.49, 95% CI -0.93 to -0.05; 2 studies), and physical aggression (SMD -0.85, 95% CI -1.46 to -0.24; 1 study; very low-quality evidence), but not in verbal aggression (SMD -0.31, 95% CI; -0.89 to 0.27; 1 study; very low-quality evidence). One intervention focused on the vector, the pre-event phase and the event phase. The study compared a two-year culture change programme in a nursing home to practice as usual and involved 101 residents. This study provided very low-quality evidence that the intervention may result in a medium-sized reduction of physical aggression (MD 0.51, 95% CI 0.11 to 0.91), but there was no clear evidence that it reduced verbal aggression (MD 0.76, 95% CI -0.02 to 1.54). Two studies evaluated a multicomponent intervention that focused on the vector (psychiatry patients and emergency department patients), the victim (nursing staff), and the environment during the pre-event and the event phase. The studies included 564 psychiatric staff and 209 emergency department staff. Both studies involved a comprehensive package of actions aimed at preventing violence, managing violence and environmental changes. There was no clear evidence that the psychiatry intervention may result in a reduction of overall aggression (odds ratio (OR) 0.85, 95% CI 0.63 to 1.15; low-quality evidence), compared to the control condition. The emergency department study did not result in a reduction of aggression (MD = 0) but provided insufficient data to test this. AUTHORS' CONCLUSIONS We found very low to low-quality evidence that interventions focused on the vector during the pre-event phase, the event phase or both, may result in a reduction of overall aggression, compared to practice as usual, and we found inconsistent low-quality evidence for multi-component interventions. None of the interventions included the post-event stage. To improve the evidence base, we need more RCT studies, that include the workers as participants and that collect information on the impact of violence on the worker in a range of healthcare settings, but especially in emergency care settings. Consensus on standardised outcomes is urgently needed.
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Affiliation(s)
- Evelien Spelten
- La Trobe Rural Health School, La Trobe University, Bendigo, Australia
| | - Brodie Thomas
- La Trobe Rural Health School, La Trobe University, Bendigo, Australia
| | - Peter F O'Meara
- Department of Emergency Health and Paramedic Practice, Monash University, McMahons Road, Australia
| | - Brian J Maguire
- School of Medical and Applied Sciences, Central Queensland University, Rockhampton, Australia
| | | | - Stephen J Begg
- La Trobe Rural Health School, La Trobe University, Bendigo, Australia
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