Qualitative Analysis of Workplace Assault Outcomes from the Perspectives of Emergency Nurses.

INTRODUCTION: Emergency nurses experience a myriad of negative consequences associated with workplace assault. The purpose of this study was to explore the experiences of emergency nurses using the Ecological Occupational Health Model of Workplace Assault. METHODS: A descriptive qualitative design was used for this study. Data from 167 emergency nurse participants who described an episode of workplace assault were analyzed using a conventional content analysis method. RESULTS: Fourteen codes emerged from the qualitative data that related to 4 categories for the theme, Outcomes of Workplace Assault. The category "Consequences of Assault to Patients and Visitors" was supported by the following codes: use of limit setting; being evicted or removed from the emergency department; having charges pressed or being arrested; use of restraints; and retaliation against aggressor. "Effects on the Worker" was supported by the following codes: physical outcomes and response; psychological outcomes and response; physical support from peers; apologies; and debriefing/supportive care. "Effects on the Workplace" was supported by the following codes: calling for and response by police or security; and visitor response, support, or assistance. "Effects on Patient Care" was supported by the following codes: impact to treatment and work productivity. DISCUSSION: Workplace assault in the ED setting is associated with consequences of workplace assault to patients and visitors as well as negative effects to emergency nurses, the workplace, and patient care. Emergency nurses need to seek and also offer emotional support after workplace assault. Providing support could serve as a deterrent to retaliation while minimizing potential adverse impacts to nurses' psychological health and work productivity.

Psychological Distress and Workplace Bullying Among Registered Nurses

Workplace bullying (WPB) behaviors are pervasive in some healthcare organizations leading to difficult work environments for registered nurses. We conducted an exploratory quantitative dominant (QUANT/qual) mixed method design study to determine the differences in respondents in three Midwestern states on psychological distress symptoms using WPB exposure levels and select nurse characteristics. This article discusses background information and WPB consequences. We report on the study purpose, methods, and Phase I qualitative results, including significant differences with perceived stress, anxiety, and posttraumatic symptoms reported by persons with frequent to daily WPB behavior exposure. The discussion section considers significant differences found between respondents related to age and posttraumatic stress symptoms. Narrative analysis on strategies used after bullying also illuminates the discussion. Finally, we examine implications for nurse leaders and empowerment of their direct reports to resolve minor interpersonal conflicts and move swiftly to resolve escalating bullying.

Recognizing, Confronting, and Eliminating Workplace Bullying.

Workplace bullying (WPB) behaviors negatively affect nurse productivity, satisfaction, and retention, and hinder safe patient care. The purpose of this article is to define WPB, differentiate between incivility and WPB, and recommend actions to prevent WPB behaviors. Informed occupational and environmental health nurses and nurse leaders must recognize, confront, and eliminate WPB in their facilities and organizations. Recognizing, confronting, and eliminating WPB behaviors in health care is a crucial first step toward sustained improvements in patient care quality and the health and safety of health care employees.

A Safe and Healthful Work Environment: Development and Testing of an Undergraduate Occupational Health Nursing Curriculum.

Occupational health nursing focuses on promotion and restoration of health, prevention of illness and injury, protection from work-related and environmental hazards, and corporate profitability. Quality education about the relationship between work and health is critical for nurses' success regardless of work setting, and is consistent with Healthy People 2020 goals, but is lacking or limited in some programs. This report introduces an innovative occupational health nursing curriculum for students enrolled in baccalaureate nursing programs. The process of designing and pilot testing this novel curriculum, its alignment with nursing competencies, and its format and learning activities are described. Preparing professional nurses to understand the role of the occupational health nurse and the relationship between work and health is an essential curricular consideration for contemporary nursing education.

Stressful incidents of physical violence against emergency nurses.

Physical violence against nurses has become an endemic problem affecting nurses in all settings. The purpose of this study was to describe acts of physical violence against emergency nurses perceived as stressful using a qualitative descriptive design with a national sample of emergency nurses. The guiding conceptual model for the study was the Ecological Occupational Health Model of Workplace Assault. Narrative accounts of physical violence were analyzed using a constant comparative analysis method. Key findings included risks related to employee, workplace, and aggressor factors, and descriptions of physical violence. Discussion of the study findings suggests that efforts to prevent violence and promote workplace safety need to focus on designing work environments that allow for the quick egress of employees, establishing and consistently enforcing policies aimed at violence prevention, and maintaining positive working relationships with security officers. While patients with mental health or substance use complaints are deemed most likely to commit physical violence, they are not the only patients to become violent. Risk reduction efforts should target all patients and visitors.

Novice nurse productivity following workplace bullying.

PURPOSE: To determine the prevalence and effects of workplace bullying (WPB) on the work productivity of novice nurses (NNs). DESIGN: Internet-based descriptive cross-sectional survey design. METHODS: One hundred ninety seven NNs (91.4% female, 8.6% male) in practice less than 2 years completed the Healthcare Productivity Survey, Negative Acts Questionnaire, and a demographic survey. FINDINGS: The majority (72.6%, n= 147) of NNs reported a WPB event within the previous month, with 57.9% (n= 114) the direct targets and another 14.7% (n= 29) witnesses of WPB behaviors. Using a weighted Negative Acts Questionnaire score, 21.3% (n= 43) of NNs were bullied daily over a 6-month period. When asked if bullied over the past 6 months, approximately 44.7% (n= 88) of NNs reported repeated, targeted WPB, with 55.3% (n= 109) reporting no WPB. WPB acts were primarily perpetrated by more experienced nursing colleagues (63%, n= 126). Further, work productivity regression modeling was significant and NN productivity was negatively impacted by workplace bullying (r=-.322, p= .045). CONCLUSIONS: WPB continues in the healthcare environment and negatively affects bullied NNs' productivity by affecting cognitive demands and ability to handle or manage their workload. CLINICAL RELEVANCE: Healthcare facilities should continue to measure WPB in the work environment after policy implementation as well as eliminate negative behaviors through root-cause analysis to correct environmental factors associated with WPB.

Migraine disorder: workplace implications and solutions.

Migraine disorder is disabling, costly, underdiagnosed, and undertreated. It affects employees' quality of life and ability to work or attend school, potentially decreasing their earning ability. Migraine disorder impacts the workplace substantially through absenteeism and presenteeism and increases health care costs. Although research on migraine disorder is expansive, no systematic research tool or design exists within population studies. This may account for the different prevalence rates seen, especially in African studies, which rely on verbal interviews instead of mail or telephone surveys. Women have a higher prevalence rate throughout the research, but they seek help more often than men. This may contribute to their higher rates, although hormones also play a role. Occupational health nurses can affect the outcome of migraine disorder for employees and employers. They can assist in identifying those employees with migraine disorder who are not diagnosed, those who have not investigated the various available medications, or the lifestyle changes that would decrease the intensity and frequency of migraine attacks. Research is needed to quantify the cost savings of workplace intervention in identifying employees with migraine disorder and its effect on absenteeism, presenteeism, and health care use. Occupational health nurses can determine the effectiveness of education by measuring motivation, lifestyle changes, and workplace modification against the intensity and frequency of migraine attacks. This, in turn, will yield measurable results in reducing absenteeism and presenteeism in the workplace. Occupational health nurses can spread this information through employees to their families. As more undiagnosed and undertreated individuals with migraine become educated and pursue diagnosis, treatment, and lifestyle changes, a measurable decrease in health care use and costs may occur. The economic impact of migraine disorder, in terms of workplace absenteeism and presenteeism and increased health care use by employees, continues to be of great concern. This impact may motivate employers to support workplace interventions that educate, screen, and refer migraineurs to appropriate care. Employers may also be motivated to request that a managed care model for migraine be included in health and welfare programs, which would allow for assignment of a nurse case manager with automatic referral to a neurologist. The workplace is an ideal environment for identifying and referring migraine sufferers who only self-treat for symptoms. Prompt and effective treatment, in and out of the workplace, will decrease the frequency and intensity of migraine attacks and increase the quality of life.

Schizophrenic-like neurocognitive deficits in children and adolescents with 22q11 deletion syndrome.

22q11.2 Deletion Syndrome (22q11DS) is the most common genetic microdeletion syndrome affecting humans. The syndrome is associated with general cognitive impairments and specific deficits in visual-spatial ability, non-verbal reasoning, and planning skills. 22q11DS is also associated with behavioral and psychiatric abnormalities, including a markedly elevated risk for schizophrenia. Research findings indicate that people with schizophrenia, as well as those identified as schizoptypic, show specific cognitive deficits in the areas of sustained attention, executive functioning, and verbal working memory. The present study examined such schizophrenic-like cognitive deficits in children and adolescents with 22q11DS (n = 26) and controls (n = 25) using a cross-sectional design. As hypothesized, 22q11DS participants exhibited deficits in intelligence, achievement, sustained attention, executive functioning, and verbal working memory compared to controls. Furthermore, deficits in attention and executive functioning were more pronounced in the 22q11DS sample relative to general cognitive impairment. These findings suggest that the same pattern of neuropsychological impairment seen in patients with schizophrenia is present in non-psychotic children identified as at-risk for the development of schizophrenia based on a known genetic risk marker.