Individual, relationship, workplace, and societal recommendations for addressing healthcare workplace violence.

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.

A workplace violence educational program: a repeated measures study.

Violence against healthcare employees is a profound problem in the emergency department worldwide. One strategy to reduce the risk of violence is prevention focused education. The purpose of this paper was to report the learning outcomes of a workplace violence educational prevention program tailored to the needs of emergency department employees. A quasi-experimental design was used to determine the knowledge retention of program content following a hybrid (online and classroom) educational intervention. One hundred twenty emergency department employees that completed the workplace violence prevention program participated in the study. A repeated-measures analysis of variance was conducted to determine if individual test scores increased significantly between baseline, posttest, and six month posttest periods. The results indicated a significant time effect, Wilk's Λ = .390, F (2, 118) = 26.554, p < .001, η2 = .310. Follow-up polynomial contrasts indicated a significant linear effect with means increasing over time, F (1, 119) = 53.454, p < .001, η2 = .310, while individual test scores became significantly higher over time. It was concluded that the use of a hybrid modality increases the probability that significant learning outcomes and retention will be achieved.

Implementation of a comprehensive intervention to reduce physical assaults and threats in the emergency department.

INTRODUCTION: The purpose of this study was to test the effectiveness of a comprehensive program to reduce the incidence of workplace violence (WPV) against ED providers by patients and visitors. METHODS: An intervention study was conducted with 3 intervention and 3 comparison emergency departments. Participants completed monthly surveys during an 18-month period to measure violent event rates before and after the WPV intervention implementation. Descriptive statistics were used to describe violent events. Analysis of variance was used to assess if the emergency departments participating in the WPV intervention experienced a significant reduction in violence rates compared with nonintervention emergency departments. RESULTS: On average, participants experienced more than 6 incidents of violence during the 18-month study period. Although the study hypothesis was not supported, 2 intervention sites had a significant decrease in violence. DISCUSSION: This study emphasizes the risk of WPV to ED workers and highlights the need for prevention programs. Future research needs to be conducted to test additional comprehensive WPV prevention interventions.

Posttraumatic stress symptomatology among emergency department workers following workplace aggression.

Workplace aggression has the potential to adversely affect the psychological health of emergency department (ED) workers. The purpose of this study was to compare posttraumatic stress symptomatology based on verbal and verbal plus physical aggression. A descriptive cross-sectional design was used with a convenience sample (n = 208) of ED workers who completed a three-component survey. Descriptive statistics were computed to compare traumatic stress scores based on type of aggression. Two-way analysis of variance statistics were computed to determine if scores differed on the demographic variables. Fewer than half of the ED workers reported traumatic stress symptomatology; however, workplace aggression has the potential to adversely affect the mental health of ED workers. Occupational health nurses can establish or maintain a nurturing and protective environment open to discussing the personal thoughts, feelings, and behaviors of ED workers related to their experiences of workplace aggression. This open and more positive work environment may aid in reducing the negative impact of posttraumatic stress symptoms among those ED workers who have been victimized.

Using proactive coping to manage the stress of trauma patient care.

Some emergency nurses are resilient following trauma patient care, while others report severe traumatic stress. The purpose of this study was to determine proactive coping behaviors used by emergency nurses to prevent traumatic stress. A cross-sectional research design was used with a national sample of emergency nurses. Participants completed a 5-component Web-based survey. Data analyses included 1-tailed partial correlations. The correlation of proactive coping score to traumatic stress was significant. Proactive coping strategies that focus on the planning and preparation to provide care for traumatically injured patients may be effective at preventing traumatic stress.

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.

Adolescents' experience with workplace aggression: school health implications.

Aggression exposure is a critical health issue facing adolescents in the United States. Exposure occurs in various settings including home, school, and the community. An emerging context for aggression exposure is in the workplace. Thirty adolescent employees age 16-18 participated in a qualitative study exploring proposed responses to future workplace aggression. Semistructured interviews were used to gather participants' proposed responses to a series of hypothetical aggressive incidents in the workplace. Conventional content analysis identified patterns and themes among the participants' responses. Results indicated adolescent employees' proposed responses to workplace aggression are similar to other forms of aggression such as peer-bullying and teen dating violence. Education and training are needed within the school setting to promote appropriate responses to various forms of aggression encountered by adolescents. Implications for school health professionals' involvement in addressing responses to such aggression and further research opportunities are explored.

The Qualitative Learning Experience of Healthcare Workers Completing a Hybrid Workplace Violence Educational Program.

Background: Hybrid educational methodologies which include online and classroom-based learning experiences increase learning. However, the course delivery preferences of learners need to be evaluated so that the design and delivery of future programs will maximize learning outcomes. The aim of this study was to describe how the delivery of a hybrid program contributes to learning outcomes. Methods: A qualitative descriptive design was used. Participants were recruited from two large emergency departments that completed a hybrid workplace violence educational program. Four focus group sessions were held with a convenience sample of 17 participants to discuss their learning experience with the hybrid educational program. Sessions were audiotaped and transcribed verbatim. Data were analyzed using a constant comparative analysis method. Results: Three themes emerged from the data. The first theme was "Implementation of the Intervention" and represented the opportunity for learning, the environment of learning, and the need for uniform training. The second theme was "Experience of the Intervention" and represented the conditions of learning, interdisciplinary learning, facilitated engagement, and realism of the learning content. The third theme was "Translation of the Intervention" which represented the transferability and retention of the program content. Conclusion: An active learning classroom-based component was perceived to yield greater knowledge attainment and retention than online learning for the participants in this study. Consideration of the learning styles and needs of learners should be taken into consideration when developing content for the online delivery or hybrid approach for educational programs.

An educational program to prevent, manage, and recover from workplace violence.

There exists a gap in the preparation of emergency department (ED) employees to prevent, manage, and recover from workplace violence (WPV). Thus, the purpose of this article is to evaluate learning outcomes following a 4-unit WPV educational program. A quasi-experimental study was used to evaluate learning outcomes with 315 employees from 3 EDs. Units 1-3 were web-based and included a pretest-posttest. Unit 4 was classroom-based and allowed employees to apply the knowledge learned during the web-based program. A paired samples t tests reflected a significant increase in knowledge attainment (p < 0.001). There was no significant difference in knowledge attainment between employees who completed the web-based learning only and employees who completed the hybrid web-based/classroom-based education (p = 0.136). A well-developed WPV educational program can achieve significant learning outcomes in ED employees. Web-based learning may be an effective alternative yielding learning outcomes equal to that of a hybrid educational program.

Emergency department workers' perceptions of security officers' effectiveness during violent events.

OBJECTIVE: The emergency department (ED) is among the most at-risk settings for violence by patients and visitors against ED workers. A first response to potential or actual events of workplace violence is often contacting hospital security officers for assistance. The purpose of this study is to describe ED workers' views of security officers' effectiveness during actual events of verbal and/or physical violence. PARTICIPANTS: Healthcare workers (n=31) from an urban pediatric ED in the Midwest United States. METHODS: Participants were interviewed regarding their experiences with workplace violence. Verbatim transcripts were qualitatively analyzed. RESULTS: Six themes were identified: (1) a need for security officers, (2) security officers' availability and response, (3) security officers' presence or involvement, (4) security officers' ability to handle violent situations, (5) security officers' role with restraints, and (6) security officers' role with access. CONCLUSIONS: It is important that early communication between security officers and ED workers takes place before violent events occur. A uniform understanding of the roles and responsibilities of security officers should be clearly communicated to ED workers. Future research needs to be conducted with hospital-based security officers to describe their perceptions about their role in the prevention and management of workplace violence.

An internet training to reduce assaults in long-term care.

Physical and verbal assaults by residents on care staff are not uncommon in long-term residential care facilities (LTCs). This research evaluated an Internet training designed to teach nurse aides (NAs) strategies to work with aggressive resident behaviors. Six LTCs were randomized in an immediate treatment (IT) and delayed treatment (DT) design, and NAs were recruited in each (IT: n = 58; DT; n = 45). The treatment involved 2 weekly visits to the online training. Hard copy assessments collected participant responses at baseline (T1), 8 weeks (T2), and at 16 weeks (T3). The DT group viewed the program after T2. Hierarchical linear models showed significant group differences at T2 in knowledge, and these levels were maintained at T3. The number of aggressive incidents reported per day by the IT group were nonsignificant at T2 but decreased significantly from T1 to T3 with a large effect size. The program was well received by users. These results suggest that the Internet training was an effective tool to reduce assaults in LTCs, and training effects may improve over time as NAs gain experience using the techniques.

Internet training to respond to aggressive resident behaviors.

PURPOSE: This research evaluated an individualized Internet training designed to teach nurse aides (NAs) strategies to prevent or, if necessary, react to resident aggression in ways that are safe for the resident as well as the caregiver. DESIGN AND METHODS: A randomized treatment and control design was implemented, with baseline, 1-, and 2-month assessments for 158 NAs. The training involved 2 weekly visits. The Internet intervention was a behaviorally focused and video-based training that included content on skills for safely dealing with physical aggression. Measures included video situation testing and assessment of psychosocial constructs associated with behavior change. RESULTS: Analysis of covariance showed positive results for knowledge, attitudes, self-efficacy, and empathy, with medium-large effect sizes maintained after 2 months. The training was well received by participants. IMPLICATIONS: Internet training is a viable approach to shape appropriate NA reactions to aggressive resident behaviors. This format has future potential because it offers fidelity of presentation and automated documentation, with minimal supervision.

Violence against nurses and its impact on stress and productivity.

The purpose of this study was to examine how violence from patients and visitors is related to emergency department (ED) nurses' work productivity and symptoms of post-traumatic stress disorder (PTSD). Researchers have found ED nurses experience a high prevalence of physical assaults from patients and visitors. Yet, there is little research which examines the effect violent events have on nurses' productivity, particularly their ability to provide safe and compassionate patient care. A cross-sectional design was used to gather data from ED nurses who are members of the Emergency Nurses Association in the United States. Participants were asked to complete the Impact of Events Scale-Revised and Healthcare Productivity Survey in relation to a stressful violent event. Ninety-four percent of nurses experienced at least one posttraumatic stress disorder symptom after a violent event, with 17% having scores high enough to be considered probable for PTSD. In addition, there were significant indirect relationships between stress symptoms and work productivity. Workplace violence is a significant stressor for ED nurses. Results also indicate violence has an impact on the care ED nurses provide. Interventions are needed to prevent the violence and to provide care to the ED nurse after an event.

Environmental changes to control obesity: a randomized controlled trial in manufacturing companies.

PURPOSE: To determine the effects of an environmental intervention on obesity, disease risk factors, and dietary intake in an employee population. DESIGN: Randomized controlled community trial. SETTING: Eight manufacturing companies in Kentucky with ∼150 to 350 employees each. SUBJECTS: Randomly selected employees. INTERVENTION: Multicomponent environmental intervention that included employee advisory committees, point-of-decision prompts, walking paths, cafeteria/vending changes, and educational materials. MEASURES: Height; weight; body fat; blood pressure; fasting lipids, glucose and insulin; and dietary intake were assessed prior to and 3, 6, and 12 months after initiation of the intervention. ANALYSIS: Mixed-model repeat-measure analyses of covariance were used to analyze data collected over the study period. Categorical data were analyzed in contingency tables. A p value of .05 was used to judge statistical significance. RESULTS: There were no intervention effects for outcome variables, with the exception of lower intake of saturated fat and dietary cholesterol in the intervention group compared to the control group. Over the course of the study, changes in anthropometry and biomeasures were similar in both groups. CONCLUSIONS: Findings indicate that subtle environmental changes alone may not impact employees' weight and health; however, such institutional-level approaches may be essential to support healthy lifestyle habits that are initiated by more intensive efforts. Academic researchers should continue to partner with employers and practitioners to develop, implement, and evaluate innovative health promotion strategies including environmental interventions.

Workplace violence in healthcare settings: risk factors and protective strategies.

This article describes the risk factors and protective strategies associated with workplace violence perpetrated by patients and visitors against healthcare workers. Perpetrator risk factors for patients and visitors in healthcare settings include mental health disorders, drug or alcohol use, inability to deal with situational crises, possession of weapons, and being a victim of violence. Worker risk factors are gender, age, years of experience, hours worked, marital status, and previous workplace violence training. Setting and environmental risk factors for experiencing workplace violence include time of day and presence of security cameras. Protective strategies for combating the negative consequences of workplace violence include carrying a telephone, practicing self-defense, instructing perpetrators to stop being violent, self- and social support, and limiting interactions with potential or known perpetrators of violence. Workplace violence is a serious and growing problem that affects all healthcare professionals. Strategies are needed to prevent workplace violence and manage the negative consequences experienced by healthcare workers following violent events.

Challenges of a worksite health promotion project.

It is estimated that American employers spend more than $900 billion annually on health care and that obesity-attributable health care expenditures total $75 billion. The authors discuss a yearlong health promotion research project aimed at obesity and involving eight small manufacturing companies. Three hundred forty-one employees randomly selected at the intervention and control worksites were followed at baseline and at 3, 6, and 12 months for anthropometric measures, lifestyle behaviors, absences, and work performance. The authors conclude that although the worksite offers unique opportunities to develop health promotion programs, these efforts are not without challenges due to the tensions regarding the need to protect and promote health for the population, the increasing concerns over health care costs and access, and the priority to maintain individuals' rights and privacy.

Violence against Healthcare Workers in a Pediatric Emergency Department.

Workplace violence (WPV) by patients and visitors against nurses and physicians is a problem in adult emergency departments (ED), but largely unrecognized and unreported in pediatric EDs. The purpose of this qualitative study was to describe the WPV that occurred in a pediatric ED and the negative effects on the workers. Data included transcribed interviews with 31 pediatric ED workers, non-participant observations, digital photographs, and archival records and analyzed using a modified constant comparative analysis method. Participants perceived that both genders and all occupational groups were at risk for experiencing verbal and physical WPV. Common perpetrator characteristics were patients receiving a psychiatric evaluation and visitors exhibiting acute anxiety. Effects were experienced by the workers, perpetrators, patient bystanders, and the healthcare employer. It is concluded that WPV is a problem in this pediatric ED and interventions need to be implemented to promote the safety of the workers and patients.