Nurses' Experience With Type II Workplace Violence and Underreporting During the COVID-19 Pandemic.

BACKGROUND: Type II (customer-on-worker) workplace violence (WPV) against nurses and its underreporting are ongoing safety and health challenges in health care. The COVID-19 pandemic has strained patients and nurses and, in turn, may have increased WPV. The purpose of this cross-sectional study was to describe and compare a sample of nurses' reported prevalence of Type II WPV and their reporting of these events during the pandemic. METHODS: Data from an online survey of registered nurses (N = 373) working in hospitals were included. Prevalence was calculated for physical violence and verbal abuse, and their reporting of these events, including the experience of violence between nurses who did and did not care for patients with COVID-19. FINDINGS: Overall, 44.4% and 67.8% of the nurses reported experiencing physical violence and verbal abuse, respectively, between February and May/June 2020. Nurses who provided care for patients with COVID-19 experienced more physical violence (adjusted odds ratio [aOR] = 2.18, 95% confidence interval [CI] = [1.30, 3.67]) and verbal abuse (aOR = 2.10, 95% CI = [1.22, 3.61]) than nurses who did not care for these patients. One in 10 nurses felt reporting the incident was more difficult during the pandemic. CONCLUSION/APPLICATION TO PRACTICE: A significant proportion of nurses who cared for patients with COVID-19 experienced more physical violence and verbal abuse, and more difficulty in reporting to management. As the pandemic continues, health care organizations need to recognize that workers may be at an elevated risk for experiencing WPV and may be less likely to report, resulting in an urgent need for prevention efforts on their part.

Understanding Reporting of Type II Workplace Violence Among Home Health Care Nurses.

Background: Home health care nurses (HHNs) work alone in patients' homes. They experience high rates of Type II (client/patient-on-worker) workplace violence (WPV); however, little is known about the extent and factors of their reporting. Methods: A convenience sample of employees aged 18 years and older and working as an HHN or management staff were recruited from a U.S. nonprofit home health care agency. To describe the extent of reporting of WPV events, an HHN survey was conducted. To identify the barriers and facilitators to reporting, two HHN focus groups were conducted, and management key informant interviews were employed. Findings: We recruited 18 HHNs and five management staff into the study. Almost all HHNs reported to management the most serious forms of violence they experienced, and that HHNs reported WPV when they perceived that reporting was beneficial (alerting other nurses and management) and supported by management staff. However, they were unwilling to report when it was perceived as disadvantageous (reliving the trauma), discouraged (by a norm that experiencing violence is a part of the job), unachievable (unstandardized reporting process), and ambiguous (uncertain of what is reportable). Management staff perceived a lack of standardized reporting processes as a barrier when responding to HHNs' reporting. Conclusion/Application to Practice: High reporting was related to strong support from management. Policies and procedures should clearly define WPV, the threshold for reporting, how to report, and how management will respond to the reports.

Prevalence of type II workplace violence among home healthcare workers: A meta-analysis.

BACKGROUND: Home healthcare workers (HHWs) provide medical and nonmedical services to home-bound patients. They are at great risk of experiencing violence perpetrated by patients (type II violence). Establishing the reliable prevalence of such violence and identifying vulnerable subgroups are essential in enhancing HHWs' safety. We, therefore, conducted meta-analyses to synthesize the evidence for prevalence and identify vulnerable subgroups. METHODS: Five electronic databases were searched for journal articles published between 1 January 2005 and 20 March 2019. A total of 21 studies were identified for this study. Meta-analyses of prevalence were conducted to obtain pooled estimates. Meta-regression was performed to compare the prevalence between professionals and paraprofessionals. RESULTS: Prevalence estimates for HHWs were 0.223 for 12 months and 0.302 for over the career for combined violence types, 0.102 and 0.171, respectively, for physical violence, and 0.364 and 0.418, respectively, for nonphysical violence. The prevalence of nonphysical violence was higher than that of physical violence for professionals in 12 months (0.515 vs 0.135) and over the career (0.498 vs 0.224) and for paraprofessionals in 12 months (0.248 vs 0.086) and over the career (0.349 vs 0.113). Professionals reported significantly higher nonphysical violence for 12-month prevalence than paraprofessionals did (0.515 vs 0.248, P = .015). CONCLUSION: A considerable percentage of HHWs experience type II violence with higher prevalence among professionals. Further studies need to explore factors that can explain the differences in the prevalence between professionals and paraprofessionals. The findings provide support for the need for greater recognition of the violence hazard in the home healthcare workplace.

Understanding the Impact of Bullying in a Unionized U.S. Public Sector Workforce.

Background: Workplace Bullying (WPB) can have a tremendous, negative impact on the victims and the organization as a whole. The purpose of this study was to examine individual and organizational impact associated with exposure to bullying in a large U.S. unionized public sector workforce. Methods: A cross-sectional Web-based survey was conducted among 16,492 U.S. state government workers. Survey domains included demographics, negative acts (NAs) and bullying, supportiveness of the organizational climate, and individual and organizational impacts of bullying. Multinomial logistic regression was used to assess the impact among respondents who reported exposure to bullying. Findings: A total of 72% participants responded to the survey (n = 11,874), with 43.7% (n = 5,181) reporting exposure to NAs and bullying. A total of 40% (n = 4,711) participants who experienced WPB reported individual impact(s) while 42% (n = 4,969) reported organization impact(s). Regular NA was associated with high individual impact (negatively impacted them personally; odds ratio [OR] = 5.03) when controlling for other covariates including: female gender (OR =1.89) and job tenure of 6 to 10 years (OR = 1.95); working in a supportive organizational climate and membership in a supportive bargaining unit were protective of high impact (OR = 0.04 and OR = 0.59, respectively). High organizational impact (transferring to another position) was associated with regular NA and bullying (OR = 16.26), female gender (OR = 1.55), providing health care and field service (OR = 1.68), and protective effect of organizational climate (OR = 0.39). We found a dose-response relationship between bullying and both individual and organizational-level impact. Conclusion/Application to Practice: Understanding the impacts of WPB should serve to motivate more workplaces and unions to implement effective interventions to ameliorate the problem by enhancing the organizational climate, as well as management and employee training on the nature of WPB and guidance on reporting.

Comparative psychometric review of the Negative Acts Questionnaire-Revised in a unionized U.S. public sector workforce.

BACKGROUND: Workplace violence is a global problem that includes actions collectively defined as bullying as perpetrated by a work colleague. PURPOSE: Two distinct studies were conducted to assess the feasibility of using an abridged 6-item scale within the 21- item Negative Acts Questionnaire-Revised (NAQ-R) designed to assess workplace bullying. METHODS: The pilot study was a psychometric review of the 21-item NAQ-R, and the main study was conducted to determine the reliability and the validity of using a 6-item version. Cronbach's alpha assessed the internal consistency of the two versions of the NAQ-R. Validity was assessed using logistic regression with theoretically related constructs with a pilot study (n = 420) using the 21-item scale, followed by the main study (n = 11,874) using the 6-item version. RESULTS: Both the pilot study (21-item)and the main study (6-item) versions of the NAQ-R demonstrated high internal consistency (Cronbach's alpha 0.93-0.86, respectively). Similar to the 21-item, the 6-item version had a significant impact on the intent to remain on the job, being personally affected, and supported the protective role of the organizational climate against exposure to negative acts. CONCLUSION: This study supports using the 6-item NAQ-R, which can reduce respondent burden and streamline data gathering and analysis.

Slips, Trips, and Falls Among Home Care Aides: A Mixed-Methods Study.

OBJECTIVE: To address the gap of knowledge about slips, trips, and falls (STFs) among home care aides (HCAs) who work in clients' homes. METHODS: This mixed method study used survey and focus group data of HCAs in a Medicaid-funded homecare program. RESULTS: STFs were common with over 12% of HCAs reporting occurrence in the previous 12 months, of whom 58% fell to the ground. Both survey and focus group data identified ice, clutter, workload, rushing and other hazards. Focus group data explained the reasons for not reporting STFs, even among those who sustained injury, and added HCAs' voices to the understanding of causes, consequences and prevention strategies for STFs. CONCLUSIONS: Empowering HCAs with knowledge, training, and involvement may transform "near miss" STFs into opportunities to prevent STFs among care workers and their clients.

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.

Exploring the Factor Structure of the Job Demands-Resources Measure With Patient Violence on Direct Care Workers in the Home Setting.

BACKGROUND AND PURPOSE: Workplace violence research in health care settings using the Job Demands-Resources (JD-R) framework is hindered by the lack of comprehensive examination of the factor structure of the JD-R measure when it includes patient violence. Is patient violence a component of job demands or its own factor as an occupational outcome? METHOD: Exploratory factor analysis and confirmatory factor analysis were conducted using a sample of direct care workers in the home setting (n = 961). RESULTS: The overall 2-construct JD-R structure persisted. Patient violence was not identified as a separate factor from job demands; rather, two demand factors emerged: violence/emotional and workload/physical demands. CONCLUSIONS: Although the three-factor model fits the data, the two-factor model with patient violence being a component of job demands is a parsimonious and effective measurement framework.

Language Barrier as a Risk Factor for Injuries From Patient Violence Among Direct Care Workers in Home Settings: Findings From a U.S. National Sample.

This study explored potential risk factors for injuries from patient violence among direct care workers in U.S. homes (DCWHs). A national probability sample of 3,377 DCWHs including home health and personal care aides was analyzed using complex sample analysis and generalized estimating equation. Injury from violence was defined as a workrelated injury sustained by aggression, violence, or abuse that was reported to the agency, required medical attention or resulted in absenteeism from work. An association between suffering an injury from patient violence and having a language barrier with patients was noted (OR = 4.44; 95% CI = 1.57, 12.56; p = .005). Findings illuminate the importance of homecare providers to match language between DCWHs and patients to reduce patient violence and improve quality of care in the home setting.

Workplace Violence Training Programs for Health Care Workers: An Analysis of Program Elements.

Commercial workplace violence (WPV) prevention training programs differ in their approach to violence prevention and the content they present. This study reviews 12 such programs using criteria developed from training topics in the Occupational Safety and Health Administration's (OSHA) Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers and a review of the WPV literature. None of the training programs addressed all the review criteria. The most significant gap in content was the lack of attention to facility-specific risk assessment and policies. To fill this gap, health care facilities should supplement purchased training programs with specific training in organizational policies and procedures, emergency action plans, communication, facility risk assessment, and employee post-incident debriefing and monitoring. Critical to success is a dedicated program manager who understands risk assessment, facility clinical operations, and program management and evaluation.

Latent classes of caregiver relationships with patients: Workplace violence implications.

The bonds and relationships that direct care workers in the home setting (DCWHs) develop with their elderly or disabled home care patients may put them at risk for patient violence. This study used a data-driven approach, latent class analysis, to identify distinct underlying patterns of DCWH-patient relationships and then assessed how DCWH-patient class membership was associated with patient violence. This study analyzed survey data obtained from 964 DCWHs working in two not-for-profit home care agencies. Four classes of DCWH-patient relationships emerged: Non-familial (40% of the sample), Overly Concerned (14%); Boundary-keeping (22%), and Overly Involved (24%). DCWHs in the Overly Involved class were more likely to experience physical violence from their patients relative to those in the Non-familial class (probability = 0.11 vs. 0.04, p = 0.01). Building a positive relationship with boundaries between caregivers and patients may have a potential to reduce patient violence toward the caregivers and ultimately improve the quality of care.

Client history and violence on direct care workers in the home care setting.

BACKGROUND: Health care workers providing home care are frequently unaware of their client's history of violence or mental illness/substance abuse disorder, recognized risk factors for workplace violence. This study estimated the associations between these factors and experiencing client violence among direct care workers in the home settings (DCWHs). METHODS: Acts and threats of violence were estimated using data from an anonymous survey among DCWHs (n = 876) working at two large home care agencies. Logistic regressions were performed to produce odds ratios. RESULTS: Physical acts and physical or verbal threats of client violence were associated with providing homecare to clients with a violence history (adjusted ORs = 6.60 and 10.78, respectively), whereas threats of client violence (adjusted OR = 5.80) were associated with caring for clients with a mental illness/substance abuse disorder. CONCLUSIONS: Policy and practices that support the communication of appropriate client risk information may reduce the likelihood of workplace violence among DCWHs. Am. J. Ind. Med. 59:1130-1135, 2016. © 2016 Wiley Periodicals, Inc.

Exploring Social Justice in Mixed/Divided Cities: From Local to Global Learning.

BACKGROUND: University of Haifa and the University of Maryland, Baltimore faculty developed a parallel binational, interprofessional American-Israeli course which explores social justice in the context of increasing urban, local, and global inequities. OBJECTIVES: This article describes the course's innovative approach to critically examine how social justice is framed in mixed/divided cities from different professional perspectives (social work, health, law). Participatory methods such as photo-voice, experiential learning, and theatre of the oppressed provide students with a shared language and multiple media to express and problematize their own and others' understanding of social (in)justice and to imagine social change. FINDINGS: Much learning about "self" takes place in an immersion experience with "others." Crucial conversations about "the other" and social justice can occur more easily within the intercultural context. In these conversations, students and faculty experience culture as diverse, complex, and personal. CONCLUSIONS: Students and faculty alike found the course personally and professionally transformative. Examination of social justice in Haifa and Baltimore strengthened our appreciation for the importance of context and the value of global learning to provide insights on local challenges and opportunities.

The Prevalence of Coworker Conflict Including Bullying in a Unionized U.S. Public Sector Workforce.

Workplace violence is an enormous problem worldwide; incidents where the perpetrator is a current or former employee are an important dimension. This large cross-sectional survey examined the prevalence of this problem among a U.S. state government unionized public sector workforce. Using participatory action research methods, we conducted a web-based survey of members of that workforce from a single northeast U.S. state, receiving 11,874 completed surveys (response rate: 71.8%). Overall, 10.0% of the respondents indicated that they had been bullied at work during the prior 6 months, with 71.9% of those who reported regular bullying identifying the perpetrator as a supervisor and/or top management. The prevalence of bullying was similar to the rates reported in Europe and Scandinavia (5%-30%). Those reports also identified the person(s) responsible for the behavior as being predominantly of higher status within the organization.

Work schedule and client characteristics associated with workplace violence experience among nurses and midwives in sub-Saharan Africa.

Violence against health care workers perpetrated by clients and/or their friends and family (Type II) is a growing problem that can severely impact health care delivery. We examined the prevalence of Type II workplace violence among nurses and midwives in sub-Saharan Africa and its association with work status, schedule, and client characteristics. Nurses and midwives (n = 712) completed an anonymous survey while attending nursing meetings. Generalized estimating equation models, accounting for clustering within residing countries, were employed. Participants who were exposed to risky client characteristics (aOR = 1.39-1.78, p < .001), and those who worked more than 40 hours a week were more likely to have experienced Type II workplace violence (aOR = 1.72-2.15, p < .05). Findings will inform policy and organization level interventions needed to minimize nurses' and midwives' exposure to Type II workplace violence by identifying risky clients and addressing long work hours.

Reducing occupational risk for blood and body fluid exposure among home care aides: an intervention effectiveness study.

The purpose of this quasi-experimental pretest/posttest research study was to examine the effectiveness of an intervention designed through a participatory process to reduce blood and body fluid exposure among home care aides. Employer A, the intervention site, was a large agency with approximately 1,200 unionized home care aides. Employer B, the comparison group, was a medium-sized agency with approximately 200 home care aides. The intervention was developed in partnership with labor and management and included a 1-day educational session utilizing peer educators and active learning methods to increase awareness about the risks for occupational exposure to blood and body fluids among home care aides and a follow-up session introducing materials to facilitate communication with clients about safe sharps disposal. Self-administered preintervention and postintervention questionnaires identifying knowledge about and self-reported practices to reduce bloodborne pathogen exposure were completed in person during mandatory training sessions 18 months apart. Home care aides in the intervention group for whom the preintervention and postintervention questionnaires could be directly matched reported an increase in their clients' use of proper sharps containers (31.9% pre to 52.2% post; p = .033). At follow-up, the intervention group as a whole also reported increased use of sharps containers among their clients when compared to controls (p = .041).

Workplace violence prevention: improving front-line health-care worker and patient safety.

There is perhaps no workplace hazard for which front-line health-care workers and patient safety are more closely linked than workplace violence. When workplace violence occurs, there are direct and indirect consequences for both staff and patients, including compromised patient care. The purpose of this article is to review risk factors for and interventions to reduce front-line health-care worker risk of injury, as well as overall strategies to improve worker and patient safety through comprehensive and participatory workplace violence-prevention programs. Numerous studies have documented risk factors and preventive factors for violence in the health-care setting. Considerably fewer have evaluated interventions designed to reduce these risks and subsequent injury. Front-line health-care workers should actively participate in developing and implementing programs to reduce the risk of injury to staff and patients.

A framework for translating workplace violence intervention research into evidence-based programs.

Workplace violence, a dangerous and complex occupational hazard in the modern health care work environment, presents challenges for nurses, other health care employees, management, labor unions, and regulators. Violence from patients, visitors, and coworkers is often tolerated and explained as part of the job in the fast-paced, stressful health care delivery workplace. Addressing violence in health care requires very purposeful organizational processes conducted by very specific organizational structures. The strength of the scientific evidence for workplace violence prevention strategies is well past the "emerging" evidence stage but has not achieved the "unequivocal" stage. It is unlikely that workplace violence interventions will be tested using randomized controlled experimental conditions. Consequently, educated and aware nurses often provide key leadership for organizations undertaking the development of workplace violence prevention programs, but must do so using local evidence generated at the facility level. In some cases, tools such as state regulations and federal workplace safety policies provide important impetus and support for nurses and hospitals undertaking these transformational programs. This article provides background information about workplace violence and offers a framework for developing comprehensive workplace violence prevention programs built on the existing scientific evidence, regulatory guidance, and locally generated practice evidence.

The Worksite Heart Health Improvement Project (WHHIP): feasibility and efficacy.

OBJECTIVE: Test the feasibility and efficacy of the Worksite Heart Health Improvement Project (WHHIP). DESIGN: The WHHIP was a quasi-experimental 6-month pilot performed in 2 long-term care facilities. SAMPLE: Thirty-nine female minority nursing assistants participated in this study with a mean age of 42.39 (SD = 12.79) years. MEASUREMENTS: Measures were collected at baseline, 3, and 6 months and included blood pressure, lipid panel, body mass index, physical activity levels, diet behaviors, depressive symptoms, and self-efficacy outcomes. INTERVENTION: The 3-month WHHIP intervention included 3 components: environmental and policy assessment; education; and on-going motivation. The control site received education only. RESULTS: Subject participation averaged 47% and 58% in exercise and diet related activities, respectively. Generalized estimating equations showed the treatment group showed significant improvements in depressive symptoms (p = .012), systolic blood pressure (p = .028), total cholesterol (p = .002) and triglycerides (p = .011) over time. The treatment group also showed trends for improvement in diet behaviors (p = .069) and diastolic blood pressure (p = .073). CONCLUSIONS: This study provided feasibility evidence for the WHHIP and preliminary evidence that the WHHIP can improve heart healthy behaviors and subsequent outcomes among nursing assistants in long-term care settings.