Factors Contributing to Increased Workplace Violence Against Nurses During COVID-19 in the Healthcare Settings of a Lower Middle-income Country: A Qualitative Study.

PURPOSE: The aim of this study was to provide the perceptions of nurses, nursing supervisors, and nursing administrators about factors contributing to increased workplace violence (WPV) against nurses within the healthcare settings in Pakistan during the first wave of the COVID-19 pandemic. METHODS: This study used a Descriptive Qualitative design, with a purposive sampling technique. From September to December 2021, In-depth interviews of 45 to 60 minutes, using a semistructured interview guide, we collected data from a private and a public healthcare setting in Pakistan. Given the travel restrictions during the COVID-19 pandemic, these interviews were conducted online, using Zoom audio features. Bedside nurses, nursing supervisors, and nursing administrators with at least six months of work experience participated in this study. RESULTS: The qualitative data analysis steps suggested by Braun and Clarke (2013) were used for thematic analysis. The overarching theme emerging from the data was "Factors perceived by nurses that contributed to increased WPV in their work settings during the first wave of COVID-19, in a lower middle-income country" The subthemes from the participants' narrations were (a) highly stressed patients, attendants, and healthcare workers; (b) the financial burden on patients and their families; (c) lack of resources and shortage of staff; (d) restricted visiting policy and a weak security system; (e) lack of awareness about the seriousness of COVID-19; (f) misconceptions about COVID-19 vaccines and nurses' role in disseminating awareness. CONCLUSIONS: The current pandemic increased the intensity of WPV against nurses in healthcare settings in Pakistan. Despite any supposed reasons for WPV, exposure to violence should never be an acceptable part of nursing. The healthcare system in Pakistan needs to pay equal attention to funding, resource provision, and ensuring a safe working environment for healthcare workers.

Increasing access to quality care for pregnant and postpartum people with opioid use disorder: Coordination of services, provider awareness and training, extended postpartum coverage, and perinatal quality collaboratives.

INTRODUCTION: Fifteen states participating in the Opioid Use Disorder, Maternal Outcomes, and Neonatal Abstinence Syndrome Initiative Learning Community (OMNI LC) developed action plan goals and activities to address the rise in opioid use disorder (OUD) among birthing persons. In a separate initiative, Perinatal Quality Collaboratives (PQCs) from 12 states participating in Centers for Disease Control and Prevention (CDC)-supported activities hosted trainings to improve the provision of OUD services and implement protocols for screening and treatment in delivery facilities. METHODS: This descriptive study synthesizes qualitative data extracted from 15 OMNI LC state action plans, excerpts from qualitative interviews conducted with OMNI LC state teams, and quantitative data from quarterly project performance monitoring reports from 12 CDC-funded PQCs implementing quality improvement activities to address clinical service gaps for pregnant and postpartum people with OUD. Qualitative data were deidentified, coded as barriers or facilitators, then aggregated into emergent themes. Count data are presented for quantitative results. RESULTS: The OMNI LC states identified a lack of coordinated care among providers, stigma toward people with OUD, discontinued insurance coverage, and inconsistencies in screening and treating birthing people with OUD as barriers to accessing quality care. State-identified facilitators for access to quality care included: 1) improving engagement and communication between providers and other partners to integrate medical and behavioral health services post-discharge, and facilitate improved patient care postpartum; 2) training providers to prescribe medications for OUD, and to address bias and reduce patient stigma; 3) extending Medicaid coverage up to one year postpartum to increase access to and continuity of services; and 4) implementing screening, brief intervention, and referral to treatment (SBIRT) in clinical practice. PQCs demonstrated that increased provider trainings to treat OUD, improvements in implementation of standardized protocols, and use of evidence-based tools can facilitate access to and coordination of services in delivery facilities. CONCLUSION: State-identified facilitators for increasing access to care include coordinating integrated services, extending postpartum coverage, and provider trainings to improve screening and treatment. PQCs provide a platform for identifying emerging areas for quality improvement initiatives and implementing clinical best practices to provide comprehensive, quality perinatal care for birthing populations.

Building Leadership Through Partnerships: Using Concept Mapping to Develop Community Capacity to Address Gender-Based Violence.

BACKGROUND: To address an unmet need for community-driven gender-based violence (GBV) responses in areas with high levels of precarious employment, a community-based organization partnered with academic researchers and community members to use concept mapping to inform the design of a leadership development program. OBJECTIVES: The objectives of the research were to identify and prioritize the skills, knowledge, and resources that "worker-leaders" (informal activists) need to help prevent and reduce acts of GBV directed toward individuals working in low-wage and precarious employment situations. METHODS: Using concept mapping as part of a community-based participatory project, the community-academic research team elicited input from Latinx and Korean residents from low-income immigrant communities. Individuals brainstormed, sorted, and rated the skills and resources necessary to reduce and respond to GBV. Quantitative analyses were jointly interpreted by community and academic researchers. RESULTS: Sixty-nine individuals participated in at least one concept mapping activity. Twenty-one unique skills and resources across seven thematic constructs were identified. Participants believed that skills and resources related to Workplace Violence would be most effective at building trainee capacity to address GBV, but Employee and Survivor Support topics were more likely to draw worker-leaders to a program. Access to organizations that support survivors was considered both highly effective and likely to be of great interest. CONCLUSIONS: This research ensures that the GBV leadership training program is grounded in community-generated evidence. The process of undertaking this research was at least as useful in the development of the leadership of the program as the results themselves.

A Systematic Review: Effectiveness of Interventions to De-escalate Workplace Violence against Nurses in Healthcare Settings.

Workplace violence (WPV) is an increasing cause of concern around the globe, and healthcare organizations are no exception. Nurses may be subject to all kinds of workplace violence due to their frontline position in healthcare settings. The purpose of this systematic review is to identify and consider different interventions that aim to decrease the magnitude/prevalence of workplace violence against nurses. The standard method by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA, 2009) has been used to collect data and assess methodological quality. Altogether, twenty-six studies are included in the review. The intervention procedures they report on can be grouped into three categories: stand-alone trainings designed to educate nurses; more structured education programs, which are broader in scope and often include opportunities to practice skills learned during the program; multicomponent interventions, which often include organizational changes, such as the introduction of workplace violence reporting systems, in addition to workplace violence training for nurses. By comparing the findings, a clear picture emerges; while standalone training and structured education programs can have a positive impact, the impact is unfortunately limited. In order to effectively combat workplace violence against nurses, healthcare organizations must implement multicomponent interventions, ideally involving all stakeholders.

Still Looking for Mechanisms: A Realist Review of Batterer Intervention Programs.

INTRODUCTION: Complex interventions, including batterer intervention or treatment programs (BIPs), require that program strategies interact with contextual factors to trigger often unseen mechanisms in individuals or communities. Although hundreds of evaluations of BIPs have been published, few identify mechanisms or explain for whom, under what conditions, and why programs are effective. The goal of this realist review is to identify evidence of the mechanisms that contribute to successful immediate outcomes in BIPs. METHODS: In accordance with published realist review standards, we defined the review questions and rational, defined outcomes and formulating initial theories, searched the literature, applied inclusion and exclusion criteria, and analyzed and synthesizing data. An initial search yielded 5,149 citations, and after a systematic process using realist principles, six articles with sufficient information were included. RESULTS: Few evaluations contain the detail necessary to discern clear generative explanations of program processes. Evidence suggested that under some contextual conditions, strategies that trigger a self-reflexive process in participants may lead to changes in attitudes about violence, which may lead to the development of empathy for their partner. Additionally, programs that help participants differentiate between shame and guilt appear to increase both acceptance of responsibility and empathy. DISCUSSION: This realist synthesis illustrates several gaps in the evaluative literature. Few evaluations captured sufficient detail to examine the influence of contextual factors. Likewise, most evaluations only describe if specific outcomes were achieved, not how, or through what mechanisms, those outcomes were accomplished. Recommendations to strengthen program theory and further examine self-reflection as a mechanism are discussed.

Impact of precarious work on neighborhood health: Concept mapping by a community/academic partnership.

OBJECTIVE: As part of community-based participatory research (CBPR) examining precarious employment and community health, academic, and community researchers used concept mapping to explore how residents in two high hardship neighborhoods perceive the impact of work on health. METHODS: Between January and May 2017, 292 individuals who lived or worked in two contiguous Chicago neighborhoods were engaged in brainstorming, sorting, and rating activities. Multidimensional scaling and hierarchical cluster analysis were applied, and findings were interpreted by a community-academic partnership. RESULTS: Brainstorming resulted in 55 unique ways that work impacts health, each of which was rated on its perceived impact on health and prevalence in the neighborhood. Four major themes emerged: Healthy Aspects of Work, Systemic/Structural Injustices, Lack of Control/Exploitation, and Psychological/Physical Stress, which was a multidimensional, cross-cutting theme. CONCLUSION: These findings provide critical insight into community perceptions of the mechanisms by which work influences health, providing a basis for community-driven, sustainable, work-focused interventions that promote community health.

Using implementation science to build intimate partner violence screening and referral capacity in a fracture clinic.

RATIONALE, AIMS, AND OBJECTIVES: Over the past two decades, research informing good clinical practices related to intimate partner violence (IPV) has been plentiful, yet partner violence screening remains challenging to translate into action. In spite of the documented efficacy of routine screening for women of reproductive age and the availability of validated screening instruments, many IPV screening programmes lack the components necessary for success. In Toronto, a multidisciplinary team of researchers and clinicians is using the tools of implementation science to scale up an evidence-based IPV screening and response programme in an urban orthopaedic clinic where prior screening attempts have been ineffective. METHODS: Using the Active Implementation Framework as a guide, researchers collected data across multiple sources to inform the first stage of implementation. Analysis focused on identifying the characteristics of the clinic that support or hinder implementation of new processes, evidence-based screening practices that fit with the clinic, and characteristics of a strong implementation team. RESULTS: Through this process, researchers and clinicians uncovered organizational strengths and weaknesses related to IPV screening that may not have been identified previously. The need to incorporate technology into our screening processes became apparent, as did the importance of shared communication and colearning between clinicians and researchers. CONCLUSIONS: The benefits of investing in the preparatory phases of implementation are discussed. Without undertaking the process of gathering and analysing data, examining the factors that support effective and sustainable implementation, and investing in the creation of a strong implementation team, it is likely that decisions about our screening approaches would have resulted in a less-effective and sustainable process.

"One program that could improve health in this neighbourhood is ____?" using concept mapping to engage communities as part of a health and human services needs assessment.

BACKGROUND: This paper presents the findings of a rapid needs assessment conducted at the request of the local health authority responsible for health care services, the Toronto Central Local Health Integration Network (Ontario, Canada), to inform health and social service planning. METHODS: We utilized concept mapping methodology to facilitate engagement with diverse stakeholders-more than 300 community members and service providers-with a focus on hard to reach populations. Key informant interviews with service providers were used to augment findings. RESULTS: Participants identified 48 unique services or service approaches they believed would improve the health of residents in the area, including those addressing health care, mental health and addictions, youth, families, people experiencing homelessness, seniors, general social services, and services targeting specific populations. While service providers consistently identified a critical need for mental health and addiction services, community members placed greater importance on the social determinants of health including access to housing, job placement supports and training and service accessibility. Both groups agreed that services and programs for seniors and people experiencing homelessness would be highly important. CONCLUSION: Our study provides a unique example of using concept mapping as a tool to aid a rapid service gap analysis and community engagement in a metropolitan area. The findings also reinforce the importance of working cross-sectorally, using a Health in All Policies approach when planning services for underserved populations.

Strategizing Safety: Theoretical Frameworks to Understand Women's Decision Making in the Face of Partner Violence and Social Inequities.

Women in physically and psychologically abusive relationships face numerous decisions related to their safety: decisions that historically have been viewed by researchers and human service practitioners as related to individual or interpersonal factors, such as how they feel about their partner, what they (or those they are close to) think is best for their children, or whether they have a safe place to go to. Social and structural factors, such as poverty, sexism, and barriers related to disability, are either left out or viewed at their individual-level consequence, such as a woman's employment status. Using interview data and case studies from a larger study on housing instability, partner violence, and health, the authors apply ecological and macro-level theoretical models that go beyond the individual level to the stories of women who struggled with partner violence, arguing that it is critical to examine the large social and structural forces that impact women's lives if we are to understand the decisions women make when facing a violent partner.

Searching for the mechanisms of change: a protocol for a realist review of batterer treatment programmes.

INTRODUCTION: Conflicting results reported by evaluations of typical batterer intervention programmes leave many judicial officials and policymakers uncertain about the best way to respond to domestic violence, and whether to recommend and fund these programmes. Traditional evaluations and systematic reviews tend to focus predominantly on whether the programmes 'worked' (eg, reduced recidivism) often at the exclusion of understanding for whom they may or may not have worked, under what circumstances, and why. METHODS AND ANALYSIS: We are undertaking a realist review of the batterer treatment programme literature with the aim of addressing this gap. Keeping with the goals of realist review, our primary aims are to identify the theory that underlies these programmes, highlight the mechanisms that trigger changes in participant behaviour and finally explain why these programmes help some individuals reduce their use of violence and under what conditions they are effective or not effective. We begin by describing the process of perpetrator treatment, and by proposing an initial theoretical model of behaviour change that will be tested by our review. We then describe the criteria for inclusion of an evaluation into the review, the search strategy we will use to identify the studies, and the plan for data extraction and analysis. ETHICS AND DISSEMINATION: The results of this review will be written up using the RAMESES Guidelines for Realist Synthesis, and disseminated through peer-reviewed publications aimed at the practitioner community as well as presented at community forums, and at violence against women conferences. Ethics approval was not needed.

"He Never Did Anything You Typically Think of as Abuse": Experiences With Violence in Controlling and Non-Controlling Relationships in a Non-Agency Sample of Women.

Traditionally, any physical aggression within intimate relationships has been labeled "domestic violence," even as researchers and advocates continue to disagree about the nature of that phenomenon vis-à-vis gender and control. As part of a larger mixed-methods study, 22 women from a non-agency, community-based sample who reported experience with relationship violence were interviewed. The existence of patterned coercive and controlling behaviors substantially differentiated experiences with violence, suggesting this dynamic is at least as important to identify as physical violence. Although preliminary, the impact of these findings on intervention and prevention strategies and on the debate surrounding gender symmetry is discussed.