Classifying Studies on Workplace Violence for Visiting Nurses Using the Social-Ecological Model: A Scoping Review

PURPOSE

To prevent workplace violence (WV) against visiting nurses (VNs), understanding the influencing factors is crucial. To better comprehend potential violence prevention strategies, the U.S. Centers for Disease Control and Prevention has presented the four-level social-ecological model (SEM) at the 1) individual, 2) relationship, 3) community, and 4) societal levels. This study aims to quantify WV studies against VNs, examine the influencing factors, identify gaps based on SEM levels, and propose future research and policy directions.

DESIGN

A scoping review was conducted following the five-stage protocol proposed by Arksey and O'Malley in 2005.

METHODS

Systematic searches, including manual searches, were performed using English and Korean databases. Published journal articles including editorials on WV against VNs were included, irrespective of the publication date.

FINDINGS

Sixty journal articles were finally selected. Until the 1990s, most of the literature comprised editorials, with empirical research emerging after the 2000s. Classifying studies by SEM level, many studies have focused on individual (86.7%) and community (66.7%) factors, but fewer have addressed relationship (21.7%) and societal (16.7%) factors.

CONCLUSIONS

The study revealed that much research has focused on individual-centered training, with gaps in risk assessment tool development, training incorporating relational aspects, standardized protocols, and understanding of the impact of legal rights and policies. This article advocates a comprehensive approach that considers all SEM levels to address WV against VNs.

CLINICAL EVIDENCE

The findings confirm a research gap, which suggests the direction for future research and policies. Stakeholders should be urged to implement evidence-based strategies that contribute to safer work environments for VNs.

Innovative services in home health nursing: a scoping review protocol

INTRODUCTION

Advances in the use of technology in home health nursing (HHN) not only can facilitate the delivery of home care but can also influence the entire healthcare system. Additionally, it can contribute to the individual autonomy in the area of health. The aim of this scoping review protocol is to identify, describe and map the types of innovative services and their delivery approaches in the HHN structure worldwide.

METHODS AND ANALYSIS

The main question of the research is as follows: what are different types of innovative services and their delivery approaches in the HHN structure around the world? The Joanna Briggs Institute (JBI) method for scoping reviews will guide the conducting this scoping review, and the participants, concept and context framework will be used as eligibility criteria. MEDLINE databases via PubMed, Embase, Cochrane Library, Scopus, Web of Science, Science Direct, Persian scientific databases and grey literature will be searched prior to May 2024 to include eligible studies, without any language restrictions. To be included, studies will be reviewed by two independent reviewers. A data extraction form developed for the study purpose will be used to extract the data relevant to the review questions. Data analysis will be performed based on each innovative service and answering the subquestions about it. According to the concepts of interest, the results will be analysed and presented using tables, figures, images and a narrative summary.

ETHICS AND DISSEMINATION

This study will not involve human or animal participants. Data will be sourced from the published literature. To be published, the results of the study will be submitted to an international peer-reviewed, open-access journal as well as scientific meetings on HHN and innovative services research.

Shifting the Safety Culture: Evaluation of a Novel Approach to Understanding and Responding to Workplace Harassment and Violence Experienced by Homecare Workers

BACKGROUND

Workplace violence and harassment are commonplace for healthcare workers and most incidents are unreported. Normalization of these experiences, lack of confidence in reporting systems, and fear of the consequences of reporting contribute to the invisibility of these experiences. Challenges are exacerbated in homecare settings and for precarious workforces including Personal Support Workers (PSWs). We created, piloted, and evaluated an intervention to enhance safety culture and encourage reporting of workplace violence and harassment.

METHODS

A multi-stakeholder steering committee designed an intervention combining policy changes, a pre-visit screening tool, education, and brief end-of-visit reporting. This was piloted with a PSW care team which provided >55,000 client visits during the 32-week intervention. Operational metrics characterized screening, education, and reporting uptake. Pre- and post-intervention surveys characterized PSWs' experiences with workplace violence and harassment, reporting experiences, training history and intervention feedback.

FINDINGS

PSWs reported increased comfort discussing workplace violence and harassment, and increased confidence managing client-to-worker incidents. The screening went smoothly with most clients in private homes. Most PSWs (75%) engaged at least once with end-of-visit reporting and nearly half submitted reports regularly. During the pilot, 21% of PSWs reported incidents and 52% of reports shared client-specific strategies for managing these situations.

APPLICATION TO PRACTICE

Changes in comfort and behavior with reporting indicated a shift toward a more open culture surrounding workplace violence and harassment. Tools created for this intervention and lessons for implementation are shared for consideration by occupational health practitioners throughout the homecare sector.

Spot It, Prevent It: Evaluation of a Rapid Response Algorithm for Managing Workplace Violence Among Home Care Workers

Background:

Workplace violence incidents remain pervasive in health care. Home care workers like personal support workers (PSWs) provide services for clients with dementia, which has been identified as a risk factor for workplace violence. The objective of this study was to evaluate whether the implementation of a rapid response algorithm resolved unsafe working conditions associated with responsive behaviors and decreased perception of risk.

Methods:

A nonexperimental pre- and post-evaluation design was utilized to collect data from PSWs and supervisors. PSWs completed an online survey about their experience with workplace violence and perception of risk. Bi-weekly check-ins were conducted with supervisors to track incidents and their level of resolution in the algorithm. Semi-structured interviews were also conducted to gather in-depth feedback about the algorithm in practice.

Findings:

We found no difference in risk perception among PSWs pre- and post-implementation. However, PSWs who had been employed for less than 1 year had a significantly higher risk perception. Overall, the algorithm was found to be helpful in resolving workplace violence incidents.

Conclusion and Application to Practice:

Opportunity exists to further refine the algorithm and ongoing dissemination, and implementation of the algorithm is recommended to continually address incidents of workplace violence. Newly hired PSWs may require additional supports. Ongoing education and training were identified as key mitigation strategies.

Determinants of violence towards care workers working in the home setting: A systematic review

Background

Home care is a rapidly growing industry. Violence towards home care workers is common, while also likely underreported. This violence adversely affects the physical and mental health of both workers and care recipients. The current study aims to identify and appraise recent evidence on the determinants of violence towards care workers working in the home setting.

Methods

Six electronic databases: the Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, Informit, Medline, PsycINFO, and Web of Science, were systematically searched. A systematic review was conducted in accordance with the Joanna Briggs Institute manual for evidence synthesis.

Results

A total of 18 papers met the inclusion criteria. All were cross‐sectional surveys. The majority of studies were from the United States. The most commonly investigated associations were those between the medical history of clients, workers' apprehension of violence, worker‐client relationship, or care plans, and any form of violence or verbal abuse.

Conclusion

Violence was common in clients with cognitive disorders, substance abuse disorder, and limited mobility; toward workers who feared that violence might happen; toward those who had very close or very distant worker‐client relationships; and when care plans were not inclusive of clients' needs. The current review highlights a gap in evidence on determinants of violence towards care workers working in the home setting, and suggests potential areas to be addressed to reduce such violence.

Home care workers' experiences of work conditions related to their occupational health: a qualitative study

Background

The need for home care workers (HCWs) is rapidly growing in Norway due to the increasingly growing elderly population. HCWs are exposed to a number of occupational hazards and physically demanding work tasks. Musculoskeletal disorders, stress, exhaustion, high sick leave rates and a high probability of being granted a disability pension are common challenges. This qualitative study explored the views of HCWs on how working conditions affect their safety, health, and wellbeing.

Methods

A descriptive and explorative design was utilised using semi-structured individual interviews with eight HCWs from three home care units in a middle-sized Norwegian city. Interviews were conducted in the Norwegian language, audio-recorded, and transcribed verbatim. The data was analysed by systematic text condensation. Key data quotes were translated into English by the authors.

Results

HCWs reported that meaningful work-related interactions and relationships contributed to their improved wellbeing. Challenging interactions, such as verbal violence by consumers, were deemed stressful. The unpredictable work conditions HCWs encounter in users’ homes contributed to their exposure to environmental hazards and unhealthy physical workloads. This was the case, although the employer promoted ergonomic work practices such as ergonomic body mechanics when mobilising and handling of clients, using safe patient handling equipment. HCWs perceived high level of individual responsibility for complying with company safety policies and practices, representing a health barrier for some. Organisational frameworks created unhealthy work conditions by shift work, time pressure and staffing challenges. Performing tasks in accordance with HCWs professional skills and identity was perceived as health-promoting.

Conclusions

This study suggests that unpredictable working conditions at users’ home can adversely affect the safety, health, and wellbeing of HCWs. The interaction between the unpredictable environment at users’ homes, HCWs’ perceived high level of individual responsibility for complying with company safety policies and practices, and staffing challenges due to sickness-related absences upon the workplace creates tense work conditions with a negative influence on HCWs health.

Simulation and coaching to prevent aggressive events in aged care: A pilot study

OBJECTIVES

Evaluation of simulation and coaching training to change ​the self-efficacy of aged care workers to prevent and manage workplace aggressive events.

METHODS

Seventeen aged care workers from a community and residential aged care service provider completed education modules and two half-days of simulation using actors and real-life scenarios, with real-time coaching. Carer self-efficacy to identify, prevent and manage anxiety and aggression was measured before, following and six months after training.

RESULTS

After training, participants reported significant improvements in preparedness to prevent and manage aggression, identify and manage triggers in their own behaviour, deflect and alter other triggers, and felt safer in the workplace. Six months after training, participants' self-efficacy remained above baseline for all measures and remained significantly improved for feeling safer in the workplace.

CONCLUSION

This pilot study supports high-fidelity simulation and coaching to improve the self-efficacy of aged care workers to prevent and manage workplace aggressive events.

Who Cares for Visiting Nurses? Workplace Violence against Home Visiting Nurses from Public Health Centers in Korea

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.

Workplace Violence Interventions Used by Home Healthcare Workers: An Integrative Review

The threat of workplace violence (WPV) is a significant occupational hazard for home healthcare workers (HHCWs). The purpose of this integrative review is to examine WPV interventions used by HHCWs to stay safe while working in the patient's home and community. The methodology used was the integrative review by , which allows for inclusion of experimental and non-experimental research, reflecting the state of the science on interventions used by HHCWs to mitigate and prevent WPV. A total of 17 articles pertained to interventions used by HHCWs. Interventions were further categorized by WPV Type. There are a number of interventions used for Type I and II WPV. However, interventions for Type III WPV are minimal and interventions for Type IV WPV are obsolete. Safety and health training were shown to be significant in increasing HHCWs' confidence and knowledge about WPV prevention. Researchers demonstrated safety and health training are effective in promoting a safe work environment and reducing incidents of WPV. This review begins to fill the gap in the literature on interventions used by HHCWs to mitigate and prevent WPV.

A communication skills intervention to minimise patient perpetrated aggression for healthcare support workers in New Zealand: A cluster randomised controlled trial

Healthcare support workers face challenging situations in their day-to-day work but may have minimal training on how to deal with such incidents. Although staff training is often recommended as an essential part of any comprehensive approach for preventing and managing workplace violence, there is paucity of evidence on the content and effectiveness of such training. This study aimed to evaluate the effect of an intervention (communication skills training) to reduce the experience of aggression for healthcare support workers. A two arm, cluster randomised, single-blinded, controlled trial among healthcare support workers in nongovernmental organisations (NGOs) and District Health Boards (DHBs) in New Zealand was conducted. The trial was conducted across 14 NGOs and DHB in Otago, Southland, and Auckland regions of New Zealand. One hundred and twenty-seven participants were randomised to one of two groups. Both the intervention (communication skills) and control condition (mindfulness) were group-based, fully scripted, and structured training interventions that consisted of four once weekly workshops that were facilitated by one of two nonclinical facilitators. Measurements of perceived aggression, psychological well-being, and distress and communication competence were taken pre-, post-, 3 months' post-, and 6 months' postintervention. There was a significant drop in the rate of aggression over time with a mean score and standard deviation of 10.37 (9.169) at baseline dropping to 6.07 (6.923) for the Perception of Patient Aggression Scale-New Zealand across both intervention and control. Equivalent results were noted with increased psychological well-being and communication competence and decreased distress with both interventions. This was sustained at 6 months' follow-up. However, the between groups effect did not demonstrate a statistically significant difference between the intervention and control groups. Both mindfulness and communication skills training can reduce the experience of aggression reported by healthcare support workers.

Incident Reporting by Health-Care Workers in Noninstitutional Care Settings

Patient-perpetrated violence and aggression toward health-care workers, specifically in noninstitutional health-care settings, cause concerns for both health-care providers and the clients whom they serve. Consequentially, this presents a public affairs problem for the entire health-care system, which the current research has failed to adequately address. While the literature overwhelmingly supports the assertion that accurate incident reporting is critical to fully understanding patient violence and aggression toward health-care providers, there is limited research examining provider decision making related to reporting incidents of patient violence and aggression targeted toward the provider. There is an even greater paucity of research specifically examining this issue in noninstitutional health-care settings. It is therefore the objective of this review to examine this phenomenon across disciplines and service settings in order to offer a comprehensive review of incident reporting and to examine rationales for providers reporting or failing to report instances of patient violence and aggression toward health-care providers.

Organizational Considerations for Supporting the Safety of Home Support Workers: Results From a Scoping Review

As the population ages, and more people are living at home with chronic conditions, there is an increasing need for home support workers (HSWs). Safety is a central concern for HSWs, and contributes to the recruitment and retention of HSWs and ultimately to a sustainable home care sector. This article reports on a scoping review that was conducted to assess the state of the literature related to the safety of HSWs. Studies were selected that address the central phenomenon and that were conducted from 2000 to 2015. One hundred twenty-six studies were included in the synthesis of findings. This article outlines two of the four major findings, those related to safety factors associated with home care organizations: (1) injury prevention initiatives and (2) human resource planning. The findings have important implications for developing strategies to address safety concerns for HSWs.

Healthcare Managers' Perceptions of Patient Perpetrated Aggression and Prevention Strategies: A Cross Sectional Survey

Patient or client aggression towards staff is a risk in healthcare. Healthcare takes place in a variety of settings, including hospitals, community, and Aged Care facilities. A minimal amount is known regarding the existence of safety and training measures available throughout the broad range of hospital and community healthcare services. A web-based survey of the type and frequency of violence experienced by healthcare staff was sent to unit managers working in mental health and older peoples' services of District Health Boards, Non-Governmental Organisations, and Aged Care facilities across New Zealand. One hundred and forty-one managers responded to the survey with a response rate of 79.21%. Managers reported high rates of verbal aggression and assaults against staff within their services. A total of 60% of respondents stated that an increase in assaults against staff was due to an increase in violent events and 43.1% related this to increased staff awareness and reporting of violent events to management. Communication skills and de-escalation training were provided across approximately 95% of organisations. The availability of safety measures including panic buttons, personal alarms, use of security personnel, and police assistance were more widely available and accessible within hospital settings and the community sector was found to mostly rely on police for assistance when violence occurs. The perception of violence is high in healthcare. Prevention and management training is provided in public hospital and aged care setting but not so much in NGOs. All areas of healthcare provision could benefit from increased evidence based aggression prevention programmes.