Work - Volume 51, issue 1

Article Type: Editorial

DOI: 10.3233/WOR-152016

Citation: Work, vol. 51, no. 1, pp. 1-1, 2015

Authors: Gillespie, Gordon Lee | Fisher, Bonnie S. | Gates, Donna M.

Article Type: Editorial

DOI: 10.3233/WOR-152017

Citation: Work, vol. 51, no. 1, pp. 3-4, 2015

Authors: Renker, Paula | Scribner, Shellie A. | Huff, Pam

Article Type: Research Article

Abstract: BACKGROUND: Violence committed by patients and their families and visitors against Emergency Department staff in the United States is common and detrimental to staff well being, morale, and care practices. Hospitals losses occur due to decreased staff retention, prestige, and patient and visitor satisfaction. OBJECTIVE: The purpose of the baseline survey reported here was to identify and describe staff experiences, concerns, and perceptions related to violence and abuse perpetrated by patients, family, and non-family visitors in a Level 1 emergency department. PARTICIPANTS: The survey sample was composed of 41 registered nurses and 10 …paramedics. The majority of the participants (84%, n= 41) were female and worked full time (82%, n= 41) on the 7P-7A (49%, n= 25) shift. METHODS: The cross-sectional mixed-method descriptive design used a survey to measure violence experiences and interviews with key informants. Specific analytical methods included descriptive and inferential statistics and ethnography. RESULTS: The findings are summarized by a model that portrays 1) Contributing factors to the development of violence in the ED, 2) maladaptive reactions to workplace violence of Cynicism, Concern for focus on customer service, and Conflict, and 3) three themes that, depending on their presence or absence, serve as barriers or facilitators to violence: Consistency, Consequences and Collaboration. CONCLUSIONS: Interventions developed to minimize violence in the ED must focus on modifiable risk factors and address what is in the department's control including staff education in recognizing escalating anxious or aggressive behavior, policy development and implementation, and environmental changes. Show more

Keywords: Nurse and paramedic patient interactions, mixed methods analysis, workplace violence interventions

DOI: 10.3233/WOR-141893

Citation: Work, vol. 51, no. 1, pp. 5-18, 2015

Authors: Ridenour, Marilyn | Lanza, Marilyn | Hendricks, Scott | Hartley, Dan | Rierdan, Jill | Zeiss, Robert | Amandus, Harlan

Article Type: Research Article

Abstract: BACKGROUND: A study by Hesketh et al. found that 20% of psychiatric nurses were physically assaulted, 43% were threatened with physical assault, and 55% were verbally assaulted at least once during the equivalent of a single work week. From 2005 through 2009, the U.S. Department of Justice reported that mental health occupations had the second highest average annual rate of workplace violence, 21 violent crimes per 1,000 employed persons aged 16 or older. OBJECTIVE: An evaluation of risk factors associated with patient aggression towards nursing staff at eight locked psychiatric units. PARTICIPANTS: Two-hundred eighty-four …nurses in eight acute locked psychiatric units of the Veterans Health Administration throughout the United States between September 2007 and September 2010. METHODS: Rates were calculated by dividing the number of incidents by the total number of hours worked by all nurses, then multiplying by 40 (units of incidents per nurse per 40-hour work week). Risk factors associated with these rates were analyzed using generalized estimating equations with a Poisson model. RESULTS: Combining the data across all hospitals and weeks, the overall rate was 0.60 for verbal aggression incidents and 0.19 for physical aggression, per nurse per week. For physical incidents, the evening shift (3 pm - 11 pm) demonstrated a significantly higher rate of aggression than the day shift (7 am - 3 pm). Weeks that had a case-mix with a higher percentage of patients with personality disorders were significantly associated with a higher risk of verbal and physical aggression. CONCLUSION: Healthcare workers in psychiatric settings are at high risk for aggression from patients. Show more

Keywords: Aggression, nursing, training

DOI: 10.3233/WOR-141894

Citation: Work, vol. 51, no. 1, pp. 19-28, 2015

Authors: Purpora, Christina | Blegen, Mary A. | Stotts, Nancy A.

Article Type: Research Article

Abstract: OBJECTIVE: To test hypotheses from a horizontal violence and quality and safety of patient care model: horizontal violence (negative behavior among peers) is inversely related to peer relations, quality of care and it is positively related to errors and adverse events. Additionally, the association between horizontal violence, peer relations, quality of care, errors and adverse events, and nurse and work characteristics were determined. PARTICIPANTS: A random sample (n= 175) of hospital staff Registered Nurses working in California. METHODS: Nurses participated via survey. Bivariate and multivariate analyses tested the study hypotheses. RESULTS: Hypotheses …were supported. Horizontal violence was inversely related to peer relations and quality of care, and positively related to errors and adverse events. Including peer relations in the analyses altered the relationship between horizontal violence and quality of care but not between horizontal violence, errors and adverse events. Nurse and hospital characteristics were not related to other variables. Clinical area contributed significantly in predicting the quality of care, errors and adverse events but not peer relationships. CONCLUSIONS: Horizontal violence affects peer relationships and the quality and safety of patient care as perceived by participating nurses. Supportive peer relationships are important to mitigate the impact of horizontal violence on quality of care. Show more

Keywords: Peer, negative workplace behavior, peer communication

DOI: 10.3233/WOR-141892

Citation: Work, vol. 51, no. 1, pp. 29-37, 2015

Authors: Shaw, Julie

Article Type: Research Article

Abstract: BACKGROUND: A teenage patient with an undiscovered gun in a pediatric emergency department (ED) created risk for violence and high staff stress. OBJECTIVE: To describe ED staff views of workplace violence risk to guide improvements and address staff fears. Participants: Two hundred thirty four health care staff in a Midwestern pediatric hospital system including ED and urgent care locations. METHODS: An electronic survey gathered staff perceptions of workplace safety via multiple choice, forced rank, and narrative responses. Frequency of concern and fear for personal safety from patient or visitor violence was calculated. Events causing …fear, and perceptions about presence of local police and hospital security staff, were examined. RESULTS: 26% of staff expressed concern for safety at least weekly. Twenty seven percent experienced situations causing fear at least monthly. Primary causes of fear were patient or visitor agitation (with violence potential) and weapons in the ED. Respondents would feel ``more safe'' with increased presence from hospital security staff (55%) and local police (71%). CONCLUSIONS: Workplace violence occurs in pediatric emergency departments. Both real and perceived threats must be addressed for staff wellbeing. Utilization of staff perception of risk and improvement ideas is a valuable strategy to guide violence reduction at work. Show more

Keywords: Safety, security, nurses, physicians, weapons

DOI: 10.3233/WOR-141895

Citation: Work, vol. 51, no. 1, pp. 39-49, 2015

Authors: Arnetz, Judith E. | Hamblin, Lydia | Ager, Joel | Aranyos, Deanna | Essenmacher, Lynnette | Upfal, Mark J. | Luborsky, Mark

Article Type: Research Article

Abstract: BACKGROUND: Documented incidents of violence provide the foundation for any workplace violence prevention program. However, no published research to date has examined stakeholders' preferences for workplace violence data reports in healthcare settings. If relevant data are not readily available and effectively summarized and presented, the likelihood is low that they will be utilized by stakeholders in targeted efforts to reduce violence. OBJECTIVE: To discover and describe hospital system stakeholders' perceptions of database-generated workplace violence data reports. PARTICIPANTS: Eight hospital system stakeholders representing Human Resources, Security, Occupational Health Services, Quality and Safety, and Labor …in a large, metropolitan hospital system. METHODS: The hospital system utilizes a central database for reporting adverse workplace events, including incidents of violence. A focus group was conducted to identify stakeholders' preferences and specifications for standardized, computerized reports of workplace violence data to be generated by the central database. The discussion was audio-taped, transcribed verbatim, processed as text, and analyzed using stepwise content analysis. RESULTS: Five distinct themes emerged from participant responses: Concerns, Etiology, Customization, Use, and Outcomes. In general, stakeholders wanted data reports to provide ``the big picture,'' i.e., rates of occurrence; reasons for and details regarding incident occurrence; consequences for the individual employee and/or the workplace; and organizational efforts that were employed to deal with the incident. CONCLUSIONS: Exploring stakeholder views regarding workplace violence summary reports provided concrete information on the preferred content, format, and use of workplace violence data. Participants desired both epidemiological and incident-specific data in order to better understand and work to prevent the workplace violence occurring in their hospital system. Show more

Keywords: Health care workers, occupational health, focus groups

DOI: 10.3233/WOR-141887

Citation: Work, vol. 51, no. 1, pp. 51-59, 2015

Authors: Burchill, Christian

Article Type: Research Article

Abstract: BACKGROUND: Much of the research on violence committed by patients and family members against healthcare providers in the hospital focus on the frequency and severity of incidents plus personal, perpetrator, and hospital characteristics. The literature lacks research on those factors that make healthcare providers in hospitals feel safe from workplace violence committed by patients and family members. OBJECTIVE: The objective of this project is to design an instrument to measure the perceptions of personal safety of emergency nurses in the workplace. METHODS: To develop the Personal Workplace Safety Instrument for Emergency Nurses (PWSI EN) …an extensive review of the literature was conducted and recurrent themes identified. Informal focus groups of emergency nurses and discussions with administrators were conducted to confirm these themes. A review by workplace violence experts and a pilot test with emergency nurses was conducted. RESULTS: The instrument has 31 Likert-scale items to measure the factors of workplace countermeasures, patient-nurse interactions, and administrative and judicial support measures. Fifteen demographic questions were developed to measure characteristics of the nurse and hospital. Results of the expert panel review yielded high content validity (cumulative validity index = 0.98). CONCLUSION: The instrument is valid to measure the perceptions of personal safety in the workplace with emergency nurses. Show more

Keywords: Workplace violence, instrument development, safety

DOI: 10.3233/WOR-141889

Citation: Work, vol. 51, no. 1, pp. 61-66, 2015

Authors: Gillespie, Gordon Lee | Gates, Donna M. | Fisher, Bonnie S.

Article Type: Research Article

Abstract: BACKGROUND: Workplace violence from coworkers, patients, and visitors is a problem affecting every occupational group in the health and social service sector [1-3]. Workplace violence is demonstrated by coworkers through bullying behaviors and by patients and visitors through physical threats and assaults. OBJECTIVE: The purpose of this article is to highlight the special issue authors' and guest editors' recommendations for protecting healthcare workers from being victimized and incurring the negative consequences of having experienced workplace violence. METHODS: Recommendations from the special issue were categorized and discussed in relation to the Social-Ecological Model and the …prevention efforts targeting individuals, relationships, communities, and society. RESULTS: Individual-level recommendations focused on the personal risk reduction for healthcare workers. Relationship-level recommendations addressed the problem of bullying between coworkers and physical violence derived from patients and visitors. Workplace-level recommendations discussed a multi-faceted systems approach to violence management. Societal-level recommendations centered on a universal health policy approach. CONCLUSIONS: The use of a model such as the Social-Ecological Model can be helpful in planning violence prevention efforts in the healthcare setting. Show more

Keywords: Healthcare, workplace violence, bullying, patient, coworker

DOI: 10.3233/WOR-141890

Citation: Work, vol. 51, no. 1, pp. 67-71, 2015

Authors: Bresler, Scott | Gaskell, Michael B.

Article Type: Research Article

Abstract: Workplace violence in healthcare settings is a complex topic with many different environments in which aggression is sometimes expressed by patients toward those entrusted with providing their healthcare. The assessment of violence risk in a nursing home containing many patients with organic brain syndrome is quite distinct from assessment in forensic psychiatric units, inner city emergency rooms, or outpatient pain clinics. Three cases are presented that are composite summaries of actual assaults which took place across different hospital settings, all within an urban Midwestern city in the United States: (1) an emergency department; (2) a psychiatric emergency services (PES) center; …(3) a short stay (typically 72 hours to 5 days) civil psychiatric inpatient unit. These case studies exemplify specific risk factors that violent patients have, depending upon the specific healthcare setting where the patient presents. Research is cited relevant to all three case studies and how one should assess their risk. Lastly, the complexity of this issue is highlighted by a brief discussion of the pitfalls entailed in profiling ``the dangerous patient.'' It is demonstrated that when violence is expressed by a patient toward a healthcare provider, it is usually a maladaptive response, one in which characteristics of that setting and behavior of those who work within it must be carefully considered when determining what factors precipitated the patient's violent act. Show more

Keywords: Violence risk assessment, workplace violence, patient perpetrated violence

DOI: 10.3233/WOR-141888

Citation: Work, vol. 51, no. 1, pp. 73-77, 2015

Authors: Hartley, Daniel | Ridenour, Marilyn | Craine, John | Morrill, Allison

Article Type: Research Article

Abstract: BACKGROUND: Many entry-level and experienced healthcare professionals have not received training in workplace violence prevention strategies. OBJECTIVE: This paper describes the development, content, and initial qualitative evaluation of an on-line course designed to give healthcare workers an opportunity to acquire free workplace violence prevention training while earning free continuing education units. METHODS: A group of healthcare violence prevention researchers worked via email and face-to-face meetings to decide appropriate content for the course. Educational strategies used in the course include: text; video re-enactments of real-life workplace violence incidents; and videos of nurses discussing incidents of …violence. Initial evaluation involved a focus group of nurses to discuss the course content and navigation. RESULTS: The on-line course has thirteen units that take approximately 15 minutes each to complete. The focus group participants liked the ``resume-where-you-left-off'' technology that enables the user to complete any portion of the course, leave to do something, and return to the course where they left off. Participants viewed the ``Nurses' Voices'' videos as relevant illustrations of violence that nurses face in their workplaces. CONCLUSIONS: The focus group participants considered the course to be an effective learning tool for people new to the profession and for those with seniority. Show more

Keywords: Workplace violence, healthcare, on-line, training

DOI: 10.3233/WOR-141891

Citation: Work, vol. 51, no. 1, pp. 79-89, 2015

Authors: Armmer, Francesca | Ball, Charlotte

Article Type: Research Article

Abstract: BACKGROUND: The impact of horizontal violence is multifaceted. From the impact upon the individual, the unit, and the institution, horizontal violence affects professional nursing activities in a variety of aspects of health care. OBJECTIVE: To examine registered nurses' experiences with horizontal violence and explore the relationship between horizontal violence and intent to leave. PARTICIPANTS: A random sample of 300 registered nurses from a Midwestern hospital received the Briles' Sabotage Savvy Questionnaire (BSSQ), the Michigan Organizational Assessment Questionnaire (MOAQ) Intent to Turnover measure, and a Demographic questionnaire. METHODS: Descriptive correlational study was implemented. …Questionnaires were distributed to the selected registered nurses. Descriptive and correlational statistics were calculated. RESULTS: Horizontal violence had been experienced by nurses of all ages and experience. Based upon measurement tools, examples of horizontal violence were: Being held responsible for coworkers' duties; Reprimanded or confronted in front of others; Failure to be acknowledged or confronted in front of others; and Untrue information about you being passed or exchanged. Correlations indicated a significant, positive relationship between perceptions of horizontal violence and intent to leave. Results also indicated the longer nurses were employed the more likely to perceive themselves as victims of horizontal violence. Additionally, results associated with the MOAQ, age and years employed indicated that older nurses and those with increasing years of employment were less likely to leave. Younger nurses indicated more willingness to leave a position due to perceived horizontal violence than older nurses. CONCLUSIONS: Activities to address the impact of perceived horizontal violence are needed. Workplace strategies may include mentoring, ongoing assessment of organizational climate, and zero tolerance for horizontal violence. Show more

Keywords: Aggression, retention, oppression, co-workers

DOI: 10.3233/WOR-152015

Citation: Work, vol. 51, no. 1, pp. 91-97, 2015

Authors: Hill, Adam K. | Lind, Michael A. | Tucker, DaVona | Nelly, Pamela | Daraiseh, Nancy

Article Type: Research Article

Abstract: BACKGROUND: Quality improvement initiative focused on staff injury reduction on a specialized inpatient psychiatric unit which offers acute stabilization for children and adolescents with complex high-risk behaviors. OBJECTIVE: To utilize quality improvement principles and interventions to reduce staff injuries on a specialized inpatient child/adolescent psychiatric unit. PARTICIPANTS: Direct care clinical staff within an inpatient psychiatric unit for patients with co-occurring developmental disabilities and psychiatric illness were the focus of the initiative. Direct care clinical staff and clinical administrators were the active participants in the quality improvement initiative, focusing upon the interactions between staff and …patients. METHODS: OSHA-recordable injuries were documented to guide initiatives and measure outcomes on weekly run charts with raw data measures of all staff injuries and the number of days elapsed between injuries. Rapid Plan, Do, Study, Act (PDSA) cycles were utilized to test interventions and guide decision making. RESULTS: Three months of a structured and systematic intervention trial produced the first adopted interventions in August 2011. The following six months reflected a 65% reduction of staff injuries (from 2.2 injuries per week to 0.77 injuries per week). Between January and August 2011, there were eight OSHA-recordable injuries with an average of 26.5 days between injuries. The average number of days between OSHA-recordable injuries has increased from 26.5 days at baseline to 124 days. CONCLUSIONS: An initiative utilizing quality improvement principles reduced staff injuries on an inpatient specialized psychiatric unit. Reliability principles, system adaption, and engagement of the frontline nursing clinicians have proven to be foundational and vital to guide the initiative. Show more

Keywords: OSHA-recordable injuries, acute crisis stabilization

DOI: 10.3233/WOR-152014

Citation: Work, vol. 51, no. 1, pp. 99-111, 2015

Authors: Chen, Su-Huang | Lee, Yung-Hui | Lin, Chiuhsiang Joe

Article Type: Research Article

Abstract: BACKGROUND: Various parameters related to pushing/pulling tasks have been examined yet the effects of changing the load position in one-wheeled wheelbarrow task has not been examined. OBJECTIVE: To explore the effects of load position and force direction on muscle activity during wheelbarrow tasks. PARTICIPANTS: Nine participants were recruited to take part in the experiment. METHODS: Each participant performed 18 trials consisting of 2 force directions (push and pull) and 9 load positions. The dependent variables were EMG of erector spinae and gripping force. ANOVA was used to identify significant differences between force …direction and load position in EMG and gripping force data. RESULTS: Results showed that peak EMG was lowest for the left and right erector spinae when the load was positioned farther from the participant. Peak EMG of the bilateral erector spinae increased when the weight was near the participant and on the ipsilateral hand. CONCLUSIONS: Based on the EMG results, we suggest that loads be arranged in the anterior part of the bin in order to reduce muscle activity on the spine during the wheelbarrow task. This finding also provides some directions in the improvement and ergonomic redesign of the one-wheeled wheelbarrow. Show more

Keywords: Push and pull, Electromyography(EMG), MMH, low back

DOI: 10.3233/WOR-141841

Citation: Work, vol. 51, no. 1, pp. 113-119, 2015

Authors: Gewurtz, Rebecca E. | Cott, Cheryl | Rush, Brian | Kirsh, Bonnie

Article Type: Research Article

Abstract: BACKGROUND: Government policy shapes and is shaped by society's views of important social issues such as employment among people with disabilities. OBJECTIVE: This article explores how unemployment among people with mental illness has been understood and characterized within social policy. METHODS: Drawing on a qualitative case study that explored the construction and implementation of policy reform within the employment support branch of the Ontario Disability Support Program, this paper examines assumptions about unemployment among people with mental illness that underlie social policy and their impact on employment services and supports. RESULTS: The …most prominent messages that emerged from the data focused on unemployment among people with mental illness as a function of personal responsibility, limitations and a lack of motivation. Although there was awareness of the role of social and systemic factors, these issues were given less weight, especially when describing employment support practices. There is a lack of sufficient attention to complex and deeply-rooted social and systemic inequalities within social policy and employment services. CONCLUSIONS: There is a need to expand conceptualizations of unemployment among people with mental illness within social policy, and develop interventions that address complex social factors and systemic constraints that can limit employment opportunities. Show more

Keywords: Causes of unemployment, employment supports, funding structures, policy reform

DOI: 10.3233/WOR-141843

Citation: Work, vol. 51, no. 1, pp. 121-133, 2015

Authors: Giorgi, Gabriele | Arcangeli, Giulio | Mucci, Nicola | Cupelli, Vincenzo

Article Type: Research Article

Abstract: BACKGROUND: Since 2008, a deep financial crisis, which started in the United States, has widely spread around the world. Scientists expressed their worry about this crisis by pointing out that potential negative health effects can be created by collective fear and panic. …OBJECTIVES: The main purpose of this cross-sectional study on the fear of the crisis has been to examine its impact on mental health through the use of structural equation modeling. In the trial a new model of economic stress we were also interested in identifying if fear of the crisis has an indirect relationship with employees' health (e.g. related to a poor social support or to work-related stress). Furthermore, this study aimed to examine whether a full or a partial mediation model best fits the data. METHODS: Data collection took place between 2010 and 2011. During this period several private organizations that comprised of 1236 employees participated in the study. RESULTS: It was found that social support and job stress fully mediated the relationship between fear of the crisis and health, with all fit indices meeting their respective criteria, and with all path coefficients being significant. CONCLUSIONS: Implications for discussion of the crisis among employees were presented. In conclusion, fear of the crisis appeared to be an important innovative construct for organizational wellbeing. Show more

Keywords: Job insecurity, mental health, economic stress, work-related stress

DOI: 10.3233/WOR-141844

Citation: Work, vol. 51, no. 1, pp. 135-142, 2015

Authors: Turner, Niall | O'Mahony, Paul | Hill, Michelle | Fanning, Felicity | Larkin, Conall | Waddington, John | O'Callaghan, Eadbhard | Clarke, Mary

Article Type: Research Article

Abstract: BACKGROUND: Conducting research on the work outcomes of first episode psychosis (FEP) samples may extend our understanding of the factors associated with the work outcome of people with schizophrenia and other psychotic illnesses. OBJECTIVE: To conduct a detailed study of the work outcome of an FEP sample. METHODS: Members of a FEP cohort, who had completed a 12-year clinical outcome assessment, were invited to participate in an adjunctive work outcome study. Engagement in paid and non-paid work was first established and the relationship with potentially influential baseline characteristics investigated. Subsequently the influence of work …outcome to participants' level of quality of life, mental health, recovery, and social inclusion were examined. RESULTS: Among the 38 participants the mean percentage of time spent in work was 62% of which 50% was in paid work and 12% was in non-paid work. Being employed at inception was the only independent predictor of the duration of the follow-up period spent in work. Relationships between work outcome and all measures of wellbeing were found. CONCLUSION: The paid and non-paid work attained by people affected by a psychotic illness played an important role in the extent of their wellbeing, recovery, and social inclusion. Show more

Keywords: Employment, schizophrenia, social inclusion, recovery, quality of life

DOI: 10.3233/WOR-141865

Citation: Work, vol. 51, no. 1, pp. 143-152, 2015

Authors: Shih, Yi-Nuo | Chen, Chi-Sheng | Chiang, Hsin-Yu | Liu, Chien-Hsiou

Article Type: Research Article

Abstract: BACKGROUND: Work attention in persons with chronic schizophrenia is an important issue in vocational rehabilitation. Some of the research literature indicates that background music may influence visual attention performance. OBJECTIVES: Based on the theory of occupational therapy, environmental sounds, colors and decorations may affect individual performance, this study thus examined the influence of music on work attention in persons with schizophrenia. PARTICIPANTS: Participants were recruited from a halfway house in Taipei. Forty-nine (49) patients with chronic schizophrenia volunteered. They had been accepted into vocational rehabilitation and a work-seeking program. The sample included 20 females …and 29 males. The participant ages ranged between 29 and 63 years old, and their average age was 47 years old. METHODS: Using a randomized controlled trial (RCT) study, the participants were assigned to one of three conditions: quiet environment as the control group (n= 16), classical light music as background music (n= 16), and popular music as background music (n= 17). RESULTS: For Group 1 (control group/quiet environment), there was no significant variance (sig = 0.172). For Group 2 (Classical light music), the intervention revealed significant variance (sig = 0.071* ). For Group 3 (popular music), the intervention had significant variance (sig = 0.048** ). CONCLUSIONS: The introduction of background music tended to increase attention test scores of persons with schizophrenia. Moreover, the increase in test attention scores was statistically significant when popular music was played in the background. This result suggested that background music may improve attention performance of persons with chronic schizophrenia. Future research is required with a larger sample size to support the study results. Show more

Keywords: Occupational form, attention test, vocational rehabilitation

DOI: 10.3233/WOR-141846

Citation: Work, vol. 51, no. 1, pp. 153-158, 2015