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Pelto-Piri V, Kjellin L, Backman G, Carlsson K, Björkdahl A. Patient responsiveness as a safewards fidelity indicator: a qualitative interview study on an acute psychiatric in-patient ward. BMC Health Serv Res 2024; 24:922. [PMID: 39135020 PMCID: PMC11321007 DOI: 10.1186/s12913-024-11326-z] [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: 02/05/2024] [Accepted: 07/17/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND The Safewards model aims to reduce conflict and use of containment on psychiatric wards. To evaluate the implementation of Safewards and understand why it is effective in some settings but not in others, it is important to assess the level of implementation fidelity. To do this, the Safewards Fidelity Checklist (SFC) is often used, which focuses on objective visual observations of interventions but does not include patient responsiveness. The latter is a key indicator of implementation fidelity and includes engagement, relevance, acceptability and usefulness. The aim of the present study was to investigate the fidelity of Safewards implementation on an acute psychiatric ward from the perspective of patient responsiveness. METHOD The study was conducted on a ward for patients with mainly affective disorders. To assess the general level of fidelity the SFC was used together with a detailed ward walkthrough. Ten patients were interviewed with a focus on patient responsiveness to each of the seven interventions implemented on the ward. Data were analysed using qualitative descriptive analysis. RESULTS The findings indicate high implementation fidelity, which was reflected in the SFC assessment, walkthrough and patient responsiveness. Patients gave examples of improvements that had happened over time or of the ward being better than other wards. They felt respected, less alone, hopeful and safe. They also described supporting fellow patients and taking responsibility for the ward climate. However, some patients were unfamiliar with a ward where so much communication was expected. Several suggestions were made about improving Safewards. CONCLUSIONS This study confirms previous research that patient responsiveness is an important factor for achieving fidelity in a prevention programme. The patients' descriptions of the acceptability, relevance and usefulness of the specific interventions reflected to a high degree the objective visual observations made by means of the SFC and ward walkthrough. Patient engagement was demonstrated by several suggestions about how to adapt the interventions. There is potential to obtain valuable input from patients when adapting Safewards in practice. This study also presents many examples of practical work with these interventions and the effects it can have on patients' experiences of care.
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Affiliation(s)
- Veikko Pelto-Piri
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
| | - Lars Kjellin
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Gabriella Backman
- Psychiatric outpatient clinic, Region Värmland, Kristinehamn, Sweden
| | - Karoline Carlsson
- Psychiatric Outpatient Clinic, Västra Götalandsregionen, Alingsås, Sweden
| | - Anna Björkdahl
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Alobaidan F, Al-Bazroun MI, Al Aman H, Al Jaroudi S, Al Qattan A, Hbiesheh A, Al Nassar H. Emergency Department Violence: A Growing Challenge for Healthcare Workers in Saudi Arabia. Cureus 2024; 16:e52455. [PMID: 38370994 PMCID: PMC10871864 DOI: 10.7759/cureus.52455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2024] [Indexed: 02/20/2024] Open
Abstract
Background Workplace violence in healthcare settings, particularly in emergency departments (EDs), is a critical issue affecting healthcare providers and the quality of patient care. This study's primary aim was to determine the prevalence and types of workplace violence experienced by healthcare workers in Saudi Arabian EDs, assess the physical and psychological consequences of such violence, and explore the factors contributing to its occurrence. Methods Employing a descriptive, cross-sectional research design, the study was conducted in two phases at three hospitals in the Eastern Region of Saudi Arabia. It targeted ED healthcare workers, including physicians, nurses, and support staff. Data were collected via a questionnaire disseminated through social media, addressing incidents of violence, their nature, and subsequent responses. Results The findings indicate a significant incidence of workplace violence in EDs, predominantly involving verbal abuse and physical aggression, mostly initiated by patients' companions. The majority of these incidents occurred prior to patient-physician interaction, with nurses frequently being the primary victims. Although incidents were more often formally reported than informally, a substantial number remained unreported. There was no significant correlation between the experienced violence and variables like working hours or hospital governance. Conclusion The research highlights the urgent need for effective policies and strategies to mitigate workplace violence in healthcare settings in Saudi Arabia. It emphasizes the necessity of implementing comprehensive violence prevention and intervention programs to ensure a safer working environment for healthcare professionals.
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Affiliation(s)
| | | | - Hussain Al Aman
- Nursing, Royal Commission Health Services Program, Jubail, SAU
| | | | - Afnan Al Qattan
- Nursing, Royal Commission Health Services Program, Jubail, SAU
| | - Ali Hbiesheh
- Nursing, Royal Commission Health Services Program, Jubail, SAU
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Kim SC, Kim YP. Violent Event Severity Tool for Reporting Violent Incidents. J Nurs Adm 2023; 53:648-653. [PMID: 37983603 DOI: 10.1097/nna.0000000000001361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
OBJECTIVES To explore the usefulness of the Violent Event Severity Tool (VEST). BACKGROUND The Joint Commission and many governing bodies require establishing workplace violence prevention programs in hospitals. Inconsistent processes have hampered the efficacy evaluation of such programs for collecting and reporting violence. The VEST was developed as a standardized tool for capturing violence data. METHODS Ninety-six healthcare workers attending the 2022 Magnet® conference completed the survey. The VEST includes 6 types and 4 intensities of violent incidents. RESULTS Most participants reported that the VEST is easy to use (79%), relevant (85%), and useful (85%). Fewer than half were satisfied with their incident report filing processes. Only 38% of participants experiencing grade 1 physical assault filed an incident report, whereas 70% and 100% experiencing grades 3 and 4 physical assaults filed. CONCLUSIONS The VEST appears to be a useful and relevant tool for consistent collection and reporting of various violence types and severities.
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Affiliation(s)
- Son Chae Kim
- Author Affiliations: Professor (Dr S. C. Kim), School of Nursing, Point Loma Nazarene University; and Physician (Dr Y. P. Kim), Scripps MD Anderson Cancer Center, San Diego, California
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van Beek J, Meijers J, Scherder EJA, Harte JM. Aggressive Incidents by Incarcerated People With Psychiatric Illness and Their Relationship With Psychiatric Symptoms. JOURNAL OF FORENSIC NURSING 2023; 19:E30-E38. [PMID: 37590946 DOI: 10.1097/jfn.0000000000000424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
AIM A prospective design was used to investigate the relationship of current psychiatric symptoms of incarcerated people with serious mental illness (SMI) and aggressive behavior on a penitentiary ward for crisis intervention. METHODS One hundred sixty detainees with SMI, detained in a high-security penitentiary psychiatric facility, were screened every 2 weeks with the Brief Psychiatric Rating Scale-Extended (BPRS-E) by trained clinicians, to ensure that the data on psychiatric symptoms were up-to-date. Aggressive behavior was registered with the Staff Observation Aggression Scale-Revised. A binary logistic regression analysis was performed to examine the relationships between factor scores of the BPRS-E and aggressive behavior. RESULTS Significant relationships between the BPRS-E factor hostility, antisocial traits, and aggressive incidents were found, but not between the positive symptoms or manic factor scores and aggressive incidents. DISCUSSION Symptoms of SMI measured with the BPRS-E did not help to explain the occurrence of aggressive behavior. This is not in line with what is commonly found. The implication is that it can be expected that this population will display aggressive behavior but that symptoms do not help in predicting when this will occur. In addition, hostility and antisocial traits were related to aggressive behavior. For this specific population, an interactional approach might be more effective in the management of aggression than treatment of symptoms of SMI.
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Affiliation(s)
| | | | - Erik J A Scherder
- Department of Clinical, Neuro- and Developmental Psychology, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam
| | - Joke M Harte
- Department of Criminal Law and Criminology, Faculty of Law, Vrije Universiteit Amsterdam
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Dafny HA, Chamberlain D, Parry YK, Beccaria G. Do nurses receive any support following incidents of workplace violence? A qualitative study. J Nurs Manag 2022; 30:1843-1851. [PMID: 35733397 DOI: 10.1111/jonm.13724] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 06/18/2022] [Accepted: 06/20/2022] [Indexed: 02/03/2023]
Abstract
AIM We aim to investigate nurses' perceptions of support after incidences of Workplace Violence. BACKGROUND Nurses experience workplace violence daily. Adequate support following incidents of violence can reduce adverse impacts. Current support systems for coping with workplace violence are lacking. METHODS Focus group interviews were conducted with 23 nurses working in a regional Queensland Hospital. Qualitative data was transcribed and thematically analyzed to determine themes. The consolidated criteria for reporting qualitative research checklist was followed. RESULTS The primary source of support after a violent incident was from other nurses. Support was needed immediately to empower nurses to be able to continue their caring role. Often the support was not provided nor were nurses aware of the support services available. Although personal family and friends were a valuable support, most nurses were reluctant to disclose their experiences to protect them. CONCLUSIONS This paper discusses nurses' experience of support following violence incidents at work as part of findings from a more extensive study that explored the perceptions of nurses regarding violence, strategies and support in a regional Queensland Hospital. Hospital support following a violent incident was perceived as inadequate and nurses felt unsupported immediately following an incident. IMPLICATIONS FOR NURSING MANAGEMENT After an incidence of workplace violence, appropriate effective support may mitigate the enduring impacts of experiencing violence. There is the need for hospital management to provide effective support services and improve staff awareness of available support services.
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Affiliation(s)
- Hila Ariela Dafny
- College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Adelaide, South Australia, Australia
| | - Diane Chamberlain
- College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Adelaide, South Australia, Australia
| | - Yvonne Karen Parry
- College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Adelaide, South Australia, Australia
| | - Gavin Beccaria
- School of Psychology and Wellbeing, Faculty of Health Engineering and Sciences, University of Southern Queensland, Toowoomba, Queensland, Australia
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Chesire DJ, McIntosh A, Hendrickson S, Jones P, McIntosh M. Dimensions of hospital workplace violence: Patient violence towards the healthcare team. J Clin Nurs 2022; 31:1662-1668. [PMID: 34459050 DOI: 10.1111/jocn.16021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 08/04/2021] [Accepted: 08/13/2021] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To investigate the cognitive dimensions nurses use when perceiving patient-to-healthcare provider workplace violence. BACKGROUND The concept of workplace violence, especially with respect to healthcare settings, has been well documented. Healthcare workers are at particular risk for experiencing violence from their patients, though these incidents often go unreported. Experiencing violence in the workplace has been associated with numerous negative outcomes, including absenteeism, burnout and diminished quality of care. However, little emphasis has been placed on understanding the concept of violence itself, or why one type of violence might go unreported whilst another is readily communicated to officials. DESIGN A card-sorting, multidimensional scaling design. METHODS Thirty two nurses completed the card-sorting task. Using multidimensional scaling (MDS), 75 reported incidents of violence were considered. SPIRIT research reporting checklist followed. RESULTS Nurses categorise patient violence in three dimensions: physical versus verbal, active versus threatening and more versus less severe. Implications for further research and intervention are discussed. CONCLUSIONS Violence in the hospital workplace is a complex perception by the healthcare worker that cannot be captured by a single dimension. RELEVANCE TO CLINICAL PRACTICE This study provides a theoretical framework for understanding the complexity of patient-to-provider violence in a hospital setting. It sheds light on why only a minority of such events are reported. This model can serve as a foundation for future research exploring interventions for hospital violence.
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Affiliation(s)
- David J Chesire
- College of Medicine, University of Florida, Jacksonville, Florida, USA
| | - Ana McIntosh
- School of Architecture and Planning, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Susan Hendrickson
- Department of Performance Improvement, Quality Administration, UF-Health Jacksonville, Jacksonville, Florida, USA
| | - Patrice Jones
- Department of Performance Improvement, Quality Administration, UF-Health Jacksonville, Jacksonville, Florida, USA
| | - Mark McIntosh
- College of Medicine, University of Florida, Jacksonville, Florida, USA
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Kumari A, Sarkar S, Ranjan P, Chopra S, Kaur T, Baitha U, Chakrawarty A, Klanidhi KB. Interventions for workplace violence against health-care professionals: A systematic review. Work 2022; 73:415-427. [PMID: 35431213 DOI: 10.3233/wor-210046] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Workplace violence (WPV) against health-care professionals has been a concern worldwide as it strains the relationship between the patient and healthcare professionals. Implementing mitigation interventions to help the healthcare professionals to prevent and manage these violent episodes might make the workplaces more secure. OBJECTIVE This study aimed to synthesize the recent evidence on intervention strategies for workplace violence. METHOD Four electronic databases (PubMed, Wiley, Cochrane and Google Scholar) were searched for peer-reviewed intervention studies published in the last 11 years to mitigate workplace violence. A qualitative synthesis of the findings from included studies was done. RESULT A total of 17 studies were identified based on prevention and management of workplace violence. The interventions were mainly educational in nature based on a workshop format. These interventions were found to be effective in improving the perceived ability to deal with situations that lead to violence. CONCLUSION Strategies to mitigate violent episodes could be helpful to health-care professionals and administrators in their attempts to make safer workplaces in the health-care settings.
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Affiliation(s)
- Archana Kumari
- Department of Gynaecology and Obstetrics, All India Institute of Medical Sciences, New Delhi, India
| | - Siddharth Sarkar
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Piyush Ranjan
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sakshi Chopra
- Department of Home Science, University of Delhi, India
| | - Tanveer Kaur
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Upendra Baitha
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Avinash Chakrawarty
- Department of Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Kamal Bandhu Klanidhi
- Department of Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, India
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Arnetz JE. The Joint Commission's New and Revised Workplace Violence Prevention Standards for Hospitals: A Major Step Forward Toward Improved Quality and Safety. Jt Comm J Qual Patient Saf 2022; 48:241-245. [PMID: 35193809 PMCID: PMC8816837 DOI: 10.1016/j.jcjq.2022.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Jansen TL, Danbolt LJ, Hanssen I, Hem MH. How may cultural and political ideals cause moral distress in acute psychiatry? A qualitative study. BMC Psychiatry 2022; 22:212. [PMID: 35321674 PMCID: PMC8944013 DOI: 10.1186/s12888-022-03832-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 02/23/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND There is growing public criticism of the use of restraints or coercion. Demands for strengthened patient participation and prevention of coercive measures in mental health care has become a priority for care professionals, researchers, and policymakers in Norway, as in many other countries. We have studied in what ways this current ideal of reducing the use of restraints or coercion and attempting to practice in a least restrictive manner may raise morals issues and create experiences of moral distress in nurses working in acute psychiatric contexts. METHODS Qualitative interview study, individual and focus group interviews, with altogether 30 nurses working in acute psychiatric wards in two mental health hospitals in Norway. Interviews were recorded and transcribed. A thematic analytic approach was chosen. RESULTS While nurses sense a strong expectation to minimise the use of restraints/coercion, patients on acute psychiatric wards are being increasingly ill with a greater tendency to violence. This creates moral doubt and dilemmas regarding how much nurses should endure on their own and their patients' behalf and may expose patients and healthcare personnel to greater risk of violence. Nurses worry that new legislation and ideals may prevent acutely mentally ill and vulnerable patients from receiving the treatment they need as well as their ability to create a psychological safe climate on the ward. Furthermore, persuading the patient to stay on the ward can cause guilt and uneasiness. Inadequate resources function as external constraints that may frustrate nurses from realising the treatment ideals set before them. CONCLUSIONS Mental health nurses working in acute psychiatric care are involved in a complex interplay between political and professional ideals to reduce the use of coercion while being responsible for the safety of both patients and staff as well as creating a therapeutic atmosphere. External constraints like inadequate resources may furthermore hinder the healthcare workers/nurses from realising the treatment ideals set before them. Caught in the middle nurses may experience moral distress that may lead to physical discomfort, uneasiness and feelings of guilt, shame, and defeat. Pressure on nurses and care providers to reduce or eliminate the use of coercion and reduction of health care spending are incompatible demands.
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Affiliation(s)
- Trine-Lise Jansen
- Norway, MF Norwegian School of Theology, Religion and Society, Lovisenberg Diakonale Høgskole (Lovisenberg Diaconal University College), Oslo, Norway.
| | - Lars Johan Danbolt
- grid.446080.e0000 0000 8775 4235MF Norwegian School of Theology, Religion and Society, Oslo, Norway
| | - Ingrid Hanssen
- grid.458172.d0000 0004 0389 8311Lovisenberg Diakonale Høgskole (Lovisenberg Diaconal University College), Oslo, Norway
| | - Marit Helene Hem
- grid.463529.f0000 0004 0610 6148VID Specialized University, Oslo, Norway
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Mediating Effects of Psychological States on Work Performance of Visiting Nurses According to COVID-19 Workplace Quarantine Measures: A Multi-Group Path Analysis Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:ijerph19010444. [PMID: 35010702 PMCID: PMC8744926 DOI: 10.3390/ijerph19010444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 12/27/2021] [Accepted: 12/30/2021] [Indexed: 01/21/2023]
Abstract
This multi-group path analysis study investigated the effects of verbal abuse (suspicion of infection and disrespect) on difficulties in work performance according to the workplace quarantine measures of visiting nurses during the COVID-19 pandemic. A total of 262 visiting nurses in Korea completed the online questionnaire between 10 October and 30 November 2020, and their data were included in the final analysis. The study found that experiences of verbal abuse mediated fear and anxiety to affect difficulties in work performance. In the path model of the group with a high level of workplace quarantine measures, experiences of verbal abuse (suspicion of infection and disrespect) did not directly affect fear. The opposite was true for the group with low levels of workplace quarantine measures. The implications for the field are that the following is required: heightened awareness of verbal abuse; workplace quarantine policies; and mental health management systems and intervention programs to detect the early fear and anxiety of visiting nurses.
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Baras S, Lekka D, Bokari M, Orlandou K, Arachoviti V, Roubi A, Tsaraklis A, Pachi A, Douzenis A. Investigation of the Relationship Between Aggression and Adult Attachment in Healthcare Professionals. Cureus 2021; 13:e19360. [PMID: 34909318 PMCID: PMC8653928 DOI: 10.7759/cureus.19360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2021] [Indexed: 11/08/2022] Open
Abstract
Introduction Multiple references to the violent and especially difficult patient have been presented by the international literature. However, there is little literature on the aggressive behaviors of health professionals in their workplaces. The aim of this research is to record and correlate aggression and attachment type data of adult health professionals. Methods The sample includes 192 individuals (43 men and 149 women) health professionals in the private and public sector, aged 20 to 60 years, who were selected by the method of random sampling. The survey was conducted from February 2018 to May 2018. The Greek version of the Aggression Questionnaire and the Greek version of the Revised Experiences in Close Relationships (G-ECR-R) self-report inventory were used and the analysis was performed with the Statistical Package of Social Sciences (SPSS 26) (IBM Corp., Armonk, NY). Results The analysis shows that the dimension of avoidance has a positive correlation with hostility and physical aggression and the dimension of stress has a positive correlation with anger, physical aggression and hostility. It also seems that the stress dimension of the adult attachment contributes significantly positively to the prediction of anger and the stress dimension contributes significantly to the prediction of hostility. The dimension of avoiding adult attachment contributes significantly to the prediction of physical aggression. Conclusions To our knowledge, no studies were found in the literature to examine the relationship between the subscales of aggression and dimensions of attachment. It is important that violence in the workplace is recognized as an underlying occupational risk and not just as a matter of criminal law. Finally, more research is needed to study the phenomenon in order to make it more understandable.
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Affiliation(s)
- Spyros Baras
- Department of Psychiatry, Sotiria Thoracic Diseases Hospital of Athens, Athens, GRC
| | - Dimitra Lekka
- Department of Psychiatry, Sotiria Thoracic Diseases Hospital of Athens, Athens, GRC
| | - Maria Bokari
- Mental Health - Cognitive Behavior Therapy (CBT), The 417 Army Equity Fund Hospital (417 Νοσηλευτικό Ίδρυμα Μετοχικού Ταμείου Στρατού) (NIMTS), Athens, GRC
| | | | - Vasileia Arachoviti
- Department of Psychology, Panteion University of Social and Political Sciences, Athens, GRC
| | - Aikaterini Roubi
- Department of Psychiatry, Sotiria Thoracic Diseases Hospital of Athens, Athens, GRC
| | | | - Argiro Pachi
- Department of Psychiatry, Sotiria Hospital, Athens, GRC
| | - Athanasios Douzenis
- Department of Psychiatry, National and Kapodistrian University of Athens, Medical School, Athens, GRC
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Schlup N, Gehri B, Simon M. Prevalence and severity of verbal, physical, and sexual inpatient violence against nurses in Swiss psychiatric hospitals and associated nurse-related characteristics: Cross-sectional multicentre study. Int J Ment Health Nurs 2021; 30:1550-1563. [PMID: 34196092 PMCID: PMC8596810 DOI: 10.1111/inm.12905] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/16/2021] [Accepted: 06/17/2021] [Indexed: 11/28/2022]
Abstract
This analysis (1) describes the prevalence and severity of psychiatric inpatient violence against nurses in Switzerland's German-speaking region and (2) investigates the associations between nurse-related characteristics (socio-demographics; previous exposure to severe forms of psychiatric inpatient violence; attitude towards psychiatric inpatient violence) and nurses' exposure to various types of psychiatric inpatient violence. We used cross-sectional survey data from the MatchRN Psychiatry study sample of 1128 nurses working on 115 units across 13 psychiatric hospitals. In addition to lifetime severe assaults, nurses' exposure to violence against property, verbal violence, verbal sexual violence, physical violence, and physical sexual violence was assessed for the 30 days prior to the survey. Descriptive statistics (frequency and percentage) were calculated for each class of violence as also for items under study. With generalized linear mixed models, odds ratios and 95% confidence intervals were calculated. Of nurse respondents, 73% reported facing verbal violence, 63% violence against property, 40% verbal sexual violence, 28% physical violence, and 14% physical sexual violence. Almost 30% had been subjected to a serious assault in their professional lifetimes. All nurse characteristics were associated with psychiatric inpatient violence against nurses, especially a history of sexual assault (OR 4.53, 95%-CI 2.19-9.34; P = 0.00) and ≤3 years' professional experience (OR 3.70, 95%-CI 1.95-7.02; P = 0.00). Prevalence data suggest that widely used strategies such as aggression management courses or alarm devices cannot fully reduce patient violence against nurses in psychiatry. This situation demands proactive strategies in safety and violence prevention.
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Affiliation(s)
- Nanja Schlup
- Solothurn Hospital Group, Solothurn, Switzerland
| | - Beatrice Gehri
- Institute of Nursing Science, Department of Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland.,University Psychiatric Clinics, Basel, Switzerland
| | - Michael Simon
- Institute of Nursing Science, Department of Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland.,Nursing Research Unit, Department of Nursing, Inselspital Bern University Hospital, Bern, Switzerland
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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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Lee Y, Kim SM, Han DH, Yoo SK, Kim H. Effects of Indirect Experience of Client Violence on Social Workers' Posttraumatic Stress Disorder. Psychiatry Investig 2021; 18:1100-1108. [PMID: 34732027 PMCID: PMC8600223 DOI: 10.30773/pi.2021.0205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 09/10/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE This study aims to empirically determine if indirect exposure to client violence has significant negative effects on social workers' posttraumatic stress disorder (PTSD) the same way direct victimization does. METHODS Using a sample of 1,359 social workers drawn from the data collected by the Seoul Association of Social Workers, this study employs descriptive statistics to examine the prevalence of indirect experiences with client violence, and utilizes a series of hierarchical regression analyses to demonstrate the potential impact of indirect exposure to client violence on PTSD. To assess the severity of PTSD symptoms in participants, the Korean version of the Impact of Events Scale-Revised (IES-R-K) was employed. RESULTS A descriptive analysis shows that 12.4% of the sample indirectly experienced client violence by witnessing it or hearing about a violent incident, whereas 6.0% were directly victimized. Hierarchical regression analyses indicate that direct experience (B=4.548, p<0.05) and indirect experience (B=7.297, p<0.001) of client violence have a significant association with the scores on IES-R-K. An investigation of the interaction terms between experiences of client violence and violence-prevention training illustrates that such training significantly moderates the influence on the scores on IES-R-K from indirect exposure to client violence (B=-8.639, p<0.01). CONCLUSION Social workers who are indirectly exposed to client violence experience PTSD symptoms comparable to their colleagues who were directly victimized. Further, violence-prevention training has greater ameliorative effects with regard to indirect experience of client violence than for direct victimization.
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Affiliation(s)
- Yongwoo Lee
- Department of Social Welfare, Konkuk University, Chungju, Republic of Korea
| | - Sun Mi Kim
- Department of Psychiatry, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Doug Hyun Han
- Department of Psychiatry, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Seo-Koo Yoo
- School of Social Welfare, Soongsil University, Seoul, Republic of Korea
| | - HyunSoo Kim
- Department of Social Welfare, Dongguk University, Gyeongju, Republic of Korea
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15
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Zhu H, Liu X, Yao L, Zhou L, Qin J, Zhu C, Ye Z, Pan H. Workplace violence in primary hospitals and associated risk factors: A cross-sectional study. Nurs Open 2021; 9:513-518. [PMID: 34655279 PMCID: PMC8685843 DOI: 10.1002/nop2.1090] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 07/30/2021] [Accepted: 09/02/2021] [Indexed: 11/07/2022] Open
Abstract
AIM To investigate the characteristics of workplace violence at primary hospitals in Southeast China and identify associated risk factors. DESIGN A cross-sectional survey design was used for this work. METHODS We distributed a workplace violence questionnaire among medical staff at primary hospitals in Southeast Zhejiang Province, China. The data were collected between December 2016 and December 2017. We analysed the categorical data by using the chi-square test and expressed it as frequencies. The risk factors were analysed by using multiple logistic regression analysis. RESULTS Among the 2,560 questionnaires, 1,842 (71.9%) medical staff indicated that they had experienced workplace violence. Verbal assault was the most common type, followed by physical and sexual assault. Furthermore, gender, age, marital status, education, technical position and number of hospital beds' numbers were independent risk factors.
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Affiliation(s)
- Hongfang Zhu
- Sir Run Run Shaw Hospital School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaona Liu
- Sir Run Run Shaw Hospital School of Medicine, Zhejiang University, Hangzhou, China
| | - Linyan Yao
- Sir Run Run Shaw Hospital School of Medicine, Zhejiang University, Hangzhou, China
| | - Liping Zhou
- Sir Run Run Shaw Hospital School of Medicine, Zhejiang University, Hangzhou, China
| | - Jianfen Qin
- Sir Run Run Shaw Hospital School of Medicine, Zhejiang University, Hangzhou, China
| | - Chenping Zhu
- Sir Run Run Shaw Hospital School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhihong Ye
- Sir Run Run Shaw Hospital School of Medicine, Zhejiang University, Hangzhou, China
| | - Hongying Pan
- Sir Run Run Shaw Hospital School of Medicine, Zhejiang University, Hangzhou, China
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16
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Warshawski S, Amit Aharon A, Itzhaki M. The public's mixed emotional responses to violence directed at nurses: A mixed methods study. J Clin Nurs 2021; 31:2208-2218. [PMID: 34528305 DOI: 10.1111/jocn.16039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 08/23/2021] [Accepted: 08/26/2021] [Indexed: 11/26/2022]
Abstract
AIMS AND OBJECTIVES To understand whether exposure to an incident of violence directed at nurses, evoke among the public a sense of identification with the victim or with the perpetrator. BACKGROUND Worldwide, evidence regarding workplace violence (WPV) in healthcare systems, explored the characteristics of the perpetrator, the healthcare settings and staff. Nevertheless, no studies examine the emotions of the public towards WPV in the healthcare systems. DESIGN A convergent mixed method parallel design. METHODS A structured questionnaire was distributed among 925 adults. Two scenarios were presented, with verbal and physical violence towards nurses. The participants rated how intensely they felt positive and negative emotions regarding the nurse and the perpetrator (quantitative stage). Sixty participants were also interviewed concerning their emotions regarding violence committed towards nurses (qualitative stage). Paired samples t-test were used to compare the emotions that were aroused regarding the perpetrator and the nurse. The effect size and Bonferroni correction for multiple comparisons were calculated. Constant comparative analysis method was used to analyzed the qualitative data. The STROBE checklist for cross-sectional studies and the COREQ guidelines for qualitative studies were used for reporting. RESULTS Positive emotions were significantly higher towards the nurse than the perpetrator. Nevertheless, there were both positive and negative emotions towards the perpetrator and the nurse. The qualitative findings yielded two themes: (1) Mixed emotions towards the perpetrator, and (2) Mixed emotions towards the nurse. CONCLUSIONS The public may emotionally identify with both the nurse and the perpetrator while positive and negative emotions are intertwined. Likewise, positive emotions are more intensely felt for the victims in both verbally and physically violent scenarios. RELEVANCE TO CLINICAL PRACTICE These complemented findings highlight the need for campaigns promoting positive emotions toward healthcare professionals in an attempt to reduce and eliminate WPV in healthcare.
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Affiliation(s)
- Sigalit Warshawski
- Nursing Department, School of Health Professions, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Anat Amit Aharon
- Nursing Department, School of Health Professions, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Michal Itzhaki
- Nursing Department, School of Health Professions, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
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17
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Lisak A, Efrat-Treister D, Glikson E, Zeldetz V, Schwarzfuchs D. The influence of culture on care receivers' satisfaction and aggressive tendencies in the emergency department. PLoS One 2021; 16:e0256513. [PMID: 34473754 PMCID: PMC8412260 DOI: 10.1371/journal.pone.0256513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 08/09/2021] [Indexed: 02/04/2023] Open
Abstract
Introduction Reducing aggressive tendencies among care receivers in the emergency department has great economic and psychological benefits for care receivers, staff, and health care organizations. In a study conducted in a large multicultural hospital emergency department, we examined how cultural factors relating to ethnicity interact to enhance care receivers’ satisfaction and reduce their aggressive tendencies. Specifically, we explored how care receivers’ cultural affiliation, individual cultural characteristics, and the cultural situational setting interact to increase care receivers’ satisfaction and reduce their aggressive tendencies. Method Data were collected using survey responses from 214 care receivers. We use structural equation models and the bootstrap method to analyze the data. Results Care receivers’ openness to diversity (an individual cultural characteristic) was positively related to their satisfaction that was associated with lower aggressive tendencies, only when they were affiliated with a cultural minority group and when the cultural situational setting included language accessibility. Conclusion Our results demonstrate that cultural affiliation, individual cultural characteristics, and cultural situational setting can affect care receivers’ satisfaction and aggressive tendencies in a multicultural emergency department context. In particular, high cultural openness of care receivers, and making information accessible in their native language, increased satisfaction and reduced aggressive tendencies among cultural minority care receivers in our study.
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Affiliation(s)
- Alon Lisak
- Department of Management, Ben-Gurion University of the Negev, Be’er Sheva, Israel
- * E-mail:
| | - Dorit Efrat-Treister
- Department of Management, Ben-Gurion University of the Negev, Be’er Sheva, Israel
| | - Ella Glikson
- The Graduate School of Business Administration, Bar-Ilan University, Ramat Gan, Israel
| | - Vladimir Zeldetz
- Department of Emergency Medicine, Soroka University Medical Center, Be’er Sheva, Israel
| | - Dan Schwarzfuchs
- Department of Emergency Medicine, Soroka University Medical Center, Be’er Sheva, Israel
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18
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Mohr DC, Curyto K, Jedele JM, McConeghy KW, Intrator O, Karel MJ, Vance K. Impact of STAR-VA on Staff Injury and Disruptive Behavior Reports in VA Nursing Homes. J Am Med Dir Assoc 2021; 23:1159-1165.e1. [PMID: 34473962 DOI: 10.1016/j.jamda.2021.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 08/06/2021] [Accepted: 08/07/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Workplace disruptive behavior incidents can be costly for organizations, employees, and customers. Persons with dementia living in long-term care settings have a high risk of exhibiting distressed behaviors. We examined whether a resident-centered, behavioral intervention for residents with dementia led to a reduction in reported workplace disruptive behaviors and staff injury rate due to assault. Impactful interventions are important for quality of care. DESIGN We examined whether a team-based behavioral program in community living centers (CLCs), where a nurse champion and behavioral coordinator were trained to work with the clinical team to understand and manage distressed behaviors commonly associated with dementia, was associated with reductions in behavior incidents. SETTING AND PARTICIPANTS The setting was Veterans Health Administration CLCs. The sample consisted of 120 aggregated CLCs operating between 2012 and 2017 with 62 completing training. CLCs were distributed across the United States. METHODS Outcomes included CLC-level rates of staff injury and number of workplace disruptive behavior incidents. Outcomes were regressed on measures of intervention completion, time since intervention, and several CLC characteristics. RESULTS The intervention was significantly associated with lower incidence of assault with staff injury rates overall, particularly following the first year of training, but not with other reported workplace disruptive behavior incident rates. CONCLUSIONS AND IMPLICATIONS A team-based behavioral intervention was associated with reduction of employee assaults, a critical repercussion of distressed behavior in dementia. Given rapid growth in patients with dementia in nursing homes, effective treatment practices, such as interdisciplinary behavioral management approaches may be impactful and valuable to implement.
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Affiliation(s)
- David C Mohr
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA; Department of Health Policy and Management, Boston University School of Public Health, Boston, MA, USA.
| | - Kim Curyto
- VA Western New York Healthcare System, Center for Integrated Healthcare, Buffalo and Batavia, NY, USA
| | - Jenefer M Jedele
- Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, Department of Veterans Affairs, Ann Arbor, MI, USA
| | - Kevin W McConeghy
- Center of Innovation in Long-Term Services and Supports, Providence VA Medical Center, Providence, RI, USA; Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI, USA
| | - Orna Intrator
- Department of Veterans Affairs, Geriatrics & Extended Care Data Analysis Center, Finger-Lakes Healthcare System, Canandaigua, NY, USA; Department of Public Health Sciences, School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA
| | - Michele J Karel
- Office of Mental Health and Suicide Prevention, Department of Veterans Affairs Central Office, Washington, DC, USA
| | - Kelly Vance
- Workplace Violence Prevention Program, Office of Mental Health and Suicide Prevention, Veterans Health Administration Central Office, Washington, DC, USA; Lexington VA Health Care System, Lexington, KY, USA
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19
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Exploring staff experiences: A case for redesigning the response to aggression and violence in the emergency department. Int Emerg Nurs 2021; 57:101017. [PMID: 34174545 DOI: 10.1016/j.ienj.2021.101017] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 05/02/2021] [Accepted: 05/10/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION A Code Black is the coordinated response by healthcare staff and security to an act or threat of verbal and physical aggression or violence perpetrated by a patient, family member or visitor towards healthcare staff within a hospital setting. Behavioural disturbance is often verbally de-escalated by staff. However, as a last resort physical and/or chemical restraint may be necessary. Reports show that there is an increasing number of violent incidents in Emergency Departments (ED), emphasising the importance of staff training for Code Black events. This research examines the response of healthcare staff to aggression and violence in the ED, the supporting structures that manage a Code Black event and potential avenues for restructuring the response. METHODS We used a constructivist methodology to evaluate the training needs of healthcare staff. In 2019, we interviewed 20 staff and conducted a series of ethnographic observations in EDs across four hospitals in the Western Sydney Local Health District (WSLHD) in New South Wales (NSW), Australia. We focussed on staff experiences of Code Black events and the current departmental response. Staff recounted experiences of 45 Code Black events which were collated and thematically analysed. RESULTS Our findings show that there are no guidelines for: assessing the risk of an agitated patient, best practice de-escalation techniques, when exactly to call a Code Black and the pre-determined allocation of staff roles for patient restraint. Code Black response efforts lacked a systematic approach to coordinating resources and personnel, and there was confusion over the role of security. When poorly managed, this placed healthcare staff, security personnel and patients at serious risk and had a negative impact on staff wellbeing. We found training in Code Black interventions relies heavily on learning on the job from experienced staff members. CONCLUSION A systematic, coordinated and consistent organisational response to Code Black events is essential for the safety of ED staff. The roles and responsibilities of health workers and security require clear definition, and health workers across the WSLHD require easily accessible and repeatable experiential training in managing Code Black events.
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20
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Basis F, Moskovitz K, Tzafrir S. Did the events following the COVID-19 outbreak influence the incidents of violence against hospital staff? Isr J Health Policy Res 2021; 10:36. [PMID: 34140034 PMCID: PMC8210496 DOI: 10.1186/s13584-021-00471-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 06/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND During the COVID-19 outbreak, (March 1 - June 15, 2020) citizens expressed sympathy and gratitude towards medical staff through the media, while the entire hospital staff faced the same danger of infection as other citizens. This might have made hospital staff develop sympathy, understanding for the patients` and family's needs, and a better communication. OBJECTIVES To investigate if there is a relation between the mutual change in attitude between citizens and hospital staff during the first COVID-19 outbreak, and the incidence of violence cases. MATERIALS AND METHODS This is a cross sectional study conducted at Rambam Medical Center (RMC) in Israel. The data about the number of violence cases were collected from the security department, and the data about hospital wards activity were collected from the hospital Business Intelligence (BI) software. The number of violence cases in relation to the number of Emergency Department (ED) visits, admissions to hospital wards, and length of stay (LOS) were compared during the COVID-19 outbreak to the corresponding period in 2019 using the T- test. The difference in the incidence of violence between general population and people with a psychiatric or social disorder (like drug abuse and criminal background) in both periods were also compared using the Fisher exact test. RESULTS During the first COVID-19 outbreak, there were 6 violence cases against medical staff out of 24,740 visits to the ED, vs. 21 cases out of 30,759 visits during the same periods in 2019 (P < 0.05). There were 19 violence cases in the whole hospital with 14,482 admissions in 2020 vs. 51 violence cases of 17,599 admissions in 2019 (P < 0.05). Violence against security guards in the entire hospital dropped from 20 to 11 cases, and in the set of the ED, from 13 to 4 cases in both periods respectively. A 20 % decrease in the number of visits to the ED, might have influenced the average LOS during the study period, 2020 compared to 2019 (4.4 + 0.45 vs. 5.4 + 0.36 h. (P < 0.001). The ratio of violence among general population vs. people with a psychiatric or social background revealed a non-significant change in both periods (P = 0.75 and P = 0.69) respectively. DISCUSSION The COVID-19 outbreak supplied some evidence that a change in environmental conditions, trust, waiting time, personal attitude and communication might have reduced violence against hospital staff. CONCLUSIONS Except for violence coming from patients with psychiatric or social disorders, most other violence cases might be reduced if the environment conditions and attitudes of both citizens and staff are improved.
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Affiliation(s)
- Fuad Basis
- Rambam Medical Campus (RMC), the Technion Faculty of Medicine, Haifa, Israel.
| | - Kobi Moskovitz
- RMC Administrative Department, Haifa University, Haifa, Israel
| | - Shay Tzafrir
- School of Business Administration, Haifa University, Haifa, Israel
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21
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Zhao X, Li X, Torgler B, Dulleck U. Patient violence, physicians treatment decisions, and patient welfare: Evidence from China. HEALTH ECONOMICS 2021; 30:1461-1479. [PMID: 33797147 DOI: 10.1002/hec.4260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 01/14/2021] [Accepted: 03/04/2021] [Indexed: 06/12/2023]
Abstract
Although violence in healthcare settings has become a common occurrence worldwide, there is limited evidence on the spillover effects of patient violence on physicians' medical decisions. Utilizing microdata on inpatients from a major public hospital, we investigated how extreme patient violence-the murder of a physician in China-affected physicians' treatment decisions and patient welfare in a hospital geographically distant from the murder site. By matching this patient dataset to physician profiles, we performed a difference-in-differences analysis in which the treatment group comprised patients admitted shortly before and after the murder shock, and the control group consisted of patients admitted during the same months in the previous year. Immediately after the shock, the provision of medical treatment was notably higher, with a 16.9% increase in the number of surgeries and a 9.5% increase in the treatment expenditures. However, patient health outcomes were worse, with an increased mortality rate of 0.9% points. Findings suggest that patient violence dramatically changed physician behavior, causing negative consequences on patients even when the healthcare workers were not direct victims of patient violence.
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Affiliation(s)
- Xin Zhao
- School of International Trade and Economics, University of International Business and Economics, Beijing, China
| | - Xiaoxue Li
- Department of Economics, University of New Mexico, Albuquerque, New Mexico, USA
| | - Benno Torgler
- School of Economics and Finance, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Uwe Dulleck
- School of Economics and Finance, Queensland University of Technology, Brisbane, Queensland, Australia
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22
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Gur A. Customer trust and perceived service quality in the healthcare sector: Customer aggressive behaviour as a mediator. JOURNAL OF TRUST RESEARCH 2021. [DOI: 10.1080/21515581.2021.1927063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Amit Gur
- The Max Stern Yezreel Valley College, Health Care Systems Management, The Max Stern Academic College of Yezreel Valley
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23
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Ursachen und Auswirkungen von Gewalt in der Notfallmedizin. Notf Rett Med 2021. [DOI: 10.1007/s10049-020-00726-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
ZusammenfassungMitarbeiter*innen in der präklinischen und klinischen Notfallmedizin sind regelmäßig mit gewalttätigem Verhalten konfrontiert. Auch wenn Definitionen und Studiendesigns sehr heterogen sind, handelt es sich um ein relativ gut im Ausmaß beschriebenes internationales Problem. Viele Mitarbeiter*innen akzeptieren gemachte Gewalterlebnisse, welche überwiegend verbaler Natur sind, als „Teil des Jobs“, obwohl sich diese gravierend auf ihre Arbeit und ihr Leben auswirken können. Der intoxikierte oder psychiatrisch erkrankte männliche Patient steht hierbei ursächlich im Vordergrund. Leider stellt das in der Notfallmedizin tätige Personal durch Unerfahrenheit im Erkennen und in der Interpretation konfrontativer Situationen sowie einen Mangel an kommunikativen Fähigkeiten oft unwissentlich einen Teil der Eskalationsspirale dar.
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24
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Camus D, Dan Glauser ES, Gholamrezaee M, Gasser J, Moulin V. Factors associated with repetitive violent behavior of psychiatric inpatients. Psychiatry Res 2021; 296:113643. [PMID: 33352415 DOI: 10.1016/j.psychres.2020.113643] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 12/10/2020] [Indexed: 11/27/2022]
Abstract
A small number of psychiatric inpatients displays a large proportion of Violent Behaviors (VB). These can have a major impact on both victims and patients themselves. This study explored personal, situational and institutional risk factors and their combined effects, which could lead to repetitive VB (three or more assaults). Data from 4518 patients, aged 18 to 65, admitted to an acute psychiatric care facility, were included in the analysis. VB, defined as physical aggressions against another person, were assessed by the Staff Observation Aggression Scale-Revised. 414 VB were reported during the study period, involving 199 patients. 0.75 % of all patients were repetitively violent and committed 43% of all VB. Factors that were linked to repetitive VB were living in sheltered housing before hospitalization, suffering from schizophrenia with substance abuse comorbidity, cumulating hospitalization days and some situational factors, like the fact of being in nursing offices and pharmacies. When all personal, situational and institutional factors were considered together, the combined effects of length of stay and living in sheltered housing increased the risk of repetitive VB. We have identified a small group of vulnerable patients for whom new modalities of inter-institutional networking should be developed to prevent repetitive VB.
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Affiliation(s)
- Didier Camus
- Department of Psychiatry, Site de Cery, 1008 Prilly, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
| | - Elise S Dan Glauser
- Unit for Research in legal Psychiatry and Psychology, Institute of Forensic Psychiatry, Department of psychiatry, Lausanne University Hospital (CHUV), Site de Cery, Bat. Les Cèdres, 1008 Prilly, Lausanne, Switzerland
| | - Mehdi Gholamrezaee
- Center for Psychiatric Epidemiology and Psychopathology, Department of Psychiatry, Site de Cery, 1008 Prilly, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
| | - Jacques Gasser
- Unit for Research in legal Psychiatry and Psychology, Institute of Forensic Psychiatry, Department of psychiatry, Lausanne University Hospital (CHUV), Site de Cery, Bat. Les Cèdres, 1008 Prilly, Lausanne, Switzerland.
| | - Valerie Moulin
- Unit for Research in legal Psychiatry and Psychology, Institute of Forensic Psychiatry, Department of psychiatry, Lausanne University Hospital (CHUV), Site de Cery, Bat. Les Cèdres, 1008 Prilly, Lausanne, Switzerland.
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Alomari AH, Collison J, Hunt L, Wilson NJ. Stressors for emergency department nurses: Insights from a cross-sectional survey. J Clin Nurs 2021; 30:975-985. [PMID: 33448044 DOI: 10.1111/jocn.15641] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 11/16/2020] [Accepted: 12/31/2020] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES This study aimed to profile stress, exploring whether demographics and/or other factors uniquely contribute to stress for emergency departments nurses. BACKGROUND Nursing has been identified as a stressful profession with the potential to have negative impacts on nurses' physical and mental health. Nurses working in emergency departments face unique daily stressors. DESIGN Cross-sectional survey using a correlational design. METHODS The survey was distributed in May 2019 to ED nurses working in New South Wales (NSW), Australia. A total of 242 nurses completed the survey, of which 190 cases were analysed. A standardised scale was used in the survey, the Expanded Nursing Stress Scale (ENSS). The sampling method for this research was non-probability purposive sampling. STROBE checklist was used for this manuscript. RESULTS The results of this study indicated that emergency department nurses experience stress in their work settings. Stress is experienced predominantly because of problems in dealing with patients and their families, high workloads, and uncertainty concerning treatment. CONCLUSIONS The results of this study provide valuable insights into the work-related stress experienced by emergency department nurses. This information can be used to inform the development of strategies to minimise stress for emergency nurses. RELEVANCE TO CLINICAL PRACTICE This study builds on existing, and contributes to new, knowledge about the current stressors for emergency department nurses. The results provide insights into how policies and procedures may need to be adjusted and interventions developed, that can help in reducing stress.
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Affiliation(s)
- Ali H Alomari
- School of Nursing and Midwifery, Western Sydney University, Sydney, New South Wales, Australia
| | - James Collison
- School of Social Sciences and Psychology, Western Sydney University, Sydney, New South Wales, Australia
| | - Leanne Hunt
- School of Nursing and Midwifery, Western Sydney University, Sydney, New South Wales, Australia
| | - Nathan J Wilson
- School of Nursing and Midwifery, Western Sydney University, Sydney, New South Wales, Australia
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Kelly EL, Fenwick KM, Brekke JS, Novaco RW. Sources of Social Support After Patient Assault as Related to Staff Well-Being. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP1003-NP1028. [PMID: 29294965 PMCID: PMC6445776 DOI: 10.1177/0886260517738779] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Patient assault is a serious issue for the well-being of staff in psychiatric hospitals. To guide workplace responses to patient assault, more information is needed about social support from different sources and whether those supports are associated with staff well-being. The present study examines social support after patient assault from work-based and nonwork-based sources, and whether inpatient psychiatric staff desires support from them and perceive the support received as being effective. Received support across sources was examined in relations to staff well-being (physical health, mental health, anger, sleep quality) and perceptions of safety. Survey data was collected from 348 clinical staff in a large public forensic mental hospital. Among the 242 staff who reported an assault in the last year, 71% wanted support and 72% found effective support from at least one source. Generally, effective support from supervisors, coworkers, and their combination was associated with better well-being. Support from nonwork sources was related to less concerns about safety, but not to other well-being measures. However, 28% of staff did not receive effective support from any source postassault. Gaps in support as reported in this study and as found by other investigators call for systematic programming by hospital organizations to enhance the well-being of clinical staff, which in turn has implications for patient care.
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Affiliation(s)
- Erin L Kelly
- University of Southern California, Los Angeles, USA
- University of California, Los Angeles, USA
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Enosh G, Freund A, Goldblatt H, Drach-Zahavy A, Guindy M, Ofer-Bialer G. Whose fault is it? Attribution of causes of patient violence among exposed and unexposed community-based family physicians. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:175-184. [PMID: 32627279 DOI: 10.1111/hsc.13080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 02/24/2020] [Accepted: 06/03/2020] [Indexed: 06/11/2023]
Abstract
Extensive research has dealt with violence directed at healthcare workers in hospital settings; however, few studies have examined community-based settings. Furthermore, there is also scant literature regarding the perceptions of healthcare providers who were exposed to violence, compared to those who were not. This study aims to narrow these gaps in the literature by examining community-based family physicians' (CBFPs) perceptions in a large national Health Maintenance Organisation (HMO) regarding patient-initiated violence. Using a voluntary online survey, directed at all CBFPs working at the HMO, 412 CBFPs were surveyed on the following issues: exposure to violence initiated by patients or their family members; perceptions of violent occurrences and possible safety measures. The differences between CBFPs who had been exposed to violence and those who had not were compared. The majority of CBFPs reported experiencing verbal attacks (64%), and a small percentage experienced property-related violence (11.7%) or physical violence (3.4%). Comparing CBFPs who were exposed to violence with those who were not, regarding their perceptions of the 'causes of violence', revealed three differentiating factors: 'waiting time', 'failure to meet the patient's expectations' and 'the nature of the physician-patient encounter'. Regarding the desired preventive actions, the four differentiating factors were as follows: 'reduction in the number of patients per physician', 'improved queue management processes', 'longer meetings' and 'violence prevention training'. Conducting separate analyses, according to violence type (verbal abuse, vandalism or physical violence), indicated finer differentiations. In terms of Attribution Theory, one might argue that CBFPs who were directly exposed to patients' aggression attributed internal locus to the attacker, and tended to blame the attacker's personal characteristics and cultural values. Conversely, family CBFPs who were not attacked attributed external locus to situational factors such as waiting time, not receiving service, and the nature of the interaction between the attacker and the CBFP.
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Lickiewicz J, Jagielski P, Hughes PP, Makara-Studzińska M. The Gender-Related Impact of a Violence Management Training Program on Medical School Students-Preliminary Results. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17197130. [PMID: 33003429 PMCID: PMC7579454 DOI: 10.3390/ijerph17197130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 09/24/2020] [Accepted: 09/26/2020] [Indexed: 11/18/2022]
Abstract
Phenomenon: Patient aggression directed toward medical personnel, including medical school students during their internships, is an increasingly important issue. To minimize this phenomenon, violence management training programs were carried out. Approach: To assess the efficacy of a violence management training program among medical school students and evaluate changes in the perception of aggressive behavior in relation to the participants’ sense of self-efficacy and self-confidence by sex. A quasi-experimental examination of medical school students was performed before and after completion of a training program. Two hundred seventy-six students, including students of medicine, nursing, emergency medical services, and physiotherapy, participated in the study. Three standardized questionnaires were used: The Perception of Aggression Scale (POAS), the Hope for Success Questionnaire (HSQ), and the General Self -Efficacy Scale (GSES). Findings: The training program had a positive impact on the sense of self-efficacy in both men and women. However, the perception of aggressive behavior changed only in women and the impact of such intervention was higher for women. Further studies should look at the long-term outcomes.
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Affiliation(s)
- Jakub Lickiewicz
- Department of Health Psychology, Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University Medical College, 31-501 Krakow, Poland;
- Correspondence: ; Tel.: +48-12-430-32-05
| | - Paweł Jagielski
- Department of Nutrition and Drug Research, Jagiellonian University Medical College, 31-501 Krakow, Poland;
| | - Patricia Paulsen Hughes
- College of Education, Health, and Aviation, Oklahoma State University, Stillwater, OK 74078, USA;
| | - Marta Makara-Studzińska
- Department of Health Psychology, Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University Medical College, 31-501 Krakow, Poland;
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Folgo AR, Iennaco JD. Staff perceptions of risk factors for violence and aggression in ambulatory care. Work 2020; 65:435-445. [PMID: 32007986 DOI: 10.3233/wor-203096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Management of violent acts of patients and their visitors in psychiatric and hospital settings has been studied. However, violence has not yet been addressed in the ambulatory care environment. OBJECTIVE To identify potential risk factors for patient and visitor violence [PVV] and staff perceptions of the impact of these risk factors in ambulatory care. METHODS A review of psychiatric inpatient research was conducted examining violence and aggression including risk factors for PVV. Identified risk factors for violence were incorporated into a survey tool and distributed to staff in a community clinic asking for their perception of the impact of these risk factors on aggression in their work environment. RESULTS Risk factors for violence and aggression were categorized as static or dynamic or as related to characteristics of staff or the environment of care. All of the risk factors were identified as possible contributors to PVV by the staff while items related to substance abuse and the clinic environment were selected by the staff as "highly likely" to contribute to PVV in their setting. CONCLUSIONS Continued research is needed in this area to better understand risk factors for PVV and develop appropriate safety interventions and crisis training for ambulatory care settings.
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Fan QQ, Feng XQ, Jin JF. Nursing rounds: A quality improvement project to improve outpatient satisfaction. J Nurs Manag 2020; 29:177-185. [PMID: 32780532 DOI: 10.1111/jonm.13131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 08/05/2020] [Accepted: 08/07/2020] [Indexed: 01/02/2023]
Abstract
AIM To implement the nursing rounds to improve the quality and patient satisfaction of the outpatient department. BACKGROUND Patient satisfaction is one of the most critical standards for judging the quality of hospitals. Clinical daily nursing rounds significantly increase patient satisfaction and influence safety. METHOD SQUIRE guidelines directed the execution of a quality improvement project, which used the Driver Model to improve patient satisfaction in a Chinese outpatient department with 15,000 visits per day (4 million/year). Patient satisfaction based on questionnaires (1,541), pre-intervention and (1,219) post-intervention provided increased satisfaction (p < .05). RESULTS Improvements validated were satisfaction with outpatient services from patients, effective nurse-patient communications, an increase in the quality of nursing care, doctors' satisfaction with the outpatient department operations, reduced wait time and more efficient management, all impact safety. CONCLUSIONS The institution of daily nursing rounds made an overall improvement in the operations of the outpatient department, which increased patient satisfaction, quality of care and safety. IMPLICATIONS FOR NURSING MANAGEMENT Nursing rounds promote patient satisfaction through assessment of operations, addressing patient and staff needs, and appropriate interventions to rectify issues and reduce adverse outcomes. Patient satisfaction impacts quality, outcomes and safety in clinical settings.
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Affiliation(s)
- Qing Qiu Fan
- Outpatient Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Xiu Qin Feng
- Nursing Department, The 2nd Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Jing Fen Jin
- Nursing Department, The 2nd Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
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31
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O'Sullivan OP, Chang NH, Njovana D, Baker P, Shah A. Quality improvement in forensic mental health: the East London forensic violence reduction collaborative. BMJ Open Qual 2020; 9:bmjoq-2019-000803. [PMID: 32928782 PMCID: PMC7488843 DOI: 10.1136/bmjoq-2019-000803] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 07/10/2020] [Accepted: 07/21/2020] [Indexed: 12/05/2022] Open
Abstract
Ward-based violence is the most significant cause of reported safety incidents at East London NHS Foundation Trust (ELFT). It impacts on patient and staff safety, well-being, clinical care and the broader hospital community in various direct and indirect ways. The contributing factors are varied and complex. Several factors differentiate the forensic setting, which has been identified as a particularly stressful work environment. Staff must constantly balance addressing therapeutic needs with robust risk management in a complex patient cohort. ELFT identified reducing inpatient physical violence on mental health wards as a major quality improvement (QI) priority. The aim was to use a QI methodology to reduce incidents of inpatient violence and aggression across two secure hospital sites by at least 30% between July 2016 and March 2018. Collaborative learning was central to this project. It sought to foster a culture of openness within the organisation around violence and to support service users and staff to work together to understand and address it. A QI methodology was applied in medium and low secure inpatient settings. A change bundle was tested for effectiveness, which included: safety huddles, safety crosses and weekly community safety discussions. Operational definitions for non-physical violence, physical violence and sexual harassment were developed and used. Reductions of 8% and 16.6% in rates of physical and non-physical violent incidents, respectively, were achieved and sustained. Compared with baseline, this equated to one less incident of physical and 17 less of non-physical violence per week averaged across seven wards. Three wards achieved at least a 30% reduction in incidents of physical violence per week. Five wards achieved at least a 30% reduction in incidents of non-physical violence per week. This collaborative brought significant improvements and a cultural shift towards openness around inpatient violence.
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Affiliation(s)
- Owen P O'Sullivan
- John Howard Centre, London, UK .,East London NHS Foundation Trust, London, UK
| | | | - Day Njovana
- John Howard Centre, London, UK.,East London NHS Foundation Trust, London, UK
| | - Philip Baker
- John Howard Centre, London, UK.,East London NHS Foundation Trust, London, UK
| | - Amar Shah
- John Howard Centre, London, UK.,East London NHS Foundation Trust, London, UK
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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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Maagerø-Bangstad ER, Sælør KT, Lillevik OG, Ness O. Exploring staff conceptions of prevention and management practices in encounters with staff-directed aggression in supported housing following education and training. Int J Ment Health Syst 2020; 14:60. [PMID: 32782470 PMCID: PMC7414712 DOI: 10.1186/s13033-020-00387-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 07/21/2020] [Indexed: 11/25/2022] Open
Abstract
Background Staff-directed aggression is a concern for service providers in mental healthcare, frequently affecting both the quality of services and staff wellbeing. This also applies to supported housing services for people with mental health problems. Staff themselves consider training to be an important route to improve the prevention and management of staff-directed aggression. The aims of this study are to explore how staff in community mental health supported housing services conceptualize practice in prevention and management of aggression and how these conceptions develop following a local education and training endeavor in disempowerment-sensitive, de-escalating and knowledge-based risk assessment and management. Method Phenomenography, a qualitative research approach, was adopted to pursue the study aims. The data consisted of 26 semi-structured interviews with 13 participants from five different municipal housing facilities in Oslo, Norway. Participants were interviewed on two occasions, once prior to participation and once subsequent to the finalization of the education and training sessions. Results The analysis led to the development of six qualitatively different, yet logically interrelated, categories of description regarding practice in encounters with staff-directed aggression: (1) Observation, alertness and awareness, (2) Established understanding and knowledge of service users, (3) Team-based risk management and deliberation, (4) Adaption of own dispositions and behaviors, (5) Reflexivity, sensitivity and care and (6) Involvement and dialogue. These conceptions were found to vary in meaning and focus; they ranged from implementing safeguarding and protective measures, to drawing on what was portrayed in terms of staff’s expert knowledge, to increasingly allowing for, and committing to, tenant perspectives in designing practice. The results indicate a moderate, yet beneficial, effect of the course on conceptual change in the participants. Conclusion This study shows that practice in encounters with staff-directed aggression is conceptualized as complex and multifaceted by staff in mental health supported housing services and that the various conceptions have different implications for the way staff-directed aggression is mitigated individually and collectively. Our findings also suggest that it is beneficial to take conceptual variation regarding practice into consideration when devising education and training aimed at enhancing staff knowledge, skills and practices.
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Affiliation(s)
- Erlend R Maagerø-Bangstad
- Dept. of Health and Social and Welfare Studies, Faculty of Health and Social Sciences, University of South-Eastern Norway, Centre for Mental Health and Substance Abuse, P.O. box 7053, 3007 Drammen, Norway
| | - Knut Tore Sælør
- Dept. of Health and Social and Welfare Studies, Faculty of Health and Social Sciences, University of South-Eastern Norway, Centre for Mental Health and Substance Abuse, P.O. box 7053, 3007 Drammen, Norway
| | - Ole Greger Lillevik
- Dept. of Health and Care Services, Faculty of Health Sciences, UiT The Arctic University of Norway, P.O. box 385, 8515 Narvik, Norway
| | - Ottar Ness
- Dept. of Health and Social and Welfare Studies, Faculty of Health and Social Sciences, University of South-Eastern Norway, Centre for Mental Health and Substance Abuse, P.O. box 7053, 3007 Drammen, Norway.,Dept. of Education and Lifelong Learning, Norwegian University of Science and Technology, P.O. box 8900, 7491 Trondheim, Norway
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34
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Halle C, Tzani-Pepelasi C, Pylarinou NR, Fumagalli A. The link between mental health, crime and violence. NEW IDEAS IN PSYCHOLOGY 2020. [DOI: 10.1016/j.newideapsych.2020.100779] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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35
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Who Cares for Visiting Nurses? Workplace Violence against Home Visiting Nurses from Public Health Centers in Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124222. [PMID: 32545730 PMCID: PMC7344994 DOI: 10.3390/ijerph17124222] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 06/08/2020] [Accepted: 06/09/2020] [Indexed: 11/16/2022]
Abstract
Visiting nurses are commonly exposed to workplace violence, but there is a lack of research on violence against these nurses. The purpose of this study was to identify visiting nurses’ workplace violence experiences during home visits. This study used a mixed method design. Survey data of 357 home visiting nurses from public health centers were collected for the quantitative data, and a focus group interview was conducted with six visiting nurses for the qualitative data. The quantitative data were analyzed using logistic regression, and the qualitative data were analyzed using content analysis. Younger, temporary visiting nurses and those who had previously been exposed to violent clients had a higher risk of workplace violence. The violence visiting nurses faced included not only violence during the visits but also unpredicted danger and harassment after the visit. After experiencing a violent event, visiting nurses’ attitudes and emotions changed toward nursing services. Visiting nurses were likely to deal with violence at the individual level given the insufficient organizational support system. An organizational-level safety management system should be established based on the characteristics of workplace violence risks and the nurses’ experiences in this study.
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36
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Goldblatt H, Freund A, Drach-Zahavy A, Enosh G, Peterfreund I, Edlis N. Providing Health Care in the Shadow of Violence: Does Emotion Regulation Vary Among Hospital Workers From Different Professions? JOURNAL OF INTERPERSONAL VIOLENCE 2020; 35:1908-1933. [PMID: 29294693 DOI: 10.1177/0886260517700620] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Research into violence against health care staff by patients and their families within the health care services shows a rising frequency of incidents. The potentially damaging effects on health care staff are extensive, including diverse negative psychological and physical symptoms. The aim of this qualitative study was to examine how hospital workers from different professions reacted to patients' and visitors' violence against them or their colleagues, and how they regulated their emotional reactions during those incidents. The research question was as follows: How do different types of hospital workers regulate the range of their emotional reactions during and after violent events? Participants were 34 hospital workers, representing several professional sectors. Data were collected through in-depth semistructured interviews, which were later transcribed and thematically content analyzed. Five themes were revealed, demonstrating several tactics that hospital workers used to regulate their emotions during incidents of violent outbursts by patients or visitors: (1) Inability to Manage Emotion Regulation, (2) Emotion Regulation by Distancing and Disengagement Tactics, (3) Emotion Regulation Using Rationalization and Splitting Tactics, (4) Emotion Regulation via the Use of Organizational Resources, and (5) Controlling Emotions by Suppression. Hospital workers who experienced dissonance between their professional expectations and their emotional reactions to patients' violence reported using various emotion regulation tactics, consequently managing to fulfill their duty competently. Workers who did not experience such dissonance felt in full control of their emotions and did not manifest responses of emotion regulation. Others, however, experienced intense emotional flooding and failed to regulate their emotions. We recommend developing health care staff's awareness of possible emotional implications of violent incidents, for themselves as people and for their intact functioning at work. In addition, we recommend further development of health care staff training programs for coping with violent patients and enhancement of formal and informal organizational support.
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Workplace Aggression and Burnout in Nursing-The Moderating Role of Follow-Up Counseling. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17093152. [PMID: 32369903 PMCID: PMC7246829 DOI: 10.3390/ijerph17093152] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/30/2020] [Accepted: 04/30/2020] [Indexed: 12/02/2022]
Abstract
The aim of this study is to obtain a better understanding of the association between the frequency of nurses’ exposure to workplace aggression from patients and their levels of burnout. In particular, we seek to shed light on the role of the availability of follow-up counseling in organizations after critical incidents in mitigating the adverse relationships between physical and verbal aggression and nurses’ burnout. A total of 582 nurses reported how frequently they had experienced physical and verbal aggression from patients in the last 12 months and whether they had the opportunity to receive follow-up counseling in their organization. In addition, nurses rated the extent to which they experienced each of the three dimensions of burnout (i.e., emotional exhaustion, depersonalization, and personal accomplishment). The results showed that both physical and verbal aggression were substantially related to the burnout dimensions. Furthermore, we found that the availability of follow-up counseling in organizations attenuated the relationships between physical aggression and all three burnout dimensions. While we found that the availability of follow-up counseling moderated the relationship between verbal aggression depersonalization, the moderating effects were not significant for emotional exhaustion and personal accomplishment. The findings indicate that the availability of follow-up counseling might help minimize the adverse impact of exposure to aggression from patients on nurses’ mental health.
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Chaimowitz GA, Mamak M, Moulden HM, Furimsky I, Olagunju AT. Implementation of risk assessment tools in psychiatric services. J Healthc Risk Manag 2020; 40:33-43. [PMID: 32301249 DOI: 10.1002/jhrm.21405] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Violence remains a major risk management concern in psychiatric services with implications on the safety and well-being of patients, staff, and the public. Serious physical and psychological consequences of violence involving property damage, bodily injuries, and threat to life have been reported in mental health services. Risk assessment tools are important safeguard measures; however, research on clinical implementation is presently limited. Structured professional judgment (SPJ) risk management tools that incorporate professional discretion with analytical understanding of evidence-based risk factors are widely accepted for risk assessment. However, clinical utility is suboptimal due to several barriers, including those related to the tool, the clinical setting, and resistance from health professionals. To better understand the challenges militating against optimal implementation of risk assessment tools, we reviewed and presented some lessons from the implementation of clinical practice guidelines on a general scale and our experience implementing an SPJ tool called Hamilton Anatomy of Risk Management across a variety of psychiatric services. In summary, the clinical utility of risk assessment tools improves if the tool is psychometrically sound, concise, consensus rated, time efficient, and practical for planning risk management. User feedbacks on the tool utility are also important to sustain implementation.
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Affiliation(s)
- Gary A Chaimowitz
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada.,Department of Psychiatry and Behavioral Neurosciences, St Joseph Healthcare Hamilton, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada
| | - Mini Mamak
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada.,Department of Psychiatry and Behavioral Neurosciences, St Joseph Healthcare Hamilton, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada
| | - Heather M Moulden
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada.,Department of Psychiatry and Behavioral Neurosciences, St Joseph Healthcare Hamilton, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada
| | - Ivana Furimsky
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada.,Department of Psychiatry and Behavioral Neurosciences, St Joseph Healthcare Hamilton, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada
| | - Andrew T Olagunju
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada.,Department of Psychiatry and Behavioral Neurosciences, St Joseph Healthcare Hamilton, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada.,Department of Psychiatry, College of Medicine, University of Lagos, PMB 12003, Lagos, 100213, Nigeria
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Aggression and Violence Toward Healthcare Workers in a Psychiatric Service in Italy: A Retrospective Questionnaire-Based Survey. J Nerv Ment Dis 2020; 208:299-305. [PMID: 32221184 DOI: 10.1097/nmd.0000000000001126] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Workplace violence and aggression are receiving increasing attention, especially when perpetrated in at-risk services such as psychiatric and emergency departments. Many healthcare providers have been victims of verbal aggressions (VAs) and physical aggressions (PAs), as well as injuries (INs), at the hands of patients. We conducted a 1-year retrospective questionnaire-based survey to assess workplace violence and aggression experienced by staff working at the Psychiatric Service of the Health District of Bolzano-Bozen (Italy). We performed parametric statistics. Logistic regression estimated the size of the association between PA occurrence and staff characteristics. Our psychiatric service's employees were frequent victims (91.5%) of 1 or more aggression/injury in the previous year. VAs and INs showed comparable frequencies among the three sites of our service, that is, the inpatient (INP), the outpatient (OUTP), and the rehabilitation (REHAB) units, differently from PAs, which were more common at INP (p < 0.001). The logistic regression model showed that female sex, working at INP, and a shorter psychiatry work experience predicted PAs occurrence. Most of the staff felt they could benefit from aggression management. Findings show that VAs, PAs, and INs are common among our psychiatric service's employees and point to the need to provide staff training on de-escalation.
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40
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Hacer TY, Ali A. Burnout in physicians who are exposed to workplace violence. J Forensic Leg Med 2020; 69:101874. [DOI: 10.1016/j.jflm.2019.101874] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 10/02/2019] [Accepted: 10/11/2019] [Indexed: 11/28/2022]
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41
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Li W, Yang Y, Hong L, An FR, Ungvari GS, Ng CH, Xiang YT. Prevalence of aggression in patients with schizophrenia: A systematic review and meta-analysis of observational studies. Asian J Psychiatr 2020; 47:101846. [PMID: 31715468 DOI: 10.1016/j.ajp.2019.101846] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/15/2019] [Accepted: 10/15/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Aggression is common in patients with schizophrenia and is clinically significant, but its prevalence is inconsistent across studies. This is a meta-analysis of the prevalence of aggression and its associated factors in patients with schizophrenia. METHODS PubMed, EMBASE, PsycINFO, the Cochrane Library, Medline and Web of Science databases were systematically searched. Studies that reported the prevalence of aggression in patients with schizophrenia using the Modified Overt Aggression Scale (MOAS) were included and analyzed using the random-effects model. RESULTS Fifteen studies with 4855 patients were initially included; of these, 13 studies with 3929 patients were pooled in the final meta-analysis. The pooled prevalence of aggression was 33.3% (95%CI: 21.5%-47.7%); specifically, the estimated prevalence of verbal, property-oriented, auto and physical aggression were 42.6% (95%CI: 17.0%-72.9%), 23.8% (95%CI: 10.1%-46.4%), 23.5% (95%CI: 6.5%-57.7%), and 23.7% (95%CI: 10.4%-45.3%), respectively. Subgroup analyses revealed that different MOAS cut-off values (P < 0.001) and source of patients (inpatients vs. community-dwelling patients) significantly moderated the results (P < 0.001). Meta-regression analyses found that studies published recently reported higher aggression rate, while higher quality assessment score was associated with lower aggression rate (both P < 0.01). CONCLUSIONS This meta-analysis confirmed that aggression is common in schizophrenia patients. Considering the significant clinical risk issues, appropriate treatments and effective management of aggression in this population need to be developed.
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Affiliation(s)
- Wen Li
- Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China; Center for Cognition and Brain Sciences, University of Macau, Macao SAR, China
| | - Yuan Yang
- Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China; Center for Cognition and Brain Sciences, University of Macau, Macao SAR, China; Department of Psychiatry and Psychology, Southern Medical University Nanfang Hospital, Guangdong, China
| | - Liu Hong
- Department of Psychiatry, WuZhongpei Memorial Hospital, Guangdong province, China; Graduate School of Guangdong Medical University, Guangdong province, China
| | - Feng-Rong An
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Gabor S Ungvari
- University of Notre Dame Australia, Fremantle, Australia; Division of Psychiatry, School of Medicine, University of Western Australia, Perth, Australia
| | - Chee H Ng
- Department of Psychiatry, The Melbourne Clinic and St Vincent's Hospital, University of Melbourne, Richmond, Victoria, Australia
| | - Yu-Tao Xiang
- Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China; Center for Cognition and Brain Sciences, University of Macau, Macao SAR, China.
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Yeh TF, Chang YC, Feng WH, sclerosis M, Yang CC. Effect of Workplace Violence on Turnover Intention: The Mediating Roles of Job Control, Psychological Demands, and Social Support. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2020; 57:46958020969313. [PMID: 33334214 PMCID: PMC7750754 DOI: 10.1177/0046958020969313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/27/2020] [Accepted: 10/03/2020] [Indexed: 11/16/2022]
Abstract
Exposing nursing staff to workplace violence workplace violence (WV) affects their psychological, emotional, and physical health; engenders increased workload; affects the medical reciprocity between nurses and patients; and ultimately leads to staff turnover intention. To preventing WV, development of intervention strategies and WV prevention measures are crucial. This study discusses the mediating effect of job control, psychological needs, and social support on WV and turnover intention. Through this discussion, this study aims to aid medical institutions in reducing their nursing staff turnover rate and to provide a reference for hospital management and decision making. A cross-sectional research method was adopted and conducted quantitative research to prove the complexity of the relationship between WV and turnover intention. Participants comprised clinical nurses working in 2 regional teaching hospital in central Taiwan. A total of 268 questionnaires were distributed, and 213 completed questionnaires were returned. Of the returned questionnaires, 198 contained valid responses, yielding a response rate of 73.9%. Our results demonstrated the mechanisms through which psychological demands and social support mediate the relationship between WV and turnover intention. This study determined the mediating effects of psychological demands and social support. The results expand the findings of previous research and demonstrate the complexity of the relationship between WV and turnover intention. Hospitals should formulate effective mechanisms for preventing and addressing incidents of WV, improve their ability to address and regulate violent incidents in clinics, reduce the psychological pressure exerted on employees, and establish communication channels for social support.
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Affiliation(s)
- Te-Feng Yeh
- Central Taiwan University of Science and
Technology, Taichung
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43
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Granek L, Ben-David M, Bar-Sela G, Shapira S, Ariad S. "Please do not act violently towards the staff": Expressions and causes of anger, violence, and aggression in Israeli cancer patients and their families from the perspective of oncologists. Transcult Psychiatry 2019; 56:1011-1035. [PMID: 30051769 DOI: 10.1177/1363461518786162] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Expressions of anger within the healthcare context are a common occurrence, particularly in clinical situations where patients can experience emotional distress in the face of illness. The purpose of this study was to examine one aspect of this phenomenon by looking at expressions and causes of anger among Israeli cancer patients and their families from the perspective of oncologists who treat them. Twenty-two Israeli oncologists were interviewed from three oncology centers between March 2013 and June 2014. The grounded theory method was used to collect and analyze the data. Our study revealed that oncologists are exposed to and cope with expressions and acts of anger, aggression, and violence from some of their cancer patients and their families. The causes of this anger include physician blame, unrealistic treatment expectations, perceived errors in communication, and lack of follow up with bereaved families. Our study also revealed that the cultural context affected patient-physician interactions, including anger. This context included a culture that has open interpersonal boundaries and is family-oriented; a multicultural society that includes citizens with different cultural norms and expectations around cancer care; and a strained healthcare system that leaves oncologists limited in time and resources, including limited access to palliative care. Policy implications include reducing oncologist workload by hiring more mental health professionals, having translators available on site to help with language barriers, reducing administrative burdens, and incorporating palliative care widely to help with the psychosocial and physical care of patients and families.
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Affiliation(s)
| | | | - Gil Bar-Sela
- Rambam Health Care Campus and Rappaport Faculty of Medicine & The Technion-Israel Institute of Technology
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Geoffrion S, Goncalves J, Marchand A, Boyer R, Marchand A, Corbière M, Guay S. Post-traumatic Reactions and Their Predictors among Workers Who Experienced Serious Violent Acts: Are There Sex Differences? Ann Work Expo Health 2019; 62:465-474. [PMID: 29548023 DOI: 10.1093/annweh/wxy011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 02/08/2018] [Indexed: 11/13/2022] Open
Abstract
Background Serious violent acts (e.g. physical violence, robbery, sexual aggression and death threats) are among the most visible and notable examples of workplace violence. Although women are commonly found to be at higher risk for post-traumatic reactions following workplace violence, little is known as regards sex differences concerning the types of post-traumatic reactions and their predictors. Objective This study aimed to describe sex differences in the post-traumatic reactions of serious violent acts and the predictors of such reactions. Methods The study was conducted among a convenience sample of 2889 French-speaking workers from Quebec, Canada by using a self-administrated survey. Linear regression modelings and post-hoc comparisons of coefficients according to the sex of the respondents were used to achieve the objective. Results Preliminary results confirmed that while men are more exposed to violence at work, women experience a greater number of post-traumatic reactions. Women were more affected by flashbacks, avoidance, and hypervigilance than men. The results also showed that being victimized by a male aggressor was associated with a greater number of post-traumatic reactions for women, whereas being victimized by an insider (e.g. colleague, supervisor, employee) was associated with a greater number of post-traumatic reactions for both sexes. Implications These findings highlight the necessity to better consider sex as a potential determinant of mental health in studies on workplace violence.
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Affiliation(s)
- Steve Geoffrion
- Trauma Studies Centre-Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, rue Hochelaga, Montreal, Canada.,School of Psychoeducation, Université de Montréal, Succursale Centre-Ville, Montreal, Canada
| | - Jane Goncalves
- Trauma Studies Centre-Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, rue Hochelaga, Montreal, Canada
| | - André Marchand
- Trauma Studies Centre-Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, rue Hochelaga, Montreal, Canada.,Department of Psychology, Université du Québec à Montréal, succursale Centre-ville, Montreal, Canada
| | - Richard Boyer
- Research Centre-Institut Universitaire en Santé Mentale de Montréal, rue Hochelaga, Montreal, Canada
| | - Alain Marchand
- School of Industrial Relations, Université de Montréal, succursale Centre-Ville, Montreal, Canada
| | - Marc Corbière
- Research Centre-Institut Universitaire en Santé Mentale de Montréal, rue Hochelaga, Montreal, Canada.,Department of Education and Pedagogy, Université du Québec à Montréal, succursale Centre-ville, Montreal, Canada
| | - Stéphane Guay
- Trauma Studies Centre-Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, rue Hochelaga, Montreal, Canada.,School of Criminology, Université de Montréal, succursale Centre-ville, Montreal, Canada
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45
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Ellison JM, Colvonen PJ, Haller M, Norman SB, Angkaw AC. Examining the relation between PTSD and insomnia on aggression. MILITARY PSYCHOLOGY 2019. [DOI: 10.1080/08995605.2019.1598220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
| | - Peter J. Colvonen
- VA San Diego Healthcare System, San Diego, California
- Department of Psychiatry, University of California, San Diego, San Diego, California
- VA Center of Excellence for Stress and Mental Health, San Diego, California
| | - Moira Haller
- VA San Diego Healthcare System, San Diego, California
- Department of Psychiatry, University of California, San Diego, San Diego, California
| | - Sonya B. Norman
- VA San Diego Healthcare System, San Diego, California
- Department of Psychiatry, University of California, San Diego, San Diego, California
- VA Center of Excellence for Stress and Mental Health, San Diego, California
- National Center for PTSD, White River Junction, Vermont
| | - Abigail C. Angkaw
- VA San Diego Healthcare System, San Diego, California
- Department of Psychiatry, University of California, San Diego, San Diego, California
- National Center for PTSD, White River Junction, Vermont
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Maagerø-Bangstad ER, Sælør KT, Ness O. Encountering staff-directed aggression within mental health and substance abuse services: exploring conceptions of practice following education. Int J Ment Health Syst 2019; 13:20. [PMID: 30984286 PMCID: PMC6444818 DOI: 10.1186/s13033-019-0277-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 03/20/2019] [Indexed: 11/10/2022] Open
Abstract
Background Staff-directed aggression represents a considerable concern in mental health and substance abuse services, and presents a substantial challenge to the quality and continuity of service provision for people with mental health and substance abuse problems. The practitioners themselves frequently request increased competence as a way to mediate the negative effects of staff-directed violence and aggression. The aim of this study is to explore how practitioners in municipal mental health and substance abuse services conceptualize practice in prevention and management of staff-directed violence. Furthermore, we seek to explore how these conceptions change following participation in two complementary and specially developed courses advancing respectively, qualified risk assessment and situational awareness and disempowerment-sensitive and de-escalation principles for practice. Method The study was conducted by using a qualitative phenomenographic research approach. The data-material comprised two-step semi-structured interviews with ten participants from various parts of community mental health and substance abuse services in the Municipality of Oslo, Norway. Results The analysis resulted in the development of five qualitatively different, hierarchically ordered, yet logically interrelated conceptual categories of practice concerning prevention and management of staff-directed aggression in community mental health and substance abuse services. These are: (1) Observation, reporting and expectation of organizational intervention, (2) Application of personalized de-escalating skills and behaviour, (3) Delivery of team-based and standardized services, (4) Provision of perceptive and responsive services, and (5) Facilitation of sensitive, involving and reflexive care. The categories vary according to the participants' attentional focus on either the responsibility of the organization, staff members' personally developed skills and techniques, team-based solutions, knowledgeable information processing in making professional judgements and reflexive, interpersonal service provision, as well as according to what meaning participants assign to practice. The authors have identified varying degrees of conceptual change following education in half of the participants. Conclusion The results of this study both show that practitioners conceptualize practice in aggressive encounters quite differently. The study also indicate that it is important to consider participant awareness of the phenomenon of interest when devising educational activities for personnel in mental health and substance abuse services.
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Affiliation(s)
- Erlend R Maagerø-Bangstad
- Faculty of Health and Social Sciences, Dept. of Health and Social and Welfare Studies, Centre for Mental Health and Substance Abuse, University of South-Eastern Norway, P.O. box 7053, 3007 Drammen, Norway
| | - Knut Tore Sælør
- Faculty of Health and Social Sciences, Dept. of Health and Social and Welfare Studies, Centre for Mental Health and Substance Abuse, University of South-Eastern Norway, P.O. box 7053, 3007 Drammen, Norway
| | - Ottar Ness
- Faculty of Health and Social Sciences, Dept. of Health and Social and Welfare Studies, Centre for Mental Health and Substance Abuse, University of South-Eastern Norway, P.O. box 7053, 3007 Drammen, Norway.,2Dept. of Education and Lifelong Learning, Norwegian University of Science and Technology, P.O. box 8900, 7491 Trondheim, Norway
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Honderich EM, Grunhaus CM, Martin CV. Counselors' Experiences of Workplace Aggression and Organizational Values: A Descriptive Analysis. COUNSELING AND VALUES 2019. [DOI: 10.1002/cvj.12097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Eleni M. Honderich
- College of Social and Behavioral SciencesWalden University Minneapolis
- Now at The Family InstituteNorthwestern University
| | - Colleen M. Grunhaus
- Department of School Psychology and Counselor Education, William & Mary
- Now at Department of Prevention ServicesNorth Carolina State University
| | - Clayton V. Martin
- Department of School Psychology and Counselor Education, William & Mary
- Now at Department of Psychology and CounselingAlvernia University
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Pelto-Piri V, Wallsten T, Hylén U, Nikban I, Kjellin L. Feeling safe or unsafe in psychiatric inpatient care, a hospital-based qualitative interview study with inpatients in Sweden. Int J Ment Health Syst 2019; 13:23. [PMID: 30996733 PMCID: PMC6452515 DOI: 10.1186/s13033-019-0282-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 04/02/2019] [Indexed: 01/19/2023] Open
Abstract
Background A major challenge in psychiatric inpatient care is to create an environment that promotes patient recovery, patient safety and good working environment for staff. Since guidelines and programs addressing this issue stress the importance of primary prevention in creating safe environments, more insight is needed regarding patient perceptions of feeling safe. The aim of this study is to enhance our understanding of feelings of being safe or unsafe in psychiatric inpatient care. Methods In this qualitative study, interviews with open-ended questions were conducted with 17 adult patients, five women and 12 men, from four settings: one general psychiatric, one psychiatric addiction and two forensic psychiatric clinics. The main question in the interview guide concerned patients' feelings of being safe or unsafe. Thematic content analysis with an inductive approach was used to generate codes and, thereafter, themes and subthemes. Results The main results can be summarized in three themes: (1) Predictable and supportive services are necessary for feeling safe. This concerns the ability of psychiatric and social services to meet the needs of patients. Descriptions of delayed care and unpredictable processes were common. The structured environment was mostly perceived as positive. (2) Communication and taking responsibility enhance safety. This is about daily life in the ward, which was often perceived as being socially poor and boring with non-communicative staff. Participants emphasized that patients have to take responsibility for their actions and for co-patients. (3) Powerlessness and unpleasant encounters undermine safety. This addresses the participants' way of doing risk analyses and handling unpleasant or aggressive patients or staff members. The usual way to act in risk situations was to keep away. Conclusions Our results indicate that creating reliable treatment and care processes, a stimulating social climate in wards, and better staff-patient communication could enhance patient perceptions of feeling safe. It seems to be important that staff provide patients with general information about the safety situation at the ward, without violating individual patients right to confidentiality, and to have an ongoing process that aims to create organizational values promoting safe environments for patients and staff.
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Affiliation(s)
- Veikko Pelto-Piri
- 1University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Tuula Wallsten
- 2Centre for Clinical Research, Uppsala University, County Hospital Västerås, Västerås, Sweden
| | - Ulrika Hylén
- 1University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | | | - Lars Kjellin
- 1University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Qiu T, Liu C, Huang H, Yang S, Gu Z, Tian F, Wu H. The mediating role of psychological capital on the association between workplace violence and professional identity among Chinese doctors: a cross-sectional study. Psychol Res Behav Manag 2019; 12:209-217. [PMID: 31114405 PMCID: PMC6474643 DOI: 10.2147/prbm.s198443] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 02/18/2019] [Indexed: 11/23/2022] Open
Abstract
Background: Workplace violence (WPV) and psychological capital (PsyCap) are linked to professional identity, however, little research has examined how WPV is associated with professional identity via PsyCap. This study is aimed to examine the association between WPV and professional identity, and to further explore whether PsyCap can serve as a mediator between WPV and professional identity among Chinese doctors. Materials and methods: A cross-sectional study was conducted from November to December in Liaoning Province in China, in 2017. The study used a questionnaire consisting of Workplace Violence Scale (WVS), Occupational Identity Scale (OIS), Psychological Capital Questionnaire (PCQ), as well as questions about demographic characteristics. Out of 1200 doctors, 995 (effective response rate of 82.92%) completed the questionnaire survey and became our final subjects. Hierarchical multiple regression and the asymptotic and resampling strategies were conducted to explore the mediating role of PsyCap in the relationship between WPV and professional identity. Results: After adjusting for demographic characteristics, WPV was negatively associated with professional identity (β=−0.37; P<0.01). Mediation analysis indicated that PsyCap was a mediator in the relationship between WPV and professional identity. Two dimensions of PsyCap: self-efficacy (a*b =−0.04, BCa 95% CI: (−0.08, −0.01); P<0.01) and hope (a*b =−0.04, BCa 95% CI: (−0.08, −0.01); P<0.01) also did exhibit mediating effects in the relationship between WPV and professional identity. The proportion of self-efficacy, hope and PsyCap mediation was 10.73%, 10.77%, 36.22% for professional identity respectively. Conclusion: These results provided evidence that PsyCap could mediate the association between WPV and professional identity. To increase the level of professional identity, positive interventions targeting PsyCap should be taken, with a focus on self-efficacy and hope.
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Affiliation(s)
- Tian Qiu
- Department of Social Medicine, School of Public Health, China Medical University, Shenyang, Liaoning Province, People's Republic of China
| | - Chunli Liu
- Department of Social Medicine, School of Public Health, China Medical University, Shenyang, Liaoning Province, People's Republic of China
| | - Hao Huang
- Department of Social Medicine, School of Public Health, China Medical University, Shenyang, Liaoning Province, People's Republic of China
| | - Shihan Yang
- Department of Social Medicine, School of Public Health, China Medical University, Shenyang, Liaoning Province, People's Republic of China
| | - Zhihui Gu
- Department of Social Medicine, School of Public Health, China Medical University, Shenyang, Liaoning Province, People's Republic of China
| | - Fangqiong Tian
- Department of Social Medicine, School of Public Health, China Medical University, Shenyang, Liaoning Province, People's Republic of China
| | - Hui Wu
- Department of Social Medicine, School of Public Health, China Medical University, Shenyang, Liaoning Province, People's Republic of China
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50
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Thompson J, Boden ZV, Newton EK, Fenton K, Hickman G, Larkin M. The experiences of inpatient nursing staff caring for young people with early psychosis. J Res Nurs 2019; 24:75-85. [PMID: 34394509 PMCID: PMC7932446 DOI: 10.1177/1744987118818857] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Early intervention services aim to improve outcomes for people with first episode psychosis and, where possible, to prevent psychiatric hospital admission. When hospitalisation does occur, inpatient staff are required to support patients and families who may be less familiar with services, uncertain about possible outcomes, and may be experiencing a psychiatric hospital for the first time. AIMS Our study aimed to understand the process of hospitalisation in early psychosis, from the perspective of inpatient nursing staff. We were particularly interested in their experiences of working with younger people in the context of adult psychiatric wards. METHODS Nine inpatient nursing staff took part in semi-structured interviews, which were transcribed and then analysed using interpretative phenomenological analysis. RESULTS Five themes are outlined: 'it's all new and it's all learning'; the threatening, unpredictable environment; care and conflict within the intergenerational relationship; motivation and hope; and coping and self-preservation. CONCLUSIONS The phenomenological focus of our approach throws the relational component of psychiatric nursing into sharp relief. We reflect on the implications for organisations, staff, families and young people. We suggest that the conventional mode of delivering acute psychiatric inpatient care is not likely to support the best relational and therapeutic outcomes.
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Affiliation(s)
- Jessica Thompson
- Clinical Psychologist, School of Psychology, University of Birmingham, UK
| | - Zoe Vr Boden
- Senior Lecturer, Department of Psychology, London Southbank University, UK
| | - Elizabeth K Newton
- Consultant Clinical Psychologist, Coventry and Warwickshire Partnership Trust
| | - Kelly Fenton
- Clinical Psychologist , Leicestershire Partnership NHS Trust, UK
| | - Gareth Hickman
- Senior Clinical Psychologist, Coventry and Warwickshire Partnership Trust, UK
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