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Byon HD, Harris C, Crandall M, Song J, Topaz M. Identifying Type II workplace violence from clinical notes using natural language processing. Workplace Health Saf 2023; 71:484-490. [PMID: 37387505 DOI: 10.1177/21650799231176078] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
BACKGROUND Type II workplace violence in health care, perpetrated by patients/clients toward home healthcare nurses, is a serious health and safety issue. A significant portion of violent incidents are not officially reported. Natural language processing can detect these "hidden cases" from clinical notes. In this study, we computed the 12-month prevalence of Type II workplace violence from home healthcare nurses' clinical notes by developing and utilizing a natural language processing system. METHODS Nearly 600,000 clinical visit notes from two large U.S.-based home healthcare agencies were analyzed. The notes were recorded from January 1, 2019 to December 31, 2019. Rule- and machine-learning-based natural language processing algorithms were applied to identify clinical notes containing workplace violence descriptions. RESULTS The natural language processing algorithms identified 236 clinical notes that included Type II workplace violence toward home healthcare nurses. The prevalence of physical violence was 0.067 incidents per 10,000 home visits. The prevalence of nonphysical violence was 3.76 incidents per 10,000 home visits. The prevalence of any violence was four incidents per 10,000 home visits. In comparison, no Type II workplace violence incidents were recorded in the official incident report systems of the two agencies in this same time period. CONCLUSIONS AND APPLICATION TO PRACTICE Natural language processing can be an effective tool to augment formal reporting by capturing violence incidents from daily, ongoing, large volumes of clinical notes. It can enable managers and clinicians to stay informed of potential violence risks and keep their practice environment safe.
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Affiliation(s)
- Ha Do Byon
- University of Virginia School of Nursing
| | | | - Mary Crandall
- University of Virginia School of Nursing
- Continuum Home Health Care, UVA Health
| | | | - Maxim Topaz
- Columbia University School of Nursing
- Columbia University Data Science Institute
- VNS Health
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Fenwick KM, Dyer KE, Klap R, Oishi K, Moreau JL, Yano EM, Bean-Mayberry B, Sadler AG, Hamilton AB. Expert Recommendations for Designing Reporting Systems to Address Patient-Perpetrated Sexual Harassment in Healthcare Settings. J Gen Intern Med 2022; 37:3723-3730. [PMID: 35266124 PMCID: PMC9585114 DOI: 10.1007/s11606-022-07467-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 02/08/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Patient-perpetrated sexual harassment toward staff and patients is prevalent in Veterans Affairs and other healthcare settings. However, many healthcare facilities do not have adequate systems for reporting patient-perpetrated harassment, and there is limited evidence to guide administrators in developing them. OBJECTIVE To identify expert recommendations for designing effective systems for reporting patient-perpetrated sexual harassment of staff and patients in Veterans Affairs and other healthcare settings. DESIGN We conducted qualitative interviews with subject matter experts in sexual harassment prevention and intervention during 2019. PARTICIPANTS We used snowball sampling to recruit subject matter experts. Participants included researchers, clinicians, and administrators from Veterans Affairs/other healthcare, academic, military, and non-profit settings (n = 33). APPROACH We interviewed participants via telephone using a semi-structured guide and analyzed interview data using a constant comparative approach. KEY RESULTS Expert recommendations for designing reporting systems to address patient-perpetrated sexual harassment focused on fostering trust, encouraging reporting, and deterring harassment. Recommendations included the following: (1) promote a climate in which harassment is not tolerated; (2) take proportional, corrective actions in response to reports; (3) minimize adverse outcomes for reporting parties; (4) facilitate and simplify reporting processes; and (5) hold the reporting system accountable. Specific strategies related to each recommendation were also identified. CONCLUSIONS This qualitative study generated initial recommendations to guide healthcare administrators and policy makers in assessing, developing, and improving systems for reporting patient-perpetrated sexual harassment toward staff and other patients. Results indicate that proactive, careful design and ongoing evaluation are essential for ensuring that reporting systems have their intended effects and mitigating the risks of inadequate systems. Additional research is needed to evaluate strategies that effectively address patient-perpetrated harassment while balancing patients' clinical needs.
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Affiliation(s)
- Karissa M. Fenwick
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA USA
| | - Karen E. Dyer
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA USA
| | - Ruth Klap
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA USA
| | - Kristina Oishi
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA USA
| | - Jessica L. Moreau
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA USA
| | - Elizabeth M. Yano
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA USA
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA USA
- Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA USA
| | - Bevanne Bean-Mayberry
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA USA
- Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA USA
| | - Anne G. Sadler
- VA Center for Access & Delivery Research and Evaluation (CADRE), Iowa City VA Healthcare System, Iowa City, IA USA
- Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, IA USA
| | - Alison B. Hamilton
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA USA
- Department of Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine, Jane & Terry Semel Institute for Neuroscience & Human Behavior, Los Angeles, CA USA
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Phoo NNN, Reid A. Determinants of violence towards care workers working in the home setting: A systematic review. Am J Ind Med 2022; 65:447-467. [PMID: 35352369 PMCID: PMC9314693 DOI: 10.1002/ajim.23351] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/14/2022] [Accepted: 03/14/2022] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Nang Nge Nge Phoo
- School of Population Health, Faculty of Health Sciences Curtin University Bentley Western Australia Australia
| | - Alison Reid
- School of Population Health, Faculty of Health Sciences Curtin University Bentley Western Australia Australia
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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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Womack KN, Alvord TW, Trullinger-Dwyer CF, Rice SPM, Olson R. Challenging Aggressive Behaviors Experienced by Personal Support Workers in Comparison to Home Care Workers: Relationships between Caregiver Experiences and Psychological Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E5486. [PMID: 32751378 PMCID: PMC7432386 DOI: 10.3390/ijerph17155486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/20/2020] [Accepted: 07/23/2020] [Indexed: 11/25/2022]
Abstract
Personal support workers (PSW) are caregivers for children and adults with intellectual and developmental disabilities (IDDs) or adults experiencing mental illness or other behavioral health conditions. The work can be very meaningful, but many PSWs must prepare for, monitor, and manage challenging behaviors, including aggression. This study was designed to estimate the prevalence of aggression experienced by PSWs in Oregon, and compare it to a previous sample of Oregon home care workers (HCWs). This comparison included an analysis of relationships between exposures to aggression and psychological health factors. PSWs in Oregon (N = 240) were surveyed electronically at a single time point. PSWs generally reported higher rates of exposure to aggression compared to HCWs. Experiences with aggression were positively associated with fatigue and weakly associated with depression, but not stress. PSWs' self-reported lost work time injury rate was elevated compared to the US average, but it was comparable to previous self-reported injury rates from HCWs. Physical demands of work were the most prevalent reported primary safety concern, followed by challenging behaviors (including aggression). Developing tailored training to help PSWs understand, plan for, minimize, and manage challenging behaviors is a social priority.
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Affiliation(s)
- Kelsey N. Womack
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University (OHSU), Portland, OR 97239, USA; (K.N.W.); (T.W.A.); (C.F.T.-D.); (S.P.M.R.)
| | - Teala W. Alvord
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University (OHSU), Portland, OR 97239, USA; (K.N.W.); (T.W.A.); (C.F.T.-D.); (S.P.M.R.)
- School of Public Health, OHSU-Portland State University (PSU), Portland, OR 97201, USA
| | - Caitlyn F. Trullinger-Dwyer
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University (OHSU), Portland, OR 97239, USA; (K.N.W.); (T.W.A.); (C.F.T.-D.); (S.P.M.R.)
| | - Sean P. M. Rice
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University (OHSU), Portland, OR 97239, USA; (K.N.W.); (T.W.A.); (C.F.T.-D.); (S.P.M.R.)
| | - Ryan Olson
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University (OHSU), Portland, OR 97239, USA; (K.N.W.); (T.W.A.); (C.F.T.-D.); (S.P.M.R.)
- School of Public Health, OHSU-Portland State University (PSU), Portland, OR 97201, USA
- Department of Psychology, OHSU-Portland State University (PSU), Portland, OR 97201, USA
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Hanna K, Rowe F. Orthoptic Home Visits for Stroke Survivors: Results from a UK Professional Practice Survey. Br Ir Orthopt J 2019; 15:105-114. [PMID: 32999981 PMCID: PMC7510398 DOI: 10.22599/bioj.134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Aim: Orthoptists are perhaps the only allied health profession without a standard home visits service in the UK, although it could arguably be of benefit to many orthoptic patients. The aim of this survey was to identify whether home visits are being offered, or have the potential to be offered, within the orthoptic profession. Method: A survey of the orthoptic professional body (BIOS) for the UK and Ireland was developed and data collected between January and March 2016. Descriptive analysis was used to report the quantitative findings. A thematic analysis approach was undertaken for the written responses within the free-text boxes of the survey. Results: 461 BIOS members responded to the survey (response rate of 30.7%). Ten hospital sites (3.7%) reported offering home visits, and 444 members (96.3%) reported that they do not offer home visits, with little desire or perceived need for such a service. Only certain patients reportedly meet requirements for an orthoptic home visit, including those unable to attend the hospital due to poor health, transport issues, reduced cognition, stroke and learning difficulties. Implementation barriers were reported including staff safety, assessment quality and cost. Conclusion: Home visits are infrequently conducted within the orthoptic profession. However, where offered, certain patient groups were suggested to benefit from this service when they cannot attend hospital and thus, home visits could present a viable means of providing equitable visual care. Future research is required to explore orthoptic home visits compared to other forms of rehabilitation, and address concerns from the orthoptic professional body.
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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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