Symptomatology of posttraumatic stress and burnout associated with aggressions suffered by primary care health professionals. A transversal study

Objective

To know the incidence of aggressions in Primary Care, and to determine the psychological symptoms that may accompany these experiences. A transversal study was carried out in North-Eastern Spain, in 2022.

Methods

207 participants (60.9% women, mean age 48.8 years), primary care professionals (nurses and doctors), responded to Questionnaire of Sociodemographic and Occupational variables, List of Aggressions, General Health Questionnaire, Posttraumatic Stress Disorder Checklist, and Maslach Burnout Inventory.

Results

57.49% had suffered aggressions in the last year (44.4% threats, 55.1% insults and 18.4% physical aggressions). They showed more psychological symptoms than those who had not been assaulted: re-experiencing, avoidance, distancing, emotional or cognitive disturbances and hypervigilance, as well as to emotional exhaustion, depersonalization and low personal realization. Although no statistically significant differences were found in terms of the number of victims with respect to gender, men showed more symptoms of trauma.

Conclusion

The data show the increase of violent episodes in Primary Care. Although the attacks perpetrated in this sector do not usually present the magnitude required for the diagnosis of post-traumatic stress, many of its symptoms were manifested in those who had suffered violence. Likewise, a relationship was found between aggression and burnout. The need to have post-incident protocols is evident, raising awareness among professionals about the importance of reporting episodes, as well as designing and implementing prevention plans. The damage generated by these behaviors does not only affect nurses and doctors, but, indirectly, all users of the health system.

Exploring nurses' emotional reactions to and reporting of patient-on-nurse workplace violence: A mixed-methods study

BACKGROUND

Workplace violence, including violent, intimidating, and disruptive acts, commonly occurs in healthcare settings. Type 2 workplace violence in nursing refers to patient/visitor behaviors directed toward clinicians, contributing to physical and psychological harm. Nurse victims often do not report these events to employers or law enforcement, making it challenging to address workplace violence.

OBJECTIVES

Our research examined nurse reactions to Type 2 workplace violence by identifying what behaviors they perceived as aggressive and reportable. Specific aims included: 1) developing and testing video vignettes to portray realistic patient aggression scenarios; 2) identifying nurse understandings of aggressive events that prompt affective reactions, and; 3) examining clinical characteristics related to the nurse victim's likelihood to report.

DESIGN

Through a sequential mixed-methods design, we qualitatively developed novel video vignettes portraying Type 2 workplace violence to experimentally examine how nurses interpreted them within a quantitative repeated measures survey.

METHODS

Two expert nurse research panels (n = 10) created five vignettes, from which nurses (n = 282) completed a survey with 1382 unique responses. Analyses included descriptive statistics and repeated measures ANOVA/regression models.

RESULTS

Video vignettes realistically portrayed workplace violence events, eliciting negative emotional responses among nurses that increased in magnitude with statistical significance as the level of displayed aggression escalated. Statistically significant factors influencing nurse reporting of workplace violence included; 1) the level of aggression displayed by the patient; 2) the level of harm received by the nurse; 3) whether the nurse felt the patient's actions were intentional, and; 4) the nurse's perceived frequency of exposure to workplace violence.

CONCLUSIONS

Results suggested that nurse victims of Type 2 workplace violence experience depression, anger, fear, and anxiety, which may contribute to long-term mental health consequences. Findings also identified factors related to nurse reporting behaviors, which may help mitigate workplace violence in healthcare settings by informing research and promoting workplace practices that encourage reporting and safety.

REGISTRATION

Not registered.

TWEETABLE ABSTRACT

Nurse reactions to workplace violence: Video vignettes reveal escalating aggression's impact on reporting. #EndNurseAbuse #WorkplaceViolence.

Workplace Violence in the Pediatric Emergency Department: A National Survey of Physicians in the United States

OBJECTIVES

Previous work shows that health care workers, and particularly emergency department (ED) staff, are at an above average risk of workplace violence (WPV), defined as verbal threats or physical violence in the workplace. Previous data suggest that staff of a single pediatric ED frequently feel unsafe. The objective of this study was to conduct the first national survey study to assess the prevalence and incidence of WPV in the pediatric ED.

METHODS

In this cross-sectional survey study, a representative sample of US pediatric emergency medicine physicians were invited to participate in a national survey adapted from the previously validated Workplace Violence in the Health Sector questionnaire from the World Health Organization. The primary outcome measure was the proportion of physicians who have been exposed to WPV. Rates of exposure to violence, reporting habits, and physician perception of various violence prevention strategies were studied secondarily.

RESULTS

Surveys were completed by 207 (45%) invited participants, representing 31 US children's hospitals. The prevalence of WPV exposure was 96%. Physical violence with a weapon was witnessed by 20% of participants. Injuries requiring medical attention or time off work were experienced by 10% of participants. Half of participants never reported violent events. Security guards were welcome by 99%, armed law enforcement officers by 70%, and metal detectors by 81% of physicians. Self-arming was opposed by 85% of respondents.

CONCLUSIONS

Exposure to WPV is frequent among pediatric emergency medicine physicians with a prevalence similar to that of general emergency departments. Workplace violence remains underreported. This national survey contributes to the objective evaluation of individual- and systems-level violence prevention interventions.

Application of the theory of planned behaviour for predicting the determinants of workplace violence reporting behaviour among public hospital healthcare workers in Malaysia: A cross-sectional study

Introduction

Reporting workplace violence (WPV) is a crucial preventive measure. Given the great impact of WPV on mental health and well-being, this study aimed to determine the prevalence and determinants of WPV reporting among healthcare workers (HCWs).

Method

A total of 557 public hospital HCWs in Melaka were recruited via probability sampling. A questionnaire guided by the theory of planned behaviour was developed, pre-tested and distributed. Malaysians with a minimum employment period of 12 months who experienced WPV within the same period in the selected public hospitals were eligible for inclusion. Multiple logistic regression analysis was conducted to determine the association between the independent variables and WPV reporting.

Results

Psychological violence was the most common WPV (80.3%), with only 177 (31.8%) respondents reporting such. The respondents who had high subjective norm (adjusted odds ratio [AOR]=2.160, 95% confidence interval [CI]=1.32-3.53) and perceived behavioural control scores (AOR=3.976, 95% CI=2.41-6.55); were clinical (AOR=2.679, 95% CI=1.43-5.02) and non-clinical (AOR=4.271, 95% CI=2.23-8.18) support staff; experienced physical WPV (AOR=13.157, 95% CI=3.83-45.24) and both physical and psychological WPV (AOR=2.029, 95% CI= 1.13-3.65); and perceived that WPV was intentional (AOR=11.111, 95% CI=6.50-19.00) were more likely to report WPV.

Conclusion

HCWs who experience physical WPV have the highest likelihood to report, followed by those who perceive WPV as intentional. The prevalence of reported WPV among public hospital HCWs is low, potentially underestimating its true occurrence owing to underreporting. Ensuring readily available reporting mechanisms for WPV, especially the psychological type, is crucial for HCWs.

National Development and Implementation of a Democratized Disruptive Behavior Reporting System in Health Care

INTRODUCTION

Workplace disruptive behavior/ violence (WDBV) is underreported in health care. This study evaluated a 7-year implementation of the Disruptive Behavior Reporting System (DBRS), the most robust consolidated WDBV reporting system developed in the United States within the Veterans Health Administration (VHA).

METHODS

After implementation of the system, implementation success was measured in real time by number of reports, types of staff entering reports, time to review the reports and time between when the incident occurred and report entry.

RESULTS

Over the seven years since implementation, there has been a significant increase in reporting within DBRS with more than 50,000 reports in fiscal year (FY) 2021 up from 0 to 2014. Types of staff reporting increased to 67 from 54. The median number of days to review events in FY19 Q2 was 4.79 days and the report latency has almost completely disappeared.

DISCUSSION

DBRS was designed to democratize reporting so staff can report WDBV anytime and anywhere playing a large role in the successful implementation. The increase in total number of reported events is an indication of the success of the system as it captures data historically lost due to underreporting.

CONCLUSION

DBRS development and implementation showcases how information systems can empower front-line personnel to voice behavioral safety concerns.

Identifying Type II workplace violence from clinical notes using natural language processing

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.

The effect of COVID-19 on workplace violence in California's hospitals: An interrupted time series analysis

AIM

This study used California's unique Workplace Violent Incident Reporting System (WVIRS) to describe changes in workplace violence (WV) exposure for hospital-based healthcare workers during the pandemic.

DESIGN

Interrupted time series analysis.

METHODS

We compared the linear trends in weekly WV incidents reported during the period before the COVID-19 pandemic (7/1/2017-3/20/2020) to the period following California's shutdown (3/21/2020-6/30/2021). We created mixed effects models for incidents reported in emergency departments (EDs) and in other hospital units. We used hospital volume data from the California Department of Health Care Access and Information.

RESULTS

A total of 418 hospitals reported 37,561 incidents during the study period. For EDs, the number of reported incidents remained essentially constant, despite a 26% drop in outpatient visits between the first and second quarters of 2020. For other hospital units, weekly incidents initially dropped-parallel to a 13% decrease in inpatient days between the first and second quarters of 2020-but then continued parallel to the trend seen in the pre-COVID period.

CONCLUSION

WV persists steadily in California's hospitals. Despite major reductions in patient volume due to COVID-19, weekly reported ED incidents remained essentially unchanged.

IMPACT

Surveys and media reported that WV increased during the pandemic, but it has been difficult to measure these changes using a large-scale database. The absolute number of WV incidents did not increase during the pandemic; however, the trend in reported incidents remained constant in the context of dramatic decreases in patient volume. New federal WV prevention legislation is being considered in the U.S. California's experience of implementation should be considered to improve WV reporting and prevention.

PUBLIC CONTRIBUTION

There was no public contribution to this study. The goal of this analysis was to summarize findings from administrative data. The findings presented can inform future discussion of public policy and action.

Nurses' rationale for underreporting of patient and visitor perpetrated workplace violence: a systematic review

BACKGROUND

Patient and visitor perpetrated workplace violence (WPV) is a problem within healthcare and is known to be underreported by nurses and other healthcare workers. However, there are multiple and diverse reasons identified in the literature as to why nurses do not report. This systematic review aimed to investigate nurses' reasons and rationale related to underreporting of violence that occurs in the workplace.

METHODS

Following PRISMA guidelines for systematic review reporting, studies conducted between 2011 and early 2022 were identified from MEDLINE, CINAHL, APA PsychInfo, and Psychological and Behavioral Sciences Collection via EBSCOHost. Quantitative studies related to patient and visitor perpetrated violence containing explanations, reasons, or rationale related to underreporting were included.

RESULTS

After quality appraisals, 19 studies representing 16 countries were included. The resulting categories identified nursing, management, and organizational factors. The most prominent nursing factors included nurses' fear of consequences after reporting, nurses' perceptions, and their lack of knowledge about the reporting process. Common management factors which contributed to nursing underreporting included lack of visible changes after reporting, non-supportive culture in which to report, and the lack of penalties for perpetrators. Organizational factors included the lack of policies/procedures/training for WPV, as well as a lack of an efficient and user-friendly reporting system. Supportive interventions from management, organizations, and community sources were summarized to provide insight to improve nurse reporting of WPV events.

CONCLUSION

Underreporting of WPV is a complex and multi-faceted problem. An investigation into the rationale for underreporting a workplace violent event illustrates nurses, management, and organizations contribute to the problem. Clear and actionable interventions such as educational support for staff and the development of a clear and concise reporting processes are recommended to encourage staff reporting and to help address WPV in healthcare.

Perception and Practice of Workplace Violence Prevention and Its Associated Factors among Employers at Healthcare Facilities in Melaka, Malaysia

Workplace violence (WPV) is a major public health concern, especially among healthcare workers. There is a negative perception and poor practice of healthcare employers towards WPV prevention. This study aims to determine the perception and practice towards WPV prevention and its associated factors among healthcare employers in Melaka, Malaysia. A cross-sectional study was conducted by recruiting 162 healthcare employers, using a validated questionnaire and utilised linear regression analysis. The participants had a mean percentage of 67.2% for perception and 80% for practice towards WPV prevention. The perception towards WPV prevention is associated with the following characteristics: female (adjusted ß = -3.95; 95% CI: -7.81, -0.09; p = 0.045), Indian ethnicity (adjusted ß = 16.04; 95% CI: 2.34, 29.74; p = 0.022), other ethnicities (adjusted ß = 25.71; 95% CI: 8.94, 42.47; p = 0.003), degree holder (adjusted ß = 4.35; 95% CI: 0.15, 8.54; p = 0.042), masters holder (adjusted ß = 7.63; 95% CI: 1.11, 14.14; p = 0.022), and enough funds (adjusted ß = -5.46; 95% CI: -9.25, -1.67; p = 0.005). Meanwhile, the practice towards WPV prevention is significantly associated with Chinese ethnicity (adjusted ß = -9.25; 95% CI: -18.36, -0.14; p = 0.047), Indian ethnicity (adjusted ß = -14.97; 95% CI: -29.48, -0.46; p = 0.043), other ethnicities (adjusted ß = 23.55; 95% CI: 5.59, 41.51; p = 0.011), degree holder (adjusted ß = -4.41; 95% CI: -8.67, -0.14; p = 0.043), and availability of standard operating procedure for reporting WPV (adjusted ß = 6.07; 95% CI: 1.58, 10.57; p = 0.008). The high perception and practice towards WPV prevention and its associated factors among healthcare employers provide evidence-based input to improve the existing measures for WPV prevention.

Nonfatal Violence Involving Days Away From Work Following California's 2017 Workplace Violence Prevention in Health Care Safety Standard

Objectives. To examine the impact of the California Occupational Safety and Health Administration's (Cal/OSHA's) 2017 workplace violence (WPV) prevention in health care safety standard on nonfatal violent injuries among health care workers (HCWs). Methods. We accessed estimated counts of WPV from the survey of occupational injuries and illness from 2011 to 2019 specific to HCWs. We used the Current Population Survey estimates of HCWs to create rates per 10 000. We conducted a longitudinal panel analysis and a comparative interrupted time-series analysis to examine the change in incidence and in rates associated with California's new standard. Results. Adoption of the 2017 safety standard led to an additional 3.48 reported WPV injuries per 10 000 HCWs in California, or an additional 473 injuries. Sensitivity analyses suggest other injuries did not change in the same period. Conclusions. It appears that the Cal/OSHA standard increased reporting of WPV injuries among HCWs in the first year of its adoption compared with the United States. Mandating reporting of all WPV incidents in the health care setting may be a means to ensure a more complete understanding of this public health problem. (Am J Public Health. 2022;112(11):1668-1675. https://doi.org/10.2105/AJPH.2022.307029).

Workplace violence in healthcare settings: The risk factors, implications and collaborative preventive measures

Violence at work refers to acts or threats of violence directed against employees, either inside or outside the workplace, from verbal abuse, bullying, harassment, and physical assaults to homicide. Even though workplace violence has become a worrying trend worldwide, the true magnitude of the problem is uncertain, owing to limited surveillance and lack of awareness of the issue. As a result, if workplace violence, particularly in healthcare settings, is not adequately addressed, it will become a global phenomenon, undermining the peace and stability among the active communities while also posing a risk to the population's health and well-being. Hence, this review intends to identify the risk factors and the implications of workplace violence in healthcare settings and highlight the collaborative efforts needed in sustaining control and prevention measures against workplace violence.

•

Workplace violence needs to be addressed more comprehensively, involving shared responsibilities from all levels.

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Emphasis on healthcare management's commitment, assurance, and clearly defined policy, reporting procedures, and training.

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The healthcare workers' commitment to update their awareness and knowledge regarding workplace violence.

•

The provision of technical support and assistance from professional organizations, NGOs, and the community.

Differences in Hospitals' Workplace Violence Incident Reporting Practices: A Mixed Methods Study

Workplace violence (WV) is a significant and growing problem for health care workers. Increased recognition of the need for improved protections has led to policy initiatives at the state and federal levels, including national Joint Commission requirements that went into effect January 2022. California's WV prevention legislation was phased in during 2017-2018 and requires hospitals to use a new incident reporting system, the Workplace Violent Incident Reporting System (WVIRS) for Hospitals. We analyzed WVIRS data collected during the first three years of its implementation, July 1, 2017 - June 30, 2020. In addition, we collected qualitative data from six California hospitals/hospital systems during 2019-2020 to better understand reporting practices. Over the three-year period, the 413 hospitals using the WVIRS reported between zero and six incidents per staffed bed. Sixteen hospitals (3.9%) reported two or more incidents per staffed bed while the rest reported fewer than two incidents. Qualitative analysis identified that reporting procedures vary considerably among hospitals. Several organizations rely on workers to complete incident reports electronically while others assign managers or security personnel to data collection. Some hospitals appear to report only those incidents involving physical harm to the worker. Regulatory guidance for reporting practices and hospitals' commitment to thorough data collection may improve consistency. As hospitals throughout the U.S. consider practice changes to comply with new WV standards, those engaged in implementation efforts should look closely at reporting practices. Greater consistency in reporting across facilities can help to build evidence for best practices and lead to safety improvements.

The Effect of Abuse and Mistreatment on Healthcare Providers (TEAM): A Survey Assessing the Prevalence of Aggression From Patients and Their Families and Its Impact

OBJECTIVE

Aggression from patients and families on health care providers (HCP) is common yet understudied. We measured its prevalence and impact on HCPs in inpatient and outpatient settings.

METHODS

Four thousand six hundred seven HCPs employed by a community teaching hospital received an anonymous survey with results analyzed.

RESULTS

Of 1609 HCPs (35%) completing the survey, 88% of inpatient staff reported experiencing different types of aggression compared to 82% in outpatient setting. Almost half did not report it to their supervisor. Younger staff were more likely to report abuse. Negative impacts on productivity and patient care were reported. A third of all responders' indicated negative effects on mental health.

CONCLUSIONS

Despite negative impacts on staff wellbeing and productivity, patient/family aggression toward HCPs is highly prevalent and underreported. Our healthcare system needs measures to address staff security and wellness.

Hospital-Based Healthcare Workers Victims of Workplace Violence in Italy: A Scoping Review

The aim of this scoping review is to synthesize the available evidence on the prevalence rates of healthcare workers being victims of violence perpetrated by patients and visitors in Italy. PubMed, Scopus, Web of Science and CINAHL were systematically searched from their inception to April 2021. Two authors independently assessed 1182 studies. All the scientific papers written in English or in Italian reporting primary quantitative and/or qualitative data on the prevalence of aggression or sexual harassment perpetrated by patients or visitors toward healthcare workers in Italy were included. Thirty-two papers were included in the review. The data extracted were summarized in a narrative synthesis organized in the following six thematic domains: (1). Methodology and study design; (2). Description of violent behavior; (3). Characteristics of health care staff involved in workplace violence (WPV); (4). Prevalence and form of WPV; (5). Context of WPV; and (6). Characteristics of violent patients and their relatives and/or visitors. The proportion of studies on WPV differed greatly across Italian regions, wards and professional roles of the healthcare workers. In general, the prevalence of WPV against healthcare workers in Italy is high, especially in psychiatric and emergency departments and among nurses and physicians, but further studies are needed in order to gather systematic evidence of this phenomenon. In Italy, and worldwide, there is an urgent need for governments, policy-makers and health institutions to prevent, monitor and manage WPV towards healthcare professionals.

Frequency and barriers of reporting workplace violence in nurses: An online survey in China

Objectives

This study aimed to explore the reporting of workplace violence against nurses and the reasons why they did not reported.

Methods

A self-designed questionnaire regarding workplace violence and reporting was used to conduct a cross-sectional survey on nurses who submitted a manuscript to a Chinese nursing journal from 2016 to 2017. A total of 324 nurses agreed to participate in this study and 266 participants from 165 hospitals in 72 cities returned questionnaires.

Results

A total of 172 nurses (64.7%) experienced violent incidents during the past year. Of these incidents, 45.5% were reported; and the reporting rate of physical assaults (69.0%) was higher than those of verbal abuse (36.9%), threatening behavior (51.7%), and sexual harassment (60.0%). Formal reporting accounted for 25.4% (15.4% in written form and 10.0% through a computer-assisted reporting system). Almost half of the nurses (49.6%) stated that the hospital had no reporting system or they were uncertain about the reporting system. For reasons of not reporting, 51.9% of the nurses were unware of how and what types of violence to report, and 50.6% of the nurses believed that the hospital paid greater attention to patients rather than staff.

Conclusions

A clear definition of workplace violence and reporting procedures, establishment of a facile system for reporting, and supervisory support following a reporting are urgently required.

What is the impact of restricted access policy on workplace violence in general hospital? A before-after study in a CHINESE tertiary hospital

BACKGROUND

To evaluate the impact of a restricted access policy on workplace violence in a healthcare setting.

METHODS

We surveyed healthcare workers before and after the implementation of a restricted-access policy at a tertiary hospital in north-eastern China. Data were collected in April 2017 and January 2019. Fisher's exact test were used to compare the difference in workplace violence prevalence between responses to two surveys. Survey 1 (S1) collected data from 345 healthcare professionals who had worked in the inpatient ward for at least 12 months. Survey 2 (S2) included 338 healthcare workers from the same ward who had been employed for more than two years. The effective response rates for the two studies was 79.31 and 83.25%, respectively. All 18 female security guards were included in the investigation in S2.

RESULTS

The prevalence of psychological violence was 62.03% in S1 and 34.62% in S2, the difference in prevalence showing statistical significance (P = 0.000), while the prevalence of physical violence was 3.77 and 4.73% respectively, showing no statistical significance (P = 0.573). The change in the rate of injury caused by physical violence was also statistically significant at 76.92 and 31.25% (P = 0.025), respectively. Security guards were at high risk of workplace violence under the policy. Most healthcare professionals thought this policy ameliorated treatment order, the sense of security, anxiety about workplace violence, and so forth, but one-third of the respondents thought that it caused patient dissatisfaction.

CONCLUSION

While the restricted access policy may be effective for healthcare professionals in avoiding or dealing with violence, such policy could contribute to new problems regarding the safety of security guards and the potential dissatisfaction of patients. The policy should be further developed to alleviate this phenomenon.

Toward prevention of behavioral emergencies in a general hospital insights from a one-year series

BACKGROUND

Behavioral emergencies endanger hospital staff and patients. The objective of this study was to identify patient characteristics that could be used to predict and prevent these incidents.

METHODS

We analyzed a one-year consecutive series of behavioral emergencies that triggered the rapid response team at a general hospital, comparing study patients with controls who did not trigger a rapid response. Standard parametric or nonparametric tests, as appropriate, were used to compare the 2 groups in univariate analyses, and multivariable logistic regression analysis was used to identify the best combination of variables for stratifying the risk of such an event.

RESULTS

There were 109 behavioral emergencies involving 83 patients. Comparison of patients who did (n = 83) or did not (n = 22,849) trigger a rapid response revealed marked differences between the two groups with respect to age, sex, and the prevalence of psychiatric comorbidities and various conditions that can diminish cognitive function. Substance use disorder was the most frequent principal diagnosis in the study group, accounting for 10.8% (9/83) of study patients vs. 0.6% (132/22849) of controls (p < 0.0001). The presence of a condition that can impair cognition (substance intoxication and withdrawal, epilepsy, cerebrovascular disease, traumatic brain injury, delirium, dementia) was associated with a 13-fold increase in the risk of a behavioral disturbance (95% CI, 8 to 22-fold).

CONCLUSIONS

Brief cognitive assessment of patients susceptible to cognitive impairment, along with diligent prophylaxis and management of substance withdrawal and delirium, may facilitate prevention of behavioral emergencies.

Factors associated with physical injury or police involvement during incidents of workplace violence in hospitals: Findings from the first year of California's new standard

BACKGROUND

Workplace violence in healthcare settings is known to be a costly and often underreported problem. In California, hospitals are required to report incidents of violence towards workers to the California Occupational Safety and Health Administration (CalOSHA) using an online reporting system that went into effect in 2017.

METHODS

Reports submitted to CalOSHA from July 2017 to September 2018 pursuant to this new requirement were analyzed using descriptive methods and logistic regression.

RESULTS

Four hundred eight hospitals submitted reports using the new incident reporting system. Behavioral health units had 1.82 times the odds of the reported incident resulting in physical injury compared to inpatient medical units, and investor-owned facilities had 2.43 times the odds of the reported incident resulting in physical injury compared to city or county-owned facilities. Inpatient and behavioral health units had significantly reduced odds of a reported incident resulting in police involvement when compared to other locations within the hospital.

CONCLUSIONS

These findings indicate that protections for healthcare workers deserve ongoing attention from stakeholders and legislators and provide insight into how healthcare facilities report incidents of violence towards workers.

Workplace violence against security personnel at a university hospital in Egypt: a cross-sectional study

Background: Violence is common among security personnel. To the best of the authors' knowledge no recent studies have investigated this problem. This study aimed to estimate the prevalence and associated factors of violence against hospital security personnel and describe circumstances of violence, type of perpetrators, and victims' response. Methods: In total, 170 security personnel from a university hospital in Egypt were recruited in this cross-sectional study. Data were collected using the Arabic version of a questionnaire developed by the International Labour Office. Results: The majority (87.3%) of security personnel reported violence exposure in the past year. Being a woman and working more than 5 years were independent predictors of violence exposure. The commonest forms of physical violence were pushing and beating. Verbal abuse and threats were the commonest emotional violence. Patients and their relatives/friends were the commonest perpetrators of violence. Conclusions: Violence is common among hospital security personnel in this setting. Adequate training and recruitment of more security personnel may contribute to decreasing violence.

An Evaluation of Verbal, Physical, and Sexual Violence Against Healthcare Workers in Ankara, Turkey

BACKGROUND

Healthcare professionals work in high-stress, fast-paced settings where individuals from different professions work together and who are exposed to many types of violence. The phenomenon of violence has become a concern of utmost importance for healthcare professionals that should be addressed with due attention.

OBJECTIVES

The aim of this study was to evaluate the verbal, physical, and sexual workplace violence experienced by healthcare professionals.

METHODS

A survey was conducted in a public hospital in Ankara, Turkey, among 104 physicians, 93 nurses, and 150 other medical staff.

RESULTS

Of the participating healthcare workers, 96.2%, 95.7%, and 80.7% of the physicians, nurses, and other medical personnel, respectively, reported having been exposed to verbal violence at least once in their professional life. Physicians were identified as a source of violence among other healthcare professionals. A logistic regression analysis was performed to determine the effects of sociodemographic features on violence. The statistically significant results showed that nurses are exposed to sexual violence more than other medical personnel are (OR = 3.11, 95% CI [1.29, 7.49]). Nurses were more exposed to verbal (OR = 5.08, 95% CI [1.54, 16.75]) and physical (OR = 3.68, 95% CI [1.15, 11.80]) violence compared with other medical personnel working in the hospital.

CONCLUSIONS

This study shows that a great majority of healthcare professionals are subjected to violence ranging from verbal violence in particular to physical and sexual violence.

Post-traumatic Reactions and Their Predictors among Workers Who Experienced Serious Violent Acts: Are There Sex Differences?

Background

Serious violent acts (e.g. physical violence, robbery, sexual aggression and death threats) are among the most visible and notable examples of workplace violence. Although women are commonly found to be at higher risk for post-traumatic reactions following workplace violence, little is known as regards sex differences concerning the types of post-traumatic reactions and their predictors.

Objective

This study aimed to describe sex differences in the post-traumatic reactions of serious violent acts and the predictors of such reactions.

Methods

The study was conducted among a convenience sample of 2889 French-speaking workers from Quebec, Canada by using a self-administrated survey. Linear regression modelings and post-hoc comparisons of coefficients according to the sex of the respondents were used to achieve the objective.

Results

Preliminary results confirmed that while men are more exposed to violence at work, women experience a greater number of post-traumatic reactions. Women were more affected by flashbacks, avoidance, and hypervigilance than men. The results also showed that being victimized by a male aggressor was associated with a greater number of post-traumatic reactions for women, whereas being victimized by an insider (e.g. colleague, supervisor, employee) was associated with a greater number of post-traumatic reactions for both sexes.

Implications

These findings highlight the necessity to better consider sex as a potential determinant of mental health in studies on workplace violence.

Workplace Violence: Experiences of Internal Medicine Trainees at an Academic Medical Center

OBJECTIVES

Healthcare professionals are at higher risk for workplace violence (WPV) than workers in other sectors. This elevated risk exists despite the vast underreporting of WPV in the medical setting. The challenge of responding to this risk is compounded by limited empirical research on medical training environments. Understanding trainees' experience and educating them on workplace safety, WPV reporting, and awareness of resources are shared goals of educational and institutional leadership. In our setting, clear understanding and education were urgent after the enactment of a statewide "constitutional carry" law affording individuals a right to carry concealed firearms in all state-owned universities and hospitals, beginning in July 2017. We sought to examine the incidence of WPV affecting Internal Medicine trainees to understand the types of violence encountered, reporting rates, and the factors that influence reporting.

METHODS

We conducted a cross-sectional online survey of Internal Medicine residents and fellows in practice for the previous 12 months. Survey items included both forced choice and open-ended questions. Descriptive statistics were calculated and used to summarize the study variables. χ² tests were performed to examine whether sex differences existed for each of the survey questions. Qualitative responses were content analyzed and organized thematically.

RESULTS

Of 186 trainees, 88 completed the survey. Forty-seven percent of respondents experienced WPV, with >90% of cases involving a patient, a patient's family member, or a patient's friend. Verbal assault was the most common type of incident encountered. Trainees formally reported fewer than half of the violent incidents disclosed in the survey. Major factors that influenced reporting included the severity of the incident, condition of the patient, and clarity of the reporting mechanism.

CONCLUSIONS

Previous research indicates similar amounts and types of WPV. Likewise, a large percentage of the incidents are not reported. Addressing the key factors related to why physicians underreport can inform institutions on how to make systematic changes to reduce WPV and its negative impact. Future research is needed to examine whether specific interventions can be implemented to improve reporting and reduce the incidence of WPV.

International Survey of Violence Against EMS Personnel: Physical Violence Report

IntroductionEach year, Emergency Medical Services (EMS) personnel respond to over 30 million calls for assistance in the United States alone. These EMS personnel have a rate of occupational fatality comparable to firefighters and police, and a rate of non-fatal injuries that is higher than the rates for police and firefighters and much higher than the national average for all workers. In Australia, no occupational group has a higher injury or fatality rate than EMS personnel. Emergency Medical Services personnel in the US have a rate of occupational violence injuries that is about 22-times higher than the average for all workers. On average, more than one EMS provider in the US is killed every year in an act of violence.Hypothesis/ObjectiveThe objective of this epidemiological study was to identify the risks and factors associated with work-related physical violence against EMS personnel internationally.

METHODS

An online survey, based on a tool developed by the World Health Organization (WHO; Geneva, Switzerland), collected responses from April through November 2016.

RESULTS

There were 1,778 EMS personnel respondents from 13 countries; 69% were male and 54% were married. Around 55% described their primary EMS work location as "urban." Approximately 68% described their employer as a "public provider." The majority of respondents were from the US.When asked "Have you ever been physically attacked while on-duty?" 761 (65%) of the 1,172 who answered the question answered "Yes." In almost 10% (67) of those incidents, the perpetrator used a weapon. Approximately 90% of the perpetrators were patients and around five percent were patient family members. The influence of alcohol and drugs was prevalent. Overall, men experienced more assaults than women, and younger workers experienced more assaults than older workers.

CONCLUSIONS

In order to develop and implement measures to increase safety, EMS personnel must be involved with the research and implementation process. Furthermore, EMS agencies must work with university researchers to quantify agency-level risks and to develop, test, and implement interventions in such a way that they can be reliably evaluated and the results published in peer-reviewed journals. MaguireBJ, BrowneM, O'NeillBJ, DealyMT, ClareD, O'MearaP. International survey of violence against EMS personnel: physical violence report. Prehosp Disaster Med. 2018;33(5):526-531.

Gender differences in workplace violence against physicians of obstetrics and gynecology in China: A questionnaire in the national congress

Background

China has witnessed a surge in violence against medical personnel, including widely reported incidents of violent abuse, riots, attacks, and protests in hospitals, but little is known about the impact of gender differences on the workplace violence against physicians of obstetrics and gynecology. The aim of this study was to analyse gender differences in workplace violence against physicians of obstetrics and gynecology in China.

Methods

Printed questionnaires were sent to participants of a national congress of obstetricians and gynecologists. The questionnaire consisted of items relevant to epidemiologic characteristics, workplace violence experienced in the past 12 months, participants’ attitudes toward violence and physician–patient relationship. Data from female and male physicians were compared in univariate and multivariate analyses.

Results

We sent out 1,425 questionnaires, and 1,300 (91.2%) physicians responded. Among 1,247 participants with specified gender, female and male physicians consisted of 162 (13.0%) and 1,085 (87.0%), respectively. Over the past 12 months, about two-thirds of these physicians suffered verbal abuse in the workplace, gender difference aside. After adjustment for education status, working hospital and subspecialty, male physicians had suffered more physical assaults than female colleagues (18.8% vs. 10.5%, adjusted odds ratio [OR] 2.3, 95% confidence interval [CI], 1.4–3.7), most attacks without apparent physical injuries (adjusted OR 2.3, 95% CI, 1.4–3.7). Male physicians also suffered more sexual assaults than female colleagues (5.0% vs. 1.3%, adjusted OR 4.8, 95% CI, 1.8–13.3), nearly all of verbal harassment. There were only two sexual attacks on female physicians, and no rapes occurred. Although almost all physicians regarded the current circumstance as “unhealthy and stressful”, more than half of them would take various active initiatives to create and maintain healthy and friendly physician–patient relationships.

Conclusion

Male physicians of obstetrics and gynecology in China suffered the same number of verbal abuse incidents but more physical and sexual assaults than their female colleagues. Both genders had similar opinions about causes, consequences and management about work violence against physicians, and had the same pessimistic perspectives but innovative wishes for the physician–patient relationship.

Preventing EMS workplace violence: A mixed-methods analysis of insights from assaulted medics

OBJECTIVE

To describe measures that assaulted EMS personnel believe will help prevent violence against EMS personnel.

METHODS

This mixed- methods study includes a thematic analysis and directed content analysis of one survey question that asked the victims of workplace violence how the incident might have been prevented.

RESULTS

Of 1778 survey respondents, 633 reported being assaulted in the previous 12 months; 203 of them believed the incident could have been prevented and 193 of them (95%) answered this question. Six themes were identified using Haddon's Matrix as a framework. The themes included: Human factors, including specialized training related to specific populations and de-escalation techniques as well as improved situational awareness; Equipment factors, such as restraint equipment and resources; and, Operational and environment factors, including advanced warning systems. Persons who could have prevented the violence were identified as police, self, other professionals, partners and dispatchers. Restraints and training were suggested as violence-prevention tools and methods CONCLUSIONS: This is the first international study from the perspective of victimized EMS personnel, to report on ways that violence could be prevented. Ambulance agencies should consider these suggestions and work with researchers to evaluate risks at the agency level and to develop, implement and test interventions to reduce the risks of violence against EMS personnel. These teams should work together to both form an evidence-base for prevention and to publish findings so that EMS medical directors, administrators and professionals around the world can learn from each experience.

Violence against emergency medical services personnel: A systematic review of the literature

BACKGROUND

Violence against emergency medical services (EMS) personnel is a growing concern. The aim of this systematic review is to synthesize the current literature on violence against EMS personnel.

METHODS

We examined literature from 2000 to 2016. Eligibility criteria included English-language, peer-reviewed studies of EMS personnel that described violence or assaults. Sixteen searches identified 2655 studies; 25 studies from nine countries met the inclusion criteria.

RESULTS

The evidence from this review demonstrates that violence is a common risk for EMS personnel. We identified three critical topic areas: changes in risk over time, economic impact of violence and, outcomes of risk-reduction interventions. There is a lack of peer reviewed research of interventions, with the result that current intervention programs have no reliable evidence base.

CONCLUSIONS

EMS leaders and personnel should work together with researchers to design, implement, evaluate and publish intervention studies designed to mitigate risks of violence to EMS personnel.

Emergency Medical Service Personnel's Risk From Violence While Serving the Community

OBJECTIVES

To determine the risks of violence-related injury among emergency medical services (EMS) personnel in the United States.

METHODS

We analyzed 1630 violence-related occupational injury cases reported to the US Bureau of Labor Statistics for the years 2012 to 2015 and conducted secondary searches within the Bureau of Labor Statistics Web site.

RESULTS

The number of cases per year varied between 250 and 560. Perpetrators included patients (77%) and coworkers (8%). Female EMS personnel had a disproportionately greater risk of violence-related injuries. The most common (35%) injury type was "sprains-strains-tears"; about 4% of the assault cases resulted in fractures, 13% resulted in surface wounds, and 190 were head injuries. About a third of the cases were classified as intentional.

CONCLUSIONS

The findings indicate a clear need for reliable interventions. The differences in risk for women indicate that some interventions may need to be demographic-specific. Because of the limitations of national data, future researchers will need access to agency-level data that include hours worked and call volume by demographic factors such as gender.

Aggressive Event Incidence using the Staff Observation of Aggression Scale-Revised (SOAS-R): A Longitudinal Study

The aim of this study was to identify aggressive event incidence rates in the inpatient psychiatric setting, describe characteristics of events and differences based on aggression target and type (verbal vs. physical). A longitudinal study was carried out of aggressive events identified by workers in four inpatient psychiatric units using the Staff Observation of Aggression Scale-Revised (SOAS-R) over 6 weeks. A total of 113 aggressive events were recorded resulting in a rate of 13.27 events per bed per year. Verbal aggression was demonstrated in 86 % and physical aggression in 57 % of events. Most events (70.8 %, n = 81) targeted a worker. Compared to other targets, workers were 3.4 times more likely to feel threatened (95 % CI 1.2-9.6, χ² = 5.08, p = 0.0242), and less likely to have a visible injury (OR 0.15, 95 % CI 0.04-0.6; χ² = 7.1, p = 0.0078). Event severity ranged from 0 to 21 with a mean of 9.5(SD = 5.1), with 20 % considered severe. Verbal events had lower mean severity of 6.5(SD = 3.8) versus physical events with a severity of 11.8(SD = 4.8; t = 6.5, df = 111, p < 0.0001). In 57.5 % of events there was no consequence to the victim. For most events (76 %) resolution included workers talking to the patient, while 54 % involved use of medication. Restrictive measures (physical hold, seclusion or physical restraint) were involved in 24.8 % of events. Aggression incidence was similar to incidence found in other studies. Workers were the target of most aggressive events and many were identified as having no understandable provocation. Further understanding of event characteristics will promote more effective prevention and management of aggressive events.

Determinants of occupational injury for US home health aides reporting one or more work-related injuries

OBJECTIVES

Home health aides (HHAs) work in a high-risk industry and experience high rates of work-related injury that have been significantly associated with reduction in workers and organisational productivity, quality and performance. The main objective of the study was to examine how worker environment and ergonomic factors affect HHA risk for reporting occupational injuries.

METHOD

We used cross-sectional analysis of data from the 2007 National Home Health and Hospice Aide Survey (NHHAS). The study sample consisted of a nationally represented sample of home health aides (n=3.377) with a 76.6% response rate. We used two scales ¹ : a Work Environment Scale and ² an Ergonomic Scale. Univariate and bivariate analyses were conducted to describe HHA work-related injury across individual, job and organisational factors. To measure scale reliability, Cronbach's alphas were calculated. Multivariable logistic regression was used to determine predictors of reported occupational injury.

RESULTS

In terms of Work Environment Scale, the injury risk was decreased in HHAs who did not consistently care for the same patients (OR=0.96, 95% CI: 0.53 to 1.73). In terms of Ergonomic Scale, the injury risk was decreased only in HHAs who reported not needing any other devices for job safety (OR=0.30, 95% (CI): 0.15 to 0.61). No other Work Environment or Ergonomic Scale factors were associated with HHAs' risk of injury.

CONCLUSION

This study has great implications on a subcategory of the workforce that has a limited amount of published work and studies, as of today, as well as an anticipated large demand for them.

The Effects of Trivialization of Workplace Violence on Its Victims: Profession and Sex Differences in a Cross-Sectional Study among Healthcare and Law Enforcement Workers

BACKGROUND

Workers from the law enforcement and healthcare sectors tend to normalize or mute their victimization from workplace violence (WPV).

OBJECTIVES

This study aims to assess the impact of the trivialization of WPV on psychological consequences for workers who have been affected by a WPV incident. The second aim is to assess the moderating effect of sex on the trivialization of WPV. The third and overarching aim is to assess the moderating effect of professional identity on the relations between individual and organizational factors and psychological consequences following a WPV incident.

METHODS

The findings are based on a convenience sample of 377 (204 female and 173 male) workers from the law enforcement and healthcare sectors. Individual factors (sex, age, professional identity, prior victimization, witnessing WPV, injuries, and trivialization of violence) and perceived support factors (colleagues' support and employer's support) were used as predictor variables of psychological consequences in hierarchical linear regression models. Sex was used as a moderator of trivialization while professional identity was used as a moderator of all predictors.

FINDINGS

When individual and social support factors were controlled for, normalizing violence was negatively associated with psychological consequences while perceiving a taboo associated with complaining about WPV was positively associated for all participants. When these relations were moderated by the sex of the participants and then by their professional identity, normalization was found to decrease psychological consequences only for male healthcare workers.

IMPLICATIONS

To help employees cope with WPV, organizations should promote strategies adapted to profession and sex differences. For male healthcare workers, normalization as a cognitive coping strategy should be formally recognized. For both professions and sexes, organizational strategies that counter the perceived taboo of complaining about violence should be reinforced.

Linking Workplace Aggression to Employee Well-Being and Work: The Moderating Role of Family-Supportive Supervisor Behaviors (FSSB)

PURPOSE

The present study examined the moderating effects of family-supportive supervisor behaviors (FSSB) on the relationship between two types of workplace aggression (i.e., patient-initiated physical aggression and coworker-initiated psychological aggression) and employee well-being and work outcomes.

METHODOLOGY

Data were obtained from a field sample of 417 healthcare workers in two psychiatric hospitals. Hypotheses were tested using moderated multiple regression analyses.

FINDINGS

Psychiatric care providers' perceptions of FSSB moderated the relationship between patient-initiated physical aggression and physical symptoms, exhaustion and cynicism. In addition, FSSB moderated the relationship between coworker-initiated psychological aggression and physical symptoms and turnover intentions.

IMPLICATIONS

Based on our findings, family-supportive supervision is a plausible boundary condition for the relationship between workplace aggression and well-being and work outcomes. This study suggests that, in addition to directly addressing aggression prevention and reduction, family-supportive supervision is a trainable resource that healthcare organizations should facilitate to improve employee work and well-being in settings with high workplace aggression.

ORIGINALITY

This is the first study to examine the role of FSSB in influencing the relationship between two forms of workplace aggression: patient-initiated physical and coworker- initiated psychological aggression and employee outcomes.

Workplace violence against women nurses working in two public sector hospitals of Lahore, Pakistan

BACKGROUND

Cultural and structural forces help sustain workplace violence (WPV) against feminized professions like nursing in Pakistan.

PURPOSE

The purpose of this study was to identify the prevalence and patterns of workplace violence (WPV) against women nurses (more than 95% of entire nursing population) in two hospitals of Pakistan.

METHODS

A standardized international survey developed by the World Health Organization was used to collect cross-sectional data. Descriptive statistics, chi-square tests, and multivariate regression were used for data analysis. A total of 309 nurse respondents were sampled from two public sector tertiary care hospitals of Lahore.

RESULTS

Findings show that 73.1% of nurses reported experiencing some sort of violence in the last 12 months; with 53.4% suffering from physical violence, 57.3% from verbal violence, and 26.9% from sexual violence. The main perpetrators were reported to be male coworkers, patients, and attendants. Higher risk for WPV includes single status, non-Punjabi provincial belonging, Islamic faith, staff and student nurse designations, temporary government contract, and working additional hours in the evening and night. The primary response to violence included not doing anything and remaining silent. It was also reported that nurse victims experienced moderate levels of emotional grievances after facing violence.

CONCLUSION

The results of this study suggest that public sector hospitals in the region need to improve their policy for the protection and monitoring of WPV against female nurses. Reporting and counseling bodies need to be installed to encourage both complaints and the seeking of medical attention after victimization.

Prevalence of workplace violence in Northwest Ethiopia: a multivariate analysis

Background

Workplace violence has been acknowledged as a global problem, particularly in the health sector. However, there is scarce data on workplace violence among nurses in Ethiopia. The aim of this study was to assess the prevalence of workplace violence and associated factors among nurses in northwest Ethiopia.

Methods

Hospital based cross-sectional study design was employed in 386 nurses from April 1 – April 30, 2015. Data were collected through the use of self-administered questionnaire developed by the International Labor Office/International Council of Nurses/World Health Organization and Public Services International. To keep the quality of the data collection training was given to supervisors and data collectors. Piloting was done in Debark hospital two weeks before actual data collection to assess the tool’s clarity and make amendments. The proposal was approved by the Institutional Review Board of University of Gondar prior to study commencement and a written consent was obtained from each study participant.

Results

The overall prevalence of workplace violence was 26.7 %. Exploratory logistic regression analyses suggested that age, number of staff in the same work shift, working in a male ward, history of workplace violence, and marital status were factors independently associated with workplace violence

Conclusion

The prevalence of workplace violence among nurses was high. Creating a prevention strategy involving different stakeholders is recommended.

The impact of training program on nurses' attitudes toward workplace violence in Jordan

BACKGROUND

Nurses' attitudes toward workplace violence are still inadequately explored, and possess an impact in preventing, and managing the violent incidents and the quality of nursing care. Creating a demand for an effective intervention program to improve nurses' knowledge of and attitudes toward workplace violence.

OBJECTIVE

To study the impact of the training program on nurses' attitudes toward workplace violence in a military hospital in Jordan.

METHODS

One group before-after design was employed. A stratified random sample of 100 nurses working in three shifts was recruited. Data were collected earlier and after the preparation program using the Attitudes Toward Patient Physical Assault Questionnaire. "The Framework Guidelines for addressing workplace violence in the health sector", was adopted in this work. The preparation sessions were for one day each week over five weeks. The post-test assessment was over five weeks using the same questionnaire.

RESULTS

A total of 97 nurses completed the survey. The outcomes demonstrated the significant impact of the training program on nurses' attitudes towards workplace violence (t=6. 62, df=96, p=0.000). The prevalence of verbal abuse by patients and visitors was 63.9% and for physical abuse, 7.2% were from patients and 3.1% of visitors. Most violent incidents occurred during day duty and during delivering nursing care (40.2% and 32%, respectively). Major source of emotional support for abused nurses was from the nursing team (88.7%), while the legal support was from nursing management (48.5%).

CONCLUSION

The study highlights a general concern among nursing staff about workplace violence. Confirming that violence prevention education for staff is a necessary step forward to deescalate the problem. A significant effect of the training program was evident in this study.

Underreporting of Workplace Violence: Comparison of Self-Report and Actual Documentation of Hospital Incidents

This study examined differences between self-report and actual documentation of workplace violence (WPV) incidents in a cohort of health care workers. The study was conducted in an American hospital system with a central electronic database for reporting WPV events. In 2013, employees (n = 2010) were surveyed by mail about their experience of WPV in the previous year. Survey responses were compared with actual events entered into the electronic system. Of questionnaire respondents who self-reported a violent event in the past year, 88% had not documented an incident in the electronic system. However, more than 45% had reported violence informally, for example, to their supervisors. The researchers found that if employees were injured or lost time from work, they were more likely to formally report a violent event. Understanding the magnitude of underreporting and characteristics of health care workers who are less likely to report may assist hospitals in determining where to focus violence education and prevention efforts.

The occupational safety of health professionals working at community and family health centers

Background:

Healthcare professionals encounter many medical risks while providing healthcare services to individuals and the community. Thus, occupational safety studies are very important in health care organizations. They involve studies performed to establish legal, technical, and medical measures that must be taken to prevent employees from sustaining physical or mental damage because of work hazards.

Objectives:

This study was conducted to determine if the occupational safety of health personnel at community and family health centers (CHC and FHC) has been achieved.

Martials and Methods:

The population of this cross-sectional study comprised 507 nurses, 199 physicians, and 237 other medical personnel working at a total of 18 family health centers (FHC) and community health centers (CHC) in Trabzon, Turkey. The sample consisted of a total of 418 nurses, 156 physicians, and 123 other medical personnel. Sampling method was not used, and the researchers tried to reach the whole population. Data were gathered with the Occupational Safety Scale (OSS) and a questionnaire regarding demographic characteristics and occupational safety.

Results:

According to the evaluations of all the medical personnel, the mean ± SD of total score of the OSS was 3.57 ± 0.98; of the OSS’s subscales, the mean ± SD of the health screening and registry systems was 2.76 ± 1.44, of occupational diseases and problems was 3.04 ± 1.3 and critical fields control was 3.12 ± 1.62. In addition, occupational safety was found more insufficient by nurses (F = 14.18; P < 0.001).

Conclusions:

All healthcare personnel, particularly nurses working in CHCs and FHCs found occupational safety to be insufficient as related to protective and supportive activities.

Impact of hospital type II violent events: use of psychotropic drugs and mental health services

BACKGROUND

While violence can adversely affect mental health of victims, repercussions of violence against workers is not as well characterized.

MATERIALS AND METHODS

We explored relationships between workplace violent events perpetrated by patients or visitors (Type II) against hospital employees and the employee use of psychotropic medications or mental health services using a data system that linked violent events with health claims.

RESULTS

Significant associations were observed between reported Type II workplace violent events and employee prescription claims for anti-depressants and anxiolytics combined (RR = 1.45, 95% CI = 1.01-2.33) and anti-depressants alone (RR = 1.65, 95% CI = 1.10-2.48). No significant association between reported violent events and health claims for treatment of depression or anxiety was observed.

CONCLUSIONS

Type II violence experienced by hospital workers may lead to increased use of psychotropic drugs, particularly anti-depressants but also anxiolytics. Our results suggest an important role of employee assistance programs in mitigating the psychological consequences of workplace violent events.

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.

Violence chain surrounding patient-to-staff violence in Japanese hospitals

The aim of this study was to determine if patient-to-staff violence is associated with staff-to-staff violence and patient-to-patient violence among nurses and patient service clerks. A survey was conducted using an anonymous questionnaire for attendees of a lecture on antiviolence in health care institutions. Patient-to-staff verbal violence was associated with staff-to-staff verbal violence (odds ratio [OR] = 1.43; 95% confidence interval [CI]: 1.16-1.66). Patient-to-staff physical violence was associated with staff-to-staff physical violence (OR = 7.80; 95% CI: 1.86-13.5) and patient-to-patient verbal violence (OR = 2.69; 95% CI: 1.18-5.42). Patient-to-staff sexual harassment was associated with staff-to-staff sexual harassment (OR = 6.55; 95% CI: 3.59-8.91) and patient-to-patient verbal violence (OR = 2.96; 95% CI: 1.44-5.17). Staff who had experienced patient-to-staff violence were likely to have experienced violence by other staff and to have witnessed or reported violence among patients.

Perpetrator, worker and workplace characteristics associated with patient and visitor perpetrated violence (Type II) on hospital workers: a review of the literature and existing occupational injury data

PROBLEM

Non-fatal type II violence experienced by hospital workers (patient/visitor-on-worker violence) is not well described.

METHODS

Hospital administration data (2004-2009) were examined for purposes of calculating rates of type II violent events experienced by workers. We also conducted a review of the hospital-based literature (2000-2010) and summarized findings associated with type II violence.

RESULTS

484 physical assaults were identified in the data, with a rate of 1.75 events/100 full-time equivalents. Only few details about events were captured, while non-physical events were not captured. The literature yielded 17 studies, with a range proportion of verbal abuse (22%-90%), physical threats (12%-64%) and assaults (2%-32%) reported. The literature lacked rigorous methods for examining incidence and circumstances surrounding events or rates of events over time.

DISCUSSION

For purposes of examining the impact of type II violence on worker safety, satisfaction and retention, rigorous surveillance efforts by hospital employers and researchers are warranted.

Development and application of a population-based system for workplace violence surveillance in hospitals

BACKGROUND

A unique and comprehensive reporting and population-based violence surveillance system in a multi-site hospital system is presented.

METHODS

Incidence rates and rate ratios (RR) were calculated by year, hospital, violence type, and job category in six hospitals, 2003-2008.

RESULTS

Incidence rates per hospital for the 6-year period ranged from a low of 1.52 to a high of 10.89 incidents/100 full-time equivalents (FTEs), with the highest risk at a hospital with an outpatient mental health facility (RR = 7.16, 95%CI = 5.17-10.26). Rates for worker-on-worker violence exceeded rates for patient-to-worker violence from 2004 to 2008. Mental health technicians (RR = 13.82, 95%CI =  1.13-17.29) and security personnel (RR = 2.25, CI = 1.68-3.00) were at greatest risk for violence.

CONCLUSIONS

This surveillance system provides ongoing information on professional groups and hospital departments at risk and trends in violence reporting over time. It can be used to determine where appropriate violence prevention efforts are most needed, and to evaluate violence interventions.

Violence against women: the phenomenon of workplace violence against nurses

Registered nurses have been the recipients of an alarming increase in workplace violence (WPV). Emergency and psychiatric nurses have been found to be the most vulnerable and yet few solid reporting procedures exist to fully account for a true number of incidents. Further compounding the problem is the lack of a standard definition of violence to guide reporting procedures, interventions, legislation, and research. While there are certain risk factors that not only predispose the nurse and the patient to WPV, research continues to attempt to parse out which risk factors are the key determinants of WPV and also which interventions prove to be significant in reducing WPV. The nursing shortage is expected only to increase; recruitment and retention of qualified staff members may be deterred by WPV. This necessitates focused research on the phenomenon of workplace violence in health care.

Strategies and Tools to Reduce Workplace Violence

The U.S. health care system is in the beginning of a crisis that can barely be comprehended. If projections are accurate, the demand for nurses will increase 40% and a 400,000-hour full-time equivalent registered nurse shortfall will occur by 2020. Not only are nurses leaving the field, but fewer candidates are entering. The reasons are unclear, but research has shown that nursing is a dangerous occupation—four times more dangerous than most other occupations. Protection from an unsafe workplace is guaranteed under Occupational Safety and Health Administration regulations, and many national and international groups call for zero tolerance of workplace violence. Health care worksites must develop specific plans to minimize and prevent workplace violence. Additional research is necessary to determine which methods are most effective. This article examines the necessary components of a workplace violence prevention program.

Strategies and Tools to Reduce Workplace Violence

The U.S. health care system is in the beginning of a crisis that can barely be comprehended. If projections are accurate, the demand for nurses will increase 40% and a 400,000-hour full-time equivalent registered nurse shortfall will occur by 2020. Not only are nurses leaving the field, but fewer candidates are entering. The reasons are unclear, but research has shown that nursing is a dangerous occupation—four times more dangerous than most other occupations. Protection from an unsafe workplace is guaranteed under Occupational Safety and Health Administration regulations, and many national and international groups call for zero tolerance of workplace violence. Health care worksites must develop specific plans to minimize and prevent workplace violence. Additional research is necessary to determine which methods are most effective. This article examines the necessary components of a workplace violence prevention program.