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