Workplace violence, work-related exhaustion, and workplace cognitive failure among nurses: A cross-sectional study.

AIM: To examine the relationships between nurses' exposure to workplace violence and self-reports of workplace cognitive failure. DESIGN: A cross-sectional study. METHODS: An online questionnaire was administered in April 2023 to nurses in Michigan, US. Structural equation modelling was used to examine effects of physical and non-physical workplace violence (occupational stressors) and work efficiency and competence development (occupational protective factors) on workplace cognitive failure. RESULTS: Physical violence was a significant predictor of the action subscale of cognitive failure. There were no direct effects of non-physical violence, workplace efficiency, or competence development on any of the workplace cognitive failure dimensions. Both types of violence and efficiency had significant indirect effects on workplace cognitive failure via work-related exhaustion. Work-related exhaustion predicted significantly higher scores for workplace cognitive failure. CONCLUSION: Workplace violence and work efficiency exhibited primarily indirect effects on workplace cognitive failure among nurses via work-related exhaustion. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Nurses experiencing workplace violence may be at increased risk for workplace cognitive failure, especially if they are also experiencing work-related exhaustion. Workplaces that nurses perceive as more efficient can help to mitigate the effects of violence on nurses' cognitive failure. IMPACT: This study addressed the possible effects of workplace violence as well as work efficiency and competence development on nurses' cognitive failure at work. Analyses revealed primarily indirect effects of workplace violence, and indirect protective effects of work efficiency, on nurses' cognitive failure via work-related exhaustion. This research has implications for healthcare organizations and suggests that efforts made by healthcare workplaces to prevent violence and work-related exhaustion, and to enhance work efficiency, may help to mitigate workplace cognitive failure among nurses. REPORTING METHOD: We have followed the STROBE checklist in reporting this study. PATIENT OR PUBLIC CONTRIBUTION: No Patient or public contribution.

Designing and Evaluating Opioid Misuse Prevention Training for Rural Communities and Health Care Providers.

Through Substance Abuse and Mental Health Services Administration funding, Michigan State University (MSU) Extension partnered with MSU's Family Medicine and Health Department of Northwest Michigan to implement trainings for community members and health care providers to increase awareness and improve prevention efforts addressing opioid use disorder (OUD) in rural areas. We formed the Michigan Substance Use Prevention, Education and Recovery (MiSUPER) project to design and evaluate opioid misuse prevention trainings. A socio-ecological prevention model was an underlying conceptual framework for this project and drove strategies used in trainings, products created, and measurement. The purpose of this study is to determine the effectiveness of one-time online educational training events for rural community members and health care providers on community OUD issues, treatment options, and supports for those in recovery. Between 2020 and 2022, rural participants completed pre- and posttraining, and 30-day follow-up evaluation surveys. We report the demographic characteristics of community (n = 451) and provider (n = 59) participants, self-reported knowledge gained, and overall perceptions of the trainings. Findings show community members' knowledge increased from pre- to posttraining (p < .001) and was maintained at 3 months, while providers' knowledge was unchanged over time. Posttraining, community participants felt more comfortable speaking about addiction with family and friends (p < .001), and providers had better knowledge of local resources for patients who could not afford opioid misuse treatments (p < .05). All participants reported gaining knowledge of community resources for opioid misuse prevention, treatment, and recovery (p < .01). Opioid misuse prevention trainings may be most effective when adapted to leverage local resources.

Preventing patient violence in hospitals: Applying critical decision method interviews to understand how skilled staff think and act differently.

AIMS: Our aims were to understand how hospital staff who are skilled at managing aggressive patients recognize and respond to patient aggression and to compare the approaches of skilled staff to the experiences of staff who were recently involved in incidents of patient violence. BACKGROUND: Violence from patients toward staff is prevalent and increasing. There is a need for greater understanding of effective approaches to managing patient aggression in a wide variety of hospital settings. METHODS: We conducted grounded theory qualitative research applying Critical Decision Method interviews at two hospitals. Skilled staff and incident-involved staff were asked to describe experiences involving aggressive patients and the data were analyzed qualitatively. RESULTS: Our interviews (N = 23) identified positive approaches and challenges to managing aggressive patients. Positive approaches included: maintaining empathy for the patient, allowing the patient time and space, exhibiting a calm demeanor, not taking things personally, and implementing strategies to build trust. Challenges included: inadequate psychiatric resources, balancing priorities between patients with urgent physical needs and those exhibiting difficult behaviors, and perceiving pressure to de-escalate situations quickly. Incident-involved staff were more likely to describe the challenges listed above and a limited tolerance for patients whose behavior they perceived as unjustified or detracting from other patients' care. CONCLUSION: The Critical Decision Method proved valuable for highlighting nuanced understandings of skilled staff that sometimes contrasted with perceptions of incident-involved staff. Our findings support investigation of novel approaches to training such as peer coaching and improving empathy through increased understanding of mental illnesses and addiction.

Data-driven clinical improvement: Oncology nurse leaders' perceptions and experiences of organisational data reports.

AIM: To elicit oncology nurse leaders' perceptions and experiences of accessing, using and interpreting report data at the unit level, and their suggestions for future reports. BACKGROUND: Nurse leaders are expected to use data reports for decisions about unit-level operations, yet data may be inaccessible, unavailable and lack relevance for improving patient care and unit-level outcomes. METHODS: A purposeful sampling was used to recruit 12 unit-level nurse leaders. Qualitative data were collected through semi-structured interviews and analysed using thematic content analysis. RESULTS: Consistent themes included the lack of accurate, useful and meaningful data specifically related to patient care. Accessibility Challenges, Limits to Applicability and Suggestions for Improvement were the main themes. CONCLUSION: Nurse leaders require real-time data to effectively implement clinical interventions and practice changes for improving unit-level patient care. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse leaders emphasized that their insight into the development of customizable reports is crucial for obtaining meaningful data relevant to the varied unit-level health care setting. Reports targeting unit-level outcomes would provide meaningful data to facilitate clinical improvement where patient care is provided. Improved reports increase the likelihood of their use and the potential for enhancing the quality and safe care outcomes.

The Development of Posttraumatic Stress Disorder and Depression Symptoms in Iraqi Refugees: Associations with Acculturation and C-reactive Protein.

ABSTRACT: Refugees experience distress from premigration trauma, often exacerbated by postmigration difficulties. To develop effective interventions, risk factors for mental health symptoms need to be determined. Male Iraqi refugees (N = 53) to the United States provided background information and reported predisplacement trauma and psychological health within 1 month of their arrival. An inflammatory biomarker-C-reactive protein (CRP) was assessed approximately 1.5 years after arrival, and a contextual factor-acculturation-and psychological health were assessed 2 years after arrival. We tested whether acculturation and CRP were associated with posttraumatic stress disorder (PTSD) and depression symptoms at the 2-year follow-up, controlling for baseline symptoms, age, body mass index, and predisplacement trauma. Acculturation was inversely related to depression, and CRP was positively related to both PTSD and depression at the 2-year follow-up. Interventions targeting acculturation could help reduce the development of depression symptoms in refugees. The role of CRP in the development of PTSD and depression symptoms warrants further research.

Risk Factors for Assault and Physical Aggression Among Medically Hospitalized Adult Patients Who Had a Behavioral Emergency Call: A Descriptive Study.

BACKGROUND: Health care settings are a primary location for workplace violence that involves clients, but risk factors for behavioral emergencies in medical settings are largely unknown. AIM: This study proposed to identify risk factors for assault and physical aggression among medically hospitalized patients who needed a behavior emergency response team. METHOD: This descriptive study, conducted at a large Midwestern academic medical center, used univariable and multivariable logistic regression to assess relationships between demographic, medical, mental health, and contextual variables with assault and physical aggression. Predictive ability was summarized using area under the receiver operating characteristic curve. RESULTS: Among patients who received a behavior emergency response (N = 820), 86 (10%) were assaultive. Physical aggression was the most significant predictor of assault. Physical aggression was predicted by older age, male gender, and verbal threats to others. Conversely, internalizing mental health conditions of anxiety, depression, and suicidal ideation were significant for decreased risk of assault and/or physical aggression. Contextual factors, identified as wanting to smoke or leave the hospital, were significantly associated with decreased risk of both assault and physical aggression. CONCLUSION: Health care providers are encouraged to (1) consider the demonstration of physical aggression as a sign to urgently implement precautionary measures for safety, (2) avoid predicting violent situations based on particular medical or mental health conditions alone, and (3) understand that not all disruptive behavior leads to violent situations.

Patient and Family Member Violent Situations in a Pediatric Hospital: A Descriptive Study.

PURPOSE: The intent of this study is to report on violent situations involving the pediatric patient and/or the patient's family member in the inpatient hospital setting. DESIGN AND METHODS: This descriptive study used two independent samples: Behavioral Emergency Response Team (BERT) recipients and surveyed pediatric healthcare staff at a pediatric hospital within a large urban Midwestern academic hospital in the United States. RESULTS: Per BERT recipients (N = 26) and staff survey respondents (N = 91), common physical patient behaviors were, respectively, hitting (60%, 77%) and kicking (53%, 82%). Fifteen (75%) patient BERT responses were for violent situations. The most common mental health condition among patients in violent situations was behavior dyscontrol (n = 8, 53%), which was absent among calls for non-violent situations (n = 5). Seizures, which was the most common medical condition among patients in BERT violent situations (n = 6, 40%), was proportionately slightly greater than among non-violent situations (n = 1, 20%). Staff who reported experience with violent situations (n = 64, 73%) were from general medical units (n = 48, 75%), and registered nurses (n = 53, 79%). CONCLUSIONS: This study helped illuminate demographic, medical and mental health clues about violent situations with patients and family members on pediatric inpatient hospital units. PRACTICE IMPLICATIONS: Pediatric patients and families may struggle to cope during hospitalization. Healthcare providers' knowledge about co-occurring conditions, stress related to hospitalization and use of BERT as a resource may help prevent violent situations.

Self-reported oral and general health related to xerostomia, hyposalivation, and quality of life among caries active younger adults.

Objective: The aim was to study prevalence of xerostomia, hyposalivation and quality of life among caries active younger adults.Materials and methods: A questionnaire regarding oral and general health, xerostomia and quality of life was mailed to 134 caries active (CA) and 40 caries inactive (CI) patients, 25-50 years of age (mean age 39.9 ± 6.2 years) treated at a Swedish Public Dental Service clinic, regarding oral and general health, xerostomia and quality of life. Caries data and unstimulated whole salivary flow rates were obtained from dental records.Results: The overall response rate was 69%. Dental records confirmed that CA patients had more decayed teeth over time than CI patients (p < .001). The CA group reported worse oral health (p < .001) and general health (p < .01), more xerostomia (p < .001) and lower salivary flow rate (p < .01) compared to CI patients. Xerostomia was inversely related to unstimulated whole salivary flow rates as well as to oral and general health (p < .01). There were no differences between groups in quality of life.Conclusion: Younger caries active adult patients reported significantly more xerostomia and hyposalivation compared to caries inactive patients. Xerostomia and hyposalivation were inversely related to perceptions of oral and general health, but not to quality of life.

Nurse-Reported Bullying and Documented Adverse Patient Events: An Exploratory Study in a US Hospital.

BACKGROUND: Negative nurse work environments have been associated with nurse bullying and poor nurse health. However, few studies have examined the influence of nurse bullying on actual patient outcomes. PURPOSE: The purpose of the study was to examine the association between nurse-reported bullying and documented nursing-sensitive patient outcomes. METHODS: Nurses (n = 432) in a large US hospital responded to a survey on workplace bullying. Unit-level data for 5 adverse patient events and nurse staffing were acquired from the National Database of Nursing Quality Indicators. Generalized linear models were used to examine the association between bullying and adverse patient events. A Bayesian regression analysis was used to confirm the findings. RESULTS: After controlling for nurse staffing and qualification, nurse-reported bullying was significantly associated with the incidence of central-line-associated bloodstream infections (P < .001). CONCLUSIONS: Interventions to address bullying, a malleable aspect of the nurse practice environment, may help to reduce adverse patient events.

Organizational determinants of bullying and work disengagement among hospital nurses.

AIMS: To identify organizational determinants of bullying and resulting work disengagement among hospital nurses. DESIGN: A cross-sectional, web-based, anonymous questionnaire study. METHODS: The questionnaire was administered in 2017 to all Registered Nurses in a regional healthcare system in the United States (N = 1,780), with 331 complete responses. Logistic regression was used to identify factors associated with personally experiencing and witnessing bullying, respectively. Linear regression was conducted to identify organizational factors associated with disengagement due to bullying. RESULTS: Psychological safety, a measure of team trust and respect, was inversely associated with being personally bullied and witnessing bullying. Being personally bullied, but not witnessing bullying, was associated with disengagement due to bullying. Psychological safety and competence development, a measure of opportunities to develop skills and knowledge at work, were both inversely associated with disengagement due to bullying. CONCLUSION: Hospital units characterized by trust and respect among nurses are less likely to have a culture of bullying. Both psychological safety and competence development have a protective effect on nurse disengagement from the workplace due to bullying. Interventions to mitigate and prevent bullying and work disengagement among nurses should encompass efforts to enhance psychological safety and opportunities for competence development. IMPACT: Bullying is a pervasive hazard in the nursing profession that contributes to unhealthy workplaces. Nurse managers and staff nurses should work together to establish psychologically safe environments where nurses dare to discuss tough issues like bullying. This research contributes to understanding the characteristics of work environments in which nurses can thrive and work effectively.

Workplace Bullying Among Nurses: Developing a Model for Intervention.

Workplace bullying is endemic to the nursing profession and it threatens nurses' health and ability to work safely. However, effective interventions to prevent workplace bullying are lacking. A sample of hospital nurses (n = 15) explored experiences of bullying and ideas for intervention via four focus groups in 2016. Four main themes emerged from the qualitative content analysis: (a) characteristics that define bullying behavior; (b) facilitators of bullying; (c) consequences of bullying; and (d) possible interventions. Although personal characteristics played a role, bullying was primarily facilitated by workplace and organizational factors that hindered the establishment of collegiality and team trust among nurses. Findings have informed a conceptual model for prevention of nurse-to-nurse bullying with ethical leadership and communication, trust, and social cohesion in work teams as key elements.

Organisational efficiency and co-worker incivility: A cross-national study of nurses in the USA and Italy.

AIM: To examine the relationship of co-worker incivility with organisational efficiency, workload and intention to leave in nursing samples from two different countries, the USA and Italy. BACKGROUND: Organisational efficiency has received little attention as a possible correlate of co-worker incivility in the nursing management literature. Studies on co-worker incivility have primarily been carried out in North America and no cross-national studies are available. METHOD: Data were collected by a self-report questionnaire involving nurses from the USA (n = 341) and Italy (n = 313). FINDINGS: Organisational efficiency was negatively associated with workload, co-worker incivility and intention to leave in both samples. The path from co-worker incivility to intention to leave was also positive and significant in both samples. Workload was positively associated with co-worker incivility and intention to leave in the US sample, but not in the Italian sample. CONCLUSION: The present study suggests that organisational efficiency is central to understanding both co-worker incivility and intention to leave among nurses. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse administrators should adopt interventions aimed at fostering organisational efficiency in an effort to reduce nurse co-worker incivility.

Diabetes Is Devastating, and Insulin Is a Death Sentence: Provider Perspectives of Diabetes Self-Management in Arab-American Patients.

IN BRIEF The purpose of this qualitative study was to examine providers' perspectives on cultural barriers and facilitators to diabetes self-management (DSM) in Arab Americans to identify factors to enhance DSM education in the Arab-American community. The main barriers to DSM from the providers' perspective were the disease itself and patients' denial or refusal to recognize it, reflecting the stigma of the disease. Cultural aspects also included overlapping themes that both facilitated and presented barriers to DSM. These results suggest that DSM education for Arab Americans will be most effective if developed and delivered in a manner consistent with the cultural facilitators and barriers noted by providers.

Patient-reported negative experiences related to caries and its treatment among Swedish adult patients.

BACKGROUND: It has been suggested that dental caries should be regarded as a chronic disease as many individuals repeatedly develop new caries lesions. How this is perceived by caries active patients is unclear. The aim of this study was to measure patient-reported attitudes and negative experiences related to caries and dental treatment. METHODS: A questionnaire was mailed to 134 caries active (CA) and 40 caries inactive (CI) adult patients treated at a Swedish public dental service clinic. The questionnaire included items regarding patient-reported oral health; attitudes towards caries and efforts to prevent them; and negative experiences related to caries and dental treatment. Questionnaire data were supplemented with data on caries and caries prophylaxis from patients' dental records. Exploratory factor analysis was conducted on items related to patients' perceptions of problems to see whether scales could be created. Experiences, perceptions and dental records of CA and CI patients were compared. RESULTS: The overall response rate was 69%. Dental records confirmed that CA patients had significantly more decayed teeth per year and a longer period of caries-active time than CI patients. Factor analysis resulted in 3 distinct scales measuring problems related to caries; 1) caries-related information; 2) negative experiences; and 3) negative treatment/staff attitudes. A fourth scale measuring perceived problems related to caries was also created. The CA group reported significantly more problems related to caries and dental treatment, received significantly more caries-related information, and reported significantly more negative treatment experiences compared to CI patients. CONCLUSIONS: Caries prophylaxis methods need to be improved in order to better meet the needs of caries active patients and to create a more positive experience with dental care.

In Search of Effective Solutions to Curb Workplace Violence.

Investigators have applied epidemiological principles to the study of workplace violence, producing results that offer intriguing information to hospitals struggling for a way forward on this issue. In a randomized, to hospitals struggling for a wary forward on this issue. In a randomized, controlled trial, the researchers found that a one-time, unit-based intervention can reduce the incidence of violent events, and that the approach offers some lasting effect over time. The intervention consisted of a 45-minute discussion with unit supervisors in which unit-specific data regarding violent incidents in their workplace were shared along with an array of improvement strategies. Unit supervisors then were directed to work with their teams to develop action plans to address violence, although they were free to adopt whatever solutions they deemed best. At six moths post-intervention, there was a clear reduction in the incident rate ratios of violent events on the intervention units as compared with control units that did not conduct an intervention. Experts note that the study demonstrates that an effective workplace violence intervention or program must be data-driven and based on principles of continuous quality improvement.

Determinants of resource needs and utilization among refugees over time.

PURPOSE: This study examined refugees' resource needs and utilization over time, investigated the relationships between pre-displacement/socio-demographic variables and resource needs and utilization, and explored the role of resource needs and utilization on psychiatric symptom trajectories. METHODS: Iraqi refugees to the United States (N = 298) were assessed upon arrival and at 1-year intervals for 2 years for socio-demographic variables and pre-displacement trauma experiences, their need for and utilization of 14 different resources, and PTSD and depressive symptoms. RESULTS: Although refugees reported reduction of some needs over time (e.g., need for cash assistance declined from 99 to 71 %), other needs remained high (e.g., 99 % of refugees reported a need for health care at the 2-year interview). Generally, the lowest needs were reported after 2 years, and the highest utilization occurred during the first year post-arrival. Pre-displacement trauma exposure predicted high health care needs but not high health care utilization. Both high need for and use of health care predicted increasing PTSD and depressive symptoms. Specifically, increased use of psychological care across the three measurement waves predicted more PTSD and depression symptoms at the 2-year interview. CONCLUSIONS: Differences emerged between need for and actual use of resources, especially for highly trauma-exposed refugees. Resettlement agencies and assistance programs should consider the complex relationships between resource needs, resource utilization, and mental health during the early resettlement period.

Diabetes self-management among Arab Americans: patient and provider perspectives.

BACKGROUND: Arab Americans have a high burden of diabetes and poor outcomes compared to the general U.S. POPULATION: Diabetes self-management (DSM) requires a partnership between patients and providers that fosters mutual understanding and shared decision-making. Cultural factors influence this process; however, little is known regarding the cultural impact on DSM or if perceptions differ between patients and providers. METHODS: Qualitative content analysis was used to analyze five focus groups-two groups with Arab American providers (n = 8) and three groups with adult Arab Americans with diabetes (n = 23). Focus groups examined patient and provider perspectives on the meaning of DSM and cultural barriers and facilitators among Arab American patients. RESULTS: Four distinct themes included limited resources for DSM education and support, stigma as a barrier to ongoing support, family support as an opportunity and challenge, and Arab American patient-provider relationships. CONCLUSIONS: Findings indicate several domains should be considered for clinical practice including a need to develop linguistically and culturally reliant educational materials and relevant supports for use in the Arab American population. Findings highlight differing views among providers and patients on the familial role in supporting DSM efforts and why some patients feel dissatisfied with clinical encounters.

Patient Involvement: A New Source of Stress in Health Care Work?

Patients have become increasingly well informed with higher expectations to be involved in decision-making processes regarding their care and treatment. However, few studies have examined the impact of patient involvement on health care providers' partnership-building communication. The aim of this study was to measure and explore the self-reported effects of patient involvement on the work of physicians and nurses. A questionnaire survey was distributed among cardiology staff in 12 Swedish hospitals (N = 488, response rate 67%). The sample was comprised of registered nurses (RNs, n = 303), licensed practical nurses (LPNs, n = 132), and physicians (MDs, n = 53). Confirmatory factor analysis was used to examine seven questionnaire statements concerning implications of patient involvement for one's clinical work. Regression analyses were used to examine factors associated with staff's partnership-building communication. Analysis confirmed two distinct factors accounting for 57% of the total variance, representing both negative-"Hassles"-and positive-"Uplifts"-aspects of patient involvement. Regression analyses revealed that only positive aspects (i.e., uplifts) of patient involvement predicted staff behavior aimed at involving patients. Working with actively involved patients may be a source of stress, both negative and positive, for health care professionals. By developing work routines for involving patients in their care, health care workplaces may help health care professionals to buffer the negative effects, and enhance the positive effects, of that stress.

Unemployment in Iraqi refugees: The interaction of pre and post-displacement trauma.

Previous refugee research has been unable to link pre-displacement trauma with unemployment in the host country. The current study assessed the role of pre-displacement trauma, post-displacement trauma, and the interaction of both trauma types to prospectively examine unemployment in a random sample of newly-arrived Iraqi refugees. Participants (N = 286) were interviewed three times over the first two years post-arrival. Refugees were assessed for pre-displacement trauma exposure, post-displacement trauma exposure, a history of unemployment in the country of origin and host country, and symptoms of posttraumatic stress disorder (PTSD) and depression. Analyses found that neither pre-displacement nor post-displacement trauma independently predicted unemployment 2 years post-arrival; however, the interaction of pre and post-displacement trauma predicted 2-year unemployment. Refugees with high levels of both pre and post-displacement trauma had a 91% predicted probability of unemployment, whereas those with low levels of both traumas had a 20% predicted probability. This interaction remained significant after controlling for sociodemographic variables and mental health upon arrival to the US. Resettlement agencies and community organizations should consider the interactive effect of encountering additional trauma after escaping the hardships of the refugee's country of origin.

Understanding patient-to-worker violence in hospitals: a qualitative analysis of documented incident reports.

AIM: To explore catalysts to, and circumstances surrounding, patient-to-worker violent incidents recorded by employees in a hospital system database. BACKGROUND: Violence by patients towards healthcare workers (Type II workplace violence) is a significant occupational hazard in hospitals worldwide. Studies to date have failed to investigate its root causes due to a lack of empirical research based on documented episodes of patient violence. DESIGN: Qualitative content analysis. METHODS: Content analysis was conducted on the total sample of 214 Type II incidents documented in 2011 by employees of an American hospital system with a centralized reporting system. FINDINGS: The majority of incidents were reported by nurses (39·8%), security staff (15·9%) and nurse assistants (14·4%). Three distinct themes were identified from the analysis: Patient Behaviour, Patient Care and Situational Events. Specific causes of violence related to Patient Behaviour were cognitive impairment and demanding to leave. Catalysts related to patient care were the use of needles, patient pain/discomfort and physical transfers of patients. Situational factors included the use/presence of restraints; transitions in the care process; intervening to protect patients and/or staff; and redirecting patients. CONCLUSIONS: Identifying catalysts and situations involved in patient violence in hospitals informs administrators about potential targets for intervention. Hospital staff can be trained to recognize these specific risk factors for patient violence and can be educated in how to best mitigate or prevent the most common forms of violent behaviour. A social-ecological model can be adapted to the hospital setting as a framework for prevention of patient violence towards staff.