Addressing Workplace Violence: Health Care Staff Safety, a Culture of Caring

Background: Workplace violence (WPV) in health care is an important public health issue and a growing concern in the ED. According to the 2018 Bureau of Labor Statistics, health care and social service industries workers experience the highest rates of injuries caused by WPV;5 times as likely to suffer a WPV injury as compared to the all-worker incidence rate of 2.1, creating harm and work-related stress and burnout. According to American Nurses Association, "A health care culture that considers workplace violence as part of the job" is the number one barrier to reporting WPV. Objective(s): Define WPV, create a multidisciplinary team, increase awareness, formalize reporting process, improve database, and track actionable trends. Method(s): Study data was ed retrospectively from 1/2019-12/2021 at an 80K visits ED, 750 bed quaternary hospital;the following variables: unit/department, persons involved (employees, patients, visitors), nature of violence, and time of day. Descriptive statistics and Wilcoxon rank sum test were used. Our Health system and committee adopted the OSHA definition of WPV: any act or threat of physical violence, harassment, intimidation, verbal abuse, or other threatening disruptive behavior that occurs at work. The multidisciplinary team includes Physicians, Nursing, Security, Quality Management, Human Resources, Safety, Patient and Family Centered Care, Patient Care Services, Case Management and Social Work, as well as close collaboration with the System Workforce Safety team. Increased WPV incident reporting was encouraged by embracing a culture of transparency. WPV events were reported to Security, Quality Management, and HR, and collected in an internal database. Data collection processes were improved and drilled down on indicators that could impact the ED specifically. Result(s): From 1/2019-12/2021, there were a total of 445 WPV incidents, 85 in the ED (19%) (graph ED incidents/quarter and year). The median number of ED WPV incidents from 2019, 2020, and 2021 was significantly different across the 3 years (the Wilcoxon rank sum test p-value= 0.0317). The rate of ED WPV incidents per 1000 ED visits was: 2019, 0.13;2020, 0.27;2021, 0.76;ED volume 84,889, 66,652, and 74,121, respectively. In 2021, 243 WPV incidents reported at the hospital level, and 56 ED incidents (23%), greater than any other location in the hospital. Of the ED WPV incidents in 2021: 78.6% occurred between patients and employees, 19.6% between visitors and employees, and 1.8% between an unknown person and an employee. The nature of violence of ED WPV incidents as follows: 21.4% physical abuse, 25% physical abuse with injury, 30.4% harassment, 17.9% verbal abuse/threats/harassment, and 5.4% sexual harassment. Most WPV incidents occurred between 2am - 4am and 3pm - 11pm. Conclusion(s): There was a significant increase of ED WPV incidents reported from 2019 to 2021. We concluded this increase was a result of a combination of factors related to data collection, emphasis on reporting, and factors related to crowding, restrictive visitation policies due to Covid-19, and patient factors. The ED was identified as having a disproportionate number of WPV incidents leading to the decision to place security posts 24/7. The ED WPV committee has also developed a formal debrief process for instances of WPV as well as "Proactive Rounding" with a combination of security and clinical teams. [Formula presented] No, authors do not have interests to disclose Copyright © 2022

What can we learn from gritty persons? Coping strategies adopted during COVID-19 lockdown

Social isolation and the loss of control associated with the COVID-19 lockdown led to elevated levels of perceived stress in many countries. The present study examines the effectiveness of 13 different coping strategies (SVF-78) and the personality trait grit (Grit-S) on perceptions of stress (PSS-10) in 438 participants (362 women, M-age = 33.45 years, SD = 12.48) from the second to third week of lockdown. A structural equation model showed that coping strategies acted as a complete mediator of the relationship between grit and perceived stress, indicating that grit does not directly affect perceived stress but that people with higher levels of grit choose more effective coping strategies and that results in lower perceived stress. Overall, active emotion-focused strategies such as minimization and positive self-instruction were associated with lower levels of helplessness and a higher self-efficacy to cope with stress. Taking into account the different ways participants adopted coping strategies and relied upon grit, non-hierarchical clustering identified four specific profiles: gritty persons, easy-goers, avoiders, and people feeling powerless. The implications for each group are discussed.