Using Space Syntax Analysis to Measure Patient Aggression Risk.

OBJECTIVES: The present study investigates whether space syntax offers appropriate tools for identifying risks of aggression, interventional opportunities, and environmental design strategies to reduce the risk of Type II violence in emergency departments. BACKGROUND: Although healthcare workers are a relatively small percentage of the U.S. workforce, they sustain almost 75% of workplace assaults. Poor environmental design has been identified as an antecedent to aggression by patients and/or their companions. METHOD: Guided by Rational Choice Theory, Lifestyle Exposure Theory, Routine Activity Theory, and Crime Prevention through Environmental Design (CPTED), the study uses five visibility graph analysis (VGA) measures: visibility, control, controllability, mean visual depth, and occlusivity. Three U.S. hospital-based emergency departments were selected. First, a VGA was performed on all three layouts. A second VGA was performed after excluding unconnected spaces, and a third was performed on key patient and staff areas. Last, a fourth VGA was conducted after performing physical modifications to the three departments. RESULTS: Statistical analysis revealed significant differences in VGA measures not only between different layouts but also between the original and modified layouts. Specifically, small changes created by architectural features can affect visual access and exposure as measured by space syntax. Alcove-style spaces in key staff areas are also associated with limited visual control of the local environment. Typically, in smaller zones, central staff workstations afford better control of patient spaces. CONCLUSION: This study shows that space syntax analysis is a useful tool for identifying risks of aggression in hospital spaces and for identifying interventional opportunities.

Assault Deterrents and Educators' Risk of Physical Assault: A Case-Control Study.

The study purpose was to identify associations between assault deterrent presence in kindergarten through 12th (K-12) grade schools and physical assaults (PAs) against educators. Data collected through a two-phase study identified physical and nonphysical violent events and utilized a nested case-control study to identify PA risk/protective factors. Analyses included multivariable modeling. Adjusted analyses demonstrated a significant decreased risk of PA with routine locker searches (odds ratio [OR] = 0.49, 95% confidence interval [CI] [0.29, 0.82]). Also important, although not statistically significant, were presence of video monitors (OR = 0.72, 95% CI [0.50, 1.03]), intercoms (OR = 0.77, 95% CI [0.55, 1.06]), and required school uniforms/dress codes (OR = 0.74, 95% CI [0.52, 1.07]). These findings are integral to school nursing practice in which there is opportunity to influence application of relevant pilot intervention efforts as a first step in determining the potential efficacy of broad-based interventions that can positively impact the problem of school-related violence.

Impact of the COVID-19 pandemic on workplace violence at an academic emergency department.

STUDY OBJECTIVES: COVID-19 brought unique challenges; however, it remains unclear what effect the pandemic had on violence in healthcare. The objective of this study was to identify the impact of the pandemic on workplace violence at an academic emergency department (ED). METHODS: This mixed-methods study involved a prospective descriptive survey study and electronic medical record review. Within our hospital referral region (HRR), the first COVID-19 case was documented on 3/11/2020 and cases peaked in mid-November 2020. We compared the monthly HRR COVID-19 case rate per 100,000 people to the rate of violent incidents per 1000 ED visits. Multidisciplinary ED staff were surveyed both pre/early-pandemic (April 2020) and mid/late-pandemic (December 2020) regarding workplace violence experienced over the prior 6-months. The study was deemed exempt by the Mayo Clinic Institutional Review Board. RESULTS: There was a positive association between the monthly HRR COVID-19 case rate and rate of violent ED incidents (r = 0.24). Violent incidents increased overall during the pandemic (2.53 incidents per 1000 visits) compared to the 3 months prior (1.13 incidents per 1000 visits, p < .001), as well as compared to the previous year (1.24 incidents per 1000 patient visits, p < .001). Survey respondents indicated a higher incidence of assault during the pandemic, compared to before (p = .019). DISCUSSION: Incidents of workplace violence at our ED increased during the pandemic and there was a positive association of these incidents with the COVID-19 case rate. Our findings indicate health systems should prioritize employee safety during future pandemics.

Medication Use and Physical Assaults in the Psychiatric Emergency Department.

Objective: To evaluate the relationship between medications used to treat acute agitation (antipsychotics, mood stabilizers, and benzodiazepines) and subsequent assault incidence in the psychiatric emergency department.Methods: Medication orders and assault incident reports were obtained from electronic health records for 17,056 visits to an urban psychiatric emergency department from 2014 to 2019. Assault risk was modeled longitudinally using Poisson mixed-effects regression.Results: Assaults were reported during 0.5% of visits. Intramuscular (IM) medications were ordered in 23.3% of visits overall and predominantly were ordered within the first 4 hours of a visit. IM medication orders were correlated with assault (incident rate ratio [IRR] = 24.2; 95% CI, 5.33-110.0), often because IM medications were ordered immediately subsequent to reported assaults. Interacted with time, IM medications were not significantly associated with reduction in subsequent assaults (IRR = 0.700; 95% CI, 0.467-1.04). Neither benzodiazepines nor mood stabilizers were associated with subsequent changes to the risk of reported assault. By contrast, antipsychotic medications were associated with decreased assault risk across time (IRR = 0.583; 95% CI, 0.360-0.942).Conclusions: Although assault prevention is not the sole reason for ordering IM medications, IM medication order rates are high relative to overall assault incident risk. Of the 3 major categories of medications ordered commonly in the psychiatric emergency setting, only antipsychotic medications were associated with measurable decreases in subsequent assault risk. As antipsychotic medication can have a significant side effect burden, careful weighing of the risks and benefits of medications is encouraged.

Working in labor and delivery unit increases the odds of work place violence in Amhara region referral hospitals: Cross-sectional study.

BACKGROUND: Workplace violence is any act of negative behavior that causes, physically and psychologically harm to health professionals face in the workplace. The prevalence of workplace violence becomes a challenging occupational issue with increasing nature worldwide. In spite of the seriousness and the impact of the problem, little is known about its magnitude and determinants in the study area and even in Ethiopia. OBJECTIVE: The study aimed to assess the magnitude of workplace violence and its associated factors among health care providers working for the last one year at Obstetrics and gynecology department in Amhara Regional State Referral Hospitals, Ethiopia 2019. METHODS: Institutional based cross-sectional study was conducted from October 1st to 30th, 2019. 503 study participants were incorporated in the study. A pre-tested structured questionnaire was used to collect the data. Data were entered into EPI info version 7.2.3.1 and analyzed using SPSS version 23. Binary Logistic regression model was fitted to identify factors associated with workplace violence considering the association to be significant p- value <0.05. RESULT: This study revealed that 44.5%of the health care providers had reported workplace violence (95% CI: 40.2-48.7). Of this majority of the Victims were experienced a verbal type of violence 200 (88.1%), followed by physical 14 (6.2%), sexual 11 (4.8%), and racial two (0.8%). Factors of workplace violence in this research with statically significant, were: working in labor ward (AOR = 7.4,95% CI: 2.9-18.7), Female sex of participant (AOR = 2.4, 95% CI:1.4-4), work experience less than 5 years(AOR 8.5, 95%CI:7.3-33.3) and numbers of staff less than5 in a shift (AOR = 5.3 95% CI:3.8-39.8) and 5-10 staff in a shift (AOR = 3.3, 95% CI:2.7-25). CONCLUSION AND RECOMMENDATIONS: The prevalence of workplace violence among obstetrics and gynecology department health professionals in Amhara regional state referral hospitals was high. Developing an incident resolution protocol and legislations to encourage health professionals to prompt report violent acts and judicial punishment of perpetrators will be useful to combat workplace violence at obstetrics and gynecology department.

Psychometric validation of the Peruvian version of a short scale to assess psychological violence in health professionals: A cross-sectional study. / Validación psicométrica de la versión peruana de la escala breve para evaluar violencia psicológica en profesionales sanitarios: estudio transversal.

OBJECTIVE: This study aimed to adapt a Peruvian version of the brief scale to assess psychological violence in health professionals (EVP-salud), exploring its validity and reliability properties. METHODS: We made a cross-sectional study of psychometric evaluation conducted between January 2019 and February 2020. It involved the voluntary and anonymous participation of 316 health professionals and administrative workers from 17 health centers in Peru, who were administered the 22-item psychological violence scale. In addition, three other instruments were used to assess convergent and discriminative validity. RESULTS: In contrast to other findings using similar instruments, the item composition of the abbreviated psychological violence scale converges on three components that assess isolation, intimidation, and belittling violence. This validation provides evidence of good fit in criterion and construct, explaining 66.7% of the accumulated variance and up to 54.3% when the final version is reduced to 13 items and three factors. The data reflect a high inverse association between psychological violence and intrinsic job satisfaction. CONCLUSIONS: The empirical results indicate psychometric properties of the instrument, with strong support in the validity and appropriate reliability according to the internal consistency indexes.

OBJETIVO: El objetivo de este estudio fue adaptar una versión peruana de la escala breve para evaluar la violencia psicológica en profesionales sanitarios (EVP-salud), explorando sus propiedades de validez y de fiabilidad. MÉTODOS: Estudio transversal de evaluación psicométrica. El estudio se llevó a cabo entre enero de 2019 y febrero de 2020. En él participaron en forma voluntaria y anónima 316 profesionales de la salud y trabajadores administrativos de 17 centros sanitarios del país, a quienes se aplicó la escala de violencia psicológica de 22 reactivos. Además, se administraron otros tres instrumentos para evaluar la validez convergente y discriminativa. RESULTADOS: En contraste con los hallazgos reportados para instrumentos similares, la composición de ítems de la escala abreviada de violencia psicológica converge en tres componentes que evalúan la violencia de aislamiento, de intimidación y de desprestigio. La validación abordada proporciona evidencias con buen ajuste, tanto de criterio como de constructo, que explican el 66,7% de la varianza acumulada y hasta 54,3%, aproximadamente, al reducirse la versión final a 13 reactivos y tres factores. Los datos reflejan una alta asociación inversa entre la violencia psicológica y la satisfacción laboral intrínseca. CONCLUSIONES: Los resultados empíricos indican propiedades psicométricas del instrumento, con fuerte apoyo en la validez y apropiada fiabilidad, según los índices de consistencia interna.

[Violence of users towards health and non-health professionals in Hospital Emergency Services: descriptive-comparative cross-sectional study.] / Violencia de usuarios hacia profesionales sanitarios y no sanitarios en Servicios de Urgencias Hospitalarias. Estudio transversal descriptivo-comparativo.

OBJECTIVE: Workplace violence is a public health problem that affects professionals in the hospital emergency services, being this environment where there is an intense interaction with users and / or relatives who require critical and / or special care. Given this, the aim of this study was to evaluate the exposure to user violence perceived by different health and non-health professionals in Emergency Services belonging to eleven Spanish hospitals. METHODS: The design was an associative, descriptive-comparative cross-sectional strategy developed in 2019 with a sample of 584 healthcare and non-healthcare professionals from eleven Spanish hospital emergency services in eight Spanish autonomous communities. Non-parametric statistics were used for between-group comparisons, post-hoc analysis and the calculation of the effect size. RESULTS: 100% of respondents acknowledged having suffered workplace violence at least once in the last year. Specifically, at least eight out of every ten professionals were exposed to non-physical violence (range 85.1%-100%). The group that most perceived this violence was administration, followed by nursing, medicine and auxiliary nursing care technician (T.C.A.E) (H=28.881; p=0.001). While the manifestations of physical violence affected approximately three out of ten professionals (range 22.6%-29.5%), it is more present in the Auxiliary Nursing Care Technicians (T.C.A.E), followed by medical and nursing health professionals, as well as non-health professionals, orderlies and administration (H=9.800; p=0.05). CONCLUSIONS: Our study shows the high prevalence of a medium or low intensity violent behavior in spanish Emergency Services. In addition, it allows to deepen in the different manifestations of violence received by the main professional groups of these services.

OBJETIVO: La violencia laboral es un problema de Salud Pública que afecta a profesionales de los Servicios de Urgencias Hospitalarias, siendo este entorno donde existe una intensa interacción con los pacientes usuarios y/o familiares que precisan cuidados críticos y/o especiales. Con ello, el objetivo de este trabajo fue evaluar la exposición a la violencia de los usuarios percibida por los distintos profesionales sanitarios y no sanitarios de los Servicios de Urgencias pertenecientes a once hospitales españoles. METODOS: El diseño fue una estrategia asociativa, de corte transversal, resultando un estudio descriptivo-comparativo, desarrollado en 2019, con una muestra de 584 profesionales sanitarios y no sanitarios de once servicios españoles de Urgencias Hospitalarias de ocho comunidades autónomas españolas. Se utilizaron estadísticos no paramétricos para las comparaciones entre grupo, análisis post-hoc y el cálculo de la magnitud del efecto. RESULTADOS: El 100% de los encuestados reconocieron haber sufrido violencia laboral al menos una vez en el último año. Específicamente, en cuanto a violencia no física, al menos ocho de cada diez profesionales estuvieron expuestos (rango 85,1%-100%). El grupo que más percibió esta violencia fue administración, seguidos de los profesionales sanitarios de enfermería y medicina, así como de los técnicos de cuidados auxiliares de enfermería (T.C.A.E) (H=28,881; p=0,001). Por otro lado, las manifestaciones de violencia física afectaron aproximadamente a tres de cada diez profesionales (rango 22,6%-29,5%), estando más presente en T.C.A.E y seguidos de los profesionales sanitarios de medicina y enfermería, así como de los profesionales no sanitarios, celadores y administración (H=9,800; p=0,05). CONCLUSIONES: Nuestro estudio evidencia la alta prevalencia de conductas violentas de media o baja intensidad en los servicios de Urgencias y Emergencias españoles. Además, permite profundizar en las distintas manifestaciones de violencia recibidas por los principales grupos profesionales de estos servicios.

Unheard Victims: Multidisciplinary Incidence and Reporting of Violence in an Emergency Department.

INTRODUCTION: Workplace violence in the emergency department (ED) is a serious threat to staff and is likely to go unreported. We sought to identify the incidence of violence among staff at our academic ED over a six-month period. METHODS: An anonymous survey was sent to all ED staff, asking whether respondents had experienced verbal abuse or physical assault over the prior six months and whether they had reported it. Those working in the department <6 months were excluded from analysis. We used chi-squared comparison to analyze the results. RESULTS: We analyzed 242 responses. Overall, 208 (86%) respondents indicated being verbally abused in the preceding six months, and 90 (37%) indicated being physically assaulted. Security officers had the highest incidence of verbal abuse (98%), followed by nursing (95%), patient care assistants (PCA) (90%) and clinicians (90%), phlebotomists (75%), care team assistants (73%), registration staff (50%) and electrocardiogram (ECG)/radiology technicians (50%). Security also had the highest incidence of physical assault (73%), followed by nursing (49%), PCAs (30%), clinicians (24%), phlebotomists (17%), and ECG/radiology technicians (13%). A total of 140 (69%) non-security personnel indicated that they never report incidents of violence. CONCLUSION: Our results indicate that violence in the ED affects more than just nurses and doctors. As health systems seek to improve the safety of their employees in violence-prone areas, it is imperative that they direct initiatives to the entire healthcare team as no one group is immune.

Police vs doctors: Harassment of Covid "heroes", by Covid "heroes"?

Violence against medical professionals and destruction of hospital property by frustrated patients and their relatives occur frequently in India (1) and in other countries (2, 3). However, harassment of healthcare workers by the police has, so far, not been an issue in the Indian healthcare system. Now, cases of harassment of medical professionals by the police have emerged during the Covid-19 pandemic. Ironically, both doctors and police personnel have been considered "frontline heroes" against the pandemic in India. We present some cases of such attacks.

Analysis of Career Stage, Gender, and Personality and Workplace Violence in a 20-Year Nationwide Cohort of Physicians in Norway.

Importance: Workplace violence (WPV) is a worldwide problem in health services. Several studies have pointed to organizational factors, such as working in psychiatry and work stress. However, there is a lack of long-term longitudinal cohort studies with respect to trends during the career and individual factors among physicians. Objective: To investigate WPV trends during Norwegian physicians' careers and assess individual and work-related factors associated with WPV in a long-term longitudinal study. Design, Setting, and Participants: This cohort study involved 2 nationwide medical student cohorts who graduated 6 years apart and were surveyed at graduation (T1: 1993-1994 and 1999) and 4 years later (T2), 10 years later (T3), 15 years later (T4), and 20 years after graduation (T5). Generalized estimated equations were used. Statistical analysis was performed from January to September 2020. Exposures: Medical career during 20 years in Norway. Main Outcomes and Measures: WPV was measured as threats or acts of violence from a patient or visitor experienced at least twice, at each of the stages after leaving medical school. Individual factors were obtained at T1 and work-related factors at T2 through T5. We analyzed WPV by repeated measures. Results: At T1, a total of 893 participants (with a mean [SD] age of 28 (2.83) years; 499 [56%] women) responded to the questionnaire. The prevalence of multiple threats of violence was 20.3% (156 of 769) at T2, 17.1% (118 of 691) at T3, 11.2% (66 of 588) at T4, and 8.6% (46 of 536) at T5; and the prevalence of multiple acts of violence was 4.3% (33 of 763) at T2, 5.2% (36 of 687) at T3, 3.1% (18 of 584) at T4, and 2.2% (12 of 532) at T5. There was a decline from T2 to T5 of both multiple threats (ß = -1.06; 95% CI, -1.31 to -0.09; P < .001) and acts of violence (ß = -1.13; 95% CI, -1.73 to -0.53; P < .001). In adjusted analysis, factors associated with multiple threats of violence were male gender (odds ratio [OR], 2.76; 95% CI, 1.73 to 4.40; P < .001), vulnerability trait (neuroticism) (OR, 0.90; 95% CI, 0.82 to 0.99; P = .03), young physician cohort (OR, 1.63; 95% CI, 1.04 to 2.58; P = .04), and working in psychiatry (OR, 7.50; 95% CI, 4.42 to 12.71; P < .001). Factors associated with multiple acts of violence in adjusted analysis were male gender (OR, 3.37; 95% CI, 1.45 to 7.84; P = .005), young physician cohort (OR, 6.08; 95% CI, 1.68 to 21.97; P = .006), and working in psychiatry (OR, 12.34; 95% CI, 5.40 to 28.23; P < .001). There were no interactions with gender or cohort in the significant associated factors. Conclusions and Relevance: Higher rates of multiple threats and acts of violence were observed during early medical careers, among male physicians, and in psychiatry. Low levels of the vulnerability trait (neuroticism) were associated with the experience of multiple threats. There was an association between the young physician cohort and WPV. Preventive efforts should include early-career and male physicians, with additional emphasis on personality.

Predictors of violence against health professionals during the COVID-19 pandemic in Brazil: A cross-sectional study.

BACKGROUND: The increase in violence against health professionals in the COVID-19 pandemic makes it necessary to identify the predictors of violence, in order to prevent these events from happening. OBJECTIVE: Evaluating the prevalence and analyzing the variables involved in the occurrence of violence against health professionals during the COVID-19 pandemic in Brazil. METHOD: This is a cross-sectional study conducted online involving Brazilian health professionals during the COVID-19 pandemic. The data were collected through a structured questionnaire (Google Online Form) sent to health professionals on social networks and analyzed through logistic regression by using sociodemographic variables. The set of grouped variables was assigned to the final model when p <0.05. A network was built using the Mixed Graph Models (MGM) approach. A centrality measurement chart was constructed to determine which nodes have the greatest influence, strength and connectivity between the nodes around them. RESULTS: The predictors of violence in the adjusted regression model were the following: being a nursing technician / assistant; having been working for less than 20 years; working for over 37 hours a week; having suffered violence before the pandemic; having been contaminated with COVID-19; working in direct contact with patients infected by the virus; and having family members who have suffered violence. The network created with professionals who suffered violence demonstrated that the aggressions occurred mainly in the workplace, with an indication of psycho-verbal violence. In cases in which the aggressors were close people, aggressions were non-verbal and happened both in public and private places. The assaults practiced by strangers occurred in public places. CONCLUSIONS: Violence against health professionals occurs implicitly and explicitly, with consequences that can affect both their psychosocial well-being and the assistance given to their patients and families.

Did the events following the COVID-19 outbreak influence the incidents of violence against hospital staff?

BACKGROUND: During the COVID-19 outbreak, (March 1 - June 15, 2020) citizens expressed sympathy and gratitude towards medical staff through the media, while the entire hospital staff faced the same danger of infection as other citizens. This might have made hospital staff develop sympathy, understanding for the patients` and family's needs, and a better communication. OBJECTIVES: To investigate if there is a relation between the mutual change in attitude between citizens and hospital staff during the first COVID-19 outbreak, and the incidence of violence cases. MATERIALS AND METHODS: This is a cross sectional study conducted at Rambam Medical Center (RMC) in Israel. The data about the number of violence cases were collected from the security department, and the data about hospital wards activity were collected from the hospital Business Intelligence (BI) software. The number of violence cases in relation to the number of Emergency Department (ED) visits, admissions to hospital wards, and length of stay (LOS) were compared during the COVID-19 outbreak to the corresponding period in 2019 using the T- test. The difference in the incidence of violence between general population and people with a psychiatric or social disorder (like drug abuse and criminal background) in both periods were also compared using the Fisher exact test. RESULTS: During the first COVID-19 outbreak, there were 6 violence cases against medical staff out of 24,740 visits to the ED, vs. 21 cases out of 30,759 visits during the same periods in 2019 (P < 0.05). There were 19 violence cases in the whole hospital with 14,482 admissions in 2020 vs. 51 violence cases of 17,599 admissions in 2019 (P < 0.05). Violence against security guards in the entire hospital dropped from 20 to 11 cases, and in the set of the ED, from 13 to 4 cases in both periods respectively. A 20 % decrease in the number of visits to the ED, might have influenced the average LOS during the study period, 2020 compared to 2019 (4.4 + 0.45 vs. 5.4 + 0.36 h. (P < 0.001). The ratio of violence among general population vs. people with a psychiatric or social background revealed a non-significant change in both periods (P = 0.75 and P = 0.69) respectively. DISCUSSION: The COVID-19 outbreak supplied some evidence that a change in environmental conditions, trust, waiting time, personal attitude and communication might have reduced violence against hospital staff. CONCLUSIONS: Except for violence coming from patients with psychiatric or social disorders, most other violence cases might be reduced if the environment conditions and attitudes of both citizens and staff are improved.

Exposure to Workplace Trauma and Posttraumatic Stress Disorder Among Intern Physicians.

Importance: Physicians are exposed to traumatic events during their work, but the impact and outcomes of these exposures are understudied. Objective: To determine the prevalence and associations of work-related trauma exposure and posttraumatic stress disorder (PTSD) among a cohort of resident physicians in their internship year of training. Design, Setting, and Participants: This cohort study involved physicians entering internship at US residency programs nationwide in 2018. Participants completed a baseline survey 1 to 2 months before commencing internship, as well as follow-up surveys at 4 time points during internship. Statistical analysis was performed from April 2020 to January 2021. Exposures: Twelve months of internship. Main Outcomes and Measures: Prevalence of work-related trauma and prevalence of PTSD among those who experienced work-related trauma. Trauma exposure and PTSD symptoms were assessed using the Primary Care PTSD Screen for Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (PC-PTSD-5). Risk factors assessed included depression, anxiety, early family environment, stressful life experiences, medical specialty, hours worked, and concern about medical errors. Results: Among 1134 interns who completed the PC-PTSD-5 at month 12 of internship, 665 (58.6%) were female and 695 (61.6%) were non-Hispanic White; the mean (SD) age was 27.52 (2.50) years. There were 640 interns (56.4%) who reported work-related trauma exposure; among these interns with trauma exposure, 123 (19.0%) screened positive for PTSD. Overall, 123 of 1134 training physicians (10.8%) screened positive for PTSD by the end of internship year, as compared with a 12-month PTSD prevalence rate of 3.6% in the general population. Multivariable logistic regression analyses, adjusting for demographic characteristics, indicated that risk factors associated with trauma exposure included non-Hispanic White race/ethnicity (odds ratio [OR], 1.51 [95% CI, 1.14-2.01]; P = .004), more hours worked (OR, 1.01 [95% CI, 1.00-1.03]; P = .03), early family environment (OR, 1.03 [95% CI, 1.01-1.05]; P < .001), and stressful life experiences at baseline (OR, 1.46 [95% CI, 1.06-2.01]; P = .02). Risk factors associated with PTSD were being unmarried (OR, 2.00 [95% CI, 1.07-3.73]; P = .03) and non-Hispanic White (OR, 1.77 [95% CI, 1.01-3.11]; P = .05), concern about medical errors (OR, 1.21 [95% CI, 1.00-1.46]; P = .05), stressful life experiences during internship (OR, 1.43 [95% CI, 1.14-1.81]; P = .002), depression at month 12 of internship (OR, 2.52 [95% CI = 1.36-4.65], P = .003), and anxiety at month 12 of internship (OR, 2.14, [95% CI, 1.13-4.04]; P = .02). Conclusions and Relevance: This study found that work-related PTSD was 3 times more prevalent among intern physicians than the general population. These findings suggest that effective interventions to reduce trauma exposure and mitigate the effects of trauma are needed.

Health Care Worker Violent Deaths in the Workplace: A Summary of Cases From the National Violent Death Reporting System.

BACKGROUND: Violent workplace deaths among health care workers (HCWs) remain understudied in the extant literature despite the potential for serious long-term implications for staff and patient safety. This descriptive study summarized the number and types of HCWs who experienced violent deaths while at work, including the location in which the fatal injury occurred. METHODS: Cases were identified from the Centers for Disease Control and Prevention's National Violent Death Reporting System between 2003 and 2016. Coded variables included type of HCW injured, type of facility, and location within the facility and perpetrator type among homicides. Frequencies were calculated using Excel. FINDINGS: Among 61 HCW deaths, 32 (52%) were suicides and 21 (34%) were homicides; eight (13%) were of undetermined intent. The occupations of victims included physicians (28%), followed by nurses (21%), administration/support operations (21%), security and support services (16%), and therapists and technicians (13%). Most deaths occurred in hospitals (46%) and nonresidential treatment services (20%). Within facility, locations included offices/clinics (20%) and wards/units (18%). Among homicide perpetrators, both Type II (perpetrator was client/patient/family member) and Type IV (personal relationship to perpetrator) were equally common (33%). CONCLUSION/ APPLICATIONS TO PRACTICE: Suicide was more common than homicide among HCW fatal injuries. Workplace violence prevention programs may want to consider both types of injuries. Although fatal HCW injuries are rare, planning for all types of violent deaths could help minimize consequences for staff, patients, and visitors.

Violence against Healthcare Workers during the COVID-19 Pandemic: A Review of Incidents from a Lower-Middle-Income Country.

Background: Healthcare workers (HCWs) across the globe have met tremendous challenges during the COVID-19 (coronavirus disease 2019) pandemic, such as shortages of personal protective equipment, extensive work hours, and constant fear of catching the virus or transmitting it to loved ones. Adding on to the already existing burnout, an increase in incidents of violence and aggression against HCWs was seen in Pakistan and globally. Objectives: Primarily to review cases of violence against HCWs in Pakistan, highlighting and comparing the instigating factors seen within the country and globally. Secondly, to enlist possible interventions to counter workplace violence in healthcare during a pandemic and in general. Methods: Incidents of violence towards HCWs in Pakistan during the COVID-19 pandemic occurring between April 7, 2020, and August 7, 2020, were included. The incidents reported from local newspapers were reviewed. Findings and Conclusion: A total of 29 incidents were identified, with perpetrators of violence most commonly being relatives of COVID-19 patients. Most frequent reasons included mistrust in HCWs, belief in conspiracy theories, hospitals' refusal to admit COVID-19 patients due to limited space, COVID-19 hospital policies, and the death of the COVID-19 patients. Protests by doctors and other HCWs for provision of adequate PPE, better quarantine conditions for doctors with suspected COVID-19, and better compensation for doctors on COVID-19 patient duty resulted in police violence towards HCWs. To avoid such incidents in the future, institutions, healthcare policymakers, media organisations, and law enforcement agencies must work together for widespread public awareness to counter misconceptions and to exhibit responsible journalism. In hospitals, measures such as de-escalation training and increased security must be implemented. Furthermore, law enforcement agencies must be trained in non-violent methods of crowd dispersal and control to manage peaceful protests by HCWs over legitimate issues.

Not Part of the Job: An Analysis of Characterizations of Workplace Violence against Nurses in Canada by Unions and Professional Associations.

In the spring of 2019, Canada's House of Commons Standing Committee on Health reviewed the issue of workplace violence in healthcare and issued a report with nine recommendations. By summer that year, the Canadian Federation of Nurses Unions had two active campaigns on workplace violence characterized by a strong social media presence. In 2020, a private member's bill was sponsored to amend Canada's Criminal Code in cases of assault against a healthcare worker. In the face of these developments, we were interested in the framing of the problem of workplace violence by professional and labour organizations in Canada. We examined documents, websites and social media posts from selected nursing unions and professional associations, including both national and provincial organizations. We found that nursing unions and professional associations have distinctive views on workplace violence. We argue that these divergent understandings preclude the creation of consistent and successful political and organizational strategies that would help create safe workplaces for nurses.