Incidence and recurrent work-related violence towards healthcare workers and subsequent health effects. A one-year follow-up study

Systematic Violence Monitoring to Reduce Underreporting and to Better Inform Workplace Violence Prevention Among Health Care Workers: Before-and-After Prospective Study

BACKGROUND

Monitoring workplace violence (WPV) against health care workers (HCWs) through incident reporting is crucial to drive prevention, but the actual implementation is spotty and experiences underreporting.

OBJECTIVE

This study aims to introduce a systematic WPV surveillance in 2 public referral hospitals in Italy and assess underreporting, WPV annual rates, and attributes "before" (2016-2020) and "after" its implementation (November 2021 to 2022).

METHODS

During 2016-2020, incident reporting was based on procedures and data collection forms that were neither standardized between hospitals nor specific for aggressions. We planned and implemented a standardized WPV surveillance based on (1) an incident report form for immediate and systematic event notification, adopting international standards for violence definitions; (2) second-level root cause analysis with a dedicated psychologist, assessing violence determinants and impacts and offering psychological counseling; (3) a web-based platform for centralized data collection; and (4) periodic training for workforce coordinators and newly hired workers. We used data from incident reports to estimate underreporting, defined as an observed-to-expected (from literature and the "before" period) WPV ratio less than 1, and the 12-month WPV rates (per 100 HCWs) in the "before" and "after" periods. During the latter period, we separately estimated WPV rates for first and recurrent events.

RESULTS

In the "before" period, the yearly observed-to-expected ratios were consistently below 1 and as low as 0.27, suggesting substantial violence underreporting of up to 73%. WPV annual rates declined in 1 hospital (from 1.92 in 2016 to 0.57 in 2020) and rose in the other (from 0.52 to 1.0), with the divergence being attributable to trends in underreporting. Available data were poorly informative to identify at-risk HCW subgroups. In the "after" period, the observed-to-expected ratio rose to 1.14 compared to literature and 1.91 compared to the "before" period, consistently in both hospitals. The 12-month WPV rate was 2.08 (95% CI 1.79-2.42; 1.52 and 2.35 in the 2 hospitals); one-fifth (0.41/2.08, 19.7%) was due to recurrences. Among HCWs, the youngest group (3.79; P<.001), nurses (3.19; P<.001), and male HCWs (2.62; P=.008) reported the highest rates. Emergency departments and psychiatric wards were the 2 areas at increased risk. Physical assaults were more likely in male than female HWCs (45/67, 67.2% vs 62/130, 47.7%; P=.01), but the latter experienced more mental health consequences (46/130, 35.4% vs 13/67, 19.4%; P=.02). Overall, 40.8% (53/130) of female HWCs recognized sociocultural (eg, linguistic or cultural) barriers as contributing factors for the aggression, and 30.8% (40/130) of WPV against female HCWs involved visitors as perpetrators.

CONCLUSIONS

A systematic WPV surveillance reduced underreporting. The identification of high-risk workers and characterization of violence patterns and attributes can better inform priorities and contents of preventive policies. Our evaluation provides useful information for the large-scale implementation of standardized WPV-monitoring programs.

Violence in Health Care: Trends and Disparities, Bureau of Labor Statistics Survey Data of Occupational Injuries and Illnesses, 2011-2017

Background: The health care sector is one of the most rapidly growing industry sectors in the United States. This study examined differences in the rates and trends of violent occupational injuries among health care workers in the United States. Methods: This study used data about violent occupational injuries among health care workers in the United States collected by the Bureau of Labor Statistics (BLS) Survey of Occupational Injuries and Illnesses (SOII). The BLS SOII collects data about injuries that result in at least one lost workday. Violent injuries are defined as intentional injury by another person. Data were obtained for years 2011 to 2017. We examined injury rates and trends according to industry and occupation, as well as age, sex, and race/ethnicity. Results: Intentional injuries increased among health care workers between 2011 and 2017. Rates, expressed as injuries per 10,000 workers, were particularly elevated in residential care facilities (44.07) and among health practitioner support technologists and technicians (22.54); nursing, psychiatric, and home health aides (28.13); and occupational therapy and physical therapist assistants and aides (39.72). Black health care support and practitioners workers had injury rates three times higher than White workers. Conclusions/Application to practice: Efforts should be made to address the increasing rates of intentional occupational injuries among health care workers. These efforts should focus on comprehensive programs enforcing policies for prevention and management (including reporting and training) and employee engagement in such efforts. High-rate industries and occupations should receive particular attention.

Recurrence of Violence Against Teachers: Two-Year Follow-Up Study

The objective of this study was to analyze whether the experience of violence by teachers in the school environment increases the risk of teachers suffering violence again within a 2-year period. This longitudinal study included 430 primary and secondary public school teachers from a city in the south of Brazil, with data collected at two time points: T1 (2012-2013) and T2 (2014-2015). The data were obtained via face-to-face interviews and the completion of a questionnaire. The forms of violence investigated included reports of insults from students, humiliation or embarrassment by colleagues or superiors, and threats and physical violence from any member of the school occurring in the 12 months prior to the study. McNemar's test and the Poisson regression with robust error variance were used in the analyses, and the relative risk (RR) and 95% confidence interval (95% CI) were calculated. After 2 years, there was a reduction in violence reported by the teachers from 65.4% (T1) to 56.9% (T2) (p = .003). Teachers who suffered a certain form of violence had three times the risk of suffering that type of violence again. Those who reported three or four forms of violence at T1 had an RR of 2.23 of suffering any form of violence at T2 (95% CI [1.70, 2.93]) compared with those who did not report violence at T1. Psychological violence at T1 was not associated with physical violence at T2, nor was physical violence at T1 associated with psychological violence at T2. Despite the reduction in violence against teachers reported at T2, some forms of violence remained stable after 2 years. Suffering more forms of violence increases the risk of suffering any future violence.

Can high workplace social capital buffer the negative effect of high workload on patient-initiated violence? Prospective cohort study

BACKGROUND

High workload seems to increase the risk of patient-initiated workplace violence (patient-initiated violence). However, the temporal association between workload and violence remains uncertain. Understanding the interplay of factors in the psychosocial working environment and patient-initiated violence is important to future preventive initiatives.

AIM

To assess whether a high workload increases the risk of patient-initiated violence, and whether intraorganizational relationships based on trust, reciprocity, justice and collaboration, known as workplace social capital, moderate this risk.

METHOD

Baseline survey data on 1823 social educators was collected followed by 12 monthly surveys on patient-initiated violence exposure. Poisson regressions, in mixed models, were conducted to assess the risk of violence at four levels of workload. Further, moderation analyses were conducted to assess the moderating effects of three sub-types of workplace social capital.

RESULTS

High and very high workload increased the risk of patient-initiated violence: RR = 1.5 [1.4-1.6], p < .001 and RR = 1.4 [1.3-1.4], p < .001. All three levels of workplace social capital had a moderating effect on the workload-violence association: Workload*Workplace social capital_(co-worker): F (3, 16,712) = 3.4, p = .017, Workload*Workplace social capital_{(local management)}: F (3, 16,748) = 11.9, p < .001, Workload*Workplace social capital_{(general management)}: F (3, 16,556) = 5.5, p < .001. Only high Workplace social capital _(co-workers) reduced the risk of violence at all levels of workload. Workplace social capital _{(general management)} reduced the risk of violence at high, medium and low workload, and Workplace social capital _{(local management)} reduced the risk of violence at medium and low workload.

CONCLUSION

High workload clearly increases the risk of patient-initiated violence. A high workplace social capital appears to be a viable protective factor and should be investigated further in studies of patient-initiated violence prevention.

'Don't show that you're scared': resilience in providing healthcare in a UK low-to-medium secure hospital

Background: Healthcare provision within specialist hospitals is associated with heightened levels of stress and burnout, risking negative implications for employees, organisations, and patients. Minimal research has focused on lower-skilled worker experiences. This study explores frontline care workers’ experience and perceptions of providing care within a low-to-medium secure hospital within the UK.

Method: Eight semi-structured interviews were conducted with healthcare assistants and mental health nurses (18–65 years) at a low-to-medium secure hospital. Thematic analysis (Braun & Clarke, 2006) was used to analyse the data.

Results: Three main themes are proposed: ‘Resilience to threat’ capturing the daily occurrence and normalisation of threat; ‘Need for support’ shows peer to peer talk as the primary coping mechanism but importantly, a possible disconnect between perceptions, and provision, of organisational support; finally, ‘Unique environment’ highlights the dual aspect of providing care and correction whilst coping with common challenges e.g. staff shortages.

Conclusions: Results provide insight into the pressures experienced by frontline healthcare workers alongside staff motivation to ‘make a difference’. Findings highlight some unique challenges of working in low-to-medium secure hospitals which contributes to negative outcomes for worker engagement, performance, and individuals’ mental and physical health. Implications for organisations and future practice are discussed.

Does acute stress disorder predict posttraumatic stress disorder following workplace violence? A prospective study of psychiatric staff

OBJECTIVES

Psychiatric staff is at risk of workplace violence (WV) and subsequent posttraumatic symptomatology. The current study assesses the prevalence of acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) in psychiatric staff following WV. This also examines the prospective association between ASD and PTSD.

METHODS

This is a prospective cohort study of staff from 18 psychiatric wards in Denmark (n = 250), that reported an incident of workplace violence.

RESULTS

The prevalence of ASD was 10.8%, while 8% had PTSD 3 months post-assault. Generalized linear mixed models showed a significant predictive power of ASD on PTSD (OR 8.45, p < 0.001) in the fully adjusted model.

CONCLUSIONS

ASD seems to be a predictor of future PTSD in an occupational context and should be considered a possible instrument in enactment of preventive strategies.

Poor Relationships and Physical Violence at School Are Associated With More Forms of Psychological Violence Among Brazilian Teachers: A Cross-Sectional Study

Our purpose was to identify individual and work-related factors that are associated with psychological violence (PV) and are related to a higher number of PV forms among teachers. This cross-sectional study included 789 elementary and high school teachers in a municipality in southern Brazil. Data were obtained through interviews and a self-administered questionnaire. PV was characterized by reports of insults from students, humiliation by colleagues or teachers, and threats in the 12 months preceding the study. Factors associated with the number of PV forms were also investigated. Poisson regression models were used for the analyses. More than half (64.1%) of the teachers reported at least one event of PV, 38.3% reported only one form, 21.5% reported two forms, and 4.3% reported all three surveyed forms. After adjustments, poor relationships with superiors or students and having suffered physical violence at school remained associated with at least one PV episode. The same variables were associated with the number of forms of PV, as were age (inverse relationship) and violence outside of school. The higher the number of aggregated factors, the more estimated forms of PV, particularly among the younger teachers. These results highlight the importance of adopting strategies that promote a nonviolent and safe school environment for teachers, which will in turn improve work conditions, the quality of education, and teachers' health.

Effects of Violence Prevention Behavior on Exposure to Workplace Violence and Threats: A Follow-Up Study

This longitudinal study investigates the relationship between prevention behaviors, that is, enacted violence prevention policies, and exposure to workplace violence and threats across four different high risk work sectors: psychiatry, special schools, eldercare, and the prison and probation services. Logistic regression analysis of a 1-year follow-up sample of 3.016 employees from these four sectors shows that prevention behaviors are significantly and negatively associated with self-reported exposure to workplace violence and threats-in the prison and probation services, eldercare, and in psychiatry, while no significant associations are found for special schools. The results therefore show clear sector differences with regard to the preventive effect of violence prevention behaviors. Furthermore, this multisector comparison suggests that prevention behaviors are more effective in relation to a moderate frequency of violence and threats, and that only top management prevention behavior can prevent very frequent incidents (odds ratio [ OR] = 0.58). This study contributes to the literature by use of a longitudinal design and acceptable response rates, while also simultaneously investigating several high risk sectors. The results imply that when managing workplace violence in high risk areas of human service work, there should be emphasis on the use of violence prevention behaviors from top management, supervisor, and among coworkers. However, type of sector and the frequency of workplace violence should be analyzed to evaluate the potential impact of prevention behaviors.

Workplace sexual harassment and depressive symptoms: a cross-sectional multilevel analysis comparing harassment from clients or customers to harassment from other employees amongst 7603 Danish employees from 1041 organizations

Background

Previous research has reported that sexual harassment can lead to reduced mental health. Few studies have focused on sexual harassment conducted by clients or customers, which might occur in person-related occupations such as eldercare work, social work or customer service work. This study examined the cross-sectional association between sexual harassment by clients or customers and depressive symptoms. We also examined if this association was different compared to sexual harassment conducted by a colleague, supervisor or subordinate. Further, we investigated if psychosocial workplace initiatives modified the association between sexual harassment by clients or customers and level of depressive symptoms.

Methods

We used data from the Work Environment and Health in Denmark cohort study (WEHD) and the Work Environment Activities in Danish Workplaces Study (WEADW) collected in 2012. WEHD is based on a random sample of employed individuals aged 18–64. In WEADW, organizational supervisors or employee representatives provided information on workplace characteristics. By combining WEHD and WEADW we included self-reported information on working conditions and health from 7603 employees and supervisors in 1041 organizations within 5 occupations. Data were analyzed using multilevel regression and analyses adjusted for gender, age, occupation and socioeconomic position.

Results

Exposure to workplace sexual harassment from clients or customers was statistically significantly associated with a higher level of depressive symptoms (2.05; 95% CI: 0.98–3.12) compared to no exposure. Employees harassed by colleagues, supervisors or subordinates had a higher mean level of depressive symptoms (2.45; 95% CI: 0.57–4.34) than employees harassed by clients or customers. We observed no statistically significant interactions between harassment from clients and customers and any of the examined psychosocial workplace initiatives (all p > 0.05).

Conclusions

The association between sexual harassment and depressive symptoms differed for employees harassed by clients or customers and those harassed by colleagues, supervisors or subordinates. The results underline the importance of investigating sexual harassment from clients or customers and sexual harassment by colleagues, supervisors or subordinates as distinct types of harassment. We found no modification of the association between sexual harassment by clients or customers and depressive symptoms by any of the examined psychosocial workplace initiatives.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-017-4669-x) contains supplementary material, which is available to authorized users.

The association between workplace bullying and depressive symptoms: the role of the perpetrator

Background

The aim of the present study was to investigate whether the depressive symptoms of the bullied respondents differed according to who the perpetrator was.

Methods

We used cross-sectional questionnaire data from two representative cohorts: the Danish Working Environment Cohort Study (DWECS 2010) and the Work and Health Study (WH 2012). After excluding respondents not having a leader, or being self-employed, assisting spouses, and those reporting multiple perpetrators in WH 2012, the statistical analysis included 2478 bullied individuals. We compared respondents reporting being bullied by their (1) leader, (2) subordinates, (3) clients / customers / patients / students, or (4) colleagues, respectively. The occurrence of depressive symptoms was measured by the Major Depression Inventory (MDI).

Results

The most frequent perpetrator of bullying was clients (41.5 %) in DWECS 2010 and colleagues (60.3 %) in WH 2012. In DWECS 2010, the MDI score of those being bullied by clients were significantly lower than the MDI scores of the other groups. In WH 2012, respondents who reported bullying from leaders had a significantly higher mean MDI score than participants being bullied by colleagues. Also in WH 2012, our results indicated that those who were bullied by leaders had a higher MDI score than those bullied by clients, although this difference was not statistically significant at conventional levels.

Conclusion

Our findings indicated a similar pattern in the two cohorts, with a tendency of more severe depressive symptoms among employees who are exposed to bullying by their leaders, and the least severe symptoms among those who are bullied by clients.

The impact of work-related physical assaults on mental health among Japanese employees with different socioeconomic status: The Japan Work Stress and Health Cohort Study (JSTRESS)

Background

Work-related physical assaults or violence has severely impacted on the safety of the work environment and employees’ mental health. The aim of the present study was to investigate the prevalence of physical assaults, the effect of socioeconomic status (SES) on it and depression associated with it in employees working at large companies.

Methods

A total of 22,770 Japanese employees responded to a self-administered questionnaire including SES (educational status and occupational status), violence victimization, worksite social support and depression (response rate, 85%). The 12-month prevalence of physical assaults and depression was examined using a single question and the Center for Epidemiologic Studies Depression scale, respectively.

Results

The prevalence of physical assaults was 1.8% both in males and females. Although the risk of exposure to physical assaults was 2–3 times higher in the blue-collar group than in the manager group, the association of exposure to physical assaults with depression was stronger in the manager and white-collar worker group (Prevalence ratio [PR]=2.1 in males; 1.8 in females) than in the blue-collar worker group (PR=1.7 in males; 1.5 in females) after adjusting demographic and occupational covariates. A similar pattern was observed for education in males; the association was stronger than in the lower education group (PR=2.1 and 1.8).

Conclusions

Low SES is a risk factor of exposure to physical assaults, however, the association of physical assaults with depression was significantly greater among company employees of higher SES than those of lower SES.

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1.8% of Japanese employees experience physical assaults during working time.

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Employees with low SES are at high risk for exposure to physical assaults.

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The impact of violence on depression is greater among employees with high SES.

Predictors of workplace violence among ambulance personnel: a longitudinal study

Aim

To examine predictors of repeated confrontations with workplace violence among ambulance personnel, the proportion of exposure to potentially traumatic events that are aggression‐related and to what extent personnel was able to prevent escalations. Although previous research assessed the prevalences among this group, little is known about predictors, to what extent PTE's are WPV‐related and their abilities to prevent escalations.

Design

A longitudinal study with a 6 months' time interval (N = 103).

Methods

At T1 demographics, workplace violence and potentially traumatic events in the past year, mental health, personality, handling of rules, coping and social organizational stressors were assessed. Confrontations with aggression were also examined at T2.

Results

Multivariate logistic regression analyses showed that only problems with superiors independently predicted repeated verbal aggression and that only the (absence of the) ability to compromise very easily predicted repeatedly being on guard and repeatedly confronted with any form of aggression. Due to very low prevalences, we could not examine predictors of repeated confrontations with physical aggression (N = 5) and serious threat (N = 7). A large majority reported that in most workplace violence cases they could prevent further escalations. About 2% reported a potentially traumatic event in the year before T1 that was WPV related and perceived as very stressful.

Trauma and the Effects on the Midwife

BACKGROUND:When practicing as a lead maternity carer, the first author (IC) found that following a traumatic practice experience, there appeared to be very little emotional support for the midwife unless provided by colleagues or family. Midwives were expected to continue as if nothing had happened and they had not been affected in any way by the event.

AIM:To explore the effects of a traumatic practice experience on the midwifery practitioner.

RESEARCH METHODOLOGY AND METHOD:A qualitative study using a narrative research method was implemented. Data were collected using an adapted biographical narrative interview method. An eclectic approach was used to analyze the data for content and form based on identity and ontology.

FINDINGS:The study demonstrated that partnership and autonomous midwifery practice are key drivers that make New Zealand midwives more likely to be blamed for unfortunate outcomes, and their competence in practice challenged. The study identified that a breach of relational trust exacerbates or prolongs the initial physiological and/or psychological symptoms experienced by the participating midwives following a traumatic practice event. The perpetrators of this betrayal of trust were organizational and clinical managers, medical and midwifery colleagues, women, and their families.

CONCLUSION:The participants’ stories have drawn attention to the effects of counterproductive behaviors that occur in dysfunctional health organizations and the need for professional emotional support.

Musculoskeletal pain and reported workplace assault: a prospective study of clinical staff in nursing homes

OBJECTIVE

This study examined prospectively the effect of workplace violence on musculoskeletal symptoms among nursing home workers.

BACKGROUND

Previously we reported a cross-sectional relationship between physical assaults at work and musculoskeletal pain. This follow-up provides stronger evidence of the effect of workplace violence on musculoskeletal outcomes within the same workforce over two years.

METHOD

Nursing home workers who responded to three consecutive annual surveys formed the study cohort (n = 344). The outcomes were any musculoskeletal pain, widespread pain, pain intensity, pain interference with work and sleep, and co-occurring pain with depression. The main predictor was self-reported physical assault at work during the 3 months preceding each survey. Prevalence ratios (PRs) were assessed with log-binomial regression, adjusting for other workplace and individual factors.

RESULTS

Every fourth nursing home worker, and 34% of nursing aides, reported persistent workplace assault over the 2 years. Among respondents assaulted frequently, two thirds experienced moderate to extreme musculoskeletal pain, and more than 50% had pain interfering with work and/or sleep. Baseline exposure to assault predicted pain outcomes 1 year later. Repeated exposure was associated with a linear increase over 2 years in the risks of pain intensity, interference with work, and interference with sleep; co-occurring pain and depression had an adjusted PR of 3.6 (95% CI = 1.7-7.9).

CONCLUSION

Workplace assault, especially when repeated over time, increases the risk of pain that may jeopardize workers' ability to remain employed.

APPLICATION

More effective assault prevention would protect and support the workforce needed to care for our increasing elderly and disabled population.

Enhancing health-care workers' understanding and thinking about people living with co-occurring mental health and substance use issues through consumer-led training

BACKGROUND

Stigma and judgemental assumptions by health workers have been identified as key barriers to accessing health care for people living with co-occurring mental health and substance use issues (dual diagnosis).

OBJECTIVE

To evaluate the effectiveness of consumer-led training by people with dual diagnosis in improving the knowledge, understanding and role adequacy of community health staff to work with this consumer group.

METHODS

A controlled before-and-after study design with four waves of quantitative data collection was used. Qualitative data were collected to explore participants' views about training. Participants were staff from two community health services from Victoria, Australia. Recruitment occurred across various work areas: reception, oral health, allied health, counselling and health promotion. At baseline, all participants attended a 4-h clinician-led training session. The intervention consisted of a 3-h consumer-led training session, developed and delivered by seven individuals living with dual diagnosis. Outcome measures included understanding of dual diagnosis, participants' feelings of role adequacy and role legitimacy, personal views, and training outcomes and relevance.

RESULTS

Consumer-led training was associated with a significant increase in understanding. The combination of clinician-led and consumer-led training was associated with a positive change in role adequacy.

CONCLUSIONS

Consumer-led training is a promising approach to enhance primary health-care workers' understanding of the issues faced by dual-diagnosis consumers, with such positive effects persisting over time. Used alongside other organizational capacity building strategies, consumer-led training has the potential to help address stigma and judgemental attitudes by health workers and improve access to services for this consumer group.

Threats and physical violence in the workplace: a comparative study of four areas of human service work

The aim of this study was to investigate threats and physical violence in the workplace by comparing four areas of human service work, namely psychiatry, eldercare, the Prison and Probation Service (PPS), and special schools (SS). The results revealed that there were statistically significant differences in the frequency of threats and violence among these areas of human service work. In particular, employees in SS were frequently exposed. More exposure was related to a higher degree of reporting incidents in writing to the workplace. However, exposure was not consistently related to self-rated seriousness of the incidents or attitudes that reflect accept of workplace threats and violence. Both threats and physical violence were rated within a moderate range of seriousness in all these areas of work. PPS and SS expressed more accept (attitude) of workplace threats and violence in comparison to psychiatry and eldercare.

CONCLUSION

workplace threats and violence toward staff in areas of human service work is a widespread phenomenon. There is a particular need for better prevention in SS, more research on the seriousness of threats in general, and more knowledge about the relationship between work environment and attitudes about workplace threats and violence.

Breakaway technique training as a means of increasing confidence in managing aggression in neuroscience nursing

OBJECTIVE

The objective of this paper was to evaluate breakaway technique training with neuroscience nursing staff as a measure of increased confidence and safety in managing aggression.

METHODS

A quasi experimental design was used in a sample of neuroscience nursing staff (n=31), participating in 2×1h breakaway technique workshops. The workshops consisted of supervised skills training in safe breakaway techniques. A pre- and postintervention-matched questionnaire measuring confidence and safety around managing aggressive patients, and exposure to and confidence in dealing with breakaways, was self administered.

RESULTS

Statistically significant increases in confidence and safety in working with aggressive patients, and confidence levels for safe breakaways were reported. Qualitative comments demonstrated a desire for ongoing skills workshops.

CONCLUSIONS

This study provides early evidence of the importance of incorporating breakaway training into existing training programs which aim to minimise and manage aggression and violence in generalist settings.

Mapping a Research Agenda for Home Care Safety: Perspectives from Researchers, Providers, and Decision Makers

Le but de cette conception qualitative et interprétative était d’examiner les perspectives des chercheurs, des pourvoyeurs de soins de santé et et des décideurs aux sujets des risques principaux, des préoccupations et des problèmes émergents rattachées à la sécurité de soins à domicile qui informerait une ligne d’enquête de recherche. La sécurité, tel qu’elle s’applique spécifiquement à ce context des soins à domicile, n’a pas encore été définie. Par conséquent, afin de profiter de diverses parties prenantes sur les questions de securité relatives aux soins à domicile est nécessaire afin d’informer les orientations stratégiques pour la recherche future. Afin de commencer à tracer un programme de recherche, une analyse en trois parties de l’environnement a été realisée: (a) une étude pilote avec les bénéficiaires et les fournisseurs de soins à domicile; (b) des entretiens avec des informateurs clés, les chercheurs, les fournisseurs de soins de santé, et les décideurs; et (c) une revue de la littérature dans trois domaines thématiques. Seulement les résultats des entrevues des informateurs clés sont présentés ici.

Violence at the workplace increases the risk of musculoskeletal pain among nursing home workers

BACKGROUND

Despite the high prevalences of workplace physical violence and musculoskeletal symptoms among health care workers, very few studies have examined the relationship between these two phenomena.

METHODS

We surveyed 920 clinical nursing home workers by questionnaire regarding musculoskeletal pain in the low back, shoulders, wrists or hands, and knees. Information was also collected on exposure to physical assaults at work during the preceding 3 months, other workplace safety features, physical workload and psychosocial work environment. Log-binomial regression was used to estimate the prevalence ratios (PR) with 95% CIs.

RESULTS

Almost one-half of respondents reported being assaulted at least once during the preceding 3 months by a resident or resident's visitor. The prevalence of low back pain increased from 40% among non-assaulted workers to 70% among those assaulted three or more times. The highest risk was found for widespread pain (three or more areas), with an adjusted PR of 2.7 (95% CI 1.8 to 3.9) for workers assaulted three or more times. Good workplace safety buffered the effects, so that violence increased the risk of most pains considerably less in a work environment perceived to be safe.

CONCLUSIONS

To our knowledge, this is the first study to show a dose-response association between physical assaults and musculoskeletal pain in a health care setting where violence is a frequent occurrence. This emphasises the need to address violence as a workplace hazard through practical measures for prevention as well as in future aetiological research on musculoskeletal disorders.

Workplace violence: a survey of paediatric residents

BACKGROUND

Paediatric residents are often exposed to verbal abuse and/or physical assaults from patients and patients' families during the course of their training. Residents may benefit from further training on how to prevent and respond to workplace violence.

AIMS

To determine the prevalence of workplace violence in paediatric residency training programmes.

METHODS

In 2007, a 25-item web-based questionnaire about experiences of verbal and/or physical abuse while on duty was distributed to 1211 paediatric residents at all training levels from 25 paediatric programmes.

RESULTS

A total of 541 questionnaires were returned giving a 45% response rate. In total, 33% of the respondents had been verbally abused or physically assaulted by patients and/or patients' families during their residency programme, although verbal abuse was much more common than physical assaults. In total, 71% of respondents reported having no teaching about workplace violence during their residency training. The majority (74%) indicated that they would like to receive more training in managing angry patients and families.

CONCLUSIONS

Paediatric residents are often exposed to verbal threats during the course of their work. They are also at risk of physical assaults by angry patients and/or families. Paediatric residents require more training on how to prevent and respond to workplace violence, and this important topic should be incorporated into the paediatric residency curriculum.