Personal safety when visiting patients in the community

The management of violence in general psychiatry

There is increasing concern about the level of violence within mental healthcare settings. In this article I review what is known on this subject, discuss the relationship between mental disorder and violence and summarise the different ways to prevent and manage violence. When planning strategies to prevent violence in such settings it is important to consider not only patient risk factors but also risk factors in the environment. Staff need to have all the possible techniques for managing violent behaviour available to them in order to weigh up the risks and benefits for any specific patient in any particular situation.

Incident Reporting by Health-Care Workers in Noninstitutional Care Settings

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

Enhancing Home Care Staff Safety Through Reducing Client Aggression and Violence in Noninstitutional Care Settings

The problematic occurrence of client violence and patient aggression toward health care workers is pervasive, with studies and reports finding that home health care workers experience one of the highest rates of client violence than any other career field. With the recent passage of the Patient Protection and Affordable Care Act in 2010, traditional health care delivery in institutional care settings is increasingly shifted to service delivery venues in noninstitutional care settings. During this transition, greater numbers of health care workers are providing services in patients’ private homes, increasing the potential risk to staff safety and well-being in these settings.

Keeping Community Health Care Workers Safe

Organizations have a responsibility to ensure the safety of staff who provide care in the community. In a survey conducted within a regional health authority in Newfoundland, health care providers reported feeling unsafe while conducting home visits. Safety initiatives were explored, and a safety program was implemented within this region to address safety concerns. The safety program includes three key components: a risk assessment screening tool, a sign-in/sign-out system, and a buddy system. This article describes the evaluation process and outcomes of these three components. The evaluation process and outcomes may be useful to other health care organizations interested in promoting workplace safety.

A Risk Assessment Screening Tool for Community Health Care Workers

Given the shift to community-based care, health care providers are facing an increased risk of workplace violence. The process of minimizing risk for staff providing home visits is a challenge and has not been extensively studied. The authors describe the development and implementation of a risk assessment instrument in a regional health authority in Newfoundland. The instrument aids community workers to identify and manage potential workplace violence risks. The process and risk assessment instrument may be useful to other health care organizations interested in promoting workplace safety.

Sources of stress and burnout in acute psychiatric care: inpatient vs. community staff

BACKGROUND

Professionals who work alone or in small teams often provide services for people with serious mental health problems in community settings. Stress is common in community teams and this may cause burnout and threaten the quality and stability of the services. This study compares levels of burnout and sources of stress among community and acute ward staff in six European centres.

METHODS

A total of 6 acute ward (N = 204) and community staff (N = 209) in 5 different European countries filled out the Maslach Burnout Inventory (MBI), the Mental Health Professional Scale (MHPSS) the Agervold Questionnaire for psychosocial work environment (QPWES) in addition to a comprehensive demographic questionnaire.

RESULTS

In the univariate analyses, except for Emotional Exhaustion (MBI), there were no differences in burnout between the two groups of staff. Community teams reported more organisational problems, higher work demands, less contact with colleagues, but also better social relations and more control over their work. The ward staff was more satisfied with the organisational structure and access to colleagues, but complained about lack of control over operating conditions at work. The multivariate analyses identified four groups of staff: (1) a Control-dissatisfied and Contact satisfied group (N = 184) with 2/3 coming from the wards. (2) A Contact-satisfied and Work-demand dissatisfied group (N = 147) with (3/4) from the community staff. (3) A Control- and Contact dissatisfied group (N = 47) with a majority from community teams, and (4) a Contact- and Work demand satisfied group (N = 37) with a majority from the wards.

CONCLUSION

Burnout as measured was not a serious problem among community and ward staff members, and did not differentiate between the two groups. Acute ward working implied lack of control but much contact with colleagues, whereas community work entailed more control but demanding work in terms of difficult task and hard-to-find-solutions.