Caregivers facing violence in long-term care setting: A cross analysis of incident reports and caregivers speech.

BACKGROUND: Workplace violence is frequent, especially in long-term care, but often unreported. AIMS: The aim of this study is to identify workers experiences and coping strategies when they face physical aggression from residents and assess the value of incident reports for violence follow-up. METHODS: This mixed method study is based on incident reports collected over 3 years from two different long-term care geriatric facilities in France and thematic analysis of 20 semi-structured interviews of nurses and nursing assistants. RESULTS: The reported frequencies of physical aggression among respondents range from none to daily aggression. Only 76 incident reports were submitted. Aggressions were under-reported by caregivers who often felt guilty for not having avoided them. Coping strategies included banalization and seeking support from colleagues. Incident reports can constitute a warning signal for the management team but are not a reliable tool for workplace violence follow-up. CONCLUSIONS: Our study emphasizes the complexity of workplace violence prevention in long-lerm care settings. Proposals can be formulated to train and support caregivers, but a shift from a task-oriented organisation to a patient-centred approach seems necessary to reduce violence. IMPLICATIONS FOR NURSING MANAGEMENT: Situations to be reported should be better defined, aggression reporting encouraged and judgmental attitudes toward reports discouraged.

Postnatal diagnosis of 9q interstitial imbalances involving PTCH1, resulting from a familial intrachromosomal insertion.

Insertions are rare chromosomal rearrangements resulting from a three breaks mechanism. The risk of chromosomal imbalance in the offspring is estimated to be 15-50%. We have identified a familial history of direct, paracentric intrachromosomal 9q insertion, balanced in healthy members. For intrachromosomal insertions, unbalanced products in the offspring are always recombinants and in our case, reciprocal deletion and duplication of the inserted segment (9q22.31-9q31.1) were observed. These imbalances involved several genes, including PTCH1. PTCH1 haploinsufficiency causes Gorlin syndrome, an autosomal dominant disorder usually linked to the gene mutation but sometimes due to a 9q deletion. Clinical findings are different in 9q deletions and duplications including PTCH1, notably concerning the predisposition to benign and malignant tumors reported in the Gorlin syndrome. Furthermore, some features may be reciprocal. This history of intrachromosomal insertion highlights the importance of morphological cytogenetic analyses to provide an accurate genetic counseling.