Interaction of Health Care Worker Health and Safety and Patient Health and Safety in the US Health Care System: Recommendations From the 2016 Summit

Patient Safety Culture: The Impact on Workplace Violence and Health Worker Burnout

BACKGROUND

Patient and health care worker safety is an interconnected phenomenon. To date, few studies have examined the relationship between patient and worker safety, specifically with respect to work safety culture. Therefore, we examined patient safety culture, workplace violence (WPV), and burnout in health care workers to identify whether patient safety culture factors influence worker burnout and WPV.

METHODS

This cross-sectional study used secondary survey data sent to approximately 7,100 health care workers at a large academic medical center in the United States. Instruments included the Hospital Survey on Patient Safety Culture, a WPV scale measuring physical and verbal violence perpetrated by patients or visitors, and the Emotional Exhaustion scale from the Maslach Burnout Inventory.

FINDINGS

These analyses included 3,312 (47%) hospital staff who directly interacted with patients. Over half of nurse (62%), physician (53%), and allied health professional respondents (52%) reported experiencing verbal violence from a patient, and 39% of nurses and 14% of physicians reported experiencing physical violence from a patient. Burnout levels for nurses (2.67 ± 1.02) and physicians (2.65 ± 0.93) were higher than the overall average for all staff (2.61 ± 1.0). Higher levels of worker-reported patient safety culture were associated with lower odds of WPV (0.47) and lower burnout scores among workers (B = -1.02). Teamwork across units, handoffs, and transitions were dimensions of patient safety culture that also influenced WPV and burnout.

CONCLUSIONS/APPLICATION TO PRACTICE

Our findings suggest that improvements in hospital strategies aimed at patient safety culture, including team cohesion with handoffs and transitions, could positively influence a reduction in WPV and burnout among health care workers.

Healthcare Workers' Mental Health in Pandemic Times: The Predict Role of Psychosocial Risks

Background

Healthcare workers perform an emotionally exhausting daily work activity, making them prone to occupational hazards, namely psychosocial ones. This study aims to assess the impact of psychosocial risk factors on healthcare workers' mental health.

Methods

A cross-sectional study was developed between May and June of 2021 with 479 healthcare workers from Portuguese hospitals. The Depression, Anxiety and Stress Scale was used to assess mental health, and psychosocial risks were assessed through the Health and Work Survey - INSAT. Statistical analysis was performed to identify the psychosocial risk factors related to anxiety, depression, and stress. Subsequently, a multiple linear regression was performed to identify the models that better explained psychosocial risk factors' relationship with anxiety, depression, and stress.

Results

Data showed a strong exposure to psychosocial risks. Work pace and intensity, work relationships, and emotional demands stood out with higher global average percentages for yes answers to "exposure and discomfort." The analysis of the β values and p-values from the multiple linear regression shows that some cross-sectional psychosocial risks are predictors of anxiety and stress dimensions, and other psychosocial risks differ in the two mental health dimensions. However, it is important to highlight that healthcare workers still showed great joy and pleasure in performing their work activities.

Conclusion

Support network development in the work environment is needed to prevent healthcare workers' emotional stress and promote their psychological well-being. Therefore, new research is essential to understand the psychosocial risks that affect healthcare workers and assess the less visible effects of work-health relationships.

Workplace Violence in Healthcare Settings: Work-Related Predictors of Violence Behaviours

Healthcare workers are exposed to workplace violence such as physical assaults, psychological violence and threats of violence. It is crucial to understand factors associated with workplace violence to prevent and mitigate its consequences. This study aims to identify work-related factors that might influence workplace violence in healthcare settings. A cross-sectional study was developed between March and April of 2022 with healthcare workers. The Aggression and Violence at Work Scale was used to assess workplace violence, and psychosocial risks were assessed through the Health and Work Survey—INSAT. Statistical analysis using bivariate analysis was performed to identify the psychosocial risk factors related to physical violence, psychological violence and vicarious violence. Subsequently, a multiple linear regression was performed to identify the models that better explained the relationship between psychosocial risk factors and the three dimensions of violence. Psychological violence was frequently experienced by the healthcare workers. Significant associations were found between psychosocial risk factors and physical, psychological and vicarious violence, namely working hours, work relationships, employment relations, high demands and work intensity. These findings highlight the importance of taking into consideration work-related factors when designing interventions to prevent and address workplace violence in healthcare settings.

Association between the nurse-led program with mental health status, quality of life, and heart failure rehospitalization in chronic heart failure patients

ABSTRACT

The nurse-led program is associated with a short-term improvement of mental health status (MHS) and quality of life (QOL) in patients with chronic heart failure (CHF). Nonetheless, the long-term effect of this program is undetermined. The aims of the current study were to evaluate the 1-year effects of the nurse-led program on MHS, QOL, and heart failure (HF) rehospitalization among patients with CHF.CHF patients in the control group received standard care, and patients in the treatment group received standard care plus telehealth intervention including inquiring patients' medical condition, providing feedbacks, counseling and providing positive and emotional talk with the patients. At the third, sixth, and twelfth month's follow-up, patients were called by registered nurses to assess the Mental Health Inventory-5 (MHI-5) and Kansas City Cardiomyopathy Questionnaire (KCCQ) scores. HF rehospitalization was also assessed.A total of 300 patients were included and 46% (n = 138) of the patients were in the treatment group. There were no significant between-group differences in the MHI-5 and KCCQ scores at baseline. In the control group, the MHI-5 score was gradually decreased with follow-up and the score was significantly lower than that in the treatment group since the third month's follow-up (63.5 ± 10.6 vs 73.6 ± 10.3). Compared with the treatment group, KCCQ score was lower in the control group from the third month's follow-up (64.3 ± 10.6 vs 73.5 ± 12.3) until the end of the twelfth months' follow-up (45.3 ± 11.2 vs 60.8 ± 11.1). During 12 months' follow-up, the proportion of patients who experienced HF rehospitalization was lower in the treatment group (19.6% vs 24.1%). After adjusting for covariates, the utilization of the nurse-led program, and increase of MHI-5 and KCCQ scores were associated with reduced risk of HF rehospitalization.The nurse-led program is beneficial for the improvement of MHS and QOL for CHF patients, which might contribute to the reduction of HF rehospitalization.

Analysing how changes in the health status of healthcare workers affects epidemic outcomes

During a disease outbreak, healthcare workers (HCWs) are essential to treat infected individuals. However, these HCWs are themselves susceptible to contracting the disease. As more HCWs get infected, fewer are available to provide care for others, and the overall quality of care available to infected individuals declines. This depletion of HCWs may contribute to the epidemic's severity. To examine this issue, we explicitly model declining quality of care in four differential equation-based susceptible, infected and recovered-type models with vaccination. We assume that vaccination, recovery and survival rates are affected by quality of care delivered. We show that explicitly modelling HCWs and accounting for declining quality of care significantly alters model-predicted disease outcomes, specifically case counts and mortality. Models neglecting the decline of quality of care resulting from infection of HCWs may significantly under-estimate cases and mortality. These models may be useful to inform health policy that may differ for HCWs and the general population. Models accounting for declining quality of care may therefore improve the management interventions considered to mitigate the effects of a future outbreak.

An analysis on the relationship between safety awareness and safety behaviors of healthcare professionals, Ankara/Turkey

OBJECTIVES

This descriptive study aims to examine the relationship between the safety awareness of healthcare professional and their safety behaviors.

METHODS

The study was carried out on 418 healthcare professionals working in a training and research hospital in Ankara/Turkey. The survey method was used as data collection tool. The questionnaire consisted of 3 sections and 18 questions. First section consisted of questions on sociodemographic characteristics and, second section consisted of the awareness scale and third section consisted of safety behaviors scale.

RESULTS

The safety awareness and safety behaviors are scored on a scale from 1 (completely disagree) to 5 (completely agree). The safety awareness and safety behaviors has an average score of 3.85 ± 0.81 and 3.56 ± 0.82, respectively. The safety awareness and safety behavior levels of healthcare professionals were found to be high.

CONCLUSION

A significant positive correlation was found between safety awareness and safety behaviors and it was concluded that the increase in safety awareness led to an increase in safety behavior.

Patient care aides: Differences in healthcare coverage, health-related behaviors, and health outcomes in a low-wage workforce by healthcare setting

OBJECTIVES

Patient care aides, who provide basic care to patients in a variety of healthcare settings, have been observed to have higher prevalences of adverse health metrics than the general US workforce. However, few studies have examined how healthcare access and health behaviors and outcomes among patient care aides differ by work setting (home health, nursing home, and hospital).

METHODS

Data from the 2013 to 2016 Behavioral Risk Factor Surveillance System were used to assess the prevalences of healthcare access, health-related behaviors, and health outcomes among patient care aides in different work settings, and among nurses (licensed vocational/practical and registered). Adjusted prevalence ratios were used to compare prevalences for healthcare workers to those for nonhealthcare clerical workers.

RESULTS

Overall, patient care aides are a low-wage workforce with high prevalences of multiple adverse health metrics and low prevalences of positive health behaviors compared to clerical workers. Results differed by work setting. Home health aides had the lowest income levels and most adverse results for multiple metrics; nursing home aides had better healthcare access and somewhat better health outcomes. Most metrics were best (though still quite poor) for hospital aides, who showed few significant differences from clerical workers.

CONCLUSIONS

These results show the need to focus resources on the patient care aide workforce, particularly those in home health. While some needs of nursing home aides, such as improving influenza vaccination coverage and reducing the prevalence of arthritis-related conditions, would benefit from standardized workplace interventions, alternate, workplace-specific approaches are needed for home health aides.

The effect of a workplace violence training program for generalist nurses in the acute hospital setting: A quasi-experimental study

BACKGROUND

Workplace violence prevalence has attracted significant attention within the international nursing literature. Little attention to non-mental health settings and a lack of evaluation rigor have been identified within review literature.

OBJECTIVES

To examine the effects of a workplace violence training program in relation to risk assessment and management practices, de-escalation skills, breakaway techniques, and confidence levels, within an acute hospital setting.

DESIGN

A quasi-experimental study of nurses using pretest-posttest measurements of educational objectives and confidence levels, with two week follow-up.

SETTING

A 440 bed metropolitan tertiary referral hospital in Sydney, Australia.

PARTICIPANTS

Nurses working in specialties identified as a 'high risk' for violence.

METHOD

A pre-post-test design was used with participants attending a one day workshop. The workshop evaluation comprised the use of two validated questionnaires: the Continuing Professional Development Reaction questionnaire, and the Confidence in Coping with Patient Aggression Instrument. Descriptive and inferential statistics were calculated. The paired t-test was used to assess the statistical significance of changes in the clinical behaviour intention and confidence scores from pre- to post-intervention. Cohen's d effect sizes were calculated to determine the extent of the significant results.

RESULTS

Seventy-eight participants completed both pre- and post-workshop evaluation questionnaires. Statistically significant increases in behaviour intention scores were found in fourteen of the fifteen constructs relating to the three broad workshop objectives, and confidence ratings, with medium to large effect sizes observed in some constructs. A significant increase in overall confidence in coping with patient aggression was also found post-test with large effect size.

CONCLUSIONS

Positive results were observed from the workplace violence training. Training needs to be complimented by a multi-faceted organisational approach which includes governance, quality and review processes.

Healthcare Workers: Occupational Health Promotion and Patient Safety

The purpose of the present study was to explore the relation of work-related risk factors and well-being among healthcare workers and the impact on patient safety, using the Health and Work Survey (INSAT) and Mental Health Continuum - Short Form (MHC-SF). A sample of 361 Portuguese healthcare workers participated in this study. The results indicate some significant work-related risk factors: for emotional well-being, Impossible to express myself (β = -0.977), Not having recognition by superiors (β = -1.028) and Have to simulate good mood and/or empathy (β = -1.007); for social well-being, Exposed to the risk of sexual discrimination (β = -2.088), Career progress is almost impossible (β = -1.518), and Have to hide my emotions (β = -2.307); finally for psychological well-being Exposed to the risk of sexual discrimination (β = -2.153), Career progress is almost impossible (β = -1.377), and Have to simulate good mood and/or empathy (β = -3.201). The results showed high levels of well-being despite the exposure of several risk factors at workplace. Regarding the work-related risk factors, the study showed that most of the participants are exposed to several risk factors at workplace (ranging from environmental risk factors, biological to physical), although psychosocial risk factors (work relations with superiors and colleagues, employment relations, and emotional demands) are the ones that most impact on well-being.